Anxiety disorders consist of excessive and frequent worrying which causes physical and mental distress and impairment in overall functioning (NIH & SAMHSA, 1999). Anxiety disorders are the most common mental health problems reported by children, adolescents and adults (Costello, Angold, & Burns, 1996; Goodman, Ford, Richards, Gatward, & Melzer, 2000; Kessler et al., 2005; Muris, Merckelbach, Mayer, & Prins, 2000). The prevalence of childhood anxiety disorders ranges from 10% to 22% (Dadds, Spence, Holland, Barrett, & Laurens, 1997.) with lifetime prevalence estimated to be about 28.8% (Kessler et al., 2005) with ages of onset between 10 to 12 years (Kessler et al, 2005). About one in 6 children have anxiety that causes impairment in their daily lives (Dadds, Spence, Holland, Barrett, & Laurens, 1997). There are many sequelae of anxiety disorders including an elevated risk for later development of mood disorders, other anxiety disorders, substance use as well as physical health concerns (Kessler et al., 2005). In addition, anxiety disorders can result in much psychosocial suffering including higher rates of dropping out of school, lower income levels, difficulties in intimate relationships and difficulty keeping one’s employment (Beidel & Turner, 1998; LeFauve et al., 2004; Lewinsohn & Clarke, 1999; Pine, Cohen, Gurley, Brook, & Ma, 1998; Schatzberg, Samson, & Rothschild, 1998; Woodward & Fergusson, 2001).
In addition to the impairment and suffering experienced by children and adolescents, there is a significant cost associated with anxiety disorders. It is estimated that the United States spends more than $42 billion a year on anxiety disorders (Greenberg et al, 1999). In a 2009 Status Report, the Canadian Pediatric Society indicated that mental health problems continue to grow among children and youth and are predicted to increase by 50% by the year 2020 (Children’s Mental Health Ontario Pre-Budget Submission 2010). However, three out of four children who need specialized services do not receive them as access to mental health services continues to be insufficient and in some cases declining (Children’s Mental Health Ontario Pre-Budget Submission, 2010). In clinics, waiting lists are long and no-show and attrition rates sometimes are over 50% (Weist et al,1999). Many children who do receive clinical intervention fail to respond (Barrett, Dadds, & Rapee, 1996; Donovan & Spence, 2000; Weisz et al., 1997) or experience recurrence of symptoms despite receiving treatment (Last et al., 1996). Yet, treating mental health issues in children and youth in a timely way prevent excessive health care costs and ensure productive lives (Children’s Mental Health Ontario Pre-Budget Submission, 2010).
Anxiety disorders are diagnosed in children and adolescents if they begin to interfere in normal daily functioning in three domains i.e. home, school and with peers. Anxiety disorders are listed under the following headings: generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, specific phobia, panic disorder, obsessive-compulsive disorder and post-traumatic stress disorder (DSM-IV, 2000). There are no definitive biological or psychological tests for anxiety disorders and diagnoses are made clinically based on information from multiple sources i.e.teachers, parents or other caregivers in other settings. Anxiety disorders in children often first manifest as physiological symptoms and are misinterpreted as physical illness. Stomach aches are a common physical manifestation of anxiety in younger children. Some young children may manifest temper tantrums when in fact they are having panic attacks. In adolescents headaches mixed in with nausea and stomach aches are more common. These physical symptoms often result in avoidance behavior which often manifests as school refusal. Behaviors resulting from anxiety such as school refusal and temper tantrums are viewed as oppositionality. Due to the avoidance as the end result of anxiety disorders, they are often unrecognized and hence untreated in children. Moreover, these children are usually perfectionistic and want to please so they further go unnoticed especially in a classroom setting. On the other hand, children with disruptive behavior disorders are noticed more and thus are more frequently referred for treatment (Compton et al, 2004, In-Albon & Schneider, 2007).
Currently, the most effective treatment available for anxiety disorders are cognitive-behavioral therapy (CBT) and antidepressant medications specifically the serotonin reuptake inhibitors (SSRIs). Both treatments alone are empirically supported options. For mild to moderate symptoms, usually CBT is offered first. For moderate to severe symptoms, a combination of CBT and SSRI is often helpful. Families, in general, prefer non-medical or psychosocial interventions at initial evaluation (Walker et al, 2001). However, often CBT therapists are in short supply (Andrews et al, 2002).
Due to these concerns, it seems logical to move toward services that provide prevention of anxiety disorders. The benefits of prevention are that a large number of people can be targeted over a short period of time, it is more cost effective and there is reduced distress for children due to earlier intervention (Lowry-Webster, 2001). Preventive mental health programs serve two purposes. From a health care perspective, they address and identify risk and protective factors in individuals, providing for better long-term prognoses. In addition, these programs accrue economic benefits because prevention is often less expensive than the economic and societal costs once an illness has manifested (Beardslee et al, 2011).
For implementation of prevention programs, it is important to consider the risk factors, protective factors and strategies for prevention. There is a complex interplay of biological, psychological and environmental factors in the development of childhood anxiety disorders (Donovan et al, 2000). In the development of childhood anxiety the following risk factors have been implicated.
Puberty results in maturational changes not only physically but also emotionally. Puberty may increase risk factors for many psychiatric disorders including anxiety disorders. According to Leen-Feldner et al, adolescents with advanced pubertal status and greater reactivity to a hyperventilation challenge were at increased risk for panic symptoms (Leen-Feldner et al, 2007).
Fear conditioning is known to be linked to the genesis of anxiety. In a study by Otto et al, 2007), risk factors for fear conditioning were examined in a nonclinical sample. Those in the sample that had higher levels of anxiety sensitivity (increased anxiety symptoms) predicted increased tendency towards fear conditioning (Otto et al,2007).
The quality of attachment between an infant and the primary caregiver is an important indicator of future development of anxiety disorders (Erickson et al, 1985; Lewis et al, 1984; Sroufe et al, 1990). In a study by Warren et al,1997, the role of attachment style on the later development of anxiety disorders was studied in 172 children at 12 months and then later at 17.5 years of age. At 12 months a pattern of anxious resistant attachment predicted later anxiety disorders, even after controlling for infant temperament and maternal anxiety.
Parental anxiety is a risk factor for childhood anxiety disorders both through the mechanism of heritability and parent’s modeling of anxious behaviors (Rosenbaum et al., 1988; Turner et al, 1987; Weissman et al, 1984). It is estimated that heritability accounts for about 40-50% of anxiety symptoms in children (Thapar et al, 1995).
Behavioral inhibition has been identified by Kagan et al( Kagan et al, 1989; Kagan et al, 1991)as a stable temperament style consisting of shyness and elevated physiological arousal having a strong genetic component (DiLalla et al, 1994; Plomin et al, 1989). Children with behavior inhibition are more likely to develop an anxiety disorder (Biederman et al, 1993; Kagan, 1997; Rosenbaum et al, 1993).
Other risk factors for childhood anxiety disorders are traumatic and stressful life events following which children have higher levels of fears. Higher rates of anxiety disorders are present in children following major natural disasters (Dollinger et al, 1984). Moreover, parenting behaviors have been identified to interact with other risk factors in the development of childhood anxiety. Parents of anxious children often model, prompt, and reinforce anxious behavior in their children (Barrett et al, 1996). Other parental characteristics that contribute to risk factors for childhood anxiety are being overly controlling, critical and, overprotective (Krohne et al, 1991).
Protective factors either promote positive development or protect against risk factors. A person’s temperament, cognitive ability and social competence can all serve as protective factors against developing anxiety disorders (Farrell et al, 2007). Other protective factors include parental monitoring of child’s behaviors (Jessor et al., 1995), peers and adults in a child’s life who are good role models (Hawkins et al, 1992) and acceptance and support by peers (Jessor et al, 1991; Quinton et al., 1993). In addition, a positive connection with the school with parental monitoring in both school and home setting and parents’ having a positive relationship with the school (Greenberg et al, 2001) all contribute towards protection from risks of anxiety disorders. Lastly, the type of responses children use to cope with stressful experiences influence how much anxiety and distress they experience (Spence et al, 2001).
In the past few years school personnel have become interested in programming to address the social and emotional needs of children due to the resultant deleterious effects of difficulties in these areas on their academic and social functioning. In this regard, there has been a shift to implement evidence-based psychosocial treatments in schools in a preventative fashion (Miller et al, 2010). Recent governmental policy initiatives are requiring the implementation of evidence-based treatments in schools (Robertson, David & Rao, 2003). Schools are an important and dominant component of children’s environment both for their academic and social learning. Having a classroom intervention by teachers and school counselors makes it easier to identify children suffering from anxiety. Teachers have unlimited access to children in their classroom and know their strengths and weaknesses well. It is not only cost-effective for teachers to provide the intervention to students but students can learn from peers and share their experiences with them thus providing support (Miller et al, 2010).
Individual cognitive behavioral therapy has been studied for childhood anxiety disorders and is effective for 70% for clinically referred children (In-Albon & Schneider, 2007). Group-based CBT has been adapted recently and researched as a school-based intervention (Barrett & Turner, 2001; Masia, Klein, Storch & Corda, 2001; Stallard, Simpson, Anderson, Hibbert & Osborn, 2007). The recent challenge for many researchers has been to study the successful implementation of these studies into a community or school setting. These studies have the challenge of following the treatment but being flexible to a real-world setting.
The Committee on Prevention of Mental Disorders (Mrazek et al, 1994) describes a continuum of interventions going from prevention at one end and treatment at the other end. The following are three main forms of prevention: universal, targeted or selective, and indicated. A
A study by Hains (Hains et al, 1992) examined the effectiveness of two cognitive-behavioral interventions to help adolescent boys cope with stress and other negative emotions. The project was described to all sophomores and juniors and those who were interested were invited to attend an orientation meeting. Twenty-five adolescent boys ages 15-16 year old were randomly assigned to either a group receiving cognitive restructuring or to a second group receiving anxiety management training. Both these groups were compared to a wait-list control group on measures of anxiety, anger, self-esteem, depression, and reports of anxious self-statements. Both the intervention groups showed significant decline in levels of anxiety, expression of anger, and depression. These treatment gains were maintained at an 11-week follow-up.
The FRIENDS program (Barrett et al, 2004) is a universal preventive program for both anxiety and depression with increasing evidence base and support from World Health Organization (World Health Organization, 2004). The FRIENDS program (acronym for F=Feelings; R=Relax and feel good; I=I can do it! I can try my best!; E=Explore solutions and coping step plans; N=Now reward yourself! You’ve done your best!; D=Don’t forget to practice; S=Smile! Stay calm for life!) consists of 10 weekly session and 2 booster sessions. This program is tailored for different developmental levels with a CBT protocol adapted from Phil Kendall’s “The Coping Cat” (Kendall, 1994).. There are 2-4 parent sessions teaching parents coping strategies for their own anxiety, reinforcement strategies, contingency management and problem-solving and communications skills. The FRIENDS program has been validated as an effective prevention program for child and youth anxiety and depression (Dadds et al, 1997; Barrett et al, 2000; Lowry-Webster et al, 2001; Lowry-Webster et al, 2003; Lock et al, 2003).
Barrett et al (2000, 2001) evaluated a “train-the-trainer” model of intervention in children ages 9-10 years in grade 6. Children with internalizing symptoms were assigned to either an intervention led by a psychologist, a teacher or a control condition with a standard curriculum. The FRIENDS 12-session program was implemented as a curriculum in the classroom by training the teachers and psychologists. There were four sessions for parents. At the end, children reported considerable decrease in anxiety symptoms in either intervention by a psychologist or a teacher.
Lowry-Webster et al (2001) studied the effectiveness of the FRIENDS universal program for prevention of anxiety in 594 students aged 10-13 years randomized to either a control or an intervention condition. Both groups reported significant decrease in anxiety and the decline was significantly greater in the intervention group regardless of their risk status. A follow up study after one year by Lowry-Webster et al (2003) showed that results were maintained with the intervention group having lower scores on anxiety self-report measures. Eighty-five per cent of children in the intervention group who were scoring above the clinical cut-off for anxiety and depression were symptom free in the intervention condition compared to 31.2% in the control group.
In a study of universal prevention with 733 children enrolled in grade 6 (ages 9-10) and grade 9 (ages 14-16), Lock et al, 2003 studied children from 7 different socioeconomic school settings. The children were assigned randomly to a FRIENDS intervention program or a control condition of a standard curriculum. Students completed self-rating measures. Students who were “high risk” based on high scores on anxiety measures were given a structured diagnostic interview. Results showed a general decrease in anxiety scores which were significant for students in the intervention group at the end of the program and at 1 year follow up. This study also showed that children in Grade 6 had higher levels of anxiety before intervention but post-intervention had greater reductions in anxiety and depression at 12 month follow up compared to grade 9 children. In addition, there was a delayed effect in improvement of depression symptoms that was apparent only at the 1 year follow up. In addition, girls tended to have higher levels of anxiety than boys and girls in Grade 6 were more responsive to the intervention than Grade 9 girls.
Barrett et al (2006) evaluated the above mentioned study by Lock et al for its long term effectiveness at 36 months. The decrease in scores due to the intervention were maintained in grade 6 but not for children in grade 9 emphasizing the fact that intervention in grade 6 might be an optimal time for decreasing risk for anxiety. There were significantly fewer high-risk students at 36-month follow-up in the intervention condition than in the control condition proving the durability of prevention effects for children in Grade 6. The outcomes were noticeable for up to 3years following a brief cognitive behavioral intervention delivered by teachers within the school. For girls who had the highest anxiety and showed the biggest decline after one year, the preventive effect lasted for only 24 months.
The FRIENDS program was implemented in the UK in a school setting by Stallard et al (2007) and its effectiveness was examined. The program was delivered by school nurses to 10-11 year olds in one urban and 2 rural schools. The school nurses were supported by teachers and teacher’s assistants. This was non-randomized study in which 106 children received the program. The children were assessed 6 months before the program, at the start of the program and 3 months after the program. Results showed that the levels of anxiety and self-esteem were stable 6 months before the program. Three months after the completion of the program, anxiety had significantly decreased and self-esteem had increased. Children with the most severe emotional problems benefited from the program. The study is limited by its small sample size, short follow-up and the single cohort design.
The study by Miller et al (2010) modified a locally developed CBT intervention program, Taming Worry Dragons (TWD; Garland & Clark, 2000). In a public elementary school, 118 children were randomly assigned either to an 8-week intervention or to a wait-list control. Teachers were trained in a full-day workshop by a licensed psychologist. The teachers then implemented the TWD program to all the children in the randomized treatment arm. The results showed no significant differences between the two groups and that the manualized CBT intervention did not reduce symptoms of anxiety in either self-reports or parent reports of anxiety symptoms in the general school population. The study cited its limitations as having a small sample size, absence of screening for co-morbid disorders and lack of follow-up.
Early intervention and prevention programs can be more cost-effective in reducing the burden of illness of childhood disorders. To effectively conduct an early intervention program there should be a reliable way to screen children at risk, an access point to identify these at-risk children., and a cost-effective intervention program (Dadds, Spence, 1997).
The Queensland Early Intervention and Prevention of Anxiety Project (Dadds et al, 1997), an indicated prevention program in Australia, targeted 1,786 children ages 7-14 years to evaluate the effectiveness of a cognitive-behavioral and family-based group intervention (using the Coping Koala: Prevention Manual) for preventing the onset and development of anxiety problems in children. All the children were screened for anxiety symptoms using children self-reports and asking teachers to nominate children in their class who displayed the most anxiety. After screening, 128 children were assigned to a 10-week school-based child and parent-focused psychosocial intervention or a control group. The children received weekly 1-2 hour cognitive-behavioral sessions delivered by psychologists. The parents attended 3 child management training sessions. After completion of the program, both groups showed improvements. At six-month follow-up, the improvement in the intervention group was maintained. This group received follow up at 12 months and at 2 years (Dadds et al, 1999). At 12 months, both the intervention and the control group converged, however, at 2-year follow-up the group receiving the intervention was again superior to the control group. This study is an example of an indicated intervention targeted towards individuals who already show early signs or low levels of a disorder. Because the interventions are targeted only towards those at greatest risk, (Offord et al, 1998) they are more cost-effective and can be provided to only those who need it.
The above study was conducted by psychologists. To assess the effectiveness of an indicated early intervention and prevention program for anxiety disorders when conducted by school staff, Hunt et al, (2009) conducted a randomized controlled trial. A total of 1120 children in their first year of high school were recruited from 19 schools. Students who were at risk for the development of an anxiety disorder (1 standard deviation above the average score based on an age-related normative sample) were screened and identified. Teachers were asked to nominate 3 students with increased anxiety and subsequently 24 students were added to the study. Nine schools were randomly assigned to the control condition (n=137), and 10 to the intervention condition (n=260). A total of 260 students were entered in the study. The FRIENDS program was implemented in each school by a school counselor assisted by a support teacher both of whom attended a 2-day training workshop. The program was run within school hours. The students completed assessments at 2- and at 4-year follow-up. No differences in outcomes were found between intervention and control groups. There was little difference between conditions at the 2 year and 4 year follow up on self-reported symptoms. This study replicated the Queensland Early Intervention and Prevention Project (Dadds et al, 1997) with a few changes. The intervention was delivered by school counselors and teachers instead of psychologist, there was assessment of treatment fidelity and a long-term follow-up was added. This study highlights the challenges of delivering a school-based program effectively by school staff.
Because of the potential role of withdrawn or inhibited temperament as an important risk factor for later development of anxiety disorders, some researchers have focused on very young age groups. It is difficult to differentiate in this age group between temperament and disorder since these can be overlapping but are also distinct constructs (Rapee & Spence, 2004; Turner et al., 1996). It is possible that some of these children with inhibited temperament already meet criteria for an anxiety disorder and thus could qualify for assignment to either selective or indicated intervention (Mrazek & Haggerty, 1994). The following studies highlight the selective treatment programs.
LaFreniere & Capuano (1997) identified 43 anxious and withdrawn preschoolers, ages 31-70 months. These preschoolers were randomly assigned to either intervention or control condition. Over the next 6 months, the intervention group received 11 home visits which included child interaction skills, providing parent education and improving parenting skills and improving social support. The study showed significant difference between the intervention group and the control group with the intervention group showing improved social competence and less maternal control. In this study, however, levels of anxiety or withdrawn behavior, which was the main variable, did not differ significantly between the groups.
Rapee et al (2005) conducted an early intervention program to prevent the development of anxiety in preschool children. Withdrawn or inhibited behavior, which is one of the best identified risk factors for later anxiety disorders, was the main selection criteria for children in the program after a lab assessment. The participants who were 146 inhibited children (ages 3-5 years) and their parents were randomly assigned to either a parent-education group (n=73) or a control group (n=73). Parent education was conducted in groups of 6 sets of parents with mothers more frequently attending the groups. Parents received a total of 6 sessions which were 90 minutes each and were weekly for the first four sessions, then one session 2 weeks later and the last session one month after that. This program was group based and brief for ease of applicability and transportability. Results showed that children with parents in the intervention group at 12 months showed a significantly greater decrease in anxiety compared to the waitlist control group but no significant changes were seen on measures of inhibition/withdrawal. In fact, both groups showed decreases in measures of inhibition so the effects of parent intervention on inhibition could not be demonstrated.
The same group of children and their parents were assessed by Rapee et al (2010) at 3 years (n=121) as they were entering middle childhood. Diagnostic interviews and questionnaires were repeated at 12, 24 and 36 months. Laboratory observations were repeated only at 12 and 24 months. Results showed that children whose parents received the intervention had lower levels of anxiety symptoms according to parents’ and child reports. No significant changes were noted on levels of inhibition.
Contrary to the above two studies, the study by Kennedy et al (2009) not only showed greater reductions in anxiety disorders but also showed greater reductions in parent and laboratory observed measures of behavioral inhibition. Participants in this study were 71 children aged 36-58 months and their parents who were randomly assigned to either a parent intervention (n=35) or a 6-month waitlist (n=36). Children were included if they met the following two criteria: they had a high score for behavioral inhibition on lab assessment and one of their parent met DSM-IV criteria for an anxiety disorder. The parent intervention was delivered in a group format with sets of 6 parents in the group. The program consisted of 8 sessions lasting 90 minutes each with a phone call after a month of the last session. Sessions consisted of psychoeducation, parent management strategies for anxious children, development of graded hierarchies, cognitive restructuring for both parents and children, exposure for parents’ fears, coping plans, maintenance and relapse prevention, reinforcement of progress and trouble shooting.
An example of a selective prevention trial is the one by Balle et al (2010). This study focuses on Anxiety Sensitivity as an early risk factor for the development of anxiety disorders. The aim of this study was to assess the efficacy of a brief school-based selective prevention program for anxiety in children and adolescents with high levels of anxiety sensitivity. Children and adolescents n= 613 aged 11 -17 years of age from 4 schools were screened. Children with over 80th percentile in the Children Anxiety Sensitivity Index but with no current psychiatric disorder or treatment (n=130) were offered the study but 105 accepted participation in the study. Out of the 105 participants, 92 entered the trial. The rest were excluded on the basis of meeting criteria for a psychiatric disorder. These 92 participants were randomly assigned to either the prevention group (n=47), waitlist control (n=45) and a third normal control group. Both groups showed a significant decrease in all outcome variables but there was no differences between the prevention or the waitlist group. Differences emerged in the six-month follow-up with greater anxiety sensitivity reductions in the prevention group compared to the waitlist control. Also, the participants in the waitlist control began to get worse. This study showcases that brief interventions for a population with a risk factor (anxiety sensitivity) are effective.
The efficacy of a school-based intervention for social anxiety disorder was examined in a randomized wait-list control trial of 35 adolescents (Masia-Warner, Klein, Dent, 2005). Participants were drawn from 1,521 adolescents of grades 9 through 11 in New York City. They were screened for social anxiety disorder and classroom teachers were asked to nominate up to five students in their class who appeared shy. The nominated students and students who scored in the top 15% on self-rating instruments were selected for further screening. Parents of these adolescents were called and interviewed over the phone and adolescents whom had impairment in functioning were invited to participate in a diagnostic evaluation. Out of the 80 that were interviewed 42 met study criteria. Students were randomly assigned to either SASS (Skills for Social and Academic Success) (n=21) or wait-list control condtion (n=21). The SASS intervention consisted of 12 weekly group school sessions, two brief individual meetings and two group booster sessions. Additionally, four weekend social events which provided “real world exposures and opportunities for skills generalization were conducted. Parents attended two group meetings at school consisting of psychoeducation. All groups were led by psychologists. Participants were evaluated at the end of treatment and 9 months later. Adolescents in the intervention group had significantly greater reduction than the control group in social anxiety and avoidance as well as significantly improved overall functioning. In addition, 67% of treated subjects compared to 6% of wait-list control no longer met criteria for social anxiety disorder following treatment.
Masia-Warner, Fisher, Shrout et al (2007) conducted another study similar to the one above but this time compared it to a credible alternate treatment: Educational Supportive Group Function (ESGF). Participants (1789) from grades 9 through 11 were recruited. Out of these 1593 completed and returned screening questionnaires and teachers were asked to nominate shy students. Finally, 36 subjects agreed to participate. Nineteen adolescents were randomized to the SASS (Skills for Social and Academic Success) described above and 17 to the attention control group (ESGF) led by psychologists. The ESGF was designed to be identical to SASS in amount of professional attention and format, however, it omits any therapeutic elements considered specific to reversing social anxiety disorder but includes instructions on relaxation training. The study demonstrated significant reductions in social anxiety for SASS compared to the control group. Parent reports of their children’s anxiety did not discriminate between groups. In the SASS group 59% compared to 0% in the control group no longer met criteria for social anxiety disorder. At 6-month follow-up, the gains from SASS were maintained.
In this review, universal prevention strategies are discussed with the beneficial effects of these programs on minimizing risk factors and enhancing protective factors in children. Given the high prevalence rates of childhood anxiety disorders, the distress and impairment associated with them and the high costs of treatment, preventive strategies implemented in the school setting seem to be the most sensible approach. Although anxiety disorders are amongst the most treatable psychiatric disorders, many children fail to receive treatment. Utilizing universal prevention strategies target the greatest number of children in a cost effective manner without stigmatizing or labeling them. By teaching coping skills to students, their anxiety is reduced. These effects have proven to be durable over the course of a few years.
The FRIENDS program (Barrett et al, 2004, 2005) has shown promise as a school based program to decrease anxiety and is being implemented in many different countries. Implementation of the program should be done in a way that fidelity is maintained but the program is still valid within the context of its implementation. It is important that outcome research is done post implementation to study effectiveness of the program and the long term gains.
Prevention and treatment exist on a spectrum and both are required to reduce the distress and impairment associated with anxiety disorders in children. Historically, however, most public investments have been made in treatment services (Waddell et al, 2004) whereas prevention efforts are often neglected. In the future, the availability of a balance between both prevention and treatment services would be ideal. Both risk and protective factors should be targeted by prevention programs to be more effective.
Traditional societies have long considered what it means to be male or female, masculine and feminine. Ancestors have watched the sun and the moon for clues and signs as to natures of man and woman, masculine and feminine [1]. The creation stories around the world have always included roles of masculine and feminine in forming the world as we know it and its organizing principles [2, 3, 4]. Moreover, many places around the world did not organize their society within fixed, mutable concepts of positional understanding of masculine or feminine, but in the sense of balance, and acknowledged other possibilities of existence in between being male or female [5, 6, 7, 8, 9]. Both in human and animals, there has been recognition in diversity and transformative powers in the early times of society [1, 10, 11]. These societies had their own narratives on sex development and these remained throughout time.
Western narratives in sex and development have origins that can be traced back to medical and nonmedical philosophers over the last 2000 years. In Particular, the ideas from Aristotle, Plato, and Galen were influential medical thought on sex and development [12]. The ideas of how sex developed by these medical minds are somewhat strange today but set the early beginnings of scientific and medical understanding of sex development from the seventeenth century [12, 13]. For example, Aristotle did not see men and women as identical but nor did he see them as polar opposites [12]. Through the expansion of the Roman Empire, there was a strong influence of religious ideals of sex which had held until the seventeenth century. Of interesting note, and seldom discussed of Western thought, intersex people have been used to understand the true nature of sex and what it could or should mean and understanding normal and abnormal development [14].
From the seventeenth century with pioneering new medical and scientific technologies, it was possible to understand sex diversity in its elements such as genetics and chromosomes, hormones, enzymes, anatomy such as genitals and gonads, and the many others. These have been important to understanding how sex develops. This chapter does not intend to reproduce detail of each of these in defining what they are, their variations, and involvement in development. There are many textbooks and articles explaining each of these.
The chapter focuses on the narrative of the understanding of sex and development. Science as with every area of life is explained and understood through narratives. Facts never speak for themselves, rather they are understood within schemas and worldviews through those narratives. Sex and development is a good example of one such point. Science has demonstrated much diversity is the elements considered to make up sex – chromosomal, genetic, gonadal, internal genital, external genital, pubertal, and psychological [13]. These have been understood for some time now. Sex development through the elements of sex is understood through narratives, and these narratives affect people’s lives, physically, psychologically, and socially. Biologist Joan Roughgarden asks how do two fertilized eggs that start out looking about the same end up producing two adults as different as a man or woman, drag queen, or CEO [11]. How we understand the question and how it is narrated is of interest in this chapter. What is called normal and how it affects people who are outside normal is also important.
From narratives taught at school through to academic articles and books, the idea that biology controls development of the body. It is seen as a natural, biological process that begins from the joining of the two gametes – the egg and the sperm. From this point, a linear development progression begins that leads to a human being. It is that developing body that interacts with society. The chapter identifies how the current narratives either reinforce a biological essentialism or diminish the importance of biology in the narrative through social constructionism. There are issues with narrating through a biological essentialism of sex while also using a social construction of gender. Development cannot be reduced to either.
Rather the chapter focuses on the need to consider an alternative version of develop that is not focused on development like a mechanism nor as a social construction of development. The alternative is one of sex/gender narrative of becoming. It is a means of embodiment as through embodied being becomes from pre-birth through death. It is a narrativity of becoming that recognizes both a biological and social, and cultural being interacting with the surrounding environment.
The purpose of the chapter is not to debate the physiology, but how the narratives of these in development occur. It will do so through the differentiating between sex development or sex becoming. As the chapter will illustrate, the difference in the narrative is the difference of how people react to the body and the outside world throughout their life and also how medicine and society reacts to people of sex/gender diversity.
Before continuing on the focus of sex and gender development, it is important to have a brief discussion of particular framings that have been utilized in interpreting sex development. These framings have often limited discussion and the historicity of such framings have often either been ignored or been forgotten in relation to discussion of sex development.
The two framings of focus here that influence the discussion of sex development are biological determinism and social constructionism. The influences of both of these have had political impact on the biological and social lives of people over the last many hundreds of years. In particular, these framings have had negative impact on diversity of sex and gender. It is important to break these down to understand the nuggets of truth in them, if there are any, and separate from issues to have oppressed groups of people.
Biological determinism is the basic idea is that there is an underlying true essence that discontinues between forms of the essence and has a constancy in the absence of change over time (p. 13) [15]. Biological determinism represents the claim that the present states of human societies are the specific result of biological forces and the biological “nature” of the human species [16]. Biological determinism refers to the idea that human behavior originates in and is dictated by biological entities or processes, either innate or constitutional (p. 16) [17]. The essence indicates that certain phenomena are natural, inevitable, universal, and biologically determined, and any variation is attributed to the imperfect manifestation of the essences (p. 10) [15].
Biological determinism of sex thus is the criteria that determine as two discrete true forms – male and female – with no overlap or ambiguity. The biological traits (genetic, hormonal, neuro-atomical, and so on) determine a person’s sex as male or female development through life (and holds their place in social life) with a heterosexual orientation (p. 10) [15]. Furthermore, it suggests that not only the biological traits, but also psychological and orientation reside within the individual as essence of their being (p. 13) [15].
Cultural determinism is another form believing that there are determinist attributes of being male or female that continues the Western ideals, for example, through gender. Gender is the viewpoint that women and men do differ because of socialization and that women are at least equal to and possibly superior to men [19]. It is another way to foil for biological determinism except for the biological but including virtually everything in the human social world such as capitalism, colonialism, urbanism, poverty, sexism, racism, social structure, imperialism, family structure, and an assortment of other social, economic, and political variables [18].
Social constructionism is the any social influence on individual experience [15]. Burger and Luckman propose that reality is socially constructed, and that the sociology of knowledge must analyze the process in which this occurs [20]. Social constructionism is not the trait of the individual such as taken from an essentialist position. Social constructionism sees it as a process external to the individual [15]. It suggests that the power and structures have control over the individual, and their traits are non-consequential. Moreover, while essentialists suggest universal values, social constructionists acknowledge there may be some universal traits, but there is no universal standard for such traits (p. 15) [15].
Social constructionism is often reflected through the notion of gender and development. The idea is that gender is not reliant on biological development, but the social structures in which the individual develops. It is not the gendered traits of the individual but the result social processes that are external to the individual that impact upon any traits of the individual [15]. Gender is defined by interactions between people, by language, and by the discourse of a culture [15]. Rather than conceiving of sexuality as an unchanging individual essence that we might trace over time, we can investigate its contingency upon historically specific frameworks of thought and practice (p. 91) [21].
Sex and gender development is still framed as both oppositional and disembodied. Like many concepts referred to in the nineteenth and twentieth centuries, they are seen as either/or concepts. While one framing focuses on biology or physiology drives development and behavior, the other framing disregards it in favor of the social and institutional derivation.
Basing sex/gender development in either biological determinism or social constructionism is both misleading and has negative impact on people, but especially those who do not fit within the ideals of male or female. Intersex and transgender people who have had various names over the years have been the most severely impacted through these framings and still continue till today. Both deny or ignore critical elements of how human beings become who they are.
Though Western feminists in particular long criticized the notion that the behavior and abilities of women are uniquely determined by their biology [22], they adopted the social constructionist framing established by medical professionals from psychological theory – plasticity thesis. While trying to overcome being bounded by biology, they shift the focus from biology to psychology, while maintaining the oppositional binary of being male or female.
What these narratives of biological determinism and social constructionism indicate are binary understandings and how the Western concepts of opposition hold in discourse. Science in all of its forms from biological through social science has been influenced by such discourses. Science is a process of narrating around the discover of facts and evidence. In itself, it is a set of information that is available to be women into narratives. These narratives are also influenced by ideologies and their worldview. It is time for a different discourse that recognizes truths while not essentializing individuals into a particular structure and form. It is also necessary to understand that people are not just machines open to receiving and performing or adopting social structures.
Though a person’s biology does not define a person’s life, it is still very important in the development of a person. The consideration of biology as a mechanical system or a controlling essence do a disservice to the embodiment of people and their life experience. The implicit denial of the biological events of our lives has also failed to appeal to people’s ideas of “common sense” [22]. At the same time, nonrecognition of the effects and/or interconnections of society and the environment also neglect major impacts on a person and development. Both determinism and constructionism in its forms deny connectedness and agency of the person and community.
Understanding the framing of sex/gender, it is now possible to begin to consider the narrating of the sex and gender development or becoming. Narrating is core to the human experience. Human beings are self-reflexive, narrative beings transformed its raw experiences into abstractions [26]. Becoming indicates a person with capabilities and agency, a life plan, make choices and responsible to others [27]. It is organic yet susceptible to significant environmental, social, and cultural influences, for example, it assumes that it includes meaning and is value laden [27].
Self-narration is an experience of temporal dimension that gathers events together into a coherent and meaningful structure that gives significance to the overall configuration, that is, the person [28]. Narration cannot be only understood in objective social categories, and these cannot adequately account for the lived dynamic aspects, rather resulting in reductive and reified understandings [28].
To ensure an illustrative difference, the chapter will discuss a difference between the development of sex and gender and (sex) becoming. The distinction is important as it illustrates how these narratives are written into people’s lives and what impact these narratives have.
Development since the early 1600s has been used to infer improvement, but for many individuals and collectives has resulted in quite the opposite. In terms of sex and gender, development implies a procedural sense or something being developed. It also indicates that such processes will follow linear paths from the beginning to the end. There is a determinist connotation within development and questions as to whether there is agency or autonomy possible in development. Development also suggests that that any deviations from the linear development processes are abnormalities. A clear example of such deviations is a population referred to as having disorders of sex development [29]. While there is a diversity of possibilities of the various biological parts of becoming, those not part of the ideal type are considered out of the normal, abnormal, or atypical.
In contrast, becoming is used to suggest organic nature of “becoming a person.” Becoming involves more than an individuated process. It has a multitude of influences and interconnections from the social, spiritual/cultural, and environmental embodiment of the person. Further, individual becoming always involves and is part of community sustenance and identity. Becoming is ongoing with the possibility of transformation from pre-birth through death. It is not linear nor immutable. Becoming is a narrativity of the socialized sex through the embodied physiological being with the surrounding community and context depending world.
This part of the chapter will discuss sex and gender development and the differences and similarities. It will also set out how biological determinism and social constructionism are or are not embedded in sex/gender development. It will then move to sex becoming and how that differs from sex/gender development.
To begin with, it is important to briefly describe the common narrative of sex and sex development. The common narrative also indicates particular understandings of what is abnormal, even disease, and outside of the common narrative. These variations outside of the norm have had impact on people outside of the standard ideal of the heterosexual male or female.
The narrative of sex/gender and its development must begin with the structures upon which it is based. That is, there is a norm, a standard pattern all life follows and that norm states that sex is an oppositional binary of being male or female with the male includes particular biological characteristics while the female has other characteristics. There are other general characteristics that are shared between the two – males and females.
The narrativity of sex development has an assumed foundation of an egg representing female and a sperm representing male. These are discrete and oppositional and the only possibilities. Females have XX chromosomes and particular physiology while males have XY chromosomes and particular physiology distinct from females. There are three core assumptions: it is binary (two different forms, male and female) which have distinct anatomical structures and biological functions; each form has different physical characteristics; and each form has different psychological and behavioral characteristics [30, 31]. There are two different species as male and female and not just two different reproductive systems (women have ovaries, a womb, and lactate while men are sperm producers) [32, 33, 34]. There are many texts defining these differences. Outside of these are mistakes of nature or abnormalities.
Sex development begins as process-based and linear. The very beginning of development is where the egg and the sperm meet and the egg provides an X and the sperm either an X or Y chromosome. Depending on what gene is provided from the sperm, X or Y, will determine if the newly formed zygote is a male or female. The zygote then begins the development process into either male physiology or female physiology. The presence of a Y chromosome makes the embryo develop as a male (individuals with Y will develop testes); in its absence, the default development is along the female pathway (ovaries will develop) [33]. Sex development theory assumes a master template (a master gene) as the norm that triggers a subordinate gene which cascades to downstream genes in a descending hierarchy of control [11]. As an analogy, development occurs as though a bowling ball was accurately rolled to hit a genetic kingpin at just the right spot and cause all the genetic bowling pins behind to fall down in perfect order and producing a normal baby is bowling a genetic strike [11]. This assumes there is a close linear association of “3G” sex – genetic, gonadal, and genitals – as core markers of sex [33]. The sex will then lead to the direction of other related sex characteristics. The chromosomes lead to a linear development of other anatomical structures including those often referred to as sex structures (e.g. ovaries, testes, uterus, scrotum, vagina, and clitoris) and most importantly the brain and the neural system [35].
From the time of birth, the linear development continues along the chromosomal pathway albeit at a slower pace until puberty. At puberty, sex development continues with “secondary sex characteristics” of body hair, breasts, voice, pitch, menstruation, and sexual sensations and desires [13, 35, 36]. One’s biological sex further develops into adulthood. Later in life, other factors change such as menopause in women. Up till recently, it has also been assumed that this determined sex will also determine one’s sexual relations, and hence the system of heterosexuality.
Development assumes an oppositional binary whereby from chromosomes to hormones to gonads to secondary sex characteristics there are only two choices: male (XY) or female (XX). The assumption is social sex social roles and function, expression follows on from sex development as male or female as biology established [37]. In another words, sex is understood here as a status determined by nature that unfurls into sociopolitical roles. Sex is so fundamental in the developmental program and experience is secondary to that of development in forming the male brain and male nature, or to a female brain and female nature [33].
The general sex development theory at its core is biological determinism. It infers that social development derives from the biological essence. The narrative imposed on these development systems upholds the oppression based on biological systems. It also maintains that any variation and difference is abnormal or not socially acceptable.
Prior to the 1950s, the term gender was not used, and social roles, expressions, and others relations to sex came within the umbrella of the term “sex.” The assumption was that the development of biology would extend to the developing of matching social roles and expressions and so on of society. When held strictly to such ideas, it became biological essentialism in that the person’s biology dictated the person’s position and function in society. Enforcement of biological determinism has led to sex oppression over the years, which has been often centered through patriarchy. Biological determinism of race and sex which began in the seventeenth century was recognized as having large social repercussions, especially for women and people of sex diversity [38]. Feminists have long criticized biological determinism that subordinated women to the behavior and abilities of women uniquely determined by their biology [22].
Gender as a concept and understanding arose with the rise of plasticity of human being [24]. The psychological theory posited that human beings are malleable or there is a plasticity of human beings [24]. This was the idea that humans are malleable beings and not fixed and subordinated to biological traits such as race and sex. It has its roots in the work of Konrad Lorenz concept of imprinting into dominance and adopted by Dr. John Money in establishing gender to imprint intersex people into the male–female binary [23]. The biological morphology (outer (and sometimes inner)) body was malleable and alterable [25]. The intersex and transgender persons’ bodies were alterable to fit the assigned or re-assigned gender. Dr. Robert Stoller extended the concept of gender to suggest that once a gender was assigned at birth, biology virtually superfluous except to medical professionals and produced the raw material (linear development) upon which gender developed which became known as the sex/gender split [23, 25, 39, 40, 41, 42].
Gender indicated that irrespective of the diversity of biology, a person’s development began from the assignment of gender at birth along with any necessary alteration of biology to match that assignment. A person’s gender identity derives from an inner sense of self – the psychological self – that usually matches the assignment at birth [23, 39, 43]. That sense of self develops social cues around them into the masculine and feminine person they were assigned to be. Gender development enables a concentration on the development psychological phenomena such as thoughts, behavior, and personality [23, 39]. A person has the ability to take roles that are not based on their biology in society and therefore be equal to each other – that is equality of man and woman (at least in theory). Gender development is the way a person perceives, expresses, and experiences sex identity within social relations of a social-political environment through imposed expectations (such as getting married and having children), norms, qualities, and behaviors upon an individual which vary across history societies, cultures, and classes [11, 44, 45, 46, 47, 48, 49]. Gender development is a complex process within the sociopolitical world. It is an integration of one’s “inner sense of being male or female” experienced within the sociopolitical expectations and is influenced by other’s view of themselves [50].
Gender development begins at the time of birth, though some cues are even learnt pre-birth. Late in the pre-birth process, the fetus recognizes cues of acceptability within society of what it means to be their gender [51, 52]. After birth and by the age of 5 years, a child recognizes their gender; however, the child also recognizes the what gender recognition is acceptable or needs to be concealed/suppressed within the social setting and expects them to be [53, 54]. Through the early years, the infant continues to pick up those cues around them. As the child develops, they encounter endless gender clues and hints in the real world including gender stereotypes, encouraging or discouraging words, expressions, or body language from others, and sex segregation of adult social roles [33]. These clues and hints are taken on board in the person’s gender development. Consciously or unconsciously, developing gender with its associated patterns of permitted freedoms is quickly understood including the boundaries of that gender [34].
From childhood onward, gender development is fortified through internal and external sense of their psychological self [13, 36]. Development includes socially appropriate cues of being male or female including the socially constructed roles, behavior, activities, and attributes [55]. Development is reinforced through carers, whether it is family or other members of society their own social interests in the child’s gender becoming are reinforced [56]. These considerations influence one’s inner sense of self as expectations about the characteristics men and women have, and as gender norms dictating double standards for how women and men should behave, influencing people’s interests, self-concept, performance, and beliefs about capabilities in gendered domains [33].
Moreover, as one matures, one continues to author gender as cued by relationships, society, and sociality [56]. This continues with the child as their status as sex determined, and gender authored. This becomes their sociopolitical status of life which is not escapable. It is central to and entangled within one’s social and legal life of recognition and relationality. At an early age, they pick up on cues about acceptable and non-acceptable relationships, even though they yet may not know their favored sexual relationships [53, 54]. As they turn to their teens, they begin to form relationships usually favoring culturally accepted values, such as heterosexual [53, 54]. The infant uses these ques. as a guide together with the gendered world around them in becoming their gender. These relationships primarily adhere to the sociopolitical way of life.
Gender introduced by Western feminists into the public sphere derived from and was based in the work of Dr. John Money and Dr. Robert Stoller. They accepted that through gender it was possible to socialize a person into an assigned sex stable sexed subject [23]. The focus of the theory was to normalize intersex and transgender people into the male female binary as they were creating ambiguity of the two-sex system. The sex/gender split introduced by Dr. Stoller was essential to feminist work. Removing biology as the root of the diversity enabling a capturing of these populations and normalizing them with the binary, oppositional system. Moreover, gender did not interfere with the broader institutional, patriarchal system, but only remove biology as an essence upon which it was built. This enabled women to be equal in social and psychological development as men. It was this idea that feminists adopted introducing gender into the public sphere [23, 39].
Western science has had an interesting relationship with biological diversity. As far back as the Greeks such as Aristotle and Plato, there was recognition of the diversity of being beyond male or female even though there was little acceptance of them as full human beings [12, 14]. Since the modern science period, there has been a large discovery of various diversities of sex and gender.
Sex development and diversity are not generally considered as possibility. When sex development ranged beyond the standard norm, they as considered as abnormal sex development. Though sex diversity was not fully accepted, especially in the West, under various names people we call intersex and transgender people today still existed.
Due to greater awareness of biological diversity and social unrest of norms including increasing awareness and recognition of gays and lesbians, and fear of communism, there was a need to protect the binary and diminish and erase diversity [23]. Gender was such an institution to remove sex and maintain the binary including its meaning and basis in society. Dr. John Money established gender it was to erase the possibility of intersex people and ensure they conform to being male or female to fit into society. He believed that in spite of the physiological characteristics, intersex children were malleable and could be assigned a gender – male or female – and raised accordingly [57]. Once assigned, there may be necessity to change the child’s body to match the assignment – completing what nature did not finish – and encourage child and parent bonding and development of gender [25].
Dr. Robert Stoller also worked with Money’s notion of gender in his work with transgender people. Transgender was earlier understood as a biological reality, but this was transformed by Stoller as an independent psychological phenomenon (p. 31) [23]. The development of gender identity as a psychological reality shifted sense of embodiment that transgender people once had (p. 99) [25]. Though transgender people may have desired transformative support of particular biological parts, they still would relate to the world through their body. The focus of gender changed that indicating that the relationship was through their psychological being.
Both for intersex and transgender people, they were seen as diseased and in need of a cure [11]. By fixing these groups, they could live successful lives in society. Such an implementation of social construction upon the bodies and lives of these groups was still rooted in biological determinism – the belief that there are only two human which are male or female.
Though gender was an attempt to overcome the problems of biological determinism, through using social constructionism, it is questionable to what extent it has done so. Gender and its development are underpinned by cultural determinism based in the male and female ideal (minus the control of biology). It has not freed society of the shackles of the binary understanding of the world as an immutable state and erased diversity. Though there is a use of the term gender diversity, it is in the sense of social constructionism and not including biological diversity such as intersex people exemplify nor does it provide for and enable embodiment.
The development of sex and gender indicated a linear process of development as either male or female. Any deviation was a developmental error. This has led to nonrecognition of people who are no longer recognized as a person without the help of medicine to rehabilitate them into the standardized norm as a male or female, even if it was the opposite to that assigned at birth (as with transgender people).
Narrativity of becoming is not just a different name but indicates a different way to understand a narrative of how a person becomes who they are. As mentioned earlier, it is organic interaction and interconnections of their embodied being within a social-cultural and environmental place. Embodiment moves beyond the body as a bodily form to a conception that through the body provides realms of agency, practice, custom, and so on [58]. It infers social relationality and connectedness – a sense of belonging. Embodiment indicates the agency and experience of the world through a person’s bodily form, mediated from physiology within and the cultural, social, political, and environmental world without [58]. Becoming throughout their life is inclusive of overlapping and intersecting multiplicities such as sex/gender, race, ethicality, class, (dis)ability, and so on. Becoming is a process of evolving, reinventing, or transforming nature. [62]. It is a mediation between stasis and change [28, 63] where nothing is resolved or in closure, yet often contradictory as it accommodates the emergence of new possibilities or transformations of the whole and the parts of one’s becoming [50, 62, 63, 64, 65, 66].
The very beginning of sex becoming is prenatal. As various physiological interactions begin, there are decisions made as to “pathways” of becoming of the future being. Each physiological part of a person is a the consequence of dozens of different genes and numerous pathways by which cells are assembled, differentiated, and assigned alternate functions in sex becoming [13]. Even chromosomes do not operate in isolation but require certain biochemicals called enzymes to makes the genes effective [11]. As Joan Roughgarden suggests as analogy, it is like a committee (chromosomes, hormones, enzymes, and other physiological members) that meets throughout becoming even at the early physiology stages before society and culture even have become part of the person’s becoming [11]. This analogy is important to indicate that diversity in biology and physiology is important in becoming but is not an automatic process but organic with multiple possibilities.
The processes continue from the time of birth. The only difference is that from the time of birth the social, cultural, and environmental members of the committee have more voice on the committee that they had pre-birth to continue the analogy further. Becoming continues through childhood, adolescence into adulthood. Even late into the later stages of life becoming, or even slowing of life, continues. Becoming is a recognition of the interconnectedness not only of the people around them but also the land from which they derive.
Sex becoming is the embodiment of being and belonging as male, female, both, or neither relating how they see themselves, and how they think others see them, in performing social roles, expressions, and functions through their biological body [51, 59, 60, 61]. Such a becoming enables people to connect with their spiritual and cultural ancestral beings and contribute to overall human potentiality and community sustenance and identity. Although sex becoming will always in and through social relations, the relations will not necessarily completely define us where reciprocity exists and there is respect for uniqueness of being.
Becoming is organic enables transformative possibilities. Though it recognizes biological and physiological importance, it is not as a controlling force as in biological determinism. Rather, it is in the sense of embodiment, that is through the body (whether it is in the form that one is born with or has been transformed due to medical necessity or gender-confirming need) with the social and environmental interconnectedness. What becomes clear is social constructionism does not provide the basis for embodiment and interconnectedness but leads back to a type of determinism.
The aim of this chapter was not to go through the various biological mechanisms involved in sex development. As mentioned near the beginning, there are numerous texts out there providing eloquent discussions of the various parts and their functions in the development process.
Rather, the chapter has aimed to focus on the narratives used in describing the development process. All facts are only understood when incorporated within a narrative. As noted in the chapter, all meaning is understood through narratives. Whether in early times, in the modern era, or the technological era, narratives are how humans understand the world. It is through these narratives that it is possible to indicate what something is worth and how it is valued. The narratives are also central to social organization and understanding how a person fits into the world around them and what functions they may have within society.
Sex and gender development narratives are bound within narratives that have been maintained over many years through religious and scientific dominions. The early understanding was through early form and the more direct biological determinism. Though it has largely been debunked regarding race, there is still a strong support for such ideas today regarding sex and sex development. Many of the texts do not use the words today but when read contextually still maintain such a theory.
The introduction of social constructionism, however, was aimed to curve the impact of sex determinism, or at least that is how some in the gender studies have argued. The idea of social constructionism is that biology should not and does not control destiny. Though there was oppression linked to biology as destiny, and hence the purpose for introducing social constructionism, at the same time it has led to the abandonment of embodiment. Furthermore, in particular for sex/gender development has been implemented as the same ideology as a binary, oppositional system of male and female only not based on biology determining future roles and functions of people. The result has been a cultural determinism and enforcement of a Western ideal of what is means to be male or female and the spreading of its particular narrative of sex/gender development.
The group or population that has suffered the most of both of these ideas has been those of sex/gender diversity. While under sex biological determinism has led to limited or no recognition and acceptance, under social constructionism it led to enforced transformation into assigned or reassigned genders which often also involved changing the morphology of the body to match their newly assigned genders. A greater impact for both intersex and transgender people was the loss of embodiment as the move to gender concentrated a person’s knowledge and sense of oneself was based in their psychology. Not only did it deny a relationship with the person’s body and being, but also it was an individualizing process separating people from community and connectedness. The effect of social constructionism, or even it could be argued cultural determinism, was a loss of ability to develop a diversity of being, for example as intersex or transgender, that was outside of the framing of maleness or femaleness.
Realizing development as a becoming enables a return to embodiment. It is a relation to the body (even if it be transformed from that at birth) and at the same time, a relatedness to the social and environmental world around them. Mover, becoming was organic, not linear nor immutable. It provided a means of agency yet still had bounds of social and cultural responsibility.
Understanding development as becoming recognized the complex organic being with multiple interconnected communicating with each other. From both internal and external directions, the physiological, social, psychological, and cultural multiplicities communicate and discuss at various stages of becoming of what possibilities there are and which direction to become. It is an ongoing process that continues through death where even some cultures would suggest that some of these multiplicities continue becoming in some way.
Becoming does not deny that there are external forces, yet at the same time recognizes that agency derives through the embodied being, and not simply a psychological sense of self. It is a means of acknowledging a cultural and spiritual connectedness of being along with its collective identity rather than the individualized and atomized notion of being. Becoming is a narrativity of the socialized sex through the embodied physiological being with the surrounding community and context depending world.
Understanding development through a different paradigm does not deny biological or physiological reality but does change the narrative of how life, society, and the surrounding environment connect and organize together. It provides a narrative of cohesiveness yet respect for difference and uniqueness, while individuals have duties to one another. As such, it provides a space of relationality rather the separateness and individuality that derives from sex/gender development.
The author declares no conflict of interest.
"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges".
\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.
",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\\n\\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
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\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
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The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
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\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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Among different technologies for hydrogen production, oxygenic natural and artificial photosynthesis using direct photochemistry in synthetic complexes have a great potential to produce hydrogen as both use clean and cheap sources - water and solar energy. Photosynthetic organisms capture sunlight very efficiently and convert it into organic molecules. Artificial photosynthesis is one way to produce hydrogen from water using sunlight by employing biomimetic complexes. However, splitting of water into protons and oxygen is energetically demanding and chemically difficult. In oxygenic photosynthetic microorganisms water is splitted into electrons and protons during primary photosynthetic processes. The electrons and protons are redirected through the photosynthetic electron transport chain to the hydrogen-producing enzymes-hydrogenase or nitrogenase. By these enzymes, e- and H+ recombine and form gaseous hydrogen. Biohydrogen activity of hydrogenase can be very high but it is extremely sensitive to photosynthetic O2. At the moment, the efficiency of biohydrogen production is low. However, theoretical expectations suggest that the rates of photon conversion efficiency for H2 bioproduction can be high enough (> 10%). Our review examines the main pathways of H2 photoproduction using photosynthetic organisms and biomimetic photosynthetic systems and focuses on developing new technologies based on the effective principles of photosynthesis.",book:{id:"3587",slug:"biomimetics-learning-from-nature",title:"Biomimetics",fullTitle:"Biomimetics Learning from Nature"},signatures:"Suleyman I. Allakhverdiev, Vladimir D. Kreslavski, Velmurugan Thavasi, Sergei K. Zharmukhamedov, Vyacheslav V. 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It performs very complex tasks while occupying about 2 liters of volume and consuming very little energy. The computation tasks are performed by special cells in the brain called neurons. They compute using electrical pulses and exchange information between them through chemicals called neurotransmitters. With this as inspiration, there are several compute models which exist today trying to exploit the inherent efficiencies demonstrated by nature. The compute models representing spiking neural networks (SNNs) are biologically plausible, hence are used to study and understand the workings of brain and nervous system. More importantly, they are used to solve a wide variety of problems in the field of artificial intelligence (AI). They are uniquely suited to model temporal and spatio-temporal data paradigms. 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Finally, applications on the chaotic time series prediction and the video frame recognition will be demonstrated.",book:{id:"6875",slug:"bio-inspired-technology",title:"Bio-Inspired Technology",fullTitle:"Bio-Inspired Technology"},signatures:"Kangjun Bai and Yang Yi",authors:[{id:"239041",title:"Prof.",name:"Yang",middleName:null,surname:"Yi",slug:"yang-yi",fullName:"Yang Yi"},{id:"245542",title:"Mr.",name:"Kangjun",middleName:null,surname:"Bai",slug:"kangjun-bai",fullName:"Kangjun Bai"}]},{id:"58622",title:"Bio-inspired Adaptable Facade Control Reflecting User's Behavior",slug:"bio-inspired-adaptable-facade-control-reflecting-user-s-behavior",totalDownloads:1619,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"The purpose of this research is to develop the process of methodology in designing adaptable façade. This study focuses on the processes of façade operation control for each resident’s unit according to the user’s lifestyle. 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His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. 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Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. 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He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Associate Prof.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. He has also been appointed to review many scientific manuscripts by established journals such as the British Medical Journal (BMJ). He has presented his research works at numerous local and international conferences such as the European Association for Cardiothoracic Surgery (EACTS) and the European Society of Cardiovascular Surgery (ESCVS), to name a few. He has also won many awards for his research presentations at meetings and conferences like the prestigious International Invention, Innovation & Technology Exhibition (ITEX); Design, Research and Innovation Exhibition, the National Conference on Medical Sciences and the Annual Scientific Meetings of the Malaysian Association for Thoracic and Cardiovascular Surgery. He was awarded the Darjah Setia Pangkuan Negeri (DSPN) by the Governor of Penang in July, 2015.",institutionString:null,institution:{name:"Monash University Malaysia",country:{name:"Malaysia"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. He is currently working on the following subjects: Aluminium toxicity, Neuroinflammation, Oxidative stress and Purinergic system. Since 2011 he has presented more than 80 abstracts in scientific proceedings of national and international meetings. Since 2014, he has published more than 20 peer reviewed papers (including 4 reviews, 3 in Portuguese) and 2 book chapters. He has also been a reviewer of international journals and ad hoc reviewer of scientific committees from Brazilian Universities.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",country:{name:"Brazil"}}},{id:"217850",title:"Dr.",name:"Margarete Dulce",middleName:null,surname:"Bagatini",slug:"margarete-dulce-bagatini",fullName:"Margarete Dulce Bagatini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217850/images/system/217850.jpeg",biography:"Dr. Margarete Dulce Bagatini is an associate professor at the Federal University of Fronteira Sul/Brazil. She has a degree in Pharmacy and a PhD in Biological Sciences: Toxicological Biochemistry. She is a member of the UFFS Research Advisory Committee\nand a member of the Biovitta Research Institute. She is currently:\nthe leader of the research group: Biological and Clinical Studies\nin Human Pathologies, professor of postgraduate program in\nBiochemistry at UFSC and postgraduate program in Science and Food Technology at\nUFFS. She has experience in the area of pharmacy and clinical analysis, acting mainly\non the following topics: oxidative stress, the purinergic system and human pathologies, being a reviewer of several international journals and books.",institutionString:"Universidade Federal da Fronteira Sul",institution:{name:"Universidade Federal da Fronteira Sul",country:{name:"Brazil"}}}]}},subseries:{item:{id:"38",type:"subseries",title:"Pollution",keywords:"Human activity, Pollutants, Reduced risks, Population growth, Waste disposal, Remediation, Clean environment",scope:"
\r\n\tPollution is caused by a wide variety of human activities and occurs in diverse forms, for example biological, chemical, et cetera. In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
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Dr. Rahman was also adjunctly attached with Kanazawa University, Japan (Visiting Research Professor, Dec 2014 to Mar 2015; JSPS Postdoctoral Research Fellow, Apr 2012 to Mar 2014), and Tokyo Institute of Technology, Japan (TokyoTech-UNESCO Research Fellow, Oct 2004–Sep 2005). \nHe received his Ph.D. degree in Environmental Analytical Chemistry from Kanazawa University, Japan (2011). He also achieved a Diploma in Environment from the Tokyo Institute of Technology, Japan (2005). Besides, he has an M.Sc. degree in Applied Chemistry and a B.Sc. degree in Chemistry, all from the University of Chittagong, Bangladesh. \nDr. Rahman’s research interest includes the study of the fate and behavior of environmental pollutants in the biosphere; design of low energy and low burden environmental improvement (remediation) technology; implementation of sustainable waste management practices for treatment, handling, reuse, and ultimate residual disposition of solid wastes; nature and type of interactions in organic liquid mixtures for process engineering design applications.",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"201020",title:"Dr.",name:"Zinnat Ara",middleName:null,surname:"Begum",slug:"zinnat-ara-begum",fullName:"Zinnat Ara Begum",profilePictureURL:"https://mts.intechopen.com/storage/users/201020/images/system/201020.jpeg",biography:"Zinnat A. 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