Indian UGS typology.
\r\n\tThe proposed subtitles are
\r\n\t• Municipal Solid waste landfills
\r\n\t• Industrial waste landfills
\r\n\t• Hazardous waste landfills
\r\n\t• Global approaches and technologies
\r\n\t• Legal and economic aspects
Throughout history, mankind has succumbed to endless infectious diseases which have been responsible of great historical changes; classic examples like “The Black Death” during the late Medieval period, a disease being the cause of profound demographical and social changes that prelude The Renaissance; we can also mention the smallpox epidemic during the New World conquest in the XVI century, a disease which was a direct cause of the pre-Columbian Mesoamerican cultures’ holocaust. These are mere examples of well characterized infectious diseases which have had a definite contribution, among other factors, to the development of great scientific and historical changes. As oppose to these notoriously famous infectious diseases, sepsis cannot be categorized as a unique nosological entity studied by medical historians through the history of western medicine. This is the reason why we feel obliged to go beyond a simple description of sepsis throughout history from ancient Egypt to pre-modern times. Therefore, this text also intends to demonstrate how the study and clinical approach of the phenomena in the past, that we’ve come to know as sepsis, gave way to the development of many important medical revolutions in the XVI and XIX century, especially in the fields of surgery and microbiology respectively.
To make a historical detailed description of sepsis referred to a variety of nosologic entities such as pulmonary, intestinal and/or urinary tract infections is yet a very difficult task, perhaps an impossible one, the latter due to the heterogeneous character of its etiology, also the diverse clinical manifestations, its wide range of complications, these summoned to a whole array of concepts, theories and conjectures applied within many determined cultural contexts in their attempt to describe and understand the meaning of sepsis. Nevertheless, the phenomena we’ve come to know as sepsis, considered as a potential consequence of any type of wound, was a clinical phenomena well identify since the Ancient Egypt and can be traced as a defined clinical entity through western civilization history. The time relation between a wound and the appearance of fever was well recognized, as were also the signs of local inflammation and the secondary systemic involvement. This is the reason why we have chosen to approach the history of sepsis through the study of traumatic lesions, and its importance in the development of the germ theory and the rise of modern surgery. Having this approach, we’re allow to understand the direct relation between trauma and infection and also the evolution in the concept of sepsis: from the birth of the word itself and its introduction as a medical concept, its etiology and pathophysiology as a disease, to the diverse forms of treatments proposed previous to contemporary medicine; all this in a fascinating journey from the ancient Egypt to the XIX century.
The word sepsis has an unequivocal Greek origin derived mainly from the word [σηψις], which is the original Greek word for “decomposition of animal or vegetable organic matter“. We come across the word for the first time in Homer’s poems, where Sepsis is a derivative of the verb form sepo [σηπω] which means “I rot” (Geroulanos and Douka 2006). Homer used the word in the 24th song of the Iliad where Priam was led by Hermes, into the Greek camps to beg Achilles for the return of Hector`s body. In vers 414, when Priam is asked for his son`s body, a slave answers: "Neither hounds nor vultures have yet devoured him; he is still just lying at the tents by the ship of Achilles, and though it is now twelve days that he has lain there, his flesh is not wasted nor have the worms eaten him although they feed on warriors.” At the end, the Greek hero Achilles is convinced by Priam to return the body and Hector’s funerals are carried out (Lattimore 1961). The term is immersed in Greek classic literature and was used by authors like Aristotle among others. Its use and its concept in the ancient Greek world could be the object for a complete revision (Majno 1991). Later on, when we talk about Greece, we will expand this concept along with its antithesis: Pepsis and its importance in the Greek ars medica (see ahead in this chapter: “Ancient Greece: Giving birth to the word Sepsis.”) In the context of medical literature we can find the word sepsis in the Hippocratic corpus (Hippocrates 1849; Geroulanos and Douka 2006), cited in the Epidemics book (B. 2,2, Prorret. I.99). Its use was related to an Egyptian concept that will be mentioned later and which explains the origin of some diseases as a consequence of self-intoxication with harmful products derived from the colon. Undoubtedly, the use of this word in Hippocratic literature gave cause to its persistence in some ancient books for more than 2500 years. However, its use as a medical term declined and, on the other hand, a big portion of the classic medical literature was unknown until the Renaissance, because of several philosophical and historical reasons implicit in the Middle Ages, so that the word sepsis, even though persisted in the dusty shelves of ancient collections, undoubtedly was of little use in the Medieval medical context. One of the first bibliographic references in a medical context appears thanks to Matthaeus Silvaticus (circa 1280- circa 1342) a physician from the famous Salerno School who wrote one of the most famous medical encyclopedias in the late Middle Ages. His Text Pandactae Medicinae was printed in at least eleven editions in various countries between the invention of the printing press and 1500 (López Piñeros 2002). In this text a description of the terms “sepsis” and “virtus” or “septic property” (“Sepsis: Putredo”; “Séptica Virtus: Putredine inducens”) is provided, undoubtedly offering a clear reference to the classic Greek concept of sepsis (Silvaticus 1541). This is not surprising. The Salerno Medical School was influenced by Greek classic work translations from Arabic, something very common in the late Middle Ages and the period preceding the Renaissance (Crombie 1987). With this gradual recovery of the most faithful translations of the classic Greek works through the Arab physicians and translators, European physicians could appropriate many concepts that had partially disappeared as it happened with the word sepsis. It is important to remember, however, that Greek medicine gave a lot of importance to the environment and its influence on health, so it is not surprising that the putrefactive phenomena were associated to the disease, reason why we cannot find the first medical uses of the term sepsis in literature related to public health, without a doubt in clear relation to the concept miasma (see ahead in this chapter ““Why then and not before: Germs before the microbiologic era”). Because of this, in 1750 Sir John Pringle, the father of military healthiness, uses for the first time in history the word in his work Experiments upon septic and antiseptic substances (Pringle 1750), a text that made him deserving of the Copley Medal because of his contributions to the birth of Military Healthiness. Pringle was among the first persons to see the importance of these principles in hospitals and camps (Thurston 2000). Some of the first references about the use of the term in several European languages can be found. In English they date from 1858 with the inclusion of the word sepsis in the Oxford English Dictionary. However, we can find the use of the term in previous specialized works. The word sepsis is introduced for the first time in a French medical dictionary in 1834, long before the microbiological revolution, and it is defined simply as putrefaction (Béclard 1834). Similarly, a German medical dictionary from 1845 uses the term in the context of the disease (Busch 1845). By the end of the XIX century the concept sepsis was already well assimilated by the medical community, using it indistinctively with the word septicaemia (Van Arsdale 1886), reason why its use had already been related with the works of microbiology founding fathers (see ahead in this chapter: “Sepsis and the birth of the germ theory”). At the end of the XIX century sepsis and septicaemia were not the only words related; also, words like pyemia (a disease produced by the absorption of pyogenic bacteria and the pressence of pus in the blood) or sapremia (a constitucional disorder due to chemical poisoning by products of bacteria that occurs as a result of putrefactive processes set up by certain forms of bacteria in a wound), (Van Arsdale 1886) had been introduced.
From prehistory, human beings have tried to take care of their wounds in a practice that has evolved from the shamans´ magical approach to the therapies and methods used presently (Broughton 2006). However, some of the practices that remained for centuries and that we would consider modern, have their origins in the ancient Egypt (Mejía Rivera 2002; Broughton 2006).
The oldest report we have about sepsis associated with wounds goes back to Edwin Smith’s discovery of a papyrus in 1862 in the Luxor, Egypt outskirts (Breasted 1980). Written arounnd 1600 BC, this papyrus seems to be the copy of another much older manuscript dated in 3000 BC, reason why it is considered the oldest known surgery treatise (Bishoy 2004; Stiefel 2006). Reference to 48 cases of traumatic lesions between wounds, fractures and dislocations in different parts of the body are mentioned in this masuscript explaining their symptoms, signs and their follow up, prognosis and treatment (Breasted 1980). This treatise demonstrates the clinical richness or the Egiptian physician who founded his diagnostic appreciations in a rigorous semiological and systematic method based on the clinical pehnomenon observation through the senses, including the inspection and palpation of the lesions such as a contermporary physician would do it (Mejía Rivera 2002). This empirism allowed the Egyptian general practitioner the construction of the prognosis with a minimum of magic or divinatory elements, supported in the assessment of the primary lesion as well as its subsequent evolution, thus allowing the search for emerging secondary complications, as it would be for us, sepsis evidenced semiologically by a systemic inflammatory response.
In five out of the forty-eight cases there are clear references to fever as a secondary phenomenon in the wound, We found fever in the following cases: Case 7: head wound; Case 28: throat wound; Case 23: jaw wound; Case 41: thoracic lesion; Case 47: shoulder with gangrene (Breasted 1980) . All of them are explanations of fever as far as prognosis and treatment.
In the forty-seventh case, an open wound of shoulder with its flesh turning black is described, and clarifications and therapeutic suggestions in case fever persists are made (Breasted 1980). The identification of a wound with necrotic appearance in the context of a secondary feverish profile demonstrates the capacity of the Egyptian physicians to diagnose what today we know as a gangrenous necrosis phenomenon, accompanied by a systemic inflammatory response. However, the case that surprises the most, because of its semiological accuracy when finding septic and suppurative complications, is the seventh case in whcih the care of a penetrating cranial wound which perforated the sutures is exposed (Breasted 1980; Seara Valero 1995). A clinical case whose diagnostic evaluation is carried out in two moments: a first moment in which the severity of the trauma and associated neurological consequences are corroborated, considering it still a treatable wound; it only is considered incurable when, after a second clinical assessment, fever accompanied by flush, perspiration, neck stiffness, convulsions and ram urine odor in the wound are detected (Breasted 1980; Seara Valero 1995). This description evidences the expertise of the ancient Egyptian physicians in the detection of a secondary infecious complication. As we know, presently such profile is compatible with a intracranial suppurative complication accompanied by meningism in the context of a systemic inflamatrory response (Adams 1999). The Egyptian physicians were pioneer in the making of the diagnostic approach of a feverish profile originated in an infected wound, establishing the bases for the Western semiological method to deal with septic patients.
It is well known that before the XIX century a theory about germs did not exist and even less in the ancient Egypt. Nevertheless, even though the Egyptians could not see microorganisms in the intestinal flora, they knew that the intestine contained some type of dangerous material. Egyptians postulated that a dangerous principle spelled WHDW (that tentatively can be pronounced as “ukhedu”) could be found there. This dangerous substance could find a way though the blood vessels and intoxicate the complete body (Majno 1991). With the “ryt” and the “ukhedu” concepts it is not surprising that the Egyptians searched for materials that did not decompose and that, consequently, prevented suppuration and bad odors form the lesions. About the therapeutic Egyptian methods one can find disagreements. Some authors propose that Egyptian medicine practiced a therapeutic practice similar to the prehistoric rituals and pharmacopoeia in accordance with pre-technical medicine and, as a consequence, it did not generate greater advances in the wounds infection control (Robinson 1947; Forrest 1982). Nontheless, other authors rehabilitate the therapeutic richness of Egyptian medicine through experiments with different substances used in antiquity (Majno 1975). Other works also support this hypothesis by means of the most rigorous study of the last archeological and historical evidences (Mejía Rivera 2002). Even though some of the first references about wounds cleaning and dressing date from the Sumerians about 2100 BC, we know that the most conservative and apyogenic techniques for wounds care were developed in Egypt. Even though it is difficult to establish whether the Egyptian physician found any association between suppuration and the subsequent development of sepsis, something in their therapeutic practices was oriented to avoid pus formation. In Eber’s papyrus (dated in 1400 BC) also found by Smith in the Luxor outskirts in 1862, the use of honey and grease on open wounds as well as pus removal to promote wounds healing are established (Broughton 2006). Some of these principles came to Greek medicine during the IV century BC through physicians trained in Egypt such as Crisipo de Gnido who discovered the use of hemostatic dressing as well as other blodless methods in the management of traumatic lesions. These methods were adopted by some of Crisipo’s eminent students like Herófilo (c. 335 BC - 280 BC) and Erasistrato (c. 304 – 250 BC) (Robinson 1947). Diverse ancient texts commonly suggest wound wash with beer, hot water and honey, to cover them subsequently with grease impregnated with herbs and grease dressings (Majno 1975; Forrest 1982). Presently it has been proved that the ancient Egyptians‘ ointments based on honey and grease have bactericide action: a mixture with one third of honey and two thirds of butter diminish the S. Aureus y E. Coli count from 105 to 102 in only 24 hours (Broughton 2006). The use of compresses impregnated with wine were also used in former times with an approximate 10% alcohol content as well as the presence of malvoside and enoside pigments (Majno 1975), winw can kill E. Coli colonies in only 60 minutes (Broughton 2006). Botanic studies show that nearly 2,500 plants possess microbiological activities and it is possible that many of them had been used in former times for wounds treatment without having any knowledge about it (Forrest 1982). The reason why these peoples promoted the use of such substances was maybe because of their good aroma and their slow decomposition. Within this framework the Egyptian physician is the pioneer in the observation of nature to try to find tools for apyogen care of wounds (Forrest 1982). As it will be seen in the paragraphs below, through Western history the cleaning of wounds was more the exception to the rule, and it is only natural that all possible means to promote supuration were looked for, an objective which was outstandingly achieved by the Middle Age physicians.
In the ancient Greece, medicine suffers deep transformations and the seeds of the care and treatment of wounds paradigm were planted for the centuries to come. Although the Hippocratic body writers were not aware of the concept of microorganism, they identified the suppurative infections clinical manifestations, excelling in their correct description (Siegel 1960). Greeks were perfectly aware of the inherent dangers of the continuous loss of skin, to which respect Hippocratic literature describes: “When a cut becomes inflamed, the neighboring tissues become intumiscent, and the lesion flush and heat spreads through the vessels. If the lesion is located in the leg, the tumors will develop in the groin; if it is in the arm they will prefer the armpit” (Grmek 1991). We can then see how the Hippocratic physicians, without any conceptual knowledge about infection or lymphatic system, accurately describe a skin primary lesion with subsequent local spread, evidenced by lymphangitis and secondary lymphadenitis. Likewise, Greek physicians were well aware of the dangers of a systemic compromise: “A local lesion, heated by humor afflux, makes the whole body become feverish. One can die because of this, especially on odd numbered days” (Joly 1970). This description demonstrates identification of the clinical phenomenon that we know today as sepsis with its deadly consequences, but supporting its pathogenesis through the classic humorism (Forrest 1982). These interactions between humors, tissues, and their implications in the origin of systemic inflammation, explain the therapeutic approach of purulent lesions in ancient Greece but, in order to understand this, first we must review what humorism was and how Greeks conceived disease. In the Hippocratic text Airs, Waters, and Places Hippocrates perfects the theory of elements proposed half a century before by the philosopher and physician Empedocles of Agrigentum (circa. 490–430 BC). In this theory Hippocrates proposed that human beings are composed by four fundamental humors (blood, phlegm, yellow bile, and black bile), representation of the four elements (air, water, fire, and earth). The health of a particular individual depended then from the adequate equilibrium of such humors (eucrasia), as well as the individual’s harmony with the environment. Hippocrates believed that disequilibrium in the humors (dyscracia) was the essential cause for disease to occur (Francis 1985). This would be the support for the Hippocratic-Galen model of physiological-environmental style, a model which would become a dogma until far after the Middle Ages (the implications of this model in the infections approach will be discussed ahead). For the Hippocratic Corpus pus formation in external wounds can appear because of decomposition of mistreated tissues, because of extravasated blood, or because of humor afflux (Grmek 1991). The process was different for internal no traumatic lesions in which purulent collections formed such as abdominal abscesses or empyemas. This process happened because of accumulation and stagnation of blood in the area in addition to the secondary rupture of small vessels or the displacement of phlegm which drained in the area and generated the collection (Grmek 1991). Likewise, Greeks had a different conception about the role of humors in primary systemic infections. They observed the characteristics of these patients’ extracted blood and, in the context of feverish-septic clinical manifestations they interpreted the blood physical changes as an increase in the black bile (Majno 1982; Francis 1985; Abbas 2002). These changes consisted of a precipitation of the form component and a darkening of the blood as a consequence of the increase in the globular sedimentation speed and the desaturation of the sample respectively (Shoemaker 1971; Pastrana 2006). As it is known nowadays, these processes are the result of a systemic inflammation which increases the acute phase reactants (Gabay 1999) and diminishes the saturation of venous blood (Shoemaker 1971). This last one is a consequence of the decrease in oxygen transportation, the increase of its tissular extraction or mitochondrial microcirculatory dysfunction (Trzeciak 2005; Cinel 2007). The etiopathogenic conceptions from the humoralism view point made the treatment change if the case was a medical profile originated from an “invisible” inflammation or if the case was a suppurative profile from a traumatic origin with secondary systemic compromise.
Although it seems paradoxical, for the Hippocratic physician suppuration could have a benign or a harmful character. To understand this it is necessary to review two very important Greek concepts: SEPSIS and PEPSIS. These two concepts, which could be understood as some sort of Ying-yang, are fundamental in order to understand suppuration and wounds care. It is difficult to translate accurately and literally the sepsis and pepsis concepts but essentially they represent the decomposition or disintegration processes which could be subject to live matter (Majno 1991). Sepsis is very close to the concept of putrefaction as we understand it nowadays, and it necessarily implies “bad odors” and “putrefaction” processes that occurred in the colon inside the body (maybe this concept was associated with the Egyptian term “ukhedu”) and was also associated with the stinking swamps and rotten organic matter (see ahead miasmas). On the other hand, PEPSIS was closer to “firing”, “maturation”, and “fermentation”. The digestive processes in the stomach, as well as tears of milk formation were maturation peptic processes of humors (Majno 1991). This way we can understand that despite there was not a microorganisms theory, somehow in the ancient world the macroscopic consequences of three phenomena caused by the microbian world could be observed: Putrefaction (SEPSIS) to which all living matter was exposed when it died; fermentation (PEPSIS) which was used to produce wine, vinegar among other ferments and ripe food products; and infection, especially wounds, which somehow was similar to sepsis and that was first explained through the humoral theory, then through miasmas and finally through infection and the germs theory as it will be presented at the end of this chapter.
For the Greeks there existed transformation processes which were subject to humors during the course of the illness either to cause it or to solve it (Grmek 1991). These processes consisted of the body substances maturation and the formation of pus in a lesion did not escape from this principle. Depending on the type of process (benign pepsis, or harmful sepsis) the lesion suppuration essence itself would be explained (Grmek 1991). For this reason, there is a clear distinction from Greek semiology between desirable and undesirable pus. For the Hippocratic physician a darker, abundant, heterogeneous, fetid and bloody secretion was interpreted as part of a bad prognosis inflammatory profile (Grmek 1991), undoubtedly closer to the concept of sepsis. Different from this type of undesirable pus, suppuration could be part of healing only if it had benign semiological characteristics or closer to the humors pepsis. In this context, suppuration helped by means of destruction of already necrotic tissues. For this reason, it is not surprising that the total absence of pus production was interpreted as an ominous sign (Grmek 1991). Nowadays we know that an absence of pyogenic response may indicate an insufficiency of secondary local inflammatory response to the immune system, even more in the context of a malnourished, elderly or weakened patient (McFarlane 1976; Opal 2005). As a result, the Hippocratic physician focused part of his therapeutic efforts in allowing a rather conservative and limited suppuration of the lesions (Grmek 1991). Although there is no clarity about any specific procedure carried out to control excessive suppuration, Greeks are attributed the implementation of abscesses-drainage. In the year 280 BC, a Greek barber invented what we could call nowadays syringe (pyúlkos or pus extractor) which was commonly used to drain purulent foci (Majno 1975). With the disappearance of Greek civilization the surgical drainage practice was buried, to be rescued only a couple of centuries ago when it started to play the fundamental role in the management of sepsis it has today (Dellinger 2008).
It is important to highlight that in the classic Mediterranean world each wound suffered infection to a greater or a lesser extent which made improbable to distinguish between healing on first intention or as a part of the resolution of a secondary infectious process with superimposed suppuration (Majno 1975; Grmek 1991). These physiopathological precisions explain the apparent ambiguity of Greek therapeutics as far as the desire to promote or restrict pus formation. In the first part of the book About Ulcers this therapeutic dilemma is illustrated and referring to the care of a recent ulcer, the Hippocratic Corpus says:
“Recent ulcers, both the ulcers themselves and the surrounding parts, will be least exposed to inflammation if one shall bring them to a suppuration as expeditiously as possible, and if the matter is not prevented from escaping by the mouth of the sore; or, if one should restrain the suppuration, so that only a small and necessary quantity of pus may be formed, and the sore may be kept dry by a medicine which does not create irritation.” [Afterwards on the origin of suppuration] “A sore suppurates when the blood is changed and becomes heated; so that becoming putrid, it constitutes the pus of such ulcers.” (Francis 1985)
Erroneously, authors suggest that for the Greek the appearance of pus was not necessary for the positions of defense of wounds healing (Forrest 1982). As it was stated before, for the Hippocratic corpus suppuration was a sign of the transformation process which allowed the wound healing through the maturation of humors (Grmek 1991). Interpreted as a clinical sign, pus could be interpreted as an adequate evolution or a compilation of the wound, a distinction which limited the Greek efforts when promoting pus formation in a conservative approach contrasting with Roman and Medieval medicine.
Hippocratic literature is prolific in the number of substances that can be applied on a wound (Majno 1975; Francis 1985). Postures defending cautery with boiling oil can be found in the texts (Blum 2002), as well as other more conservative postures such as the use of ointments, bandages and baths with wine, water and vinegar (Forrest 1982; Francis 1985; Broughton 2006). Even some references indicated keeping the wounds dry (Francis 1985; Francis 1985). Bandages as a bloodless haemosthasis and healing method were fundamental in the Greek therapeutics. Greeks made of this technique an art reaching great mastery in their production using them for diverse purposes (Majno 1975; Francis 1985; Francis 1985). Its use was accompanied by different substances that impregnated them, favoring the use of wine (Francis 1985), verdigris, green copper ore (Forrest 1982 escences and ointments (Majno 1975). It was also common that venesection was promoted to evacuate blood contanied in the lesion, perhaps with the intention to reduce the blood afflux and the excessive pus formation (Forrest 1982). All these procedures would be adopted by the Medieval Roman medicine, with some qualitative changes as it will be shown below.
“Pus bonum et laudabile” In Spanish: “Pus buena y digna de alabanza”. (from Latin: Bonus: Useful and on purpose for something and Laudabilis: praiseworthy). Concept proposed by Galen from Pergamo (129 – 200 d. C.) who made public that wounds healed on second intention and that pus formation was fundamental for healing. This concept stimulated the indiscriminate use of cautery during the Middle Ages, as well as ointment composed by rotten or caustic substances to facilitate suppuration of a lesion.
“Those diseases which medicines do not cure iron cure; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable.” Hippocrates from Cos. V - IV Centuries BC.
The Roman Empire received many of their knowledge from Greek science (Haggard 1947). In general, during the Roman period of Greek medicine the same antiseptic components were used, adding a few ones such as silver nitrate (Broughton 2006). Galen and Dioscorides were authors who standed out in the Medieval Ages as a mandatory reference, being their texts followed as dogmas until the Renaissance. Galen (129 – 200 AD), who would become the undisputed medical authority for the next fifteen centuries, did not contribute too much to the a-pyogen wound care strengthening the previous ideas about the importance of suppurative healing, introducing the concept of Pus bonum et laudabile (Pollak 1970; Forrest 1982; Thurston 2000; Blum 2002). This concept stated that wounds were cured on second intention and that pus formation was fundamental for their healing. This approach stimulated the indiscriminate use of cautery during the Middle Ages period, as well as the use of ointments composed by rotten or caustic substances to facilitate suppuration in the lesion (Blum 2002). Celsus (45 BC- AD 25) was the first Western physician in characterizing the four cardinal signs of inflammation: “Notae vera inflammationis sunt quattuor; rubor et tumor cum calore et dolore”. (Forrest 1982; Blum 2002). Regarding wounds, Celsus proposed different treatments from those proposed by Hyppocrates and Galen, applying some of the Alexandrian school As mentioned before, it is possible that Celsus had as sources some texts or sources from Alexandrian physicians such as Erasistratus and Herophilus whose master, Crisipo of Gnido was educated in the apyogen surgical techniques in Egypt.
After the peak of Roman medicine, Arabians became the receivers of medical science by accumulating, translating and commenting many of the classic texts that would serve as a reference for the physicians during the Middle Ages (Haggard 1947). Medical texts survived thanks to the efforts of great translators and commentators such as Hunayn, Avicenna, Rhazes and Averroes who compiled knowledge in important Greek-Arabic summaries allowing discrete advances in clinic (Robinson 1947). Nonetheless, surgery did not share the same luck; as the Middle Ages progressed, the sacred character of nature became preponderant, the human body as a divine creation at God’s image and likeness, became an inexplorable taboo which made inacceptable any diagnostic or therapeutic technique that could outrage its sacred character (Mejía Rivera 1990; Mejía Rivera 2005). This giving up of the human being corporal reality exploration added up to the academic and social tendency to see surgery as a “second category” discipline, causing its gradual transformation into an empirical and despicable task separated from the distinguished academic environment of that period. These reasons explain why surgical treatises fell into the ostracism (Haggard 1947). Regarding this, Albucasis, one of the greatest Arabian surgeons, would comment: “The surgical art has disappeared between us almost without leaving any mark. Only in the writings of some ancients we find references: but these, wrongly translated, erroneous and altered have become unintelligible and useless” (Robinson 1947). Undoubtedly Arab literature is influenced mainly by Galen texts whose treatments supported the value of suppuration in the healing of wounds: consequently, during the Middle Ages the use of sutures, wounds exploration and vessels ligature were pushed into the background, making of the painful cautery the appropriate procedure for all kinds of lesions (Robinson 1947; Forrest 1982; Forrest 1982). As it has been discussed so far, the most conservative approaches practiced by Alexandrian and Greek physicians got lost in time and would only be taken up again in the Renaissance thanks to the recovery of lost texts and to the new scientific spirit of that period which allowed the development of an empirical mental attitude that would confront the old preestablished dogmas.
The practice of surgery in Europe remained unaltered during the late Middle Ages because of the use of cautery, a consequence of the unanimous acceptance of pus bonum et laudabile, and it was only in the XIII century that some authors dared to contradict Galen. The first of them was the surgeon from Bologna Teodorico de Borgognoni (1205-1298) who proposed in his work Chirurgia (a compilation of his father’s Hugh of Lucca, who was the founder of the Bologna Surgery School teachings) the use of clean dressings to try to keep the wounds dry thus avoiding caustic substances which promoted pus appearance (Forrest 1982). At the same time, in Montpellier, Henri de Mondeville (1260-1320) criticized Galen work, particularly wound healing, and in his work Cyrurgia from 1320 he proposed the use of spring water or boiled water to clean wounds (Blum 2002). In line with this, William of Saliceto (1210-1280) maintained ardently that pus formation was deleterious for both, the patient and the wound, suggesting that healing must be given on first intention (Thurston 2000). However, these works did not have a lot of impact in this period: most of these authors were attacked by their contemporary authors who defended passionately the status quo and the continuity of the Galen paradigm as a dogma. We could summarize the causes of the failure of these new proposals as follows: 1) the lack of a change in the philosophical corpus of each period which epistemologically supported the change of a model; 2) the absence of some anomaly which systematically challenged the paradigm in each period; 3) authors, times, and places cohesion which coincided and supported a growing corpus of evidence that challenged the old paradigm. These obstacles would be surmounted thanks to the Renaissance and the introduction of gunpowder in the war, as well as the great men such as Ambroise Paré, Paracelsus and subsequently the fathers of microbiology.
As it can be inferred from the previously described, sepsis became a silent partner for barber surgeons in hospices and battle fields taking innumerable lives in olden days. This tragedy was a consequence of the Galen dogma bomun et laudabile, a concept that defined the wounds treatment for many centuries. What made such somnolence of medicine possible? In the first place, many of the surgical procedures in the olden days, particularly the Greek and Alexandrian -less iatrogenic and perhaps more effective- were abandoned or simply lost the medical corpus allowing cautery to become the surgical tool of choice during the last half of the Middle Ages (Hernández Botero 2009). Secondly, within the scientific framework of the period, there existed neither a philosophical nor a scientific corpus which allowed the development of new paradigms in medicine. In this way, the Galen postulates were the guideline, wounds continued to be treated with fire, the injured burned in fever and the pus stench was the norm, and, even though there were isolated and fruitless efforts to fight sepsis, the scientific spirit of that period simply was not ready for a change in paradigm (Kuhn 2004; Hernandez Botero 2009).
In the period of arrows and swords, wounds in the torso or the head ended up being lethal; as a consequence, most of the ancient texts focused on the management of wounds in the limbs which could have a relatively benign prognosis if hemorrhagic shock was not present (Helling 2000). The war surgeon’s arsenal in olden days was limited and the efforts were focused in the search for homeostasis through a diversity of techniques from poultice, dressings, and packaging to ligature and cautery (Castiglioni 1941; Singer 1962; Laín Entralgo 1979). Amputation was very-little practiced and the necessary surgical techniques to perform this procedure had not been developed (Majno 1975; Forrest 1982; Helling 2000; Broughton 2006; Hernandez Botero 2009). As we can see, medicine could not offer much for the development of an appropriate surgical management of infected wounds.
Firearms checkmated the Western surgical knowledge because they hastened a dramatic change in the wounds pattern during armed confrontations from their gradual introduction by the second half of the XIV century (Singer 1962; Blum 2002; Chase 2003; Broughton 2006). The primary lesion was now accompanied by the bullet contaminant material, external debris and gunpowder residues (Chase 2003). Serious burns, open fractures, avulsions and extensive lacerations, undoubtedly associated with a significant increase in mortality (Blum 2002; Broughton 2006). This new lesion pattern, as well as an unquestionable increase in mortality produced by non-hemorrhagic shock, started to generate the wrong perception that wounds were being poisoned by harquebus gunpowder. Although the specific author who suggested this hypothesis is unknown, some pioneer surgeons who defended this posture stand out: German surgeon Hieronymus Brunschwig (1450 – 1533), one of the first war surgery text authors, proposed that the increase in mortality was due to a “blood poisoning” caused by gunpowder, and he even proposed in his book Chirurgia in 1497, that the treatment must have been focused in extracting this dangerous substance: “In case a man has been shot with a gun and the bullet is still in place, he is poisoned by the powder, or part of the powder is still in the body, in the arm or leg or wherever the wound may be. Take a seton, push it through the wound, and pull it back and forth to force the powder out... You may then insert a lint plug moistened with bacon or lubricated with ox grease.” (Brunschwig 1497). Giovanni de Vigo (1460 – 1520), Italian author introduces the most copied and translated surgical text in his time, Practica in arte chirurgica copiosa (Roma 1514). He makes popular, because of his Galen Midievalist essence, the use of boiling oil on the wounds as an efficient way to counteract the poisoning with gunpowder, and, without any doubt, something equally efficient in producing abundant pus quantity (Robinson 1947). On the other hand, the Italian physician Alfonso Ferri (1515 – 1595) aptly proposed in 1552 that portions of the armor and clothes that remained deep in the wounds were responsible for suppuration and even he encouraged their removal (Thurston 2000). When interpreting these innovative works in war surgery, one can conclude that the increase in mortality was due to an accentuation of sepsis as a secondary phenomenon to the initial wound. This was an awaited situation because of the appearance of more extensive, exposed and contaminated wounds, factors which increased their susceptibility to infection. The so called “blood poisoning” would rather have corresponded to an increase in the sepsis and septic shock cases behind the battle front due, not only to the wounds pattern and contamination, but also to the different treatment promoting their suppuration.
Once the Middle Ages period finished, the Renaissance started and more than two hundred years went by since the harquebus in the European battle fields started to sound in order to have real advances in the war wounds treatment (Singer 1962; Pollak 1970; Forrest 1982; Broughton 2006). The first one happened thanks to the great Swiss physician and surgeon Paracelsus (1493-1541), an angry critic of Hippocratic and Galen medicine who furiously claimed against what was called “the reprehensible precept that teaches that it is necessary to make wounds suppurate” (Robinson 1947). His declarations were undoubtedly revolutionary: “The true physician of wounds is nature. All treatment must be reduced to infection prevention. Complexion, humors, diet and time, and the stars don’t have any influence. The results will be determined by a treatment which allows nature to act in peace” (Robinson 1947). If Paracelsus was the great innovator theorist in the XVI century, it was a French barber who, through empirical evidence, was able throw one more shovelful of soil on the pus bonum et laudabile. This happened in Italy in 1536 when out of serendipity (Mejía Rivera 2004) the French surgeon and father of modern surgery, Ambroise Paré (1509 -1590) decided to put to an end the indiscriminate production of pus. It was during the siege of Turin that the young surgeon found himself in the obligation to use dressings and poultice instead of the standard treatment with boiling oils because of the scarcity of supplies. The anecdote of this finding published in his text The Method of Curing Wounds Made by Arquebus and Other Firearms (1545), is well-known:
“The soldiers within the castle, seeing our men come on them with great fury, did all they could to defend themselves, and killed and wounded many of our soldiers with pikes, harquebus, and stones, whereby the surgeons had all their work cut out for them. Now I was at this time a fresh water soldier; I had not yet seen wounds made by gunshot at the first dressing. It is true I had read in Giovanni de Vigo’s first book, “Of wounds in general”, eighth chapter [Practica in arte chirurgica copiosa (Roma 1514)], that wounds made by firearms partake venenosity, by reason of the powder; and for their cure he bids you cauterize them with oil of elders scalding hot, mixed with a little treacle. And to make no mistake, before I would use the said oil, knowing this was to bring great pain to the patient, I asked first before I applied it, what other surgeons did for the first dressing; which was to put the said oil, boiling well, into the wounds, with tents and setons; wherefore I took courage to do as they did. At last my oil ran short, and I was forced instead thereof to apply a digestive made of the yolk of eggs, oil of roses and turpentine. In the night I could not sleep in quiet, fearing some default in not cauterizing, that I should find the wounded to whom I had not used the said oils dead from the poison of their wounds; which made my rise very early to visit them, where beyond my expectation I found that those to whom I had applied my digestive medicament had but little pain, and their wounds without inflammation or swelling, having rested fairly well that night; the others, to whom the boiling oil was used, I found feverish, with great pain and swelling about the edges of the wounds. Then I resolved never more to burn thus cruelly poor wounded men. [...] See how I learned to treat gunshot wounds; not by books.” (Paget 2005)
These observations have deep epistemological implications. First of all, it is a prototype of what we know today as clinical test with control; in the second place, this discovery through the mixture of the scientific method and out of serendipity actions, in the context of therapeutic difficulties posed by the use of firearms, achieves the beginning of an experimental evidence corpus that would serve to bury Galen dogma that had prevailed for centuries (Kuhn 2004; Mejía Rivera 2004). It is then that young Paré, with only twenty-six years of age, abandons boiling oil, recovering from ostracism, among other things, ligature as a more asceptic hemostasia technique (Robinson 1947), thus reducing significantly the occurrence of infection and setting the bases for new and revoluationary surgical developments (Baskett 2004; Drucker 2008). Even though Paré himself continued being reluctant to surgical exploration of wounds and only performed it when he was going to pull out foreign bodies and fragments of bone (Helling 2000), in few years great advances in exploration of surgical techniques would be achieved. This happened with the publication of his fellow countryman Pierre Joseph Desault (1744-1759) who managed to introduce the modern debridement concept (Broughton 2006). Desault observed that tissue inflammation produces constriction inside the fascias or aponeurosis and attributed to it the cause of gangrene (Broughton 2006). Similarly John Hunter (1728 -1793) identified the deleterious effect devitalized and necrotic tissues have for wounds healing and he proposed their surgical removal (Hunter 1985; Ellis 2001). Subsequently, the Russian military surgeon Carl Reyher (1846 – 1899) combined antiseptic techniques along with the careful mechanical cleaning through surgical techniques, thus giving shape to debridement as we know it today (Helling 2000). Before Desault, Hunter and Reyher, the lesions surgical approach consisted basically in removing the bullet from the wound, inflicting more damage and introducing more contaminants (Ellis 2001). Debridement could generate a preventive approach by allowing the removal of desvitalized tissues thus preventing infection and, similarly, it allowed the surgical approach of the already established sepsis.
In this context, it is necessary to ask: How was the clinical course of the injured person after the introduction of gunpowder in combat? When a soldier receives an extensive damage in a limb because of a cannonball or an explosion, the wound process suffered a characteristic natural history (Helling 2000):
The patient could die during the first hours because of hemorrhagic shock because of extensive vascular damage.
If the patient survived the initial hemorrhage, a period of thirty days called “the first inflammation” started, period in which the following might happen in the exact order it appears below:
Dead produced by non-hemorrhagic posttraumatic shock, this struck within the first 48 hours and was independent from the hemorrhage or gangrene.
If the patient survived the shock, gangrene started within the five or seven days following the lesion, surely accompanied by fatal septic shock.
If the patient still continued alive, he was at the mercy of chronic infections stressed by malnutrition as well as any other preexistent or new disease.
During the primary inflammation period we can differentiate between post-trauma shock and septic shock because of the starting time and their clinical characteristics. Following, Nocholas Senn describes a shock pot-trauma case during the war between The United States and Spain:
“A young soldier has been struck down by a fragment of a bursting shell, which has almost completely severed both legs just below the knee-joint. The patient lies on the ground, motionless. He has lost little blood, but his lips are pale...the hands are cold, and the pulse at the wrist cannot be felt. The respirations are irregular...it takes repeated questions to elicit the simplest answer.”(Senn 1900)
In those first post-trauma hours many surgeons were aware that the patient’s dead might strike from the shock in spite of an adequate control of the bleeding (Helling 2000). This shock of difficult explanation was attributed to neurological causes because of the deceitful characteristics of its appearance and to the patient’s inability (Larrey 1812). Nontheless, the specific physiopathology of this shock resides in the molecular response the seriously injured tissues develop; a powerful inflammatory response with systemic consequences which can cause multiple organic dysfunction even if there is not infection (Lenz 2007). The mechanisms responsible of this response have been philogenetically preserved to react energically before diverse inflammatory stimulus (O\'Neill 1998; Opal 2000; Beutler 2001). This inflammatory post-traumatic response continues to be a problem nowadays, not only because of the organic damage it generates, but also because it increases the possibilities of systemic superimpossed infection. This association has been called the two impact theory which suggests that the initial inflammatory response is the bridge to develop sepsis through the apoptosis of immune cells or splachnic perfusion with bacterial translocation from the intestinal light (Border 1987; Keel 2005)
Up to this point we have seen the gradual development of some surgical techniques. However we have not tackled amputation, a procedure that, even though bloody and horrible, would be the only hope for seriously injured soldiers during the pre-antibiotic period. Amputation was not a very popular practice through history and there is a variety of cultural and scientific reasons for that. In the primitive societies this practice was only performed for religious or punishment reasons, never as a medical intervention; primitive human beings were terrified to go to the supernatural world with incomplete bodies (Pollak 1970). Centuries later, Hippocratic physicians did not know how to amputate, but they witnessed how gangrenous limbs of some patients which, without evidence of infection self-mummyfied and fell, process that was called melasmas (Majno 1975). During the rest of the Greek-Roman period amputation continued out of the medical practice and even thouhg some Greek schools improved fundamental techniques to perform this procedure such as the vessel ligature (Robinson 1947), they were never used in the context of such surgery (Helling 2000). Later, during the Middle Ages, these techniques were buried with the rest of the ancient surgical knowledge at the expense of the use of cautery, making it impossible to develop an appropriate amputation technique (Robinson 1947; Helling 2000; Hernandez Botero 2009). Ever since the new and harmful war artefacts were introduced, the need came up to reconsider the approach of a patient with a smashed limb and whose final destination in most cases would be death. Amputation would be the answer to approach these types of patients not only for the bleeding control, but also for the traumatic shock and, of course, the infection. However, it was a hard way.
At the beginning of the XVI century, amputation was seen as a second line therapy and it was reserved as the treatment for established gangrene being treated only when other procedures such as poultice, dressings and cautery had already been used (Helling 2000). Vessels ligature, a fundamental technique when amputating, had not been rescued yet and did not make a part of the surgical knowledge. As a consequence, when amputation was considered, it was performed on the established necrotic tissue in order to avoid hemorraghe, which did not allow to avoid a subsequent systemic infection (Helling 2000). After the advances of surgery in the XVI and XVII centuries, amputation started to earn the place it deserved in the sepsis surgical control.
XIX century: two nations at war, France and England; two conflicting strategists, Napoleon Bonaparte and Field Marshal Arthur Wellesley, Duke of Wellington. Amidst this bloody conflict, their respective surgeons would demonstrate that science goes beyond flags and conflicts. Napoleon’s surgeon at that time, Dominic Jean Larrey (1766 - 1842), proposed the use of early amputation as a way to reduce mortality. In his memories he adds: “amputation must be performed instantly. Otherwise, the damaged areas will soon become gangrene” (Larrey 1812). Larrey creates the concept of early amputation, changing an affected limb into a small wound, less contaminated, with more possibilities to control hemorraghe and where infeccion would be inevitable. With great expertise in this procedure, Larrey performed more tha two hundred amputations per day in the Borodino Campaign (Ellis 2001), and could report an approximate of 75% survival rates (Larrey 1812). This concept of early amputation was of paramount importance to avoid both sepsis and the feared post-trauma shock.
On his side, the British surgeon, George James Guthrie (1785-1856), who was Wellington chief surgeon (called “the British Larrey”), describes in his Treatise on Gunshot Wounds the typical clinical profile of a septic shock which could be observed after the Battle of Waterloo (1815). A clear difference compared with the post-trauma shock description can be seen: “Pain, heat, redness, tumefaction of neighbouring parts constituting inflammation comes on, which speedily runs into suppuration or gangrene... fever becomes more violent and frequently ends in death in the course of a few day." (Guthrie 1827). As it can be seen, a temporal distinction between local inflammation and sepsis development in the following days is made, evidenced by the continuous in character feverish profile with a fast physiological decline which ends up in death. In the context of the pre-antibiotic period, early amputation proposed by Larrey was the only option to give hope to a seriously injured soldier because it limited the systemic response to the lesion thus diminishing the damaged tissues to be susceptible of patogen colonization.
However, only a few agreed with Larrey about tissue damaged by itself as the stimulus for “shock and prostration of strength” and about removal using early amputation being an effective way to avoid gangrene. In fact, this point provoked a great debate between the XVII and the XIX centuries; to amputate or not to amputate, that was the question (Helling 2000). Several medical figures added to this controversy, even John Hunter himself, who was inclined towards a more conservative and late use of amputation, arguing that the battle field was the least suitable to perform a surgery of these characteristics (Hunter 1985; Ellis 2001). Even so, history and multiple wars would give Larrey the reason. Guthrie himself collected the Battle of Waterloo data about the total population of 596 soldiers and he found that in the 371 group of patients who were performed amputation in the battle field, mortality was only 22% while in the 225 soldiers group who were performed late amputations (possibly after 30 days), mortality was 37% (Helling 2000). Similar results were observed during the American Civil War (Otis 1883). These data show us that during the pre-intibiotic period the early performance of such procedure had an impact in mortality reducing the incidence of complications such as post-trauma shock and sepsis.
With the disappearance of the pus bonum et laudabile concept it is evident so far how important the advances in the field of surgery were for the sepsis control. However, in spite of the expertise gained with the scalpel, very few has been attained in the identification of the real enemy of the septic patient: microorganisms. Towards the XIX century it was a heroic deed to come out alive from an operating room, and it is no surprise that before the asepsis and antisepsis techniques appeared, surgeries could draw mortality rates higher than 90% (Robinson 1947; Pollak 1970; Ledermann 2008). It was well put by the Scottish physician James Young Simpson in 1847: “The man laid on the operating table in one of our hospitals, is exposed to more chances of death than the English soldier on the field of Waterloo."(Pollak 1970).
Let’s analyze some approximations to the theory of contagion and infection before the XIX century in which the emphasis will be placed on the reasons why these postulates did not have a greater incidence in the medical corpus in their respective period, and we will stop in a case that perfectly can summarize the epistemological framework of the rest. Let’s begin in Greece again. It was not difficult for the Greek to identify that some of the signs of intoxication such as vomit, diarrhea and, in some cases, fever were similar to the clinical profiles caused by infections. For them, the fact that some diseases, especially feverish ones, affected groups of people closely related or even complete populations did not go unnoticed. What was this poison that could intoxicate, alter humors and also affect a great number of people at the same time and in the same place? Greek physicians did not take long in finding the similarity stinking exhalations had in those sick with the plague and the foul vapors emanating from marshes. These stinking exhalations, called miasmas, were nothing different from the odors rising from putrefaction (in the Greek sense of the word sepsis) of undesirable substances. The putrid swamp areas filled with mosquitoes were clearly related with the appearance of malaria (mal’aria, Roman word for “bad air”),so that Greeks, Romans, and everyone from them on, associated the appearance of feverish diseases with the bad environmental odors that intoxicated the body and caused humorous disorder. This explained for them the appearance of disease like that, in a great number of people in the same place and at the same time (Castiglioni 1941). Another approximation consisted of contagion (from latin ‘contigere’ meaning ‘to touch’) which argued that a venous, non volatile material caused the disease while intoxicating the part of the body it contacted permitting humor sepsis to happen. These two theories, both miasmas and contagion, were not something different from a part of the Galen postulates from physiological-environmental essence: according to Galen, disease was the expression of a disorder in proportion to humors or their quality which occurred because of the conjunction of three factors:
Initial causes: external factors such as heat, cold, miasmas that might produce damaging changes in the humors.
Precedent Cause: It is the personal predisposition to a disorder which explains why some individuals are more susceptible than others to a determined disease.
Cohesive Cause: It is the alteration in composition, proportion or quality of humors (dyscrasia) and that could be triggered by the union of precedent and initial causes. The disease was a manifestation of the cohesive cause in which the other factors (initial or precedent) had already acted as a whole or separately.
Which was the fundamental detail here? All therapeutics was directed to this cohesive cause or humorous disorder in order to achieve eucrasia (the adequate humor proportion). In this sense, the initial cause, whichever it was, was an “associated factor” and it was not seen as a neither necessary nor sufficient cause for the maintenance of a disease (Nutton 1983). This indicates that any postulate that intended to pose the existence of invisible living forms able to cause a disease could only be seen as one of the many factors which caused the disease, and different from what is stated in the germs theory in the XIX century, it would hardly be seen as a determinant factor to be attacked with the therapeutics to solve the disease.
Were there in olden days similar approximations to what we know today as germs or different approaches to the humoralism-environmental theory? The truth is that there were. Years after Hippocrates times, in his book about the generation of animals (Generation of animals. III.xi), Aristotle explains that new animals are born from putrid material This principle, known as the spontaneous generation of life, remained unaltered as a dogma until Luis Pasteur, in the XIX century demonstrated that it was false, thanks to his experiments with microorganisms (see next section). Rerum Rusticarum – De agricultura Libri Tres: “…siqua loca palusteria, et quod [arescunt] crescunt animalia quaedam minuta, quae non possunt pculi consequi, et per aera intus in corpus per os ac nares perueniunt atque efficiunt difficilis morbos.” (Terrencio Varrón 1992)
The search for sepsis seeds continues until the mid XVI century. Paré had just published in France his experiences in the Villaine Castle and Paracelsus lied in his grave in Salzburg leaving behind an immense legacy. It was in 1546, in Padua, and emblematic Renaissance city where only three years back Copernicus and Vesalius had published their great works, when a great poet and physician’s text saw the light: Girolamo Fracastoro (1478 – 1553). Native form Verona, this author proposed in his text De Contagione et Contagiosis Morbis et Eorum Curatione (Wright 1930) what seemed to be an approximation to the modern concept of contagion In 1930 Wilber C. Wright was the first one to translate and publish G. Fracastoro’s text in English. A version brilliantly translated into Spanish is available in the collection Clásicos de la Medicina, Medicina Renacentista III. Gerolamo Fracastoro: De Contagione Et Contagiosis Morbus. Revista MD En Español, Octubre, 1970. p: X1-X8. In his text, Fracastoro argues that infection is not produced because of unknown causes but because of seeds of the disease: semina morbi o seminaria, which are imperceptible particles composed by different elements and propagate (propagare) and breed (gignere) other seeds, and cause corruption at the level of the constituent particles of things. However, at no time Fracastoro specifies that those are living organisms or makes clear precisions about the difference between contagion and infection, or about any of the conceptual meanings. Lucrecio, great poet in the century I BC, would say in his book De Rerum Nature: “I have already shown that there are many seeds useful for our life, but also there are many others that fly around bringing diseases and death” (Nutton 1983). This poet, contemporary author from Asclepiades, probably had access to Methodist texts, or he knew Aristotelian explanations on the animals’ formation, or he had access to the hidden but devastating critics that Galen used to do of the Methodists and their texts.
During the XVI and XVII centuries there were some theoreticians and scientists who started to question the Galen concept on physiology of the disease and consequently, preestablished conceptions about infection. These men would plant the seeds that later would be harvested during the XIX century. The first of them was the Jesuit Athanasiuus Kircher (1602-1680). This great German scientist whose contributions extend from Biology to Philosophy, transcended Fracastoro and suggested that contagion was due to living organisms (contagia animata), an approach derived from his investigations in the plague patients’ blood and pus. Kircher was the first one to infer that the recently discovered animalcules must have been the cause of the disease. However, his microscopic techniques did not allow him to see some free living protozoa without any relation with the disease (Bustíos Romaní 2004).
Until the end of the XVIII century the breaking with Galen humoralism had started consolidating with the anatomopathologic approach inaugurated by Morgagni which allowed locating the disease in a specific place (organ) and with a demonstrable cause, and later, with the works of the German doctor Rudolph Virchow (1821 - 1902) who, after many hours of study with the microscope started to postulate the cellular theory (Omnis cellula e cellula), which invited to find the causes of the disease in the tissular and cellular structures (Pollak 1970). However, and still within this context, humoralists’ ideas from the Greco-Roman era about pus were still sounding and the origin of that secretion continued to be a mystery (Grmek 1991; Hernandez Botero 2009). With the development of cellular theory proposed it was already known that cells could only originate from preexistent cells and not from amorphous material which allowed elucidating the cellular character of suppuration. One of his most outstanding students, Julius Cohnheim (1839-1884), published a controversial work in 1873: Neue Untersuchungen ubre die Entzündung (New Studies on Inflammation) in which, based on previous studies about the local origin of white cells present in pus, could verify diapedesis and the importance of blood vessels in its production through the ingenious studies in frogs mesentery (Malkin 1984). These first advances allowed future advances in the understanding of chemotaxis, diapedesis, and locall inflammation, and they, laid down the foundations for the beginning of immunological and physical chemical studies that opened new ways to understand the phenomenon off inflammation (López Piñeros 1974).
This way we arrive to the XIX century. By this time microbiology was a branch of Botanic, and it will be within some few decades that microbiology not only will change medicine forever, but also the human beings’ destiny. Everything begins with a martyr prophet of science: the Hungarian obstetrician Ignaz Semmelweis (1818 – 1865). His story is well known. Semmelweis was able to associate the physicians and medicine students’ contaminated hands during autopsies with the increase of puerperal sepsis and theorized that it was cadaverous particles and not “cosmic, hygromatic or telluric” influences the responsible ones for the significant increase in mortality in a maternity ward at the general hospital in Vienna, and through simple hygienic measurements, he could diminish dramatically puerperal sepsis mortality (Charles 1994; Henao 1999; De Costa 2002). Nevertheless, his observations are not accepted by the medical community and after a long struggle for disseminating his theory, he is accused of having lost his mind and he is hospitalized against his will in a psychiatric hospital in Vienna where he dies alone. Through his clinical observations, Semmelweis makes the first attempt to consolidate the ontological character of sepsis, based on the evident etiological specificity of its theory. However, the necessary biological concepts to give a scientific sense to his observations did not exist. It is sad to know that only some years would go by after his dead when Pasteur, without knowing Semmelweis’ work (Debré 2000), would isolate streptococcus from purulent lochia of women to whom Semmelweis could have saved (Charles 1994; Henao 1999; Magner 2009).
During the XIX century a good corpus of evidence had already been collected which demonstrated how bacteria appeared to be responsible for sepsis. Vichow’s famous helper, the German student Edwin Klebs (1834–1913), reviewed under the microscope multiple samples of autopsies that he collected while serving as military physician during the Franco-Prussian war in 1879. In his revision of more than one-hundred specimens, Klebs found bacteria in almost every case and, even though he supposed erroneously that all of them were all the same type of organism which he called Microsporon Septicum, he was one of the first scientist in seeing and relating what no one had seen before: the agents causing sepsis and their role in the clinical phenomena itself (Magner 2009). This revolutionary finding would not have been important if the works of other great researchers who developed the microbiological theory and demonstrated the importance that converting the invisible and theoretical in something practical and visible had not been combined. The concepts about what bacteria are and how they are related to the disease still needed to be matured, answers that would come from both sides of the war in which Klebs had served: France and Germany.
The first lights came from France where a rather mediocre student who desired to be a painting teacher, would revolutionize all the fields of knowledge he dealt with. Louis Pasteur (1822 – 1895), after his prolific career in Chemistry, started to study in depth the world of microorganisms and, after several years of work, he summarized and published in 1865 the results of a fermentation in which he refutes spontaneous generation of life and demonstrated in an irrefutable way the existence of microorganisms.
His works gave cause for important conclusions: He demonstrated that the air is filled with microbes ready to develop and that the putrid liquids can be sterilized by heating. About half way through his career, his studies about fermentation gave him the possibility to state that contagious diseases might be caused by microscopic organisms (Aguirre 1996; Restrepo 1996). After these studies, Pasteur would carry a prolific academic career that would not only allow him great developments in the newborn infectology, but also his works would be the scientific bases, among others, for the practical development that later on would be known as asepsis and antisepsis.
If Pasteur opened the way for bacteriology, a German doctor, Robert Koch (1843 – 1910) consolidated its development as a discipline. After multiple achievements harvested in the study of bacterial etiology of diverse diseases, Koch started to worry since 1887 about the growth of bacteria in wounds and in surgical incisions. From his observations he published that same year the book Untersuchungen über die Aetiologie der Wundinfektionskrankheiten (About Etiology of Traumatic Infective Diseases) in which he exposes his experiments infecting wounded animals with putrid substances. In his work he would explain: “I conclude that bacteria are not present in the blood or tissues of healthy animals,” however, “bacteria are present in all sick animals [in blood and tissues], and their number and distribution is in such a way that they perfectly explain the symptoms of the disease” (Brock 1999). These observations are a rough draft of what would become Koch\'s postulates. Without any doubt these postulates could causally relate microbes and sepsis and thus constituted a first look at the disease pathogenesis. Nontheless, Koch’s works had a problem: they were completely carried out with animals. But he didi not take too long in establishing a relation in humans thanks to the Scotish physician Alexander Ogston (1844 - 1929),who used the same methods Koch used and could establish in an unequivocal way the relation between bacteria and sepsis and even detailed two different types of coccus: staphylococcus and streptococcus which were present in blood and pus of many septic patients. His publications were pioneer without any doubt and constituted a cornerstone for the study of sepsis in the areas of pathology, surgery and bacteriology (Van Arsdale 1886; Brock 1999; Magner 2009).
The English surgeon Joseph Lister (1827 – 1912) took his observation to the practice even when he did not know his enemy: the microbe. His works were already well advanced when he had access to the first pioneer works in bacteriology and he could start collating his practical results with the experimental and theoretical evidence of the microbiology colossus (Ledermann 2008). In his work what stands out is his particular worry for diminishing infections in open fractures, traumatic lesions and the surgical act in general. Lister observed that fractures where the skin was intact healed without infection while in the open fractures sepsis and pus drainage were common (Thurston 2000). His observations on amputation wounds and infected wounds took him to conclude that dust of disease was responsible for these complications (Lister 1867; Walker 1956; Ledermann 2008). When Pasterur’s work came into his hands, he could finally see the connection between his observations on wounds and the microscopic bacteria responsible for fermentation (Thurston 2000). That is how in 1867 he publishes his work about the antiseptic management of open fractures with carbolic acid (Lister 1867; Lister 1870) which changed forever the treatment of this type of lesions (Schwartz 1932). Lister started to become active in the microbiology studies and he attended the Seventh International Medical Congress in London in the summer of 1881 where he could exchange opinions with Koch and Pasteur. Later he continued updated with these two researchers’ work and even he received a copy of the first germs microphotographs in septic rabbits’ tissues taken by Koch during his investigations about etiology of infective traumatic diseases (Robinson 1947; Brock 1999).
With the bacterial etiology of sepsis established by the end of the XIX century, many concepts about bacteria already made part of the surgery and pathology texts: Terms like pyaemia, sapremia, purulent infection, putrid infection, septicemia, surgical sepsis and traumatic fever were used indistinctively for the systemic condition that we know today derives from the invasion of bacteria after the colonization of a wound (Van Arsdale 1886). Through their conclusive scientific evidences Koch and Pasteur change animalcules, semina morbi, contagia animata, cadaveric particles, disease powder, in the microbiological revolution, while Lister can take all these concepts into practice saving innumerable lives thus changing medicine practice forever.
“...when a man has been wounded who can be saved, there are in the first place two things to be kept in mind: that he should not die from hemorrhage or inflammation” Aurelius Cornelius Celsus. I Siglo d.C.
The identification of the phenomenon we know as sepsis today, secondary to any type of wound, was a constant from olden times to the Middle Ages. The temporal association between lesion and subsequent appearance of fever was well known, as well as the different inflammation signs in the primary lesion and the secondary systemic compromise. The interpretation of these phenomena changed from magical-religious conceptions to the classic humoralism which dominated western medicine for more than a thousand years. The governing paradigm in each period supported the medical and surgical management of wounds, beginning with the relatively a-pyogen healing from the Ancient Egypt and Alexandria, going through the surgical and non surgical management of the classic Greek and Greco- Roman medicine whose therapeutic objective, though qualitatively was the same, varied in the gradual importance suppuration as fundamental healing process gained. Finally, during the Middle Ages, an imminently Galen approach, Arab medicine performed a determined defense of suppuration as a comprehensive part of the treatment and favored non surgical procedures as cautery in order to facilitate it. This historical evolution was sprinkled by multiple facts of epistemological relevance, In the first place, during the Middle Ages there was a split between the medical knowledge and surgery allowing the gradual loss of surgical knowledge from the classic texts, which explains why during this period the use of sutures, wound exploration and vessels ligatures were pushed into the background turning the painful cautery in the suitable conduct for all types of lesions. Secondly, none of the intents to defeat the Galen dogma “pus bonum et laudabile” succeeded: without a philosophical corpus that supported the paradigm changes, without experimental coincident evidences in time-place which could force such change, and without any anomaly that placed a doubt on the established conceptions, this task would continue to be a chimera. These factors of a strictly epistemological order, explain why the Galen dogma continued taking lives through the Middle Ages until after the Renaissance. Sepsis, understood as an anomaly in Khunian terns, put in crisis the Galen paradigm allowing important developments in medicine; change would finally come with the transformation in the philosophical conception of the disease in which it was accepted that it could be caused by entities and not by simple deviations of normality. This turn from the physiological to the ontological provided the support that would allow the acceptance that those gracious animalcules seen through the microscope lenses, microorganisms, are the real enemies of the injured and infected patient.
Many of the quantitative novelties achieved by medicine during the XX century are nothing but reforms, subtractions and contributions to those models which pioneers from past centuries conceived. As we could observe, these deep ruptures needed a fertile soil in the scientific spirit and in the minds of men of science in order to assume the doctrinal and practical changes which allowed facing up to the scientific challenges. Historiographic misunderstandings like the ones raised by Fracastolo’s work, or scientific tragedies such as Semmelweis’ life, are irrefutable proof that the development of a discipline is neither an isolated fact from the rest of the sciences and human activities since that discipline nurtures with them, nor an isolated fact from society since it is immersed in it and serves its purposes. To conclude, we might ask a last question: Is sepsis nowadays an overcome challenge? Definitively, no. Sepsis constitutes, today, one of the main challenges in intensive care: it is the main cause of death in non coronary ICUs, up to 35% of patients in these units will suffer the disease. 18 million cases per year with a global mortality of 30% are reported each year. It is responsible for more deaths than AIDS and its incidence will increase in 8% annually. After 40 years of exhaustive research mortality has been reduced in only 10% (Martin 2003; Jaimes 2005). 17 billion dollars per year in costs and attention are spent yearly and, from the medicines researched, several dozen in three decades only two have marginally diminished mortality. It is not surprising then that sepsis has been called with sarcasm “the pharmaceutics cemetery”. All these factors show a problem: Is sepsis becoming a systematic challenge for the present medical paradigm? It is very possible since many factors in our world are analogous in medical and social consequences to the challenges that allowed sepsis to take innumerable lives in olden days. Our immune system evolved in a context which demanded the most vigorous answers before the invading pathogen, a killing or dying fight; however, the game rules have changed. Present and unavoidable conditions in our modern world such as population aging, microbial endurance, immunosuppression, increasing intravenous and other types of invasions are related with an increase in the incidence and seriousness of the disease. These factors not only give advantages to microorganisms but also exert a tremendous evolutionary pressure on us. We have a permanent armed race in which our invaders will always have an advantage over us and we find ourselves unrelentingly urged to innovate from the biomedical sciences. In conclusion, maybe sepsis imposes new challenges of great magnitude in the following years that can allow us, and force us to open new ways to develop new paradigms in this century’s medicine… at least that is what the costly lessons of the past teach us.
“Greenspace” the word itself is so vast for the academicians that it has been used by researchers differently in different contexts. With the revolutions in the research of sustainability, the term “green” not only symbolizes trees and vegetation but is also used as an adjective for environment-friendly built environments and even technologies. In urban planning, the term “greenspace” is referred to as the vegetation cover of the spatial area. Greenspace is an urban space that fulfills various esthetics, air purification, conservation of ecology, etc. Urban green spaces (UGSs) in cities exist as natural or semi-natural, managed parks and gardens, supplemented by scattered vegetation pockets associated with roads and random green spaces [1].
Some traditional and cultural parameters, including health, ecological, social, and recreational, remain a major deterministic factor for the optimum usability of these spaces. These UGS can be accessible or inaccessible within city areas. Accessibility of green spaces is an important aspect to assess its impact. There are many UGS within the city area which are inaccessible to the public, and thus citizens are not able to avail themselves of its best benefits. In such cases, green space may not perform its function. Therefore, it is necessary to understand the context of green spaces in urban planning. To further elaborate the green space, ‘public open spaces’ is another term that can further help understand the concept, functionality, and psychological impact of the population affected by green spaces. UGS include natural elements like green belts, soil, water, parks, etc. have a positive effect on human wellbeing, as shown in Figure 1.
UGS in Chandigarh city, India (Chandigarh is the first the planned city of India by architect-planner Le Corbusier and is famous for its green spaces integration in the master plan). (Source: author).
The sustenance of human life on Earth is entirely due to a natural environment and large biodiversity functions. Fresh air, water, fruits, woodlands and minerals are all provisioned by various ecosystem services. Green spaces in cities serve as a natural gathering place for the community, fostering social interaction and integration. They also promote individuality and belongingness to urban areas. The effectiveness of UGS to attenuate air pollution is enhanced by vegetation density. Urban greenery provides a safe and healthy atmosphere for walking, jogging, and running and a conducive environment for social contact and physical and leisure activities. Consuming the maximum benefits of city greens requires them to remain unaltered by the urban infrastructure such as the buildings, highways, and other infrastructural components. The current times require greens to be planned as ecological functional spaces coexisting to support the human functions of recreation, esthetics, leisure activities and conserving environmental values.
Vacant built-up space remains as elapsed wasteland or gaps between buildings and other constructions. These spaces have a high potential for reconstruction and repurposing by integrating them into the public, and for creating stunning spaces by distinguishing their specific character. For example, the exact characteristic of a former railway track is that it connects two regions and can be renovated into a green corridor. Depending on their location, abandoned areas can be converted into different facilities. Every city has such vacant spaces that are waiting to be adapted to the current urban fabric so that they can be part of the total cityscape.
An environmental justice issue that affects so many communities is the lack of green space. Most cities have green areas throughout them for the health of the citizens. In areas that are predominantly lower income or a minority group tend to have less green space. Green spaces are very important to maintain good air quality and promote exercise [2]. There are many cases of this environmental justice problem that were acknowledged and even fixed. A few examples are Tartu, Estonia, Faro, Portugal, and Phoenix, Arizona. Green space is something everyone should have equal access to, but due to the environmental justice problem certain groups are deprived of easily accessible green space.
Living near a green space might even help you live longer. A scientific review published in The Lancet Planetary Health found urbanites living near a park or a garden had a lower risk of premature passing. In their work, the researchers used a vegetation index to measure the density of greenery in locales. Using their scale, infertile areas composed of rocks or sand would score closer to a zero, while an area like a lush tropical rainforest would score closer to one.
The chapter holistically covers and generalizes concepts and concerns associated with UGS across urban planning domain. The chapter is written based on the review and analysis of secondary data available in the form of published literature from reputed data sources, government reports and based personal observation of the author may during the course of study.
The green space can be differentiated from open space as it constitutes only a two-dimensional land area that has not been modified to buildings, highways, and other infrastructural components. Greens should be mainly classified into an ecological function space (flora and fauna, physical infrastructure (drainage, stormwater management, and water quality conservation), and human function (provision for recreational, aesthetical, emotional, and leisure activities, preservation of environmental values, and solar access). Green space may consist of a vast range of pre-hold and leasehold land tenure with different use and access rights. Green space may also find its share in further land-use planning.
In the early 1700s, garden squares and parks were firstly introduced in urban areas. In the late eighteenth and early nineteenth century, the parkway movement, headed by Frederick Law Olmsted, led to the belief that green space was an important cultural and social element of the urban form. The idea of integrating green space into the urban development process came out with the regeneration of the environmental movement in the 1960s [3]. Although public access is defined for various green spaces, green space does not imply public accessibility automatically. Here the green space categories the open spaces which support human socio-cultural and health requirements, biodiversity preservation as well as discussion related to historical green space perspective [4, 5].
There are different types of green spaces like food production areas, national parks, grasslands, green belts, and playfield (like a golf course) that are predominately utilized for corps and live stocks, habitation to animals and medicinal herbs, cattle grazing, the barrier between the pavement and human settlement, and sports activity respectively. Green space categories intermingled with the next one, parks and gardens, where the needs of individuality for recreation and enjoyment are fulfilled [6, 7]. Table 1 shows the Indian UGS typology according to the designated documents with different contexts, categories, classification, and other hierarchies.
Many cities in India have a categorization of spaces that are derived from literature (Table 2). And then, there is a hierarchy of classification of categorized spaces. The planned cities have systematic cataloging of green spaces like the recreational spaces, green areas and tourist areas. Each town has its USP (unique selling point), and it offers the spaces it has according to its function. Table 3 showcases the different cities of India and how they have their green spaces categorized, their further classification and the hierarchy.
Documents | Context | Category | Classification | Hierarchy |
---|---|---|---|---|
UDPFI (1996) | Open spaces | Recreational facilities | Parks and open spaces Sports centers and playgrounds Botanical and zoological parks Water bodies/other natural features Places of tourist interest | Housing cluster Sector Community District Sub-city center |
URDPFI (2014) | Open spaces | Recreational space Organized green Other common spaces (such as vacant lands/open spaces including flood plains, forest cover etc. In plain areas) | Recreational | Recreational P-1 Playgrounds/stadium/sports complex P-2 parks and gardens—public open spaces P-3 multi-open space (Maidan) Organized green Housing cluster Neighborhood Community District/zone Sub-city center |
Urban Green Guideline (2014) | Green spaces | Urban greens | Reserved forest Protected forest District park Neighborhood park Tot-lots Playgrounds Green belts (buffer) Green strip | Tot lot Playground Neighborhood park Community park |
Indian UGS typology.
Typology | International typology | Indian typology |
---|---|---|
Amenity green space | Recreational green space Parks and gardens Outdoor sports areas Green street space Private green space Green roofs Courtyard Greenery at housing estates Greenery at commercial buildings | Reserved forests Protected forests National parks Sanctuary |
Functional green space | Green trail Car parking space Pedestrian area Stormwater retention area Old landfills/dumps Productive green space Remnant farmland City farms Cemeteries/churchyards | City parks District parks Neighborhood parks Tot lots |
Linear green space and open spaces | River and canal banks Transport corridors—road/rails | Green belts (buffers) Green strips Transport corridors |
Natural and semi-natural spaces | Wetlands Woodlands Vacant land Post-industrial land | Playgrounds |
Green corridors | Tree belts Canal and riverbanks Disused railways | |
Allotments, community gardens, and urban farms | Allotments Community gardens City farms | |
Outdoor sports facilities | School playing fields Community playing fields | |
Provision for children and young people | Facilities for young people Community parks Children’s play area | |
Privately usable areas | Facade greening Roof garden Front garden Courtyard Balcony | |
Leisure areas | Campsite Multifunctional leisure facility Sports ground | |
Eco-sensitive areas | Waterlogged Marshy Swampy |
Categorization of green spaces according to the typology.
City name | Categorization of spaces | Classification of categorized spaces | Hierarchy of classification of categorized spaces |
---|---|---|---|
Jaipur | Recreational space/tourism zone | G1 eco sensitive areas G2 green zones G3 parks | Parks Gardens Stadium Sports ground |
Jodhpur | Recreational space | Parks and open spaces Stadium and play grounds Fair and tourism Public entertainment | No further classification |
Sriganganagar | Recreational space | Parks, open spaces and playground stadium | No further classification |
Chandigarh | Recreational space/green areas | Sports facilities Cremation ground Cultural facilities | Organized open space Forest Agriculture |
Naya Raipur | Recreational space | Open spaces | Film city Parks and play areas Stadium and sports complex Nature resort/theme park Reserved forest Botanical park, jungle safari |
Lucknow | Recreational space/green areas | Parks and open spaces | No classification |
Pune | Recreational space | Community hall Museum/theaters Parks and open spaces | No classification |
Varanasi | Recreational space | Gardens, open spaces and urban forest | No classification |
Panaji | Recreational space | City level parks and playgrounds | Housing area park Neighborhood park Community park District park |
Pudducherry | Recreational space/tourism zone | Open space | Parks Gardens Stadium |
Categorization of green spaces according to the typology.
Figure 2 shows an overall view of UGS and countries’ happiness worldwide. This map highlights regional differences in the green space distribution due to climate; countries near the Equator in tropical climates have relatively high UGSs, while countries in the 20–30 latitude range have exceptionally low UGSs due to the dry climate. The UGS increases with latitude in higher-latitude regions. On the other hand, Northern and Western European and North American countries display relatively high happiness scores. Western Asian countries also show relatively high happiness with a low UGS, indicating that the relationship between happiness and green space is not trivial.
UGS and happiness index of countries worldwide (a) The map of urban green space and happiness in 60 developed countries. The size and color of circles represent the level of happiness and urban green space in a country, respectively. The markers are placed on the most populated cities of each country. (b) Histogram of happiness (c) Histogram of UGS (d) Histogram of log-GDP.
The distribution of UGS and happiness over the world. (a) The map of UGS and happiness in 60 developed countries. The size and color of circles represent the level of happiness and UGS in a country, respectively. The markers are placed on the most populated cities of each country. (b)–(d) The histograms of (b) happiness, (c) UGS and (d) logarithmic GDP per capita (log-GDP). We use the logarithm of the total NDVI per capita as an indicator of UGS and the logarithm of GDP per capita as a measure of wealth.
The usage of Greenspace for recreation and leisure purposes led to the identification of its economic, cultural, environmental, and social values, which further increased the attention on its management and planning. In this chapter, the focus is on the relationship of Greenspace to human interaction on various levels of livability, recreational purposes and improved quality of life. The other perspective describes urban vegetation, such as parks, yards, and gardens related to a green stuff kind of open space. This perspective may be defined as a subsidiary of a comprehensive notion of Greenspace, i.e., limited to the built-up environment subsection of open space.
UGS are critical for making our cities sustainable and energy-efficient [8]. However, for UGS to contribute to the optimum, they have to be planned, designed, developed and managed/maintained appropriately so that they are accessible both in terms of area and population coverage. It is a fact that urbanization in India will continue unabated. The Urban Greenspaces generate diverse ecosystems of substantial significance for human wellbeing and human activities, shaping their dynamics. Many green spaces in cities disconnected from the wider environment tend to lose biodiversity due to continuous construction activities. Hence, protecting green spaces in isolation will often fail to sustain the capacity of urban ecosystems to generate value and have to be well integrated into the overall city landscape.
Figure 3 shows the distribution, parts and sub-parts of the UGS.
Synonymous nature of UGS.
Furthermore, the socio-cultural, functional, health-related aspects are labeled for a specific place, i.e., “Greenspace”, as a park or recreational area [9]. Sprawling population, commerce, industries, transportation accelerated the gross domestic production, varied product availability to the consumers, and more excellent connectivity. With the high-rise demand of time, the researchers explored the correlation between these sectors and related aspects of “Greenspace”.
Typology | Definition |
---|---|
Natural land | Unoccupied/unused lands, left unturned by the authorities or the locals, come under this category. Grasslands are also a big part of the natural land group. |
Green belts | Green belts of buffers include green girdle, park belt, rural belt, agricultural belt, country belt etc., which generally refers to a stretch between towns or regions separating one from the other. These areas are dominantly farmlands as they support agriculture and related functions. Green belts are established to keep in check the growth of the built-up regions, preserve neighboring towns from merging and also maintain a unique character of a town. |
National parks | National park is an area that is protected and conserved due to the presence of remarkable natural flora, fauna, geological formations and natural scenic spots. |
Reserved forests | Area duly notified under the Indian Forest Act, 1927 or the State Forest Acts having complete protection. All activities inside are prohibited unless expressly permitted. |
Protected forests | They are found in urban and peri-urban areas secured by fencing or constructing a compound wall, or both. Here no construction activity is allowed. |
District parks | It is a designated term per the hierarchy of green spaces in an urban city. It is a prominent use of a vast green area and developed as a crucial green space in a city. As per UDPFI guidelines, one district park serves 500,000 of the population in plain areas. |
Typology | Definition |
---|---|
Campsite leisure | Land that is dedicated to camping acquires a significant part of the green space category, especially in the trekking zones of any country |
Wetlands/marshy land | A wetland is a part of the ecosystem flooded by water, either permanently or seasonally. Wetlands are considered amongst the most biologically diverse of all ecosystems, serving as home to a wide range of plant and animal species. |
Functional green space | Spaces like cemeteries, pedestrian area, landfills, farms, etc., are functional green spaces. These areas acquire land which is usable for the users. |
Playing fields | As part of any institution/university/school, fields serve as a decent open area for any city. It enables the users to use it for any leisure/formal purposes. |
Typology | Definition |
---|---|
Linear green space | Areas like pedestrians, river canals, street trees are included in Linear Green Space. It adds to the esthetic and usability value of any city. |
Green stripe | A green strip is developed on vacant land, for instance, land under high tension power supply lines. It is also developed along the arterial roads, separating residential areas from other land uses. |
Green roof/facade | Green roofs are the most popularly deployed form of roofs; they are generally lightweight and low cost. They are purposely fitted or cultivated with vegetation. They are also be known as living roofs, eco-roofs or vegetated roofs. They can reduce both heating and cooling loads in buildings. This has positive implications in terms of their energy consumption. The green roofs and facades increase the esthetic value of the scape. |
Neighborhoods parks | It is developed at the neighborhoods level for a population of 10,000. Neighborhoods Parks are conveniently located within the developed residential areas, preferably within walking distance. It is planned on a site of 2000−4000 m2 |
Indian city | Typology |
---|---|
Chandigarh: The capital city has a forest and tree cover of 35.5% in its 114-km2 area. Chandigarh has become the greenest city in the country. The tree cover saved the city from becoming an all-concrete jungle, a fate that has overcome many Indian towns. | The green belts of Chandigarh also facilitate a healthy population of diverse birds. The parks along the spine of Chandigarh include Rajendra Park, Bougainvillea Garden, Leisure Valley Garden, Zakir Rose Garden, Shanti Kunj, Bamboo Valley Garden, Bulbous Hibiscus Garden, Fragrance Garden and Dahlia Garden. |
See Figure 4.
Indian city | Typology |
---|---|
Delhi: The capital of India is one of the greenest capitals in the world due to the consistent emphasis on greening and strict monitoring of tree cutting. | Recently, the parks and garden society has been set up to coordinate the greening activities in Delhi. The city has some well-maintained parks and gardens like Lodhi Gardens, Mughal Gardens, Deer Park, Budha Jayanti Smarak Park, Indraprastha Millennium Park and The Garden of Five Senses besides the Ridge. |
Plan of Chandigarh.
See Figure 5.
City abroad | Typology |
---|---|
New York – Central Park: Central Park is an urban park in New York City located between Manhattan’s Upper West and Upper East Sides. It is the fifth-largest park in the city, covering 843 acres (341 ha). It is the most visited urban Park in the United States, with an estimated 42 million visitors annually as of 2016, and is the most filmed location in the world. | The Park has natural-looking plantings and landforms, having been almost entirely landscaped when built in the 1850s and 1860s. It has eight lakes and ponds created artificially by damming natural seeps and flows. Several wooded sections, lawns, meadows, and minor grassy areas. There are 21 children’s playgrounds and 6.1 miles (9.8 km) of drives. |
Plan of Delhi.
See Figure 6.
City abroad | Typology |
---|---|
London – Hyde Park: Hyde Park is famous for being the largest Park in Central Park and the royal parks of London and its speaker’s corners. | Hyde Park is a Grade I-listed major park in Central London. It is the largest of four Royal Parks that form a chain from the entrance of Kensington Palace through Kensington Gardens and Hyde Park, via Hyde Park Corner and Green Park, past the main entrance to Buckingham Palace. The Park is divided by the Serpentine and the Long Water lakes. |
Plan of New York Central Park.
See Figure 7.
Plan of London Hyde Park.
Different direct accessibility Greenspace typologies provide ecological benefits such as ambient temperature, air and noise pollution reduction, water harvesting, and a barrier between pavement and locality. Green Space provides indirect health benefits instead of direct benefits. These green spaces offer various herbs, vegetables, cereals, fruits, etc., supporting human health. Flourished greenspaces promote tourism, health wellness product vending and fetch high real sale values for the properties near parks and greenways. Apart from these direct benefits, many researchers have established many indirect benefits of Greenspace, which will be discussed later in this chapter.
Recreation opportunities, Areas that are culturally and historically valuable. It has an impact on physical and mental health. Green spaces provide a refreshing contrast to the harsh shape, color, and texture of buildings and stimulate the senses with their simple color, sound and smell. Particular types of green space may offer a bigger diversity of land uses and opportunities for a wide range of activities, help to foster active lifestyles, and can be of real benefit to health.
Green Spaces add to the Landscape features of any cityscape; screened views are formed from different angles of the city. Growing trees and experiencing nature is a path to a positive passive lifestyle.
Air pollution reduction, Sound Control, Glare and Reflection reduction. Impacts on urban climate through temperature and humidity control. Urban forests act as temperature buffers providing shade in the summer and windbreaks in the winter in addition to reducing noise pollution and CO2 levels and providing a habitat for wildlife [10]. Urban greening improves air, water, and land resources by absorbing air pollutants, increasing water catchment in floodplain surfaces, and stabilizing soils.
Biotopes for flora and fauna in any urban environment is benefitted and, in turn, help the environment. Trees absorb pollutants; moderate the impact of humans, absorbing pollutants and releasing oxygen. They contribute to maintaining a healthy urban environment by providing clean air, water and soil. Green vegetation has been shown to lower wall surface temperatures by 17°C, which led to a reduced air conditioning load by an average of 50%. They improve the urban microclimate and maintain the balance of the city’s natural urban environment [11]. They preserve the local natural and cultural heritage by providing habitats for various wildlife and conserving a diversity of urban resources.
Tourism is increased due to the aesthetical change in any scape. The property value is increased—the value of market-prices benefits [12]. Property owners value urban greenery by the premium they pay to live in the neighborhood of UGS and public parks. Plots and flats adjoining Park add to the value. In densely populated areas, this effect is even more noticeable. For example, the view of green spaces and proximity to water bodies increases the real estate prices. The impact of neighborhood parks on the transaction price of multi-storied residential units in cities illustrates that neighborhood parks could increase the cost.
Humans appear to adapt to almost anything in their environment, including air pollution, noise and environmental dullness. Man’s apparent ability to adapt may be his most significant liability. On the one hand, it allows him to adjust to slowly developing adverse conditions; on the other, it could easily threaten his survival. Adaptability permits human adjustment to damaging environmental circumstances we aren’t aware of. When environmental conditions deteriorate to a point where they are readily apparent, it may be too late to reverse the cycle. If an individual has a feeling of wellbeing in the built environment that surrounds him, it is reflected in his activities. The type of space that covers us can either stimulate or be in habitus. Some have tried to isolate how spaces (man-made and open space) play a behavior role in our way of life and specific ways of thinking. While these studies can be rationalized from many perspectives, a case can be made that the type and amount of spaces in our urban areas do, to some degree, shape our social behavior. As urban life becomes more stressful, the more significant the influence of open space [13]. Stress is most pronounced in low-income neighborhoods.
Higher-income neighborhoods outside our major cities tend to be less densely populated, which may reduce the resident’s perceived need for public open space. Often, the lower a neighborhood’s economic scale is, the less likely it becomes for that neighborhood to have the available space and recreational activities required for good physical and mental development.
Placing an economic value on urban open space related to public benefits is a difficult task. Land value in a free enterprise system depends on supply and demand. The value of the real estate is directly proportional to the market demand, potential use, and rights of ownership within its geographic locality. Publicly owned open space used for recreation does not fit into the regular private land market. The parcel’s value as open space cannot be measured in dollars in the same way as land or improvements for a commercial venture.
One method of estimating the economic value of public open space is to monitor the success of a program and determine the revenue that is directly or indirectly generated by it [14]. At the same time, public parks are primarily supported by tax dollars appropriated through the general fund.
More indirectly, open space generates revenues by enhancing the value of adjacent private properties. For example, a 1977 study in Chicago concluded that property prices were $1000 higher for parcels within one block of an urban park as compared to a similar area. Hammer [15] estimated that for each acre of a public park adjacent to a stream, sur-rounding private property values would increase an average of $2600.
Ecological considerations directly related to land and resource preservation often are neglected. These include the function of open space for water-shed management, environmental quality, and esthetic appreciation.
Greenbelts adjacent to natural water bodies can reduce sedimentation, increase preservation, reduce the need for excessive flood control projects and lessen flood damage [16]. Areas of open space can:
Ensure groundwater recharge.
Improve water quality by reducing soil erosion and sedimentation.
Increase recreational benefits, such as nature study, fishing and boating.
Sustain wetlands, which provide wildlife habitats.
Absorb peak water discharge and naturally filter some of the suspended pollutants.
Keep lake and stream levels more constant over the entire year.
Enhance the community appearance.
The benefits of green spaces for our cities are well documented, but they are seldom given desired attention with other computing land uses such as the residential, commercial and industrial use within the urban planning process. Negligence by planning authorities and decision-makers results in not meeting the quantitative and qualitative standards of green spaces and results in their unequal distribution on the spatial scale. Inaccessible green spaces within urban centers also raise concerns regarding city dwellers’ utilization. Primarily new developments in urban centers diminish the future opportunities for recreational provision, and most often, the existing green spaces are not very well managed. Various UGS planning and management issues are thus identified in the subsequent subsections.
The quality of green space is a critical determinant to assess its value to the urban population. In generic terms, the quality of green space is understood in terms of its esthetic outlook and the level of facilities served by it. But in the spatial planning domain, the density of vegetation and the spread of tree crowns can be realized as they essentially lead to the several ecological and social benefits associated with green space. Improved physical and mental health, reduced stress levels, and increased happiness and satisfaction amongst citizens indicate the existence of superior quality greens in the city. Scenarios of degenerating UGS quality are well reported across many cities [17]. The city of Bengaluru in India has seen a decrease of 78% in green cover over the course of four decades, along with its deteriorating quality. These scenarios can be related to rising accounts of air pollution, obesity, shrinking health, and social and psychological collapse amongst the citizens. Overall degenerating quality of the greens and cities can be associated with multiple factors such as lack of maintenance, not choosing native trees, urban sprawl on green belts and ecological areas, deterioration of green riverfronts and loss of biodiversity in forests.
Policy frameworks in an urban planning setup are intended to guide associated decision-makers in the field towards achieving suitable outcomes related to various city infrastructures. Provision, maintenance and broadening of appropriate green covers in cities require policy measures supporting the existence and promotion of several ecosystem services delivered by UGS. Recommendations made by World Health Organization (WHO) suggests the availability of a minimum of 9 m2 of green space per person, ceases the intent at large of appropriate green space provision policy as it follows the ‘one size fits all approach and neglects varying physical and social circumstances across world cities [18]. Furthermore, catering to large densities in urban centres, many cities fail to meet the standard. For example, (see Table 4) amongst many Indian cities, only a few cities like Chandigarh, Delhi, and Bangalore meet the WHO standard, and numerous like Mumbai, Ahmedabad, Surat, Chennai, and Hyderabad miss it on a large scale.
City | City area (km2) | City population in million (census 2011) | Area of UGS (km2) | Per capita UGS (m2 per person) |
---|---|---|---|---|
Chandigarh | 114 | 1.05 | 50 | 47.37 |
Delhi | 1484 | 16.34 | 324.44 | 19.84 |
Bangalore | 709 | 8.43 | 150 | 17.80 |
Mumbai | 735 | 18.45 | 122 | 6.61 |
Ahmedabad | 464 | 5.57 | 21.8 | 3.91 |
Surat | 326.5 | 4.46 | 11.84 | 3.32 |
Chennai | 176 | 8.69 | 11 | 1.26 |
Hyderabad | 172 | 7.75 | 8.72 | 0.88 |
Per capita UGS in Indian cities.
Source: author.
The Ministry of Urban Development sets out urban and regional development plan formulation and implementation (URDPFI) guidelines for, Government of India and suggests appropriate urban development standards. It identifies UGS as part of organized greens within the city’s social infrastructure and categorizes them based upon their spatial hierarchy as housing area, neighborhood, community, district and sub-city parks (see Table 5). The population to be served per unit and associated area requirements are mentioned within these categories. Such standards meet the quantitative aspects of UGS, but attention to their physical distribution and accessibility in regards to providing the serving radius is missed out.
S. no. | Category | Population served per unit | Area requirement (ha) |
---|---|---|---|
1 | Housing area park | 5000 | 0.50 |
2 | Neighborhood park | 15,000 | 1.00 |
3 | Community park | 1,00,000 | 5.00 |
4 | District park | 5,00,000 | 25.00 |
5 | Sub city park | 10,00,000 | 100.00 |
Categories of UGS in Indian cities as per URDPFI guidelines.
Source: URDPFI, volume 1.
Indian cities broadly vary in topography, and thus while setting out UGS standards and policy measures, it is crucial to incorporate their diverse local climate context and cultural practices, which these standards miss out on largely.
Developing the proper functionality of an UGS is vital to make it enduring. In the context of UGS associating them with the recreational programming during the planning process, it drives them to become more functionally sound and exciting and vibrant for citizens use. But a large number of green spaces in urban centers lack on this front as greens existing across the riverfront, green belts and even large cities scale greens are usually found with the least footfall and thus are encroached by slums and squatters [19]. Even in low hierarchy greens such as local or neighborhood parks, the absence of supporting recreational amenities such as sitting area, walking pathways, sports facilities, biking trails, open gyms, etc. are either not found or are not so well maintained. One of the studies in the Alexandria city of Egypt brings forth the lack of recreational programming of UGS and how it negatively affects the usability of city greens by the urban citizens (see Figure 8).
Inappropriate recreational programming in Al Shalalat park Alexandria, Egypt. (Source: 2003; De Sousa; thinking brownfields into green space in the city of Toronto).
Improving the UGS scenarios in our cities requires strategic measures with the coordinated efforts of all decision-makers and the stakeholder’s participation. These measures would intend to improve the qualitative and quantitative structure of urban greens in our cities, ensuring equitable distribution and making the greens accessible for citizens. Improving the planning process, strengthening the spatial data, enhancing quality greens, applying ecological principles, using altered greening practices and promoting public participation are discussed in the subsections below as the strategies for UGS improvements.
UGS assists sustainable development by being environmentally, socially and economically viable. The accustomed green planning process involves using standards approach wherein a set of standards are used while deciding greens provision. The standards approach ensures enough green spaces exist in cities, but it often compromises other vital aspects. UGS should be of satisfactory quality, adequate quantity, well-distributed and variably accessible [19, 20]. The process of determining standards should be appropriate for the greens’ of the greens and should be custom made. They are using local intensive methods such as neighborhood index which are more suitable for the green planning process. The planning process needs to be flexible enough to take in the political change occurring in the cities and should integrate a multi-disciplinary approach involving natural, social, economic, planning, and legal components.
UGS are a system of ever-evolving complexity, and to plan them effectively, spatial information is required that is fine, vigorous, and constantly updated. Geographic Information System (GIS) is one such tool that processes the geospatial data from satellite imagery, aerial photography and remote sensors helping to understand the current green spaces needs. It puts together vast amounts of spatial information and thus assists in analyzing the areas of priorities for UGS and determining the feasibility of developing new green sites in our cities [21]. In GIS, one can run numbers on queries, monitor fluctuations, predict environmental effects and thus help urban planners seek amplified visibility into the available data. Improved public participation is also achieved by using GIS tools for planning UGS, as people can get to know the actual ground reality to be achieved.
For adequate UGS planning, the existing green spaces in the city need to be addressed first. The stub semi-natural land with quality vegetation and varied, rich species can produce sound recreational and biodiverse spaces. The choice of vegetation plays a crucial role in determining and enhancing the quality of greens in a space. Choosing a natural species composition that supplements the biodiversity of the area is required. In cities undergoing densification, innovative greening techniques such as green roofs, green walls, street sites, and renaturation are very beneficial to improving green quality [22]. On an architectural scale, green needs to be saved by making effective plans. Also, site trees should not be cut during the construction phase. Proper distribution of UGS within the cities should be ensured to enhance their accessibility and visibility. Efforts to green the city streets should be made using various shrub species in order to improve the overall quality of UGS.
The efficacious planning of city greens can be achieved by utilizing ecological principles such as greenways, green fingers, and green belts. Using these principles aims at availing the optimal use of UGS geometry, thus enhancing their accessibility and diversity. Greenways act as a UGS management tool and are usually developed linearly across cities, contributing effectively to city greens. They are created along roads, railways, rivers and ridges helping to preserve green spaces and bring green vegetation into urban areas. Green fingers are conceptualized in the shape of human fingers and have green spaces set in a radial form spreading from city centre to periphery [23]. They bring green vegetation into the core of settlements and their adjoining areas, enabling citizens easy access to UGS. Green belts are set out to act as a protective mechanism checking the outward growth of cities. They are usually created in a ring form at city outskirts to prevent urban sprawl. They also acted as city boundaries separating one city from another. They contributed mainly to preserving city vegetation by safeguarding peripheral land for agriculture, forestry and recreation.
Within compact, dense cities, the land availability is less and thus, altering greening practices are required to fulfill the cities UGS requirements. In such cases practice of green roofs and walls comes to the rescue. Green roofs are the roof of a building covered with vegetation [19]. They not just provide esthetically pleasing landscapes but also create a habitat for wildlife and lower air temperature and mitigate the urban heat island effect. Providing green roofs increases property value in addition to many other benefits. Green wall, on the other hand, is a vertical greening typology wherein the walls are covered with vegetation. It can be used to enhance green spaces on land by using effective multi-level greenery designs. To encourage more and more people to use green roofs and walls, various policy measures in terms of economic incentives and tax exemption is required. Also, spreading environmental knowledge regarding them will increase the willingness of more people to implement these alternative greening measures.
The end-users of the UGS are city residents, and thus it is essential to involve them in the planning process. Public participation programs need to be thoughtfully planned and provide all the necessary information to the stakeholders. The urban planners and decision makers need to be open-minded and committed to considering the stakeholder’s inputs. To have active participation, the stakeholders need to explain the decision-making process and have a visual presentation clearly. For effective public participation, the demographic structure of the area needs to be identified, and further, the goals for UGS needs to be set accordingly [24]. Developing a questionnaire based on the area profile, demographics and UGS requirements should be formulated. To educate the citizens regarding UGS, workshops, seminars, and expert discussions can be conducted, which will also help the decision makers better identify local needs and demands.
With the rapid urbanization occurring in our cities, the need for sustainable development is more than ever. UGS are significant contributors to sustainable development as they provide us with several ecological services. They assist carbon sequestration, reduce the urban heat island effect, act as a barrier for noise pollution and bring down air pollution. The built environment is majorly affected by the UGS as they comprise recreational spaces for citizens that promote social inclusion in communities. Urban planners play a significant role in the provision of UGS in our cities. They are the primary decision-makers guided by the various standards, policies, laws and legislations. But most of the time, UGS seldomly take a back seat in the planning process over other land use such as residential, commercial, industrial and institutional. Therefore, it is essential for urban planning to address the challenges associated with UGS and suggest various strategies and measures. Indian cities face many challenges with the incredible pace of urbanization, such as less quantity of UGS and inappropriate quality. UGS is not equitably distributed in many cities and is not easily accessible [25]. The intended purpose not being served causes dissatisfaction amongst the city residents. To improve the situation of UGS in our cities, it is utterly vital to improve the planning process and at the same time strengthen the spatial data available to the decision-makers [26]. It is primarily important to work on enhancing the quality of UGS and incorporate various ecological principles available to us in the planning process. In cities undergoing densification and reduced land availability, alternative greening practices such as green roofs and walls can be of great help. Above people are all that avail the UGS, so it’s imperative to involve them in the planning process. It is equally essential for the youth to take this up in their hands of responsibility, and that is only possible if they have been given a chance, ensured support and most importantly, allotted funds for improving the UGS.
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\n\nPlease consult our Open Access Funding page to explore some of these funding opportunities and learn more about how you could finance your IntechOpen publication. Keep in mind that this list is not definitive, and while we are constantly updating and informing our Authors of new funding opportunities, we recommend that you always check with your institution first.
\n\nFor Authors who are unable to obtain funding from their institution or research funding bodies and still need help in covering publication costs, IntechOpen offers the possibility of applying for a Waiver.
\n\nOur mission is to support Authors in publishing their research and making an impact within the scientific community. Currently, 14% of Authors receive full waivers and 6% receive partial waivers.
\n\nWhile providing support and advice to all our international Authors, waiver priority will be given to those Authors who reside in countries that are classified by the World Bank as low-income economies. In this way, we can help ensure that the scientific work being carried out can make an impact within the worldwide scientific community, no matter where an Author might live.
\n\nThe application process is open after your submitted manuscript has been accepted for publication. To apply, please fill out a Waiver Request Form and send it to your Author Service Manager. If you have an official letter from your university or institution showing that funds for your OA publication are unavailable, please attach that as well. The Waiver Request will normally be addressed within one week from the application date. All chapters that receive waivers or partial waivers will be designated as such online.
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In this chapter, you understand the details of ageing processes and associated physiological changes.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Shilpa Amarya, Kalyani Singh and Manisha Sabharwal",authors:[{id:"226573",title:"Ph.D.",name:"Shilpa",middleName:null,surname:"Amarya",slug:"shilpa-amarya",fullName:"Shilpa Amarya"},{id:"226593",title:"Dr.",name:"Kalyani",middleName:null,surname:"Singh",slug:"kalyani-singh",fullName:"Kalyani Singh"},{id:"243264",title:"Dr.",name:"Manisha",middleName:null,surname:"Sabharwal",slug:"manisha-sabharwal",fullName:"Manisha Sabharwal"}]},{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:1941,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:"36452",doi:"10.5772/38931",title:"Qualitative Research Methods in Psychology",slug:"qualitative-research-methods-in-psychology",totalDownloads:35854,totalCrossrefCites:13,totalDimensionsCites:18,abstract:null,book:{id:"1997",slug:"psychology-selected-papers",title:"Psychology",fullTitle:"Psychology - Selected Papers"},signatures:"Deborah Biggerstaff",authors:[{id:"123274",title:"Dr.",name:"Deborah",middleName:null,surname:"Biggerstaff",slug:"deborah-biggerstaff",fullName:"Deborah Biggerstaff"}]},{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:2342,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"}]}],mostDownloadedChaptersLast30Days:[{id:"73271",title:"Social Media and Its Effects on Beauty",slug:"social-media-and-its-effects-on-beauty",totalDownloads:2991,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Beauty is concerned with physical and mental health as both are intimately related. Short-term decisions to alter one’s body structure irrespective of genetic, environmental, occupational and nutritional needs can leave medium- and long-term effects. This chapter analyzes the role of social media and its effects on the standards of beauty. The researchers have summarized the literature on how social media plays a role in affecting beauty trends, body image and self-esteem concerns. There is support that social media affects individuals negatively, in pushing them to engage in life threatening beauty trends due to social compliance and acceptance in society. The aim was to review social networking sites’ impact on perception of standards of beauty and newer unrealistic trends gaining popularity that could alter opinions and also cause harm to individuals in the long run. This is an emerging area of research that is of high importance to the physical and mental health in the beauty, health and hospitality industry with the latter being manifested in depression, anxiety and fear of non-acceptability and being seen as a social gauche.",book:{id:"7811",slug:"beauty-cosmetic-science-cultural-issues-and-creative-developments",title:"Beauty",fullTitle:"Beauty - Cosmetic Science, Cultural Issues and Creative Developments"},signatures:"Mavis Henriques and Debasis Patnaik",authors:[{id:"320016",title:"Ph.D. Student",name:"Mavis",middleName:"Lilian",surname:"Henriques",slug:"mavis-henriques",fullName:"Mavis Henriques"},{id:"320978",title:"Dr.",name:"Debasis",middleName:null,surname:"Patnaik",slug:"debasis-patnaik",fullName:"Debasis Patnaik"}]},{id:"60564",title:"Ageing Process and Physiological Changes",slug:"ageing-process-and-physiological-changes",totalDownloads:6884,totalCrossrefCites:16,totalDimensionsCites:31,abstract:"Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and pace. In the broader sense, ageing reflects all the changes taking place over the course of life. These changes start from birth—one grows, develops and attains maturity. To the young, ageing is exciting. Middle age is the time when people notice the age-related changes like greying of hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit cannot escape these changes. Slow and steady physical impairment and functional disability are noticed resulting in increased dependency in the period of old age. According to World Health Organization, ageing is a course of biological reality which starts at conception and ends with death. It has its own dynamics, much beyond human control. However, this process of ageing is also subject to the constructions by which each society makes sense of old age. In most of the developed countries, the age of 60 is considered equivalent to retirement age and it is said to be the beginning of old age. In this chapter, you understand the details of ageing processes and associated physiological changes.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Shilpa Amarya, Kalyani Singh and Manisha Sabharwal",authors:[{id:"226573",title:"Ph.D.",name:"Shilpa",middleName:null,surname:"Amarya",slug:"shilpa-amarya",fullName:"Shilpa Amarya"},{id:"226593",title:"Dr.",name:"Kalyani",middleName:null,surname:"Singh",slug:"kalyani-singh",fullName:"Kalyani Singh"},{id:"243264",title:"Dr.",name:"Manisha",middleName:null,surname:"Sabharwal",slug:"manisha-sabharwal",fullName:"Manisha Sabharwal"}]},{id:"27237",title:"Emotional Intelligence",slug:"emotional-intelligence",totalDownloads:5728,totalCrossrefCites:6,totalDimensionsCites:9,abstract:null,book:{id:"679",slug:"emotional-intelligence-new-perspectives-and-applications",title:"Emotional Intelligence",fullTitle:"Emotional Intelligence - New Perspectives and Applications"},signatures:"Adrian Furnham",authors:[{id:"85492",title:"Prof.",name:"Adrian",middleName:null,surname:"Furnham",slug:"adrian-furnham",fullName:"Adrian Furnham"}]},{id:"70731",title:"Theoretical Perspective of Traditional Counseling",slug:"theoretical-perspective-of-traditional-counseling",totalDownloads:1582,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter discusses the theoretical perspective of traditional counseling from an African context. Traditional counseling involves a broad perspective that enhances learning for transformation and integration of sociocultural values that are peculiar to each human society. A cursory review of the literature suggests that the concept of traditional counseling is rooted in traditional systems of knowledge and sociocultural customs and practices, and it promotes a collective approach to problem identification, resolution, and management. The traditional counseling process centers on four aspects: traditional counselor, client, family, and community. The key elements that inform the theoretical framework of traditional counseling from an African perspective are: cultural context, collective belief system, and initiation rituals Traditional systems of knowledge deemed essential for each generation are passed on successively to the next generation by elderly people who do not only have the necessary wisdom and experience, but are also adorned with social competences and skills.",book:{id:"9136",slug:"counseling-and-therapy",title:"Counseling and Therapy",fullTitle:"Counseling and Therapy"},signatures:"Hector Chiboola",authors:[{id:"314172",title:"Prof.",name:"Hector",middleName:null,surname:"Chiboola",slug:"hector-chiboola",fullName:"Hector Chiboola"}]},{id:"55388",title:"Beauty, Body Image, and the Media",slug:"beauty-body-image-and-the-media",totalDownloads:7678,totalCrossrefCites:5,totalDimensionsCites:12,abstract:"This chapter analyses the role of the mass media in people’s perceptions of beauty. We summarize the research literature on the mass media, both traditional media and online social media, and how they appear to interact with psychological factors to impact appearance concerns and body image disturbances. There is a strong support for the idea that traditional forms of media (e.g. magazines and music videos) affect perceptions of beauty and appearance concerns by leading women to internalize a very slender body type as ideal or beautiful. Rather than simply being passive recipients of unrealistic beauty ideals communicated to them via the media, a great number of individuals actually seek out idealized images in the media. Finally, we review what is known about the role of social media in impacting society’s perception of beauty and notions of idealized physical forms. Social media are more interactive than traditional media and the effects of self‐presentation strategies on perceptions of beauty have just begun to be studied. This is an emerging area of research that is of high relevance to researchers and clinicians interested in body image and appearance concerns.",book:{id:"5925",slug:"perception-of-beauty",title:"Perception of Beauty",fullTitle:"Perception of Beauty"},signatures:"Jennifer S. Mills, Amy Shannon and Jacqueline Hogue",authors:[{id:"202110",title:"Dr.",name:"Jennifer S.",middleName:null,surname:"Mills",slug:"jennifer-s.-mills",fullName:"Jennifer S. Mills"}]}],onlineFirstChaptersFilter:{topicId:"21",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82260",title:"Psychometric Analysis of an Instrument to Study Retention in Engineering",slug:"psychometric-analysis-of-an-instrument-to-study-retention-in-engineering",totalDownloads:4,totalDimensionsCites:0,doi:"10.5772/intechopen.105443",abstract:"Although engineering programs admit highly qualified students with strong academic credentials, retention in engineering remains lower than most other programs of study. Addressing retention by modeling student success shows promise. Instruments incorporating noncognitive attributes have proven to be more accurate than those using only cognitive variables in predicting student success. The Student Attitudinal Success Instrument (SASI-I), a survey assessing nine specific noncognitive constructs, was developed based largely on existing, validated instruments. It was designed to collect data on affective (noncognitive) characteristics for incoming engineering students (a) that can be collected prior to the first year and (b) for which higher education institutions may have an influence during students’ first year of study. This chapter will focus on the psychometric analysis of this instrument. Three years of data from incoming first-year engineering students were collected and analyzed. This work was conducted toward investigating the following research questions: Do the scale scores of the instrument demonstrate evidence of reliability and validity, and what is the normative taxonomy of the scale scores of first-year engineering students across multiple years? Further, to what extent did the overall affective characteristics change over the first year of study?",book:{id:"11441",title:"Psychometrics - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/11441.jpg"},signatures:"Kenneth J. Reid"},{id:"82112",title:"Comparative Senescence and Lifespan",slug:"comparative-senescence-and-lifespan",totalDownloads:9,totalDimensionsCites:0,doi:"10.5772/intechopen.105137",abstract:"The word senescence is derived from the Latin word “senex” (meaning old). In biology, senescence is a process by which a cell ages and permanently stops dividing. Senescence is a natural universal phenomenon affecting all living organisms (e.g., humans, animals, and plants). It is the process of growing old (aging). The underlying mechanisms of senescence and aging at the cellular level are not fully understood. Senescence is a multifactorial process that can be induced by several stimuli including cellular stress, DNA damage, telomere shortening, and oncogene activation. The most popular theory to explain aging is the free radical theory. Senescence plays a role in the development of several age-related chronic diseases in humans (e.g., ischemic heart disease, osteoporosis, and cancer). Lifespan is a biological characteristic of every species. The lifespan of living organisms ranges from few hours (with mayfly) to potential eternity (with jellyfish and hydra). The maximum theoretical lifespan in humans is around 120 years. The lifespan in humans is influenced by multiple factors including genetic, epigenetic, lifestyle, environmental, metabolic, and endocrine factors. There are several ways to potentially extend the lifespan of humans and eventually surpass the maximum theoretical lifespan of 120 years. The tools that can be proposed include lifestyle, reduction of several life-threatening diseases and disabilities, hormonal replacement, antioxidants, autophagy inducers, senolytic drugs, stem cell therapy, and gene therapy.",book:{id:"10935",title:"Mechanisms and Management of Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg"},signatures:"Hassan M. Heshmati"},{id:"81748",title:"Emotional Creativity",slug:"emotional-creativity",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.104544",abstract:"Creativity encompasses and is influenced by several emotions. Emotional creativity is a critical component in the creative process. It is the ability to create something new through the influence of emotions evoked from the personal or experiences of others. Creative works inspired by emotions are often original and greeted with Euphoria. This chapter demonstrates how different emotions inspire different forms and levels of creativity with examples of notable artists who experienced emotional creativity. This chapter discusses research linking emotions to creativity and the explanations of how the identification and regulation of emotions, which are often referred to as emotional intelligence, make a difference in whether creativity becomes useful, helpful, or hurtful. The dark side of creativity, which occurs when creativity becomes hurtful instead of helpful, and research into its causes is also discussed in this chapter. An example of a notable figure in the twentieth century, i.e., Adolf Hitler who masterminded World War II, is used to demonstrate how emotions played a role in this phenomenon. A conclusion alluding to the fact that creativity or creative outcomes are not necessarily bad but the application of creative work and the ability to identify emotions and regulate or control the emotions to drive creative performance validates emotional creativeness.",book:{id:"11303",title:"Creativity",coverURL:"https://cdn.intechopen.com/books/images_new/11303.jpg"},signatures:"Cynthia Naa Anyimah Botchway"},{id:"82097",title:"Including Religion in Rational-Emotive Behavior Counseling",slug:"including-religion-in-rational-emotive-behavior-counseling",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.104980",abstract:"Cognitive-behavioral therapies (CBT) have been disseminated worldwide. This therapeutic approach is being considered some of the best empirically supported treatments for a large variety of psychological disorders. The core tenet of CBT is to restore mental health and promote psychological well-being by focusing on cognitive dysfunctional patterns that cause emotional distress and maladaptive behaviors. First, a general view of the basic principles and origins of cognitive-behavior therapies constitute the basis on which the chapter is built. Thereafter, a more in-depth discussion on specific forms of CBT, namely cognitive therapy (CT) and rational-emotive behavior therapy (REBT) provides further support for the integration of religion and psychological intervention. Next, a thorough analysis of the theoretical premises of this integration and the ways in which religious beliefs and psychological mechanisms merge in practice is provided. Finally, the REBT conceptualization, techniques, and strategies are illustrated in a practical situation; here, the relationship between religious beliefs and practices on the one hand, and irrational beliefs, dysfunctional emotions, and maladaptive behaviors, on the other hand, is easy to observe. The example provided aptly illustrates the many ways in which REBT can incorporate religious principles, beliefs, and practices; all of them, advocating for the harmonious relationship between Christian values and REBT.",book:{id:"11305",title:"Counseling and Therapy - Recent Developments in Theories and Concepts",coverURL:"https://cdn.intechopen.com/books/images_new/11305.jpg"},signatures:"Adrian Opre and Bianca Macavei"},{id:"82075",title:"Sexuality and Disability",slug:"sexuality-and-disability",totalDownloads:10,totalDimensionsCites:0,doi:"10.5772/intechopen.104325",abstract:"Sexuality and disability is an important topic in our global society. Dismantling myths about sexuality and disability is considered a final frontier for people with disabilities. Dismantling myths about sexuality and disability is vital to the overall health and well-being of people with disabilities. A major aspect of the dismantling process is to acknowledge that sexuality is a significant quality of life determinant for all human beings. This chapter provides information that will promote a healthier and more accurate view of Sexuality and Disability. Dismantling this last frontier involves providing the readership with relevant historical information; information about psychosocial factors and attitudes that influence sexuality; and information about ethical practice guidelines. Information pertaining to sexuality training, specific provider competencies and how select disabilities and chronic illness impact sexuality is also covered in the chapter.",book:{id:"11267",title:"Human Sexuality",coverURL:"https://cdn.intechopen.com/books/images_new/11267.jpg"},signatures:"Danita H. Stapleton, Sekeria V. Bossie, Angela L. Hall and Lovett O. Lowery"},{id:"81962",title:"Gender and Modern-Day Slavery: Aggression and Violence in the Context of a Nigerian Focus",slug:"gender-and-modern-day-slavery-aggression-and-violence-in-the-context-of-a-nigerian-focus",totalDownloads:16,totalDimensionsCites:0,doi:"10.5772/intechopen.104727",abstract:"This chapter explored the various forms of gender-based modern-day slavery in Nigeria. Such modern slaveries as baby factories (unlawful maternity and orphanages where children are sold and their mothers serve as ‘economic-slaves, sex-slaves, procreation-slaves, and money-ritual-slaves’), peonage (debt bondage), and early forced marriage were found to be common and on the increase in Nigeria and fundamentally precipitated by patriarchy. The predictors and risk factors of these slavery typologies were supported by the tenets of feminist and political economy theories, which formed the framework. A patriarchal society engenders inequalities, alienation, subjugation, aggression, violence, deprivations, and frustration, with women on the receiving end, when compared to men. The female population is largely the victim, while most perpetrators are males. The new, emerging trend in slavery enterprise are typically organised and largely motivated by women’s vulnerabilities and powerlessness, with dehumanising and destructive consequences. Arising from this is the conclusion that certain cultural practices and socioeconomic forces intertwine with poverty, lack of qualitative education, and other exclusions to expose women and girls to servitudes. The problem requires robust intersectoral approaches—that is, coordinated intervention, programmes, and collaborative efforts between governments and local authorities and institutions—to (re)solve.",book:{id:"11440",title:"Aggression and Violent Behaviour",coverURL:"https://cdn.intechopen.com/books/images_new/11440.jpg"},signatures:"Mary Juachi Eteng and Macpherson Uchenna Nnam"}],onlineFirstChaptersTotal:50},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:133,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:107,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:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,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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",coverUrl:"https://cdn.intechopen.com/series/covers/22.jpg",latestPublicationDate:"June 27th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:1,editor:{id:"356540",title:"Prof.",name:"Taufiq",middleName:null,surname:"Choudhry",slug:"taufiq-choudhry",fullName:"Taufiq Choudhry",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000036X2hvQAC/Profile_Picture_2022-03-14T08:58:03.jpg",biography:"Prof. Choudhry holds a BSc degree in Economics from the University of Iowa, as well as a Masters and Ph.D. in Applied Economics from Clemson University, USA. In January 2006, he became a Professor of Finance at the University of Southampton Business School. He was previously a Professor of Finance at the University of Bradford Management School. He has over 80 articles published in international finance and economics journals. His research interests and specialties include financial econometrics, financial economics, international economics and finance, housing markets, financial markets, among others.",institutionString:null,institution:{name:"University of Southampton",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"86",title:"Business and Management",coverUrl:"https://cdn.intechopen.com/series_topics/covers/86.jpg",isOpenForSubmission:!0,annualVolume:11970,editor:{id:"128342",title:"Prof.",name:"Vito",middleName:null,surname:"Bobek",slug:"vito-bobek",fullName:"Vito Bobek",profilePictureURL:"https://mts.intechopen.com/storage/users/128342/images/system/128342.jpg",biography:"Dr. Vito Bobek works as an international management professor at the University of Applied Sciences FH Joanneum, Graz, Austria. He has published more than 400 works in his academic career and visited twenty-two universities worldwide as a visiting professor. Dr. Bobek is a member of the editorial boards of six international journals and a member of the Strategic Council of the Minister of Foreign Affairs of the Republic of Slovenia. He has a long history in academia, consulting, and entrepreneurship. His own consulting firm, Palemid, has managed twenty significant projects, such as Cooperation Program Interreg V-A (Slovenia-Austria) and Capacity Building for the Serbian Chamber of Enforcement Agents. He has also participated in many international projects in Italy, Germany, Great Britain, the United States, Spain, Turkey, France, Romania, Croatia, Montenegro, Malaysia, and China. Dr. Bobek is also a co-founder of the Academy of Regional Management in Slovenia.",institutionString:"Universities of Applied Sciences FH Joanneum, Austria",institution:null},editorTwo:{id:"293992",title:"Dr.",name:"Tatjana",middleName:null,surname:"Horvat",slug:"tatjana-horvat",fullName:"Tatjana Horvat",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hXb0hQAC/Profile_Picture_1642419002203",biography:"Tatjana Horvat works as a professor for accountant and auditing at the University of Primorska, Slovenia. She is a Certified State Internal Auditor (licensed by Ministry of Finance RS) and Certified Internal Auditor for Business Sector and Certified accountant (licensed by Slovenian Institute of Auditors). 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Singh",profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8018",title:"Extracellular Matrix",subtitle:"Developments and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/8018.jpg",slug:"extracellular-matrix-developments-and-therapeutics",publishedDate:"October 27th 2021",editedByType:"Edited by",bookSignature:"Rama Sashank Madhurapantula, Joseph Orgel P.R.O. and Zvi Loewy",hash:"c85e82851e80b40282ff9be99ddf2046",volumeInSeries:23,fullTitle:"Extracellular Matrix - Developments and Therapeutics",editors:[{id:"212416",title:"Dr.",name:"Rama Sashank",middleName:null,surname:"Madhurapantula",slug:"rama-sashank-madhurapantula",fullName:"Rama Sashank Madhurapantula",profilePictureURL:"https://mts.intechopen.com/storage/users/212416/images/system/212416.jpg",institutionString:"Illinois Institute of Technology",institution:{name:"Illinois Institute of Technology",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9759",title:"Vitamin E in Health and Disease",subtitle:"Interactions, Diseases and Health Aspects",coverURL:"https://cdn.intechopen.com/books/images_new/9759.jpg",slug:"vitamin-e-in-health-and-disease-interactions-diseases-and-health-aspects",publishedDate:"October 6th 2021",editedByType:"Edited by",bookSignature:"Pınar Erkekoglu and Júlia Scherer Santos",hash:"6c3ddcc13626110de289b57f2516ac8f",volumeInSeries:22,fullTitle:"Vitamin E in Health and Disease - Interactions, Diseases and Health Aspects",editors:[{id:"109978",title:"Prof.",name:"Pınar",middleName:null,surname:"Erkekoğlu",slug:"pinar-erkekoglu",fullName:"Pınar Erkekoğlu",profilePictureURL:"https://mts.intechopen.com/storage/users/109978/images/system/109978.jpg",institutionString:"Hacettepe University",institution:{name:"Hacettepe University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Proteomics",value:18,count:4},{group:"subseries",caption:"Metabolism",value:17,count:6},{group:"subseries",caption:"Cell and Molecular Biology",value:14,count:9},{group:"subseries",caption:"Chemical Biology",value:15,count:13}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:8},{group:"publicationYear",caption:"2021",value:2021,count:7},{group:"publicationYear",caption:"2020",value:2020,count:12},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:2}],authors:{paginationCount:250,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"10",type:"subseries",title:"Animal Physiology",keywords:"Physiology, Comparative, Evolution, Biomolecules, Organ, Homeostasis, Anatomy, Pathology, Medical, Cell Division, Cell Signaling, Cell Growth, Cell Metabolism, Endocrine, Neuroscience, Cardiovascular, Development, Aging, Development",scope:"Physiology, the scientific study of functions and mechanisms of living systems, is an essential area of research in its own right, but also in relation to medicine and health sciences. 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Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. 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