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1. Introduction
Chiropractic Biophysics® (CBP®) technique is a full-spine and posture correcting method that incorporates engineering and mathematical principles into a unique approach in the treatment of spine disorders [1, 2, 3, 4, 5]. CBP technique is best described as a ‘structural’ rehabilitation approach as opposed to ‘functional’ rehabilitation that typically encompasses physiotherapeutic modalities, stretching and exercises to regain function. The goal in structural rehabilitation is to restore the spine alignment and posture to as near normal as possible.
CBP operates on three main premises: 1. There is a normal/ideal static spinal configuration; 2. Abnormal alterations of the spine/posture result in abnormal function disrupting homeostatic balance; 3. Altered static spine/postural alignment results in abnormal dynamics [1]. The contemporary spine literature supports all three of these premises (See Section 4). CBP technique has published research on many facets of the technique including defining what normal/ideal spine alignment is, how to measure spine alignment parameters with reliable and repeatable methods, how to correct/re-align spinal displacements, and evidence proving correcting spine and postural displacements correlates with improvements in pain, disability and quality of life (QOL) measures (These studies are detailed later).
Herein, an overview is given of the scientific approach to treating spine disorders (i.e. subluxation) by the unique approach of CBP technique. A review will be given of the historical beginnings of CBP, rotations and translations of posture, the Harrison normal spinal model, radiographic analysis, posture and spinal coupling, the CBP protocol, clinical evidence of efficacy as well as the safety of the use of X-rays (The term ‘X-rays’ imply the use of plain radiographs throughout this chapter).
2. Historical beginnings
Donald D. Harrison, who had a Master’s degree in Mechanical Engineering and a Doctorate degree in Applied Mathematics developed a devote urgency to bring contemporary science to chiropractic. In the late 1970s, Harrison was the main instructor for the chiropractic technique named ‘Pettibon.’ Dissatisfied with the failure to produce spinal correction, he often incorporated his own methods in certain cases to better attain spine and posture improvements. It was in the treatment of one particular case (circa 1980) where he discovered that the body must be treated using the principles of mathematics; the term ‘mirror image®’ adjusting he later coined to describe these new approaches [1].
A 1974 paper by Panjabi et al. describes a Cartesian coordinate system for use in the description and study of joint biomechanics (Figure 1) [6]. Harrison was the first to apply this system of analysis to upright human posture (Figures 2 and 3). Harrison began discovering the rotations and translations of human posture in 1980. During the early 1980s, the analysis system evolved to incorporate a full spine analysis of the head, rib cage and pelvis in three-dimensions. The technique methods continued to evolve with intellectual contributions from early practitioners of CBP including among others, Drs. DeGeorge, Gambale, Pope and Deed Harrison (founder’s son).
Figure 1.
A vertebra described in terms of rotations about and translations along the x, y, and z-axes on a cartesian coordinate system as proposed by Panjabi (courtesy CBP seminars).
Figure 2.
If the head, thoracic cage, and pelvis are considered rigid bodies, then the possible rotations in three-dimensions are illustrated. Flexion and extension are rotations on the x-axis, axial rotation is about the y-axis, and lateral flexion is rotation about the z-axis (courtesy CBP seminars).
Figure 3.
If the head, thoracic cage, and pelvis are considered rigid bodies, then the possible translations in three-dimensions are illustrated. Lateral translations occur along the x-axis, vertical translations occur along the y-axis, and anterior–posterior translations (protraction-retraction) occurs along the z-axis (courtesy CBP seminars).
One of the unique methods within CBP is the use of ‘extension traction’ to restore the normal cervical or lumbar lordosis (Figures 4 and 5). The first cervical extension traction was with use of an inclined bench that utilized a camlock and pulley system to hyperextend the neck by pulling on the forehead [7]. This is the traction used in the first CBP non-randomized controlled clinical trial (nRCT) that showed that no traction either by no treatment or only cervical manipulation but no traction resulted in no improved alignment, while the traction group (also receiving cervical spinal manipulation) achieved improved lordosis [7].
Further development in cervical traction involved the addition of a posterior-to-anterior (PA) pull through the mid cervical spine with simultaneous extension and distraction of the head while sitting in a chair, so-called ‘Pope’s 2-way’ traction (Figure 4) [8]. A slight modification of this traction involves the use of a chin-forehead strap to add weight directly to the patients head as an extension-compression 2-way traction (Figure 4) [9]. More recently, a cervical extension orthotic (Denneroll) has been shown to be effective at increasing cervical lordosis (Figure 4).
In the mid 1990s, Deed Harrison helped to develop precision vectors for lumbar extension traction (Figure 5), where the first nRCT showing lumbar curve restoration was published in the Archives of Physical Medicine and Rehabilitation in 2002 and concluded: “This new method of lumbar extension traction is the first nonsurgical rehabilitative procedure to show increases in lumbar lordosis in chronic LBP (low back pain) subjects with hypolordosis” [10]. A lumbar extension orthotic device by Denneroll is also used for lumbar extension traction (Figure 5).
CBP technique is one of the most scientifically based posture and spine correcting techniques. There are many randomized controlled trials (RCTs), nRCTs, and well over 100 case reports/series documenting the improvement of diverse spine deformity patterns with concomitant reduction of pain, disability and increased QOL measures [11].
3. Rotations and translations of posture
The main strength of CBP technique is its fundamental underpinnings in engineering and mathematics [1]. It is a general theorem that any object can be decomposed as a rotation, a translation and a deformation [12]. Acknowledging that deformation of living tissues occurs, as in compressing of discs, ligaments, muscles etc., we divert attention to rotations and translations of posture. The main masses of the body, namely the head, thorax and pelvis can be described in relation to the body mass below within a Cartesian coordinate system (Figures 2 and 3). That is, the head is described in relation to the thorax, the thorax in relation to the pelvis, and the pelvis in relation to the feet [1, 13].
Any rotations or translations of the body masses as seen in neutral posture via external observation or internally by X-ray is acknowledged as abnormal. Therefore, no offset of the masses equates to the normal postural alignment (i.e. un-subluxated position). It is important to note that in the assessment of a patient, it is the presence of a rotation or translation in the neutral standing position that is abnormal. When Harrison first applied this method of analysis, the treatment became apparent with the postural diagnosis. That is, for any rotation or translation apparent in neutral standing posture, the opposite position would need to be the treatment as applied during exercises, spinal traction or spinal adjustments, as this is the mathematical solution, “the exact reversing of the patient’s abnormal posture.” [1] In fact, because the soft tissues require a significant magnitude of stress and strains to attempt to correct the spinal position via mirror image methods, Harrison suggested that postural reflections (i.e. ‘mirror image’ adjustments) need to be applied in “twice the negative of the translation distances and rotation angles.” [1].
It should be noted when Harrison finally developed the full spine analysis of rotations and translations of posture in the mid 1980s, he discovered that virtually 50% of all human movements had never been studied (except forward head posture). Thus, the Harrison research group performed several studies to evaluate the normal range of motion for several translation postures including lateral head and thoracic postures as well as anterior and posterior thoracic translation postures (Discussed in Section 6). [2, 3] Clinically, the spinal coupling patterns as discovered to be associated with these common postural positions are of utmost importance in the treatment of these spinal disorders.
Importance of the study of these never previously studied translation postures can be highlighted in the distinction between true scoliosis and ‘pseudo-scoliosis’ (Figure 6) [14] Pseudo-scoliosis is a lateral thoracic translation posture that characteristically features little to no vertebral rotation (simple to correct) [15, 16], whereas, true scoliosis characteristically features significant vertebral rotation (and is typically much more difficult to treat). X-ray screening of the spine is the only way to differentiate true scoliosis from pseudo-scoliosis.
Figure 6.
Posture image and antero-posterior lumbar radiographs depicting a left lateral thoracic translation (side shift). Both patients in the radiographs have a 20 mm left lateral shift of T10 off midline. Left patient has a pure left lateral thoracic translation posture, aka ‘pseudo-scoliosis.’ Right patient has a true left lumbar scoliosis (vertebral rotation). Green line is vertical; red line highlights patient alignment (courtesy CBP seminars).
As mentioned, the absence of rotations and translations of the body masses in standing posture is normal. However, the shape of the spine position, particularly in the sagittal plane has traditionally been debated.
4. The Harrison normal spine model
In the mid 1990s to the mid 2000s, the Harrison research team performed a series of spine modeling studies of the sagittal spinal curves (Figure 7) [17, 18, 19, 20, 21, 22, 23, 24]. To this day, this seminal work serves as the treatment outcome goal (i.e. gold standard) for providing structural rehabilitation by CBP methods (Figure 8). In a series of systematic studies, elliptical shape modeling of the path of the posterior longitudinal ligament was performed as it could be easily compared to the posterior vertebral body margins on X-rays, the same anatomical region used for measuring the sagittal spinal curves (i.e. Harrison posterior tangents (Figure 9) [25, 26, 27, 28]).
Figure 7.
The Harrison normal sagittal spine model as the path of the posterior longitudinal ligament. The cervical, thoracic and lumbar curves are all portions of an elliptical curve having a unique minor-to-major axis ratio. The cervical curve is circular meaning the minor and major axes are equal (courtesy CBP seminars).
Figure 8.
Three patients demonstrating dramatically different spine alignment patterns. Left: excessive lumbar hyperlordosis, L4 anterolisthesis, and excessive anterior sagittal balance in a mid-aged female with disabling low back pain; middle: excessive thoracolumbar kyphosis and early degenerative changes in a mid-aged male; right: excessive thoracic hyperkyphosis in a young male with Scheuermann’s disease. Red line is contiguous with posterior vertebral body margins; green line represents Harrison normal spinal model (courtesy PAO).
Figure 9.
Harrison posterior tangent method involves lines drawn contiguous with the posterior vertebral body margins. Intersegmental as well as regional sagittal curves are easily quantified having a standard error of measurement within about 2° (courtesy CBP seminars).
Computer iterations of spine shape modeling were applied to determine the best-fit geometric spinal shapes by fitting ellipses of varying minor-to-major axis ratios to the digitized data points from the posterior vertebral body corners from X-ray samples for each of the three regions of the spine (cervical [17, 18, 19], thoracic [20, 21], and lumbar spine [22, 23, 24]). As shown in Figure 7, the Harrison normal spinal model features a circular cervical lordosis, an elliptical thoracic curve featuring greater curvature cephalad with a straightened thoraco-lumbar junction and an elliptical lumbar lordosis showing a greater distal lumbar curvature. The spine is assumed to be vertical in the front view.
Although some have attempted to criticize the Harrison normal spinal model, it is important to acknowledge that it has been validated in several ways. Simple analysis of alignment data on samples of normal, asymptomatic populations have been done [17, 18, 19, 20, 21, 22, 23, 24]. Comparison studies between normal samples to symptomatic samples have been performed [17, 29]. Comparisons between normal samples to theoretical ideal models have been done [17, 18, 20, 23]. Statistical differentiation of asymptomatic subjects from symptomatic pain group patients based on alignment data has been performed [19, 24].
In subsequent biomechanical modeling studies, the Harrison group used a validated postural loading model to verify that sagittal spinal balance and the sagittal curves of the spine are critical biomechanical parameters for maintaining postural load balance in healthy subjects [30]. Keller et al. [30] stated “because the pattern of [intervertebral disc] IVD postural stresses mirrored the sagittal curvatures and sagittal displacement of the spine, a failure of the IVD’s hydrostatic mechanism under these sustained loads could occur”. In a similar biomechanical modeling study, Harrison et al. determined that anterior sagittal thoracic posture (anterior thorax translation relative to the pelvis) resulted in significant increases in disc loads and stresses for all vertebral levels below T9 and that the extensor muscle loads required to maintain static equilibrium in upright anterior posture increased almost five times that of normal [31]. In another study Keller et al. [32] determined that “postural forces are responsible for initiation of osteoporotic spinal deformity in elderly subjects”.
The Harrison group also used an elliptical shell model to evaluate the loads and bending moments on the cervical vertebrae in varying cervical spine deformity alignments [33, 34]. They found that in normal lordosis the anterior and posterior vertebral body stresses are nearly uniform and minimal, whereas, in cervical deformity configurations having kyphosis (S-shape kyphosis high or low, total kyphosis), the vertebral body stresses are ‘very large’ and opposite in direction compared to normal lordosis [33]. They concluded “This analysis provides the basis for the formation of osteophytes (Wolff’s Law) on the anterior margins of vertebrae in kyphotic regions of the sagittal cervical curve. This indicates that any kyphosis is an undesirable configuration in the cervical spine” [33]. Anterior head translation and a ‘military’ neck also displayed significantly increased vertebral body stresses that are reverse in direction from C5-T1 and are also proven to be “undesirable configurations in the cervical spine” [34].
5. Radiographic analysis
All radiographs should be taken in the ‘neutral’ standing position with the feet positioned with the heels at hips width apart. This is to avoid any induced postural deviations due to foot position. Also, to ensure a reproducible neutral (i.e. natural) body position, the subject should close their eyes and nod the head back and forth a couple times to where the subject should stop in their preferred position and then open their eyes while maintaining this adopted stance. Any postural misalignments seen in the subject should not be corrected. The lower body mass on the particular view being taken should be centered to the bucky. All X-rays should be taken without footwear.
It should be mentioned that the measurement of different sagittal spinal contours including regional curves or absolute rotation angles (ARAs) (i.e. cervical/lumbar lordosis; thoracic kyphosis) and intersegmental relative rotation angles (RRAs) between adjacent vertebrae can be easily quantified by use of the Harrison posterior tangent (HPT) lines (Figure 9) [25, 26, 27, 28]. The HPT method is preferred for three main reasons, 1. The posterior margins of the vertebral bodies are less affected by osteoarthritic changes as compared to the anterior margins which makes anatomical measurements more reliable and valid; 2. The posterior tangents are contiguous with the slope of the spinal curves and represent the first derivative in an engineering analysis and therefore, their intersection accurately depicts the sagittal configuration; 3. The HPT method has a small standard error of measurement (SEM) of approximately 2° versus higher SEMs with the Cobb (4.5–10°) [25, 26, 27]. This is why the HPT method is superior to other methods of sagittal spine mensuration including the popular Cobb method.
Generally, the global curves are measured as C2-C7, T1-T12, and L1-L5, however since the inflection of the cervical lordosis to thoracic kyphosis occurs at T1, some clinicians prefer to measure the cervical curve from C1-T1, and the thoracic curve from T2-T11 or T3-T10. Anterior sagittal translation distances are simply measured by the horizontal displacement offset between comparison vertebrae such as C2-S1, C2-C7 or T1, T1-T12, etc.
The anterior-to-posterior (AP) or PA X-rays are taken using the same postural positioning. The modified Risser-Ferguson method is employed to measure coronal plane alignment (Figure 10) [28]. On the AP/PA cervicothoracic view an upper angle is created as the angle between the best fit line of the upper cervical segments and intersection with the bite line, and a lower angle is formed between the best fit lines of the upper to lower spine segments [28]. The Rz angle is the angle formed by a vertical axis line (VAL) drawn from T4 and the lower cervicothoracic best fit line. Normal upper angle, lower angle and Rz cervicothoracic angles are 90°, 0° and 0°, respectively. The AP/PA thoracic view may show an angle. The lumbo-pelvic view has an upper angle, the angle between the best fit line of the upper versus lower lumbar segments, and a lower angle, the angle between the best fit line between the lower segments and the horizontal pelvic line [28]. The upper angle and lower angle should be 0° and 90°, respectively. Any regional or full-spine coronal balance offset (i.e. imbalance) can be easily quantified as the horizontal distance between the uppermost segment to the lowermost segment (e.g. C2-T2, T1-T12, T12-S1, C2-S1).
Figure 10.
AP radiographic line drawing by modified Risser-Ferguson method.
6. Posture and spinal coupling
Postural rotations and translations as described by Harrison (Figures 2 and 3) are understood as ‘main motions’ and the corresponding spinal displacements to accommodate the postural positions are termed ‘coupled motions’ [2, 3, 35, 36, 37, 38]. In CBP, a considerable clinical significance is placed on the correlation between the patient’s three-dimensional postural presentation (posture displacement in terms of rotations and translations) and the two-dimensional X-ray coupled motion (spinal rotations and translations) [2, 3, 38].
Of prime importance is the appreciation that unless there is buckling, anomalies or ligament damage, standing neutral postural rotation and translation displacements of the head or thorax cause the vertebral spinal coupling patterns as seen on X-ray. If a patient’s rotations and/or translations of posture ‘match’ the associated spinal coupling pattern as expected (i.e. normal coupling), then it is considered an ‘easy’ or typical case and the intuitive mirror image application of CBP methods would apply. When the patient’s rotations and/or translations of posture do not match the expected spine coupling pattern (i.e. spinal coupling does not match postural displacement), then it is considered an atypical case where the clinician needs to consider alternative (i.e. more complicated) strategies for spine rehabilitation.
A classic demonstration of the ‘matching’ versus ‘mismatching’ of rotations and translations of posture and spine coupling patterns can be illustrated with forward head posture, aka, anterior head translation (AHT) (Figure 11). The natural and expected spine coupling with a forward translated head posture involves lower cervical spine flexion and upper cervical spine extension. As seen in Figure 11, many spine different vertebral coupling patterns are possible including hyperlordosis, hypolordosis, or kyphosis and accordingly, each cervical configuration requires its own unique application of CBP methods for its ideal correction.
Figure 11.
Forward head translation as shown in posture and in three unique lateral cervical radiographs. All three X-ray images have about 25 mm of forward head translation. Left: hyperlordosis; middle: hypolordosis; right: kyphosis. Green line is normal alignment; red line highlights patient alignment.
These cervical spine patterns have been termed harmonics and their presence can only be determined by radiography [2, 39]. Importantly, in CBP treatment approaches, each cervical spine coupling pattern (harmonic) requires its own unique treatment protocol. This is why many manual therapy approaches (e.g. Mackenzie head retractions) are inadequate at correcting posture and spine alignment as these are prescribed universally (i.e. ‘blackbox treatment’) resulting in many patients receiving treatment protocols that are contraindicated. A patient with a hyperlordotic cervical spine should never be prescribed neck extension exercises as this would dynamically hyperextend the cervical joints. A patient with a complete cervical kyphosis should never be prescribed head retraction exercises as this often ‘buckles’ the spine into further kyphosis.
Also, as mentioned and illustrated in Figure 6, ‘pseudo-scoliosis’ or pure lateral translations of the thorax (or head) must be distinguished from true scoliosis by examination of the spinal coupling patterns [14]. If there is minimal or no vertebral rotation then this represents a typical case requiring CBP mirror image postural correction [3]. If there is vertebral rotation then it is considered true scoliosis and a completely different application of CBP methods (i.e. non-commutative properties of finite rotation angles [40, 41]). Case examples of the special application of CBP methods in the treatment of scoliosis is described later.
7. CBP protocol
The CBP patient management protocol [2, 3, 4] involves all typical initial patient examination procedures including the consultation, examination as well as pain, disability and quality of life questionnaires (Figure 12). In addition, CBP treatment consideration requires, without exception, a full-spine posture assessment as well as full-spine AP and lateral standing radiographs. Posture needs to be either qualitatively, but ideally quantitatively assessed as rotations and translations of the head, thorax and pelvis in three-dimensions (Figures 2 and 3). The X-rays need to be digitized and quantified, ideally with the Harrison posterior tangent method for the sagittal images and with the modified Risser-Ferguson on the AP images.
Figure 12.
CBP protocol treatment algorithm.
As seen in Figure 12, if appropriate, a new patient should be treated for their acute pain that is distinct and separate from CBP methods. It is recommended that the acute ‘pain care’ treatment include spinal manipulation, stretching (e.g. proprioceptive neuromuscular facilitation (PNF), Yoga, etc.), heat/ice, soft tissue myofascial therapy (e.g. transverse friction, Nimmo-receptor tonus technique, etc.). Once the patient experiences some initial pain relief (e.g. 6–12 treatments) they can be re-assessed and graduated to CBP structural rehabilitation. The decision to first treat a new patient with ‘acute’ pain care is a clinical decision that is mainly for patients that have either never seen a chiropractor previously or they have not been previously treated for their acute condition. For patients who have received recent previous treatment without relief, CBP rehabilitation care is recommended from the start of treatment [2, 3, 4].
CBP structural rehabilitation is suggested as either three times per week for 12-weeks (36 treatments) or four times per week for 9-weeks (36 treatments), however, the controlled trial data support treatment blocks of 30–40 treatment sessions [7, 8, 9, 10, 15, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. An initial patient who has acute or chronic pains and who has not been treated recently or at all for their current spine issue should be treated for an initial 6–12 sessions to provide pain relief. After signs of relief have occurred, a progress exam should be performed and the patient should be transitioned or ‘graduated’ to CBP corrective care.
CBP treatment occurs in ‘blocks of care.’ Numerous CBP controlled clinical trials (RCTs [43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55] and nRCTs [7, 8, 9, 10, 15, 42]) provide evidence for spine altering changes to occur in the range of 30–40 treatment sessions; thus, it is the practitioners’ choice to set their protocol within this range (i.e. treatment blocks). The end of each ‘block’ of CBP care requires a progress exam which includes all of the typical assessment procedures as well as a posture and X-ray assessment. Exam results may either dictate the need for further CBP treatment or the recommendation for ‘supportive’ or maintenance care. An initial block of CBP structural rehabilitation will include any acute care provided in the first 2–4 weeks. It is always recommended that ongoing ‘progress exams’ be performed regularly, at either 4-week or 12 treatment intervals, or as frequently as recommended by each practitioner’s regional regulatory board requirements.
CBP does not specifically support ‘long-term’ care plans. However, based on the data, an adult typically needs 6-months of corrective care (e.g. 72 treatments over 6-months at 3x/week) which is an evidence-based recommendation. Although, any given patient may require a shorted (i.e. 3-month) or longer treatment program based on their initial presenting postural parameters—approximate treatment extrapolations can be made by studying Tables 1–3. There is also support for supportive/maintenance care at a frequency of approximately 2×/month [8, 9, 10].
Study
Journal
Traction method
Traction time
Number of treatments
Change (*)
Change/txt (*)
Theoretical treatment extrapolation
Hypolordotic -20°
No curve 0°
Kyphotic +20°
RCTs
Moustafa
Sci Reports
Denneroll
20m
30
13.9
0.46
32
76
119
Moustafa
Heliyon
Denneroll
15–20m
30
13.4
0.45
34
78
123
Moustafa
J Athl Train
Denneroll
20m
30
14.7
0.49
31
71
112
Moustafa
APMR
Denneroll
20m
30
13.1
0.44
34
80
126
Moustafa
EJPRM
Denneroll
20m
30
13.7
0.46
33
77
120
Moustafa
BFPTCU
Denneroll
20m
36
12.8
0.36
42
98
155
nRCTs
Harrison
JMPT
Pope 2-way
20m
38
17.9
0.47
32
74
117
Harrison
APMR
2way
20m
35
14.2
0.41
37
86
136
Harrison
JMPT
Ext-comp
10m
60
13.2
022
68
159
250
Table 1.
Summary of cervical lordosis improvement by number of treatments, magnitude correction/treatment and the extrapolation to typical sagittal cervical curve subluxation types and the theoretical treatment number required for their correction to -35° C2-7 ARA.
*Note: Correction is estimated to achieve -35 of cervical lordosis.
Study
Journal
Traction method
Traction time
Number of treatments
Change (*)
Change/ txt (*)
Theoretical treatment extrapolation
Hypolordotic -30°
Hypolordotic -15°
No curve 0°
RCTs
Moustafa
JBMR/JMPT
LET
20m
30
6.2
0.21
48
121
194
Moustafa
Clin Rehab
LET
20m
30
8.7
0.29
34
86
138
nRCTs
Harrison
APMR
LET
20m
36
11.3
0.31
32
80
127
Table 2.
Summary of lumbar lordosis improvement by number of treatments, magnitude correction/treatment and the extrapolation to typical sagittal lumbar curve subluxation types and the theoretical treatment number required for their correction to -40° L1-5 ARA.
*Note: Correction is estimated to achieve -40 of lumbar lordosis.
Study
Journal
Traction method
Traction time
Number of treatments
Change (mm)
Change/txt (mm)
Theoretical treatment extrapolation
Mild offset ±10mm
Moderate offset ±20mm
Severe offset ±30mm
nRCTs
Head trans Harrison
JRRD
Lat trans
20 m
37
6.9
0.19
54
107
161
Thorax trans Harrison
Eur Sp J
Lat trans
20 m
36
7.7
0.21
47
94
140
Table 3.
Summary of AP head and thorax lateral translation reduction by number of treatments, magnitude correction/treatment and the extrapolation to larger coronal plane offset subluxations and the theoretical treatment number required for their correction.
Note: Correction is estimated to achieve 0mm of offset.
8. Clinical evidence of efficacy
As mentioned, CBP technique has an abundance of clinical evidence supporting its effectiveness in correcting spine deformity and posture [7, 8, 9, 10, 15, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. Recently, systematic reviews have summarized the clinical evidence as reported in the published controlled trials on these methods [56, 57]. We summarize the evidence here in four parts: cervical lordosis, lumbar lordosis, lateral translation (pseudo-scoliosis) postures of the head and thorax, and finally, evolving evidence from case reports/series on other important spine deformities including lumbar spondylolisthesis, cervical spondylolisthesis, thoracic hyperkyphosis, thoraco-lumbar junctional kyphosis, thoracic hypokyphosis (straight back syndrome), anterior sagittal balance, lumbar kyphosis (flat back syndrome), lumbar hyperlordosis, post-surgical cervical spine fusion and scoliosis.
8.1 Cervical lordosis
A recent systematic review found that of the RCTs and nRCTs on CBP extension traction methods, a 12–18° improvement in cervical lordosis can be achieved in 10–15 weeks after 30–36 treatment sessions [57]. Most RCTs have used the cervical Denneroll [43, 44, 45, 46, 47, 49, 50], and the three nRCTs all used different CET methods (Table 1) [7, 8, 9].
Table 1 shows the improvement in degrees per treatment as well as theoretical numbers of treatments for various presenting cervical spine subluxations. On average, there appears to be just less than a half degree improvement per treatment session; obviously, there are patients that will have both more correction and less correction than this. Using this estimation as an initial guideline, evidence-based treatment numbers can be predicted. For example, a patient presenting with a cervical kyphosis of 20° would require over 100 treatments to restore the neck to a curve of 35°.
Figures 13 and 14 show the long-term outcomes in patients receiving cervical extension traction versus comparative groups not receiving the traction. The patients restoring lordosis via CBP traction methods show improved cervical alignment which is maintained at a years’ follow-up (Figure 13) whereas, comparative groups receiving various physiotherapeutic treatments less the extension traction do not experience cervical improvement (Figure 13) and also show that any initial pain relief regresses back towards baseline levels after the cessation of treatment (Figure 14). Patient’s with improved lordosis retain their initial pain relief a year later (Figure 14). This is alarming as it shows patients receiving various physiotherapeutic treatments who do not improve their cervical lordosis (in hypolordotic patients) will have a future regression of symptoms post-treatment and may be misled by ‘apparent treatment efficacy’ [5, 57].
Figure 13.
Data from five RCTs demonstrates patients achieving cervical lordosis improvement (via extension traction) as well as conventional treatments have lordosis improvements that are sustained for 1 year after stopping treatment versus the cervical curve of comparative groups (controls not achieving lordosis improvement) remain unaffected by conventional treatments (weighted averages from five RCTs [44, 45, 47, 49, 50]). * indicates a significant group difference as specified in each of the five trials; brackets represent weighted standard deviation.
Figure 14.
Data from five RCTs demonstrates patients achieving cervical lordosis improvement (via extension traction) as well as conventional treatments have pain reductions that are sustained for 1 year after stopping treatment versus comparative groups (controls not achieving lordosis improvement) who show a regression (increase) of pain intensity towards baseline after stopping treatment (weighted averages from five RCTs [45, 46, 47, 49, 50]). * indicates a significant group difference as specified in each of the five trials; brackets represent weighted standard deviation.
8.2 Lumbar lordosis
A recent systematic review found “Limited but good quality evidence substantiates that the use of extension traction methods in rehabilitation programs definitively increases lumbar hypolordosis” [56]. The authors further stated: “Preliminarily, these studies indicate these methods provide longer-term relief to patients with low back disorders versus conventional rehabilitation approaches tested” [56]. On average, a 7–11° increase in lordosis can be achieved over 10–12 weeks after 30–36 treatment sessions (Table 2).
It must be mentioned that lumbar extension traction is necessary to increase the lumbar lordosis. Importantly, using the data from published trials [10, 53, 54, 55], one can extrapolate approximate treatment duration (Table 2). As seen, a mild hypolordotic lumbar spine of 30° (L1-L5 ARA) may only require 32–48 treatments, whereas, a flat lumbar curve would require 127–194 treatments to achieve a normal 40° lordosis.
The same trend as observed in patients receiving cervical lordosis correction versus comparative groups not receiving lordosis improvement is seen in the trials on the lumbar spine [5, 56]. Lordosis increase in patients receiving lumbar extension traction is achieved and maintained at 6-months follow-up (Figure 15); these patients also retain their initial pain relief whereas, comparative patient groups not receiving lordosis improvement (Figure 15) lose their initial pain relief by 6-months after cessation of treatment (Figure 16). Again, this is alarming and shows how active low back treatment, although offering transient pain relief, will likely regress after treatment if not receiving concurrent lordosis correction in those suffering from hypolordotic-related LBP [5, 56].
Figure 15.
Data from two RCTs demonstrates patients achieving lumbar lordosis improvement (via extension traction) as well as conventional treatments have lordosis improvements that are sustained for 6-months after stopping treatment versus the lumbar curve of comparative groups (controls not achieving lordosis improvement) remain unaffected by conventional treatments (weighted averages from two RCTs [53, 54]). * indicates a significant group difference as specified in each of the two trials; brackets represent weighted standard deviation.
Figure 16.
Data from two RCTs demonstrates patients achieving lumbar lordosis improvement (via extension traction) as well as conventional treatments have pain reductions that are sustained for 6-months after stopping treatment versus comparative groups (controls not achieving lordosis improvement) who show a regression (increase) of pain intensity towards baseline after stopping treatment (weighted averages from two RCTs [53, 54]). * indicates a significant group difference as specified in each of the two trials; brackets represent weighted standard deviation.
8.3 AP head and thorax postures
Coronal plane lateral translations of the head and thorax also referred to as ‘pseudo-scoliosis’ each has an nRCT published [15, 42] and many case reports demonstrating its reduction [16, 58, 59, 60, 61, 62, 63]. As discussed earlier, the differentiation from true scoliosis is that the involved vertebrae have minimal to no rotation, whereas, true scoliosis has substantial vertebral rotation (Figure 6). Also, the spinal coupling pattern of a laterally translated body mass (head or thorax) will demonstrate the lower involved spinal region to laterally flex towards the side of the translation and the upper involved spinal region to laterally flex back towards the vertical [35, 36].
Based on the data, a laterally translated body mass can be reduced about 7–8 mm after about 35 treatments. On average, correction of a laterally translated head or thorax can be corrected at about 0.2 mm per treatment, or about 1 mm per five treatments. Extrapolations of treatment numbers to patient subluxation presentation are shown in Table 3. From the data in each of the nRCTs, an approximate 50% reduction of the initial laterally translated head and thorax postures occurred; therefore, an average patient having an approximate 15 mm translation posture (head or rib cage) requires 6-months of corrective care (approximately 72 treatments). It must also be mentioned that many case reports have demonstrated larger lateral translation postural corrections/reductions with CBP methods in similar time frames [16, 58, 59, 60, 61, 62, 63], thus, these serve as approximate treatment extrapolations.
8.4 Other spine deformities
It is known that the science for manual therapies is lacking [64]. Therefore, lesser forms of evidence must be considered when evaluating various treatment approaches used to treat various spinal conditions by manual therapists [65, 66]; this includes treatment utilizing CBP methods. We now highlight more recent case studies and series showing structural spinal correction for a variety of relatively common disorders.
8.4.1 Lumbar spondylolisthesis
Fedorchuk et al. [67] reported on an 11 mm reduction (13.3–2.4 mm) of an L4 anterolisthesis in a 69-year old suffering from LBP and leg cramping. Pain relief was achieved after 60 treatments over 45 weeks. This was the first documented report of a reduction of a Grade 2 lumbar spondylolisthesis by CBP methods, as well as any other non-surgical method.
Oakley and Harrison reported on the reduction of multiple retrolistheses from L1-L4 ranging from 4.5 to 5.9 mm in a 32-year old male with LBP [68]. These were all reduced to within normal (<4.5 mm) after approximately 36 treatments over 14-weeks. A 13-month follow-up indicated the patient remained well and reported no back pain and the corrections had remained stable.
Fedorchuk et al. [69] reported on the reduction of L1 (−6.6 to −1.7 mm) and L2 (−6.1 to −2.0 mm) retrolistheses and an L5 anterolisthesis (+6.8 to −2.5 mm) in a 63-year old female bodybuilder with severe LBP and osteoarthritis. Thirty treatments were given over 10-weeks which resulted in normalizing all spondylolistheses as well as a dramatic reduction in pain and an ability to leg press 60 more pounds in the gym.
Fedorchuk et al. reported the complete reduction of an L3 retrolisthesis and L4 anterolisthesis after 50 treatments over a 7-month period [70]. The patient was 57-years old with severe LBP and sciatica. The L3 retrolisthesis reduced from −5.3 to −1.7 and the L4 anterolisthesis reduced from +5.4 to +1.0 mm. After treatment the patient was able to return to playing hockey and experienced full resolution of the back pain which had forced him to retire from sport. A 1-year follow-up showed the patient had remained well and maintained the corrections.
8.4.2 Cervical spondylolisthesis
Recently, Fedorchuk et al. present a case series of eight female patients with concomitant cervical hypolordosis, forward head translation and spondylolistheses [71]. All were in motor vehicle collisions, each having at least one, and at most four simultaneous cervical vertebral spondylolistheses ranging in magnitude from >2 mm up to 4.5 mm. All cases experienced a reduction in translational offset of the spondylolistheses, and increase in cervical lordosis and a decrease in forward head translation as well as an increase in spinal canal diameter at the location of the spondylolisthesis after 30 treatment sessions that included cervical extension traction over a duration of 12-weeks. On average, the spondylolistheses reduced by 2.6 mm and there was an average drop in neck disability by 30%.
In another case, Fedorchuk et al. presented a single case of a 52-year old with chronic neck pain [72]. The patient had a C4 anterolisthesis of 2.4 mm which was reduced to 0.7 mm as well as an increase in cervical lordosis and reduction in forward head translation after 30 treatments over 12-weeks. The patient reported a resolution of their neck pain and stiffness.
8.4.3 Thoracic hyperkyphosis
Thoracic hyperkyphosis is a relatively common subluxation pattern in the aging. Although there is one RCT on CBP methods showing reduction of the deformity, it is yet to be formally published [52]. A systematic review of CBP methods used to reduce thoracic hyperkyphosis was published [73] and summarized the outcomes of several case reports and series [74, 75, 76, 77, 78, 79]. In Table 2 of the Oakley and Harrison review an average 12° reduction in thoracic kyphosis occurred after 32 treatments over 14.5 weeks from a total of 17 patients [52]. The improved posture correlated with reduced pain, disability and improved QOL [52]. Figures 17 and 18 show various CBP mirror image spinal exercises and traction, respectively.
Figure 17.
CBP recommended mirror image exercises for patients with thoracic hyper-kyphosis.
Figure 18.
CBP mirror image traction for patients with thoracic hyper-kyphosis.
8.4.4 Thoracolumbar junctional kyphosis
Thoracolumbar kyphosis is the forward angled spine at the junction of the thoracic and lumbar spine and is associated with chronic LBP (CLBP). Gubbels et al. presented a case of the minimization of pain in a 16-year old female after a 22° reduction of thoracolumbar kyphosis, a 48 mm reduction of posterior sagittal balance, an 11° increase in lumbar lordosis and a 10° increase in sacral inclination [80]. Twenty-four in office treatments were given over an 8-week period with daily home traction resulting in a minimization of back pains.
8.4.5 Thoracic hypokyphosis (straight back syndrome)
Thoracic spine hypolordosis is termed straight back syndrome (SBS) and is associated with back pains and exertional dyspnea. Fortner et al. [81] reported on an 18-year old male suffering from back pains and exertional dyspnea. Twenty-four treatments over a 9-week period resulted in a 15° increase in thoracic kyphosis, a decrease in pain and improved exertional dyspnea symptoms. A 4-month follow-up showed the patient remained well.
Betz et al. [82] reported the improvement in a 19-year old male who suffered from exertional dyspnea and back pain. Over 12-weeks a 14° increase in thoracic curve was achieved resulting in relief of exertional dyspnea and pain, as well as increases in both the antero-posterior thoracic diameter and the ratio of antero-posterior to transthoracic diameter, both measures critical to the wellbeing of patients with SBS. A 2.75-year follow-up showed the patient remained well.
Fedorchuk et al. [83] reported on a 13° increased thoracic curve in a 26-year old male with back pains and type 1 diabetes. Treatment over 7-weeks included 36 sessions. Back pains reduced and importantly, there was also improvement in blood glucose immediately following the onset of each visit. An improvement in blood glucose averages, percentage of time of blood glucose in a healthy target range, and glycosylated hemoglobin occurred and the patient was able to reduce their basal insulin need by approximately half after the 7-weeks of care.
Mitchel et al. [84] reported a 10° increase in thoracic curve over 16-weeks in a 33-year old male suffering from exertional dyspnea and back pains. The measured lung capacity improved by 2L, the back pain diminished and the exertional dyspnea resolved. A 7-month follow-up indicated the patient remained well.
8.4.6 Anterior sagittal balance
Anterior sagittal balance (ASB) is the forward displacement of the upper body over the pelvis. Haas et al. reported on the dramatic 110 mm reduction in ASB in an 87-year old female with CLBP and sciatica [85]. Treatment consisted of 24 in office sessions over an 8-week period. The patient achieved a dramatic reduction of symptoms, improvements in flexibility and orthopedic testing.
Anderson et al. [86] reported on a 91 mm reduction in ASB in a 59-year old male patient suffering from a variety of symptoms associated with Parkinson’s disease. Initial treatment involved 38 treatments over 5 months. The patient experienced significant improvements in multiple postural parameters, gait, balance, hand tremors, low back and knee pains and SF-36 values. A 21-month follow-up showed the patient remained essentially well and most of the initial postural improvements were maintained.
8.4.7 Lumbar kyphosis (flat back syndrome)
Flat back syndrome (FBS) is the anterior translation of the upper body and gross loss (or kyphosis) of the lumbar spine and is associated with high pain and disability. In a case series, Harrison and Oakley describe the significant restoration of lumbar lordosis in two patients suffering from debilitating CLBP from flat back syndrome [87]. One patient had a 50° lordosis improvement in 100 treatments over 20 weeks, the other had a 26° lordosis improvement in 70 treatments over 16.5 weeks. In the discussion section of the report, it was calculated that the treatment costs of the patients receiving CBP treatment versus the projected costs for the surgical procedures recommended to the two patients equated to only 1–8%; the authors stated “at first 70 or 100 treatments may be criticized as ‘over-treatment,’ however, considering the overall cost-effectiveness and positive patient outcomes, it certainly is not” [87].
8.4.8 Lumbar hyperlordosis
Although lumbar hypolordosis is the most common lumbar misalignment in those presenting with chronic LBP [10], lumbar hyperlordosis is also seen clinically. CBP methods can be directed at decreasing lumbar lordosis and its typically associated anteriorly rotated pelvis. In a recent case, Oakley et al. [88] presented a case demonstrating the relief of CLBP and hip pains after an 8° reduction in lumbar hyperlordosis, a 5° reduction in pelvic tilt and an accompanying 17 mm reduction of forward sagittal balance. This occurred over a period of 13 months and 73 total treatments.
8.4.9 Post-surgical cervical spine fusion
Post-surgical cervical spine intervertebral fusion is not a common finding in clinical practice however, it is occasionally encountered. Many of these patients continue to suffer years after the intervention. Harrison et al. [89] presented a case showing improvement in sagittal postural parameters which corresponded with improved clinical outcome in a 52-year old male. Over a 6-month period, a 6° increase in cervical lordosis was achieved as well as a 13 mm reduction in anterior head translation (AHT). These improvements were maintained at a 2.5-year follow-up.
Fedorchuk et al. [90] also presented a successful outcome in a 43-year old with a C5-6 intersegmental fusion. After 36 treatments over 3-months, there was a 13° increase in cervical lordosis, a 9 mm decrease in AHT and a 5 mm reduction in lateral head translation.
8.4.10 Scoliosis
Although too large of a topic to address in this chapter, CBP technique has a unique approach in the treatment of scoliosis [3]. CBP methods incorporates the ‘non-commutative property of finite rotation angles under addition’ to ascertain the order of postural movements to be prescribed in the mirror image treatment of this disorder. Harrison and Oakley described reductions in curve magnitude in five lumbar or thoracolumbar scoliosis patients ranging from 5° to 24° after 18–84 treatments [40]. All patients were female and ranged in age from 19 to 45 years.
Haggard et al. reported a 19° reduction in a thoracolumbar curve in a 15-year old female patient after 24 office treatments over 15-weeks. The patient also performed 45 at home spine blocking sessions as prescribed by the attending chiropractor [41]. The patients LBP and headaches were dramatically improved, and the curve was reduced to 8°.
9. Use of X-ray
Use of X-ray for spine analysis is essential for treating spine deformities, including with CBP technique methods. Historically, there has been concerns of carcinogenicity associated with X-ray use. Recently, however, new evidence has come to light showing that anti-X-ray sentiment stemming from the supposed carcinogenicity is based on flawed science [91, 92, 93]. The bottom line is the linear no-threshold (LNT) model used to support radiation risk analysis is not scientific as it is not consistent with current radiobiological data [94, 95, 96, 97, 98].
X-rays and CT scans deliver low-dose radiation doses (<200 mGy), and because of this they cannot cause cancer. This is because low-dose (versus high-dose) radiation exposures stimulate the adaptive repair systems of the body to repair any damage done [99, 100, 101]. Although this topic is important, it is a much larger issue than the scope of this chapter but many recent reviews have found that X-rays (and CT scans) are not harmful [103]. In fact, after a substantial and critical review of higher quality studies on radiation exposure, Schultz et al. concluded: “The evidence suggests that exposure to multiple CT scans and other sources of low-dose radiation with a cumulative dose up to 100 mSv (approximately 10 scans), and possibly as high as 200 mSv (approximately 20 scans), does not increase cancer risk.” Thus, there should be no hesitation or misunderstanding surrounding X-ray risks. Doctors and patients need to become updated on X-ray safety and not succumb to the traditional carcinogenicity misinformation.
10. Conclusion
CBP technique is a well-studied approach to the structural improvement of spinal disorders. Many spinal disorders with associated pain and functional syndromes have either well characterized or evolving evidence for their treatment by the mirror image approach that underpins CBP methods. The correlation of the spine alignment and postural rotations and translations of posture are of critical importance and unique in the CBP approach.
Acknowledgments
We acknowledge the pioneering work of Dr. Donald D. Harrison.
Conflict of interest
D.E.H. teaches spine rehabilitation methods and sells products related to the treatment of spine deformities; P.A.O. is a paid consultant to CBP.
Nomenclature
AHT
anterior head translation
ASB
anterior sagittal balance
AP
anterior-to-posterior
ARA
absolute rotation angle
CBP
Chiropractic BioPhysics®
CLBP
chronic low back pain
HPT
Harrison posterior tangent
IVD
intervertebral disc
LBP
low back pain
LNT
linear no-threshold
nRCT
non-randomized controlled trial
QOL
quality of life
PA
posterior-to-anterior
PNF
proprioceptive neuromuscular facilitation
RCT
randomized controlled trial
RRA
relative rotation angle
SEM
standard error of measurement
SBS
straight back syndrome
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Mirror image® postural positions and movements are utilized including spinal extension positions to improve the spine and posture towards a normal/ideal alignment. Specifically, corrective exercises, corrective traction and chiropractic adjustments are performed encompassing a multimodal rehabilitation program with the goal of improving the posture and spine alignment. CBP Rehabilitation programs are typically performed in-office with supportive at-home measures. Repeat assessment including radiographs are used to quantify and monitor structural improvements. CBP technique is an evidence-based approach to treat spine deformities and is supported by all forms of clinical evidence including systematic literature reviews, randomized controlled trials, non-randomized controlled trials, case reports/series as well as is supported by biomechanical posture-spine coupling validity, radiographic and posture analysis reliability/repeatability and use of a validated biomechanical spinal model as the outcome goal of care. CBP technique is a proven method to improve pain, disability and quality of life in those with structural deformities.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/81876",risUrl:"/chapter/ris/81876",signatures:"Deed E. Harrison and Paul A. Oakley",book:{id:"11042",type:"book",title:"Complementary Therapies",subtitle:null,fullTitle:"Complementary Therapies",slug:null,publishedDate:null,bookSignature:"Prof. Mario Bernardo-Filho, Prof. Redha Taiar, Danúbia Da Cunha De Sá-Caputo and Dr. Adérito Seixas",coverURL:"https://cdn.intechopen.com/books/images_new/11042.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-012-9",printIsbn:"978-1-83969-011-2",pdfIsbn:"978-1-83969-013-6",isAvailableForWebshopOrdering:!0,editors:[{id:"157376",title:"Prof.",name:"Mario",middleName:null,surname:"Bernardo-Filho",slug:"mario-bernardo-filho",fullName:"Mario Bernardo-Filho"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"308067",title:"Dr.",name:"Paul A.",middleName:null,surname:"Oakley",fullName:"Paul A. Oakley",slug:"paul-a.-oakley",email:"docoakley.icc@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"308068",title:"Dr.",name:"Deed E.",middleName:null,surname:"Harrison",fullName:"Deed E. Harrison",slug:"deed-e.-harrison",email:"drdeedharrison@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Historical beginnings",level:"1"},{id:"sec_3",title:"3. Rotations and translations of posture",level:"1"},{id:"sec_4",title:"4. The Harrison normal spine model",level:"1"},{id:"sec_5",title:"5. Radiographic analysis",level:"1"},{id:"sec_6",title:"6. Posture and spinal coupling",level:"1"},{id:"sec_7",title:"7. CBP protocol",level:"1"},{id:"sec_8",title:"8. Clinical evidence of efficacy",level:"1"},{id:"sec_8_2",title:"8.1 Cervical lordosis",level:"2"},{id:"sec_9_2",title:"8.2 Lumbar lordosis",level:"2"},{id:"sec_10_2",title:"8.3 AP head and thorax postures",level:"2"},{id:"sec_11_2",title:"8.4 Other spine deformities",level:"2"},{id:"sec_11_3",title:"8.4.1 Lumbar spondylolisthesis",level:"3"},{id:"sec_12_3",title:"8.4.2 Cervical spondylolisthesis",level:"3"},{id:"sec_13_3",title:"8.4.3 Thoracic hyperkyphosis",level:"3"},{id:"sec_14_3",title:"8.4.4 Thoracolumbar junctional kyphosis",level:"3"},{id:"sec_15_3",title:"8.4.5 Thoracic hypokyphosis (straight back syndrome)",level:"3"},{id:"sec_16_3",title:"8.4.6 Anterior sagittal balance",level:"3"},{id:"sec_17_3",title:"8.4.7 Lumbar kyphosis (flat back syndrome)",level:"3"},{id:"sec_18_3",title:"8.4.8 Lumbar hyperlordosis",level:"3"},{id:"sec_19_3",title:"8.4.9 Post-surgical cervical spine fusion",level:"3"},{id:"sec_20_3",title:"8.4.10 Scoliosis",level:"3"},{id:"sec_23",title:"9. Use of X-ray",level:"1"},{id:"sec_24",title:"10. Conclusion",level:"1"},{id:"sec_25",title:"Acknowledgments",level:"1"},{id:"sec_28",title:"Conflict of interest",level:"1"},{id:"sec_27",title:"Nomenclature",level:"1"}],chapterReferences:[{id:"B1",body:'Harrison DD, Janik TJ, Harrison GR, Troyanovich S, Harrison DE, Harrison SO. Chiropractic biophysics technique: A linear algebra approach to posture in chiropractic. Journal of Manipulative and Physiological Therapeutics. 1996;19(8):525-535'},{id:"B2",body:'Harrison DE, Harrison DD, Haas JW. Structural Rehabilitation of the Cervical Spine. Evanston, WY: Harrison CBP® Seminars, Inc.; 2002'},{id:"B3",body:'Harrison DE, Betz JW, Harrison DD, et al. CBP Structural Rehabilitation of the Lumbar Spine. Eagle, ID, USA: Harrison Chiropractic Biophysics Seminars; 2007'},{id:"B4",body:'Oakley PA, Harrison DD, Harrison DE, Haas JW. Evidence-based protocol for structural rehabilitation of the spine and posture: Review of clinical biomechanics of posture (CBP) publications. Journal of the Canadian Chiropractic Association. 2005;49(4):270-296'},{id:"B5",body:'Oakley PA, Moustafa IM, Harrison DE. Restoration of Cervical and Lumbar Lordosis: CBP® Methods Overview. In: Bettany-Saltikov J, Kandasamy G, editors. Spinal Deformities in Adolescents, Adults and Older Adults [Internet]. London: IntechOpen; 2019 [cited 2022 Apr 26]. DOI: 10.5772/intechopen.90713'},{id:"B6",body:'Panjabi MM, White AA 3rd, Brand RA Jr. A note on defining body parts configurations. Journal of Biomechanics. 1974;7(4):385-387'},{id:"B7",body:'Harrison DD, Jackson BL, Troyanovich S, Robertson G, de George D, Barker WF. The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: A pilot study. Journal of Manipulative and Physiological Therapeutics. 1994;17(7):454-464'},{id:"B8",body:'Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: A nonrandomized clinical controlled trial. Archives of Physical Medicine and Rehabilitation. 2002;83(4):447-453'},{id:"B9",body:'Harrison DE, Harrison DD, Betz JJ, Janik TJ, Holland B, Colloca CJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: Nonrandomized clinical control trial. Journal of Manipulative and Physiological Therapeutics. 2003;26(3):139-151'},{id:"B10",body:'Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Changes in sagittal lumbar configuration with a new method of extension traction: Nonrandomized clinical controlled trial. Archives of Physical Medicine and Rehabilitation. 2002;83(11):1585-1591'},{id:"B11",body:'CBP NonProfit. www.cbpnonprofit.com'},{id:"B12",body:'Beer FP, Johnston ER. Vector Mechanics for Engineers: Statics and Dynamics. 4th ed. New York: McGraw-Hill; 1984. p. 95'},{id:"B13",body:'Harrison DD. Abnormal postural permutations calculated as rotations and translations from an ideal normal upright static spine. In: Sweere J, editor. Chiropractic Family Practice. Gaitherburg, MD: Aspen Publishers; 1992'},{id:"B14",body:'Harrison DE, Betz JW, Cailliet R, Colloca CJ, Harrison DD, Haas JW, et al. Radiographic pseudoscoliosis in healthy male subjects following voluntary lateral translation (side glide) of the thoracic spine. Archives of Physical Medicine and Rehabilitation. 2006;87(1):117-122'},{id:"B15",body:'Harrison DE, Cailliet R, Betz JW, Harrison DD, Colloca CJ, Haas JW, et al. A non-randomized clinical control trial of Harrison mirror image methods for correcting trunk list (lateral translations of the thoracic cage) in patients with chronic low back pain. European Spine Journal. 2005;14(2):155-162'},{id:"B16",body:'Henshaw M, Oakley PA, Harrison DE. Correction of pseudoscoliosis (lateral thoracic translation posture) for the treatment of low back pain: A CBP® case report. Journal of Physical Therapy Science. 2018;30(9):1202-1205'},{id:"B17",body:'Harrison DD, Janik TJ, Troyanovich SJ, Holland B. Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine. 1996;21(6):667-675'},{id:"B18",body:'Harrison DD, Janik TJ, Troyanovich SJ, Harrison DE, Colloca CJ. Evaluations of the assumptions used to derive an ideal normal cervical spine model. Journal of Manipulative and Physiological Therapeutics. 1997;20(4):246-256'},{id:"B19",body:'Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, et al. Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: Results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine. 2004;29:2485-2492'},{id:"B20",body:'Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon S. Can the thoracic kyphosis be modeled with a simple geometric shape? The results of circular and elliptical modeling in 80 asymptomatic subjects. Journal of Spinal Disorders. 2002;15(3):213-220'},{id:"B21",body:'Harrison DE, Harrison DD, Janik TJ, Cailliet R, Haas JW. Do alterations in vertebral and disc dimensions affect an elliptical model of the thoracic kyphosis? Spine. 2003;28(5):463-469'},{id:"B22",body:'Troyanovich SJ, Cailliet R, Janik TJ, Harrison DD, Harrison DE. Radiographic mensuration characteristics of the sagittal lumbar spine from a normal population with a method to synthesize prior studies of lordosis. Journal of Spinal Disorders. 1997;10(5):380-386'},{id:"B23",body:'Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE. Can the sagittal lumbar curvature be closely approximated by an ellipse? Journal of Orthopaedic Research. 1998;16(6):766-770'},{id:"B24",body:'Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE, Holland B. Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects. Journal of Spinal Disorders. 1998;11(5):430-439'},{id:"B25",body:'Harrison DE, Harrison DD, Cailliet R, et al. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine. 2000;25:2072-2078'},{id:"B26",body:'Harrison DE, Cailliet R, Harrison DD, et al. Reliability of centroid, Cobb, and Harrison posterior tangent methods: Which to choose for analysis of thoracic kyphosis. Spine. 2001;26:E227-E234'},{id:"B27",body:'Harrison DE, Harrison DD, Cailliet R, et al. Radiographic analysis of lumbar lordosis: Centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine. 2001;26:E235-E242'},{id:"B28",body:'Harrison DE, Holland B, Harrison DD, et al. Further reliability analysis of the Harrison radiographic line drawing methods: Crossed ICCs for lateral posterior tangents and AP modified-Risser Ferguson. Journal of Manipulative and Physiological Therapeutics. 2002;25:93-98'},{id:"B29",body:'McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. Journal of Manipulative and Physiological Therapeutics. 2005;28(3):187-193'},{id:"B30",body:'Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: Implications for the ideal spine. The Spine Journal. 2005;5(3):297-309'},{id:"B31",body:'Harrison DE, Colloca CJ, Harrison DD, Janik TJ, Haas JW, Keller TS. Anterior thoracic posture increases thoracolumbar disc loading. European Spine Journal. 2005;14(3):234-242'},{id:"B32",body:'Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ. Prediction of osteoporotic spinal deformity. Spine. 2003;28(5):455-462'},{id:"B33",body:'Harrison DE, Harrison DD, Janik TJ, William Jones E, Cailliet R, Normand M. Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clinical Biomechanics. 2001;16(4):276-284'},{id:"B34",body:'Harrison DE, Jones EW, Janik TJ, Harrison DD. Evaluation of axial and flexural stresses in the vertebral body cortex and trabecular bone in lordosis and two sagittal cervical translation configurations with an elliptical shell model. Journal of Manipulative and Physiological Therapeutics. 2002;25(6):391-401'},{id:"B35",body:'Harrison DE, Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ. Cervical coupling during lateral head translations creates an S-configuration. Clinical Biomechanics (Bristol, Avon). 2000;15(6):436-440'},{id:"B36",body:'Harrison DE, Cailliet R, Harrison DD, Janik TJ, Troyanovich SJ, Coleman RR. Lumbar coupling during lateral translations of the thoracic cage relative to a fixed pelvis. Clinical Biomechanics (Bristol, Avon). 1999;14(10):704-709'},{id:"B37",body:'Harrison DE, Cailliet R, Harrison DD, Janik TJ. How do anterior/posterior translations of the thoracic cage affect the sagittal lumbar spine, pelvic tilt, and thoracic kyphosis? European Spine Journal. 2002;11(3):287-293'},{id:"B38",body:'Harrison DE, Harrison DD, Haas JW, Oakley PA. Spinal Biomechanics for Clinicians. Vol. I. Evanston, WY: Harrison Chiropractic Biophysics Seminars, Inc.; 2003'},{id:"B39",body:'Oakley PA, Cuttler JM, Harrison DE. X-ray imaging is essential for contemporary chiropractic and manual therapy spinal rehabilitation: Radiography increases benefits and reduces risks. Dose-Response. 2018;16(2):1559325818781437'},{id:"B40",body:'Harrison DE, Oakley PA. Scoliosis deformity reduction in adults: A CBP® Mirror image® case series incorporating the \'non-commutative property of finite rotation angles under addition\' in five patients with lumbar and thoraco-lumbar scoliosis. Journal of Physical Therapy Science. 2017;29(11):2044-2050'},{id:"B41",body:'Haggard JS, Haggard JB, Oakley PA, Harrison DE. Reduction of progressive thoracolumbar adolescent idiopathic scoliosis by chiropractic biophysics® (CBP®) mirror image® methods following failed traditional chiropractic treatment: A case report. Journal of Physical Therapy Science. 2017;29(11):2062-2067'},{id:"B42",body:'Harrison DE, Cailliet R, Betz J, Haas JW, Harrison DD, Janik TJ, et al. Conservative methods for reducing lateral translation postures of the head: A nonrandomized clinical control trial. Journal of Rehabilitation Research and Development. 2004;41(4):631-639'},{id:"B43",body:'Moustafa IM, Diab AA, Hegazy F, Harrison DE. Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: A randomized, placebo-controlled trial. Scientific Reports. 2021;11(1):15379'},{id:"B44",body:'Moustafa IM, Diab A, Shousha T, Harrison DE. 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Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: A randomized trial. Journal of Manipulative and Physiological Therapeutics. 2012;35(4):246-253'},{id:"B56",body:'Oakley PA, Ehsani NN, Moustafa IM, Harrison DE. Restoring lumbar lordosis: A systematic review of controlled trials utilizing Chiropractic Bio Physics® (CBP®) non-surgical approach to increasing lumbar lordosis in the treatment of low back disorders. Journal of Physical Therapy Science. 2020;32(9):601-610'},{id:"B57",body:'Oakley PA, Ehsani NN, Moustafa IM, Harrison DE. Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: A systematic review of controlled trials. Journal of Physical Therapy Science. 2021;33(10):784-794'},{id:"B58",body:'Haas JW, Oakley PA, Harrison DE. Cervical pseudo-scoliosis reduction and alleviation of dystonia symptoms using chiropractic BioPhysics® (CBP®) technique: A case report with a 1.5-year follow-up. The Journal of Contemporary Chiropractic. 2019;2:131-137'},{id:"B59",body:'Jaeger JO, Oakley PA, Moore RR, Ruggeroli EP, Harrison DE. Resolution of temporomandibular joint dysfunction (TMJD) by correcting a lateral head translation posture following previous failed traditional chiropractic therapy: A CBP® case report. Journal of Physical Therapy Science. 2018;30(1):103-107'},{id:"B60",body:'Oakley PA, Harrison DE. Alleviation of pain and disability in a post-surgical C4-C7 total fusion patient after reducing a lateral head translation (side shift) posture: A CBP® case report with a 14 year follow-up. Journal of Physical Therapy Science. 2018;30(7):952-957'},{id:"B61",body:'Berry RH, Oakley P, Harrison D. Alleviation of radiculopathy by structural rehabilitation of the cervical spine by correcting a lateral head translation posture (-TxH) using Berry translation traction as a part of CBP methods: A case report. The Chiropractic Journal of Australia. 2017;45(1):63-72'},{id:"B62",body:'Berry RH, Oakley PA, Harrison DE. Alleviation of chronic headaches by correcting lateral head translation posture (-TxH) using Chiropractic Biophysics & Berry Translation Traction. Annals of Vertebral Subluxation Research. 2017;(1-2):87-92'},{id:"B63",body:'Oakley PA, Berry RH, Harrison DE. A structural approach to the postsurgical laminectomy case. Journal of Vertebral Subluxation Research. 2007;(March 19):1-7'},{id:"B64",body:'Nuckols TK, Lim YW, Wynn BO, et al. Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers. Journal of General Internal Medicine. 2008;23(1):37-44'},{id:"B65",body:'Rome P, Waterhouse JD. An evidence-based narrative of the evidence-base concept. Asia-Pacific Chiropractic Journal. 2020;1:004. https://doi.org/10.46323/2021004'},{id:"B66",body:'Ebrall P, Doyle M. The value of case reports as clinical evidence. The Chiropractic Journal of Australia. 2020;47(1):29-43'},{id:"B67",body:'Fedorchuk C, Lightstone DF, McRae C, Kaczor D. Correction of grade 2 spondylolisthesis following a non-surgical structural spinal rehabilitation protocol using lumbar traction: A case study and selective review of literature. Journal of Radiology Case Reports. 2017;11(5):13-26'},{id:"B68",body:'Oakley PA, Harrison DE. Correction of multilevel lumbar retrolistheses by non-surgical extension traction procedures in a patient with congenital fusion of L5-S1: A CBP® case report with a 13-month follow-up. The Journal of Contemporary Chiropractic. 2020;3(1):137-142'},{id:"B69",body:'Fedorchuk C, Haugen H. Reduction in three levels of lumbar degenerative spondylolisthesis following chiropractic care: A case report & review of the literature. Annals of Vertebral Subluxation Research. 2020;(Dec. 3):165-170'},{id:"B70",body:'Fedorchuk CA, Lightstone DF, Oakley PA, Harrison DE. Correction of a double spondylolisthesis of the lumbar spine utilizing chiropractic biophysics® technique: A case report with 1-year follow-up. Journal of Physical Therapy Science. 2021;33(1):89-93'},{id:"B71",body:'Fedorchuk C, Lightstone DF, DeVon CR, Katz E, Wilcox J. Improvements in cervical spinal canal diameter and neck disability following correction of cervical lordosis and cervical spondylolistheses using chiropractic BioPhysics technique: A case series. Journal of Radiology Case Reports. 2020;14(4):21-37'},{id:"B72",body:'Fedorchuk C, Lightstone D. Reduction in cervical anterolisthesis & pain in a 52-year-old female using chiropractic biophysics® technique: A case study and selective review of literature. 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Treating \'slouchy\' (hyperkyphosis) posture with chiropractic biophysics®: A case report utilizing a multimodal mirror image® rehabilitation program. Journal of Physical Therapy Science. 2017;29(8):1475-1480'},{id:"B77",body:'Miller JE, Oakley PA, Levin SB, Harrison DE. Reversing thoracic hyperkyphosis: A case report featuring mirror image® thoracic extension rehabilitation. Journal of Physical Therapy Science. 2017;29(7):1264-1267'},{id:"B78",body:'Fedorchuk C, Snow E. Reduction in thoracic hyperkyphosis with increased peak expiratory flow (PEF), forced expiratory volume (FEV) and SF-36 scores following CBP protocols in asymptomatic patients: A case series. Annals of Vertebral Subluxation Research. 2017;(Oct. 12):189-200'},{id:"B79",body:'Jaeger JO, Oakley PA, Colloca CJ, et al. Non-surgical reduction of thoracic hyper-kyphosis in a 24-year old music teacher utilizing chiropractic biophysics® technique. British Journal of Medicine and Medical Research. 2016;11:1-9'},{id:"B80",body:'Gubbels CM, Werner JT, Oakley PA, Harrison DE. Reduction of thoraco-lumbar junctional kyphosis, posterior sagittal balance, and increase of lumbar lordosis and sacral inclination by chiropractic BioPhysics® methods in an adolescent with back pain: A case report. Journal of Physical Therapy Science. 2019;31(10):839-843'},{id:"B81",body:'Fortner MO, Oakley PA, Harrison DE. Chiropractic biophysics management of straight back syndrome and exertional dyspnea: A case report with follow-up. The Journal of Contemporary Chiropractic. 2019;2:115-122'},{id:"B82",body:'Betz JW, Oakley PA, Harrison DE. Relief of exertional dyspnea and spinal pains by increasing the thoracic kyphosis in straight back syndrome (thoracic hypo-kyphosis) using CBP® methods: A case report with long-term follow-up. Journal of Physical Therapy Science. 2018;30(1):185-189'},{id:"B83",body:'Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M. Improved glycosylated hemoglobin, hyperglycemia, and quality of life following thoracic hypokyphosis vertebral subluxation correction using Chiropractic BioPhysics®: A prospective case report. Journal of Diabetes & Metabolism. 2018;9(10):1-10'},{id:"B84",body:'Mitchell JR, Oakley PA, Harrison DE. Nonsurgical correction of straight back syndrome (thoracic hypokyphosis), increased lung capacity and resolution of exertional dyspnea by thoracic hyperkyphosis mirror image® traction: A CBP® case report. Journal of Physical Therapy Science. 2017;29(11):2058-2061'},{id:"B85",body:'Haas JW, Harrison DE, Oakley PA. Non-surgical reduction in anterior sagittal balance subluxation and improvement in overall posture in a geriatric suffering from low back pain and sciatica: A CBP® case report. The Journal of Contemporary Chiropractic. 2020;3(1):45-50'},{id:"B86",body:'Anderson JM, Oakley PA, Harrison DE. Improving posture to reduce the symptoms of Parkinson’s: A CBP® case report with a 21 month follow-up. Journal of Physical Therapy Science. 2019;31(2):153-158'},{id:"B87",body:'Harrison DE, Oakley PA. Non-operative correction of flat back syndrome using lumbar extension traction: A CBP® case series of two. Journal of Physical Therapy Science. 2018;30(8):1131-1137'},{id:"B88",body:'Oakley PA, Ehsani NN, Harrison DE. Non-surgical reduction of lumbar hyperlordosis, forward sagittal balance and sacral tilt to relieve low back pain by Chiropractic BioPhysics® methods: A case report. Journal of Physical Therapy Science. 2019;31(10):860-864'},{id:"B89",body:'Harrison DE, Oakley PA, Betz JW. Anterior head translation following cervical fusion-a probable cause of post-surgical pain and impairment: A CBP® case report. Journal of Physical Therapy Science. 2018;30(2):271-276'},{id:"B90",body:'Fedorchuk C, Lightstone DF, Andino H. Failed neck surgery: Improvement in neck pain, migraines, energy levels, and performance of activities of daily living following subluxation correction using Chiropractic Biophysics® Technique: A case study. Annals of Vertebral Subluxation Research. 2017;(May 18):93-100'},{id:"B91",body:'Calabrese EJ. Cancer risk assessment foundation unraveling: New historical evidence reveals that the US National Academy of Sciences (US NAS), biological effects of atomic radiation (BEAR) committee genetics panel falsified the research record to promote acceptance of the LNT. Archives of Toxicology. 2015;89(4):649-650'},{id:"B92",body:'Calabrese EJ. An abuse of risk assessment: How regulatory agencies improperly adopted LNT for cancer risk assessment. Archives of Toxicology. 2015;89(4):647-648'},{id:"B93",body:'Calabrese EJ. On the origins of the linear no-threshold (LNT) dogma by means of untruths, artful dodges and blind faith. Environmental Research. 2015;142:432-442'},{id:"B94",body:'Scott BR, Sanders CL, Mitchel REJ, Boreham DR. CT scans may reduce rather than increase risk of cancer. The Journal of the American Physicians and Surgeons. 2008;13(1):8-11'},{id:"B95",body:'Lemon JA, Phan N, Boreham DR. Single CT scan prolongs survival by extending cancer latency in Trp53 heterozygous mice. Radiation Research. 2017;188(4.2):505-511'},{id:"B96",body:'Lemon JA, Phan N, Boreham DR. Multiple CT scans extend lifespan by delaying cancer progression in cancer-prone mice. Radiation Research. 2017;188(4.2):495-504'},{id:"B97",body:'Cuttler JM. Application of low doses of ionizing radiation in medical therapies. Dose-Response. 2020;18(1):1559325819895739'},{id:"B98",body:'Calabrese EJ, Dhawan G, Kapoor R, Kozumbo WJ. Radiotherapy treatment of human inflammatory diseases and conditions: Optimal dose. Human & Experimental Toxicology. 2019;38(8):888-898'},{id:"B99",body:'Pollycove M, Feinendegen LE. Radiation-induced versus endogenous DNA damage: Possible effect of inducible protective responses in mitigating endogenous damage. Human and Experimental Toxicology. 2003;22(6):290-306'},{id:"B100",body:'Pollycove M. Radiobiological basis of low-dose irradiation in prevention and therapy of cancer. Dose-Response. 2006;5(1):26-38'},{id:"B101",body:'Feinendegen LE, Cuttler JM. Biological effects from low doses and dose rates of ionizing radiation: Science in the service of protecting humans, a synopsis. Health Physics. 2018;114(6):623-626'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Deed E. Harrison",address:null,affiliation:'
CBP NonProfit, Inc., USA
'},{corresp:"yes",contributorFullName:"Paul A. Oakley",address:"docoakley.icc@gmail.com",affiliation:'
Private Practice, Canada
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Its response to diverse environmental stressors is dynamics and complicated, and it can be plastic (irreversible) or elastic (reversible). There is a wide range of soil and climatic conditions in which Maize can be grown. Climate change, for example, has the potential to impair grain quality and productivity of Maize all over the world. For the best harvest yield, the maize crop requires the right temperature. As a result of climate change, environmental stress factors such as abiotic and biotic stress factors are projected to intensify and become more common. Abiotic stress such as drought, temperature, and salinity are the major constraints limiting Maize’s worldwide production (Z. mays L.). In places prone to various stresses, the development of stress-tolerant crop types will be useful. Drought, salinity, and temperature extremes are examples of abiotic factors that can significantly impact the development and growth of the plant. Furthermore, various management options available may aid in the development of strategies for better maize performance in abiotic stress conditions to understand the maize response to resistance mechanisms and abiotic stress. Therefore, this chapter will focus on the impact of abiotic stress regarding temperature on Maize.",signatures:"Yousaf Ali, Taufiq Nawaz, Nazeer Ahmed, Muhammad Junaid, Mehwish Kanwal, Fazli Hameed, Saeed Ahmed, Rafi Ullah, Muhammad Shahab and Fazli Subhan",authors:[{id:"420070",title:"Mr.",name:"Saeed",surname:"Ahmed",fullName:"Saeed Ahmed",slug:"saeed-ahmed",email:"saeeddikhan@gmail.com"},{id:"420222",title:"Dr.",name:"Rafi",surname:"Ullah",fullName:"Rafi Ullah",slug:"rafi-ullah",email:"rafiullah@uoswabi.edu.pk"},{id:"423681",title:"Dr.",name:"Yousaf",surname:"Ali",fullName:"Yousaf Ali",slug:"yousaf-ali",email:"yousaf@aup.edu.pk"},{id:"445125",title:"Dr.",name:"Nazeer",surname:"Ahmed",fullName:"Nazeer Ahmed",slug:"nazeer-ahmed",email:"drnazeerento@gmail.com"},{id:"456159",title:"Dr.",name:"Taufiq",surname:"Nawaz",fullName:"Taufiq Nawaz",slug:"taufiq-nawaz",email:"taufiqnawaz@gmail.com"},{id:"456161",title:"Dr.",name:"Muhammad",surname:"Junaid",fullName:"Muhammad Junaid",slug:"muhammad-junaid",email:"junaid.pbg@gmail.com"},{id:"456162",title:"Dr.",name:"Mehwish",surname:"Kanwal",fullName:"Mehwish Kanwal",slug:"mehwish-kanwal",email:"mehwishkanwal.j@gmail.com"},{id:"456163",title:"Dr.",name:"Fazli",surname:"Hameed",fullName:"Fazli Hameed",slug:"fazli-hameed",email:"fazlhameed@yahoo.com"},{id:"456164",title:"Dr.",name:"Muhammad",surname:"Shahab",fullName:"Muhammad Shahab",slug:"muhammad-shahab",email:"mshahab7@gmail.com"},{id:"456165",title:"Dr.",name:"Fazli",surname:"Subhan",fullName:"Fazli Subhan",slug:"fazli-subhan",email:"fazlsubhan@uoswabi.edu.pk"}],book:{id:"11016",title:"Maize Genetic Resources",slug:"maize-genetic-resources-breeding-strategies-and-recent-advances",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"435349",title:"Ph.D.",name:"Ulin",surname:"Basilio-Cortes",slug:"ulin-basilio-cortes",fullName:"Ulin Basilio-Cortes",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440007",title:"Dr.",name:"Daniel",surname:"González-Mendoza",slug:"daniel-gonzalez-mendoza",fullName:"Daniel González-Mendoza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440009",title:"Dr.",name:"Carlos Enrique",surname:"Ail-Catzim",slug:"carlos-enrique-ail-catzim",fullName:"Carlos Enrique Ail-Catzim",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440010",title:"M.Sc.",name:"Carlos",surname:"Ceceña-Durán",slug:"carlos-cecena-duran",fullName:"Carlos Ceceña-Durán",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440011",title:"Dr.",name:"Adabella",surname:"Suarez-Vargas",slug:"adabella-suarez-vargas",fullName:"Adabella Suarez-Vargas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440012",title:"Dr.",name:"Onésimo",surname:"Grimaldo-Juárez",slug:"onesimo-grimaldo-juarez",fullName:"Onésimo Grimaldo-Juárez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440013",title:"Dr.",name:"Dagoberto",surname:"Durán-Hernández",slug:"dagoberto-duran-hernandez",fullName:"Dagoberto Durán-Hernández",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440014",title:"Dr.",name:"Olivia",surname:"Tzintzun-Camacho",slug:"olivia-tzintzun-camacho",fullName:"Olivia Tzintzun-Camacho",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440015",title:"Dr.",name:"Ángel Manuel",surname:"Suárez-Hernández",slug:"angel-manuel-suarez-hernandez",fullName:"Ángel Manuel Suárez-Hernández",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"440016",title:"Dr.",name:"Aurelia",surname:"Mendoza-Gómez",slug:"aurelia-mendoza-gomez",fullName:"Aurelia Mendoza-Gómez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"conflicts-of-interest-policy",title:"Conflicts of Interest Policy",intro:"
As an Open Access publisher, IntechOpen is dedicated to maintaining the highest ethical standards and principles in publishing. In addition, IntechOpen promotes the highest standards of integrity and ethical behavior in scientific research and peer-review. To maintain these principles IntechOpen has developed basic guidelines to facilitate the avoidance of Conflicts of Interest.
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IntechOpen requires:
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Authors to declare all relevant Conflicts of Interest that might have any bearing on research reported in their submitted manuscript.
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All Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
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For manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
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membership of relevant company boards or governmental organizations;
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personal relationships, either through friendship, marriage, acting as a mentor, family relationships or being a student of other contributors, whether they are Authors, Reviewers or Academic Editors.
\\n
\\n\\n
Authors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\\n\\n
Academic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\\n\\n
All Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\\n\\n
EXAMPLES:
\\n\\n
Authors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\\n\\n
Authors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\\n\\n
Academic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\\n\\n
Academic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
In each instance of a possible Conflict of Interest, IntechOpen aims to disclose the situation in as transparent a way as possible in order to allow readers to judge whether a particular potential Conflict of Interest has influenced the Work of any individual Author, Editor, or Reviewer. IntechOpen takes all possible Conflicts of Interest into account during the review process and ensures maximum transparency in implementing its policies.
\n\n
A Conflict of Interest is a situation in which a person's professional judgment may be influenced by a range of factors, including financial gain, material interest, or some other personal or professional interest. For IntechOpen as a publisher, it is essential that all possible Conflicts of Interest are avoided. Each contributor, whether an Author, Editor, or Reviewer, who suspects they may have a Conflict of Interest, is obliged to declare that concern in order to make the publisher and the readership aware of any potential influence on the work being undertaken.
\n\n
A Conflict of Interest can be identified at different phases of the publishing process.
\n\n
IntechOpen requires:
\n\n
\n\t
Authors to declare all relevant Conflicts of Interest that might have any bearing on research reported in their submitted manuscript.
\n\t
Book Editors and Reviewers to declare all possible Conflicts of Interest that might warrant their exclusion from any further handling of submissions.
\n
\n\n
CONFLICT OF INTEREST - AUTHOR
\n\n
All Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
\n\n
CONFLICT OF INTEREST – ACADEMIC EDITOR
\n\n
Editors can also have Conflicts of Interest. Editors are expected to maintain the highest standards of conduct, which are outlined in our Best Practice Guidelines (templates for Best Practice Guidelines). Among other obligations, it is essential that Editors make transparent declarations of any possible Conflicts of Interest that they might have.
\n\n
Avoidance Measures for Academic Editors of Conflicts of Interest:
\n\n
For manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\n\n
If a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\n\n
CONFLICT OF INTEREST - REVIEWER
\n\n
All Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
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EXAMPLES OF CONFLICTS OF INTEREST:
\n\n
FINANCIAL AND MATERIAL
\n\n
\n\t
ownership of relevant stocks or shares;
\n\t
past and/or present work or consulting work for the research funder;
\n\t
membership of the relevant board;
\n\t
payment to the Reviewer/Academic Editor of financial fees by the Author;
\n\t
acceptance by the Reviewer/Academic Editor of gifts from the Author;
\n\t
other direct or indirect sources of funding or material benefit gained by the Reviewer/Academic Editor through the Author.
\n
\n\n
NON-FINANCIAL
\n\n
\n\t
professional or personal relationships with institutions and funding bodies, including non-governmental organizations, research institutions and charities;
\n\t
membership of relevant company boards or governmental organizations;
\n\t
personal relationships, either through friendship, marriage, acting as a mentor, family relationships or being a student of other contributors, whether they are Authors, Reviewers or Academic Editors.
\n
\n\n
Authors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\n\n
Academic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\n\n
All Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\n\n
EXAMPLES:
\n\n
Authors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\n\n
Authors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\n\n
Academic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\n\n
Academic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\n\n
Policy last updated: 2016-06-09
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This approach highlights such side effects as unaddressed (suppressed) discriminatory attitude towards employees with disabilities in enterprises, organisational weakness in dealing with interpersonal conflicts, the lack of competence of the managerial staff and the lack of systematic knowledge on work with personnel. In this case, there is a debatable question of whether the efforts of the state will reach the desired goal, i.e. the fully-fledged work and social integration of the people who the investments are intended for, or continue the traditions of silent social segregation? This study shows that it is necessary to critically evaluate the selected model for fostering businesses to integrate into the labour market, in which the issues of psycho-social welfare and social initiative of enterprises are underestimated.",book:{id:"5145",slug:"social-enterprise-context-dependent-dynamics-in-a-global-perspective",title:"Social Enterprise",fullTitle:"Social Enterprise - Context-Dependent Dynamics In A Global Perspective"},signatures:"Jolita Vveinhardt",authors:[{id:"179629",title:"Prof.",name:"Jolita",middleName:null,surname:"Vveinhardt",slug:"jolita-vveinhardt",fullName:"Jolita Vveinhardt"}]},{id:"50229",title:"Social Entrepreneurship by Community-Based Organizations: Innovations and Learning through Partnerships",slug:"social-entrepreneurship-by-community-based-organizations-innovations-and-learning-through-partnershi",totalDownloads:1877,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"This chapter examines the social entrepreneurship potentials of community-based organizations (CBOs) linked to nongovernmental organizations (NGOs) in the implementation of development programs. The conceptual framework of the study draws on the existing literature on social entrepreneurship and cooperatives. The study highlights the social and ecological roles and significance of CBOs in the creation of social value at the local community level. The research findings reveal that NGO-CBO partnerships help to transform CBOs into social enterprises by creating revenue generation streams. Such partnerships also catalyze social innovations and social learning outcomes. In this chapter, three case studies from Bangladesh are examined, which demonstrate how the social entrepreneurial roles of these CBOs have been instrumental in the management of local natural resources and in fostering social learning. The case studies reveal that institutional support and favorable public policies are crucial in sustaining social entrepreneurship by CBOs.",book:{id:"5145",slug:"social-enterprise-context-dependent-dynamics-in-a-global-perspective",title:"Social Enterprise",fullTitle:"Social Enterprise - Context-Dependent Dynamics In A Global Perspective"},signatures:"A.K.M. Shahidullah and C. Emdad Haque",authors:[{id:"179555",title:"Ph.D. Student",name:"Akm",middleName:null,surname:"Shahidullah",slug:"akm-shahidullah",fullName:"Akm Shahidullah"},{id:"179612",title:"Prof.",name:"C. Emdad",middleName:null,surname:"Haque",slug:"c.-emdad-haque",fullName:"C. Emdad Haque"}]},{id:"77203",title:"Fostering Education for Circular Economy through Life Cycle Thinking",slug:"fostering-education-for-circular-economy-through-life-cycle-thinking",totalDownloads:165,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Since 2002, the University of the Basque Country has supported several teaching experiences related to the so-called Life Cycle Thinking and Ecodesign in collaboration with local and regional public institutions and private companies. The implementation of a Master’s Degree entitled ‘Circular Economy: Business Application’ constitutes a milestone in the framework of these teaching experiences. From the very moment the European Green Deal was approved and, subsequently, before the state and regional strategies were launched, thanks to our prior experience, we have been able to offer the postgraduate course required by our administration and companies. The courses have been specifically designed to provide education for Circular Economy for new graduates as well as professionals with backgrounds as varied as product manufacturing engineering, environmental engineering, business administration or economics. It aims to become a European reference in its goal of promoting Circular Economy, life cycle thinking, ecodesign, industrial symbiosis and sustainable development and, at the same time, support the transition to circular economy in our region. As a result, in just two years the master’s degree has led to the creation within our university of a knowledge hub in Circular Economy, which hosts more than 20 research groups.",book:{id:"10680",slug:"product-life-cycle-opportunities-for-digital-and-sustainable-transformation",title:"Product Life Cycle",fullTitle:"Product Life Cycle - Opportunities for Digital and Sustainable Transformation"},signatures:"Rikardo Minguez, Erlantz Lizundia, Maider Iturrondobeitia, Ortzi Akizu-Gardoki and Estibaliz Saez-de-Camara",authors:[{id:"225070",title:"Dr.",name:"Maider",middleName:null,surname:"Iturrondobeitia",slug:"maider-iturrondobeitia",fullName:"Maider Iturrondobeitia"},{id:"354233",title:"Dr.",name:"Rikardo",middleName:null,surname:"Minguez",slug:"rikardo-minguez",fullName:"Rikardo Minguez"},{id:"354295",title:"Dr.",name:"Estibaliz",middleName:null,surname:"Saez-de-Camara",slug:"estibaliz-saez-de-camara",fullName:"Estibaliz Saez-de-Camara"},{id:"354296",title:"Dr.",name:"Erlantz",middleName:null,surname:"Lizundia",slug:"erlantz-lizundia",fullName:"Erlantz Lizundia"},{id:"354297",title:"Dr.",name:"Ortzi",middleName:null,surname:"Akizu-Gardoki",slug:"ortzi-akizu-gardoki",fullName:"Ortzi Akizu-Gardoki"}]},{id:"50075",title:"A Comparative Study of Social Enterprises: North vs. South Perspectives",slug:"a-comparative-study-of-social-enterprises-north-vs-south-perspectives",totalDownloads:1763,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Social entrepreneurship as a practice that integrates economic and social value creation has a strong global presence. This chapter capitalizes on the evolution of the concept of social enterprise in the Western literature to analyze its manifestation in the Middle East and North Africa (MENA) region. Specifically, using empirical evidence from seven Arab countries, this chapter documents the understanding and application of social enterprises in the MENA region. Through the voices of social entrepreneurs who are working across the MENA countries, we document how social enterprise is displayed in practice along with both the constraints and the opportunities facing social entrepreneurs across this region. This new context-specific approach is then used to shed light on the similarities and differences of social enterprise practices across the international scene and the MENA region. The findings presented highlight the uniqueness of social enterprise in the MENA context, combining elements of both European and American approaches, in addition to some context-specific features.",book:{id:"5145",slug:"social-enterprise-context-dependent-dynamics-in-a-global-perspective",title:"Social Enterprise",fullTitle:"Social Enterprise - Context-Dependent Dynamics In A Global Perspective"},signatures:"Dima Jamali, Nadine Mohanna, Dina H. Sherif and Salma El Sayeh",authors:[{id:"179628",title:"Prof.",name:"Dima",middleName:null,surname:"Jamali",slug:"dima-jamali",fullName:"Dima Jamali"},{id:"179775",title:"M.Sc.",name:"Nadine",middleName:null,surname:"Mohanna",slug:"nadine-mohanna",fullName:"Nadine Mohanna"},{id:"184857",title:"MSc.",name:"Salma",middleName:null,surname:"El Sayeh",slug:"salma-el-sayeh",fullName:"Salma El Sayeh"},{id:"184858",title:"MSc.",name:"Dina",middleName:null,surname:"H. Sherif",slug:"dina-h.-sherif",fullName:"Dina H. 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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, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for 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:"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:"Beijing University of Technology",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:"Lakhno Igor Victorovich 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.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of 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 a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), 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 DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. 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: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{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:"243698",title:"M.D.",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:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{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:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{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:"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:"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"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",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:"4",type:"subseries",title:"Fungal Infectious Diseases",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment",scope:"Fungi are ubiquitous and there are almost no non-pathogenic fungi. 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In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. 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