Complete parameters in the preoperative assessment in plastic surgery.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"9173",leadTitle:null,fullTitle:"Moving Broadband Mobile Communications Forward - Intelligent Technologies for 5G and Beyond",title:"Moving Broadband Mobile Communications Forward",subtitle:"Intelligent Technologies for 5G and Beyond",reviewType:"peer-reviewed",abstract:"The deployment of 4G/LTE (Long-Term Evolution) mobile networks has solved the major challenge of high capacities to build a real broadband mobile internet. This was possible mainly through a very strong physical layer and flexible network architecture. However, bandwidth-hungry services such as virtual reality (VR) and augmented reality (AR), have been developed in an unprecedented way. Furthermore, mobile networks are facing other new services with extreme demand for greater reliability and almost zero-latency performance, like vehicle communications and the Internet of Vehicles (IoV). Therefore, industries and researchers are investigating new physical layers and softwarization techniques and including more intelligence in 5G and beyond 5G (B5G/6G). This book discusses some of these softwarization techniques, such as fog computing, cloud computing, and artificial intelligence (AI) and machine learning (ML). It also presents use cases showing practical aspects from 5G deployment scenarios, where other communications technologies will co-habit to build the landscape of next-generation mobile networks (NGMNs).",isbn:"978-1-83962-344-8",printIsbn:"978-1-83962-343-1",pdfIsbn:"978-1-83962-345-5",doi:"10.5772/intechopen.83169",price:119,priceEur:129,priceUsd:155,slug:"moving-broadband-mobile-communications-forward-intelligent-technologies-for-5g-and-beyond",numberOfPages:146,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"650198e6e9da2a9a52d8e67b63ccd832",bookSignature:"Abdelfatteh Haidine",publishedDate:"August 18th 2021",coverURL:"https://cdn.intechopen.com/books/images_new/9173.jpg",numberOfDownloads:4983,numberOfWosCitations:0,numberOfCrossrefCitations:5,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:14,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:19,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 25th 2019",dateEndSecondStepPublish:"March 27th 2020",dateEndThirdStepPublish:"May 26th 2020",dateEndFourthStepPublish:"August 14th 2020",dateEndFifthStepPublish:"October 13th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"187242",title:"Dr.",name:"Abdelfatteh",middleName:null,surname:"Haidine",slug:"abdelfatteh-haidine",fullName:"Abdelfatteh Haidine",profilePictureURL:"https://mts.intechopen.com/storage/users/187242/images/system/187242.jpg",biography:"Dr.Ing. Abdelfatteh Haidine received his Ph.D. in 2008 from the Technische Universität Dresden, Germany, with a focus on the planning and optimization of telecommunications networks. He worked as a consultant and manager for the deployment of smart metering systems and smart grid applications.\n\nCurrently, he is a professor for wireless/mobile communications and intelligent systems with the Laboratory of Information Technologies, National School of Applied Sciences, Morocco. His research interests include different issues related to Machine-to-Machine (M2M) and Internet-of-Things (IoT) communications, networking technologies for smart domains: smart maritime port, smart city and smart grid applications, and so on. This covers LPWA networks and their techno-economical aspects. Dr. Haidine also deals with the application of combinatorial optimization as well as the Game Theory paradigm in network planning/migration and resources allocation in broadband mobile networks. In addition, he investigates artificial intelligence and machine learning in optimization procedures/paradigms.",institutionString:"National School of Applied Sciences",position:null,outsideEditionCount:null,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"541",title:"Wireless Communication System",slug:"communications-and-security-wireless-communication-system"}],chapters:[{id:"77006",title:"Trends in Cloud Computing Paradigms: Fundamental Issues, Recent Advances, and Research Directions toward 6G Fog Networks",doi:"10.5772/intechopen.98315",slug:"trends-in-cloud-computing-paradigms-fundamental-issues-recent-advances-and-research-directions-towar",totalDownloads:331,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"There has been significant research interest in various computing-based paradigms such as cloud computing, Internet of Things, fog computing, and edge computing, due to their various associated advantages. In this chapter, we present a comprehensive review of these architectures and their associated concepts. Moreover, we consider different enable technologies that facilitate computing paradigm evolution. In this context, we focus mainly on fog computing considering its related fundamental issues and recent advances. Besides, we present further research directions toward the sixth generation fog computing paradigm.",signatures:"Isiaka A. Alimi, Romil K. Patel, Aziza Zaouga, Nelson J. Muga, Qin Xin, Armando N. Pinto and Paulo P. Monteiro",downloadPdfUrl:"/chapter/pdf-download/77006",previewPdfUrl:"/chapter/pdf-preview/77006",authors:[{id:"208236",title:"Dr.",name:"Isiaka",surname:"Alimi",slug:"isiaka-alimi",fullName:"Isiaka Alimi"},{id:"419218",title:"Dr.",name:"Romil K.",surname:"Patel",slug:"romil-k.-patel",fullName:"Romil K. Patel"},{id:"419219",title:"Dr.",name:"Aziza",surname:"Zaouga",slug:"aziza-zaouga",fullName:"Aziza Zaouga"},{id:"419220",title:"Dr.",name:"Nelson J.",surname:"Muga",slug:"nelson-j.-muga",fullName:"Nelson J. Muga"},{id:"419221",title:"Dr.",name:"Qin",surname:"Xin",slug:"qin-xin",fullName:"Qin Xin"},{id:"419222",title:"Dr.",name:"Armando N.",surname:"Pinto",slug:"armando-n.-pinto",fullName:"Armando N. Pinto"},{id:"419223",title:"Dr.",name:"Paulo P.",surname:"Monteiro",slug:"paulo-p.-monteiro",fullName:"Paulo P. Monteiro"}],corrections:null},{id:"71376",title:"Low-Latency Strategies for Service Migration in Fog Computing Enabled Cellular Networks",doi:"10.5772/intechopen.91439",slug:"low-latency-strategies-for-service-migration-in-fog-computing-enabled-cellular-networks",totalDownloads:617,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"This chapter presents a fog computing enabled cellular network (FeCN), in which the high user-mobility feature brings critical challenges for service continuity under stringent service requirements. Service migration is promising to fulfill the service continuity during mobility. However, service migration cannot be completed immediately and may lead to situations where the user-experience degrades. For this, a quality-of-service aware service migration strategy is proposed. The method is based on existing handover procedures with newly introduced distributed fog computing resource management scheme to minimize the potential negative effects induced by service migration. The performance of the proposed schemes is evaluated by a case study, where realistic vehicular mobility pattern in the metropolitan network of Luxembourg is used. Results show that low end-to-end latency for vehicular communication can be achieved. During service migration, both the traffic generated by migration and the other traffic (e.g., control information, video) are transmitted via mobile backhaul networks. To balance the performance of the two kinds of traffic, a delay-aware bandwidth slicing scheme is proposed. Simulation results show that, with the proposed method, migration data can be transmitted successfully within a required time threshold, while the latency and jitter for nonmigration traffic with different priorities can be reduced significantly.",signatures:"Jun Li, Xiaoman Shen, Lei Chen and Jiajia Chen",downloadPdfUrl:"/chapter/pdf-download/71376",previewPdfUrl:"/chapter/pdf-preview/71376",authors:[{id:"313110",title:"Dr.",name:"Lei",surname:"Chen",slug:"lei-chen",fullName:"Lei Chen"},{id:"313111",title:"Prof.",name:"Jiajia",surname:"Chen",slug:"jiajia-chen",fullName:"Jiajia Chen"},{id:"313112",title:"Dr.",name:"Jun",surname:"Li",slug:"jun-li",fullName:"Jun Li"},{id:"316559",title:"Dr.",name:"Xiaoman",surname:"Shen",slug:"xiaoman-shen",fullName:"Xiaoman Shen"}],corrections:null},{id:"77411",title:"Artificial Intelligence and Machine Learning in 5G and beyond: A Survey and Perspectives",doi:"10.5772/intechopen.98517",slug:"artificial-intelligence-and-machine-learning-in-5g-and-beyond-a-survey-and-perspectives",totalDownloads:642,totalCrossrefCites:1,totalDimensionsCites:4,hasAltmetrics:0,abstract:"The deployment of 4G/LTE (Long Term Evolution) mobile network has solved the major challenge of high capacities, to build real broadband mobile Internet. This was possible mainly through very strong physical layer and flexible network architecture. However, the bandwidth hungry services have been developed in unprecedented way, such as virtual reality (VR), augmented reality (AR), etc. Furthermore, mobile networks are facing other new services with extremely demand of higher reliability and almost zero-latency performance, like vehicle communications or Internet-of-Vehicles (IoV). Using new radio interface based on massive MIMO, 5G has overcame some of these challenges. In addition, the adoption of software defend networks (SDN) and network function virtualization (NFV) has added a higher degree of flexibility allowing the operators to support very demanding services from different vertical markets. However, network operators are forced to consider a higher level of intelligence in their networks, in order to deeply and accurately learn the operating environment and users behaviors and needs. It is also important to forecast their evolution to build a pro-actively and efficiently (self-) updatable network. In this chapter, we describe the role of artificial intelligence and machine learning in 5G and beyond, to build cost-effective and adaptable performing next generation mobile network. Some practical use cases of AI/ML in network life cycle are discussed.",signatures:"Abdelfatteh Haidine, Fatima Zahra Salmam, Abdelhak Aqqal and Aziz Dahbi",downloadPdfUrl:"/chapter/pdf-download/77411",previewPdfUrl:"/chapter/pdf-preview/77411",authors:[{id:"187242",title:"Dr.",name:"Abdelfatteh",surname:"Haidine",slug:"abdelfatteh-haidine",fullName:"Abdelfatteh Haidine"},{id:"209714",title:"Dr.",name:"Abdelhak",surname:"Aqqal",slug:"abdelhak-aqqal",fullName:"Abdelhak Aqqal"},{id:"346723",title:"Dr.",name:"Salmam",surname:"Fatima Zahra",slug:"salmam-fatima-zahra",fullName:"Salmam Fatima Zahra"},{id:"346724",title:"Dr.",name:"Aziz",surname:"Dahbi",slug:"aziz-dahbi",fullName:"Aziz Dahbi"}],corrections:null},{id:"71476",title:"A Brief Overview of CRC Implementation for 5G NR",doi:"10.5772/intechopen.91790",slug:"a-brief-overview-of-crc-implementation-for-5g-nr",totalDownloads:832,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In fifth generation (5G) new radio (NR), the medium access control (MAC) layer organizes the data into the transport block and transmits it to the physical layer. The transport block consists of up to million bits. When the transport block size exceeds a threshold, the transport block is divided into multiple equal size code blocks. The code block consists of up to 8448 bits. Both the transport block and the code block have a cyclic redundancy check (CRC) attached. Due to the difference in the size of the transport block and the code block, the CRC processing scheme suitable for the transport block and that suitable for the code block are different. This chapter gives an overview of the CRC implementation in 5G NR.",signatures:"Hao Wu",downloadPdfUrl:"/chapter/pdf-download/71476",previewPdfUrl:"/chapter/pdf-preview/71476",authors:[{id:"312541",title:"Mr.",name:"Hao",surname:"Wu",slug:"hao-wu",fullName:"Hao Wu"}],corrections:null},{id:"70821",title:"Prospects of 5G Satellite Networks Development",doi:"10.5772/intechopen.90943",slug:"prospects-of-5g-satellite-networks-development",totalDownloads:1557,totalCrossrefCites:4,totalDimensionsCites:6,hasAltmetrics:1,abstract:"In the future, 5G networks will represent the global telecommunication infrastructure of the digital economy, which should cover the whole world including inaccessible areas not covered by 5G terrestrial networks. Given this, the satellite segment of 5G networks becomes one of the pressing issues of development and standardization at the second stage of 5G networks development in the period 2020–2025. The requirements for 5G satellite network will be determined primarily by combination of key services supported by 5G networks, which are combined by three basic business models of 5G terrestrial networks: enhanced Mobile Broadband Access (eMBB), Massive Internet of Things connections (mIoT), and Ultra-reliable low-latency communication (uRLLC). 3GPP as leading international standards body has identified several use cases and scenarios of 5G satellite networks development. 5G satellite networks are understood to mean networks in which the NG-RAN radio access network is constructed using a satellite network technology. The chapter has discussed the spectral and technological aspects of 5G satellite network developments, issues of architecture and role of delays on quality of services of 5G satellite segment, and possibility of constructing a 5G satellite segment based on distributed and centralized gNB base stations. The issues of satellite payload utilization have considered for bent-pipe and on-board processing technologies in 5G satellite segment.",signatures:"Valery Tikhvinskiy and Victor Koval",downloadPdfUrl:"/chapter/pdf-download/70821",previewPdfUrl:"/chapter/pdf-preview/70821",authors:[{id:"305314",title:"Prof.",name:"Valery",surname:"Tikhvinskiy",slug:"valery-tikhvinskiy",fullName:"Valery Tikhvinskiy"},{id:"316696",title:"Dr.",name:"Victor",surname:"Koval",slug:"victor-koval",fullName:"Victor Koval"}],corrections:null},{id:"72121",title:"An LTE-Direct-Based Communication System for Safety Services in Vehicular Networks",doi:"10.5772/intechopen.91948",slug:"an-lte-direct-based-communication-system-for-safety-services-in-vehicular-networks",totalDownloads:838,totalCrossrefCites:0,totalDimensionsCites:3,hasAltmetrics:0,abstract:"With the expected introduction of fully autonomous vehicles, the long-term evolution (LTE)-based vehicle-to-everything (V2X) networking approach is gaining a lot of industry attention, to develop new strategies to enhance safety and telematics features. The vehicular and wireless industries are currently considering the development of an LTE-based system, which may co-exist, with the IEEE 802.11p-based systems for some time. In light of the above fact, our objective is to investigate the development of LTE Proximity Service (ProSe)-based V2X architecture for time-critical vehicular safety applications in an efficient and cost-effective manner. In this chapter, we present a new cluster-based LTE sidelink-based vehicle-to-vehicle (V2V) multicast/broadcast architecture to satisfy the latency and reliability requirements of V2V safety applications. Our proposed architecture combines a new ProSe discovery mechanism for sidelink peer discovery and a cluster-based round-robin scheduling technique to distribute the sidelink radio resources among the cluster members. Utilizing an OMNET++ based simulation model, the performance of the proposed network architecture is examined. Results of the simulation show that the proposed algorithms diminish the end-to-end delay and overhead signaling as well as improve the data packet delivery ratio (DPDR) compared with the existing 3GPP ProSe vehicle safety application technique.",signatures:"Shashank Kumar Gupta, Jamil Yusuf Khan and Duy Trong Ngo",downloadPdfUrl:"/chapter/pdf-download/72121",previewPdfUrl:"/chapter/pdf-preview/72121",authors:[{id:"2898",title:"Dr.",name:"Jamil Y.",surname:"Khan",slug:"jamil-y.-khan",fullName:"Jamil Y. Khan"},{id:"313099",title:"Ph.D.",name:"Shashank Kumar",surname:"Gupta",slug:"shashank-kumar-gupta",fullName:"Shashank Kumar Gupta"},{id:"313579",title:"Dr.",name:"Duy T.",surname:"Ngo",slug:"duy-t.-ngo",fullName:"Duy T. Ngo"}],corrections:null},{id:"77600",title:"Healthcare Application-Oriented Non-Lambertian Optical Wireless Communications for B5G&6G",doi:"10.5772/intechopen.98275",slug:"healthcare-application-oriented-non-lambertian-optical-wireless-communications-for-b5g-6g",totalDownloads:172,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"With the continuous improvement of user communication requirements and the rapid development of information services, optical wireless communication (OWC), which has unlimited bandwidth and precise positioning, is widely used in indoor scenes such as healthcare. For healthcare monitoring application, the optical wireless (OW) link using non-Lambertian emission pattern is investigated in the typical mobility scenario. Numerical results show that the potential gain could been provided by the concerned emission pattern to the OW performance uniformity.",signatures:"Jupeng Ding, I. 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Patients who consult a plastic surgeon do so with the purpose of improving their body appearance to achieve the image of a beautiful body, increase their self-esteem, and to be more competitive in a globalized world where appearance is a determinant of success. Most are people looking for various alternatives during long time; they search on the Internet, with friends, with patients, in local or distant locations from their place of residence, inside or outside of their country. Some of them make face-to-face consultations with several plastic surgeons before deciding where to have surgery [1]. They seek perfection and full satisfaction to their demands, the best prices, and high expectations with each planned surgical procedure. Complications—small or catastrophic—have no place in the final results. Medical care for these people with special expectancies is a continuous defy, a constant challenge that keeps us at the top of our professional practice and able to achieve excellent results while keeping us competitive in a growing medical market [2, 3]. Fortunately, complications in this clinical environment are rare but often are catastrophic and, to a lesser extent, can be fatal. As in other areas of surgery-anesthesia, adherence to existing guidelines and recommendations is mandatory to avoid any possible unwanted effects.
In recent years, there has been an increase in litigation against the medical profession—justified or not—increasing the costs of health care [4, 5].
The aim of this chapter is to review several aspects related to complications that may occur in the perioperative period of people who undergo plastic surgery procedures under anesthesia.
In this clinical setting, there are certain general features of paramount importance that should always receive proper attention to avoid unexpected complications. Like any other types of surgical patients, people who desire plastic surgery should be meticulously evaluated regardless of the opinion of the plastic surgeon or the anesthesiologist involved. Standards and guidelines have been described with loose criteria or very strict principles according to the experiences of their authors. The main idea is to study these patients regarding factors that may be important to prevent unfortunate outcomes and staying away from unorthodox practices of our profession [6].
The preanesthetic-preoperative assessment is vital and of paramount importance in all patients who undergo plastic surgery. This clinical assessment is an easy, inexpensive, and essential way to decrease catastrophic incidents and complications. Unfortunately, these patients are often considered healthy by their doctors and are not adequately reviewed as determined by the respective certified standards.
During the preanesthetic evaluation, two major groups will be considered; the healthy people and the patients with systemic pathologies that modify their physical conditions (ASA). The evolution and marketing of plastic surgery have generated a third special group of patients—healthy or sick—who travel long distances in search of various aesthetic or reconstructive procedures. This group of patient-tourists has special characteristics that are challenging for the medical group, peculiarities that must be properly evaluated before the patients begin their trip to the surgical destination chosen by them or immediately after their arrival.
Preoperative assessment includes a complete medical history with physical examination. Laboratory and other exams are tailored to each patient depending on their past medical history and findings on previous exams. The current trend is to minimize this type of tests; however, when a perioperative complication occurs and the so-called routine tests (CBC, blood chemistry, blood clotting, blood group) were not carried out, the plaintiffs will have arguments against the medical-surgical team, which is why it is prudent to perform routine exams, leaving the electrocardiogram for hypertensive patients, patients with history of heart disease, diabetics, and healthy people over 50 years old. Table 1 lists the usual exams for all types of patients.
Parameters | ASA 1 | ASA 2–3 | Observations |
---|---|---|---|
Clinical history | Yes | Yes | The general and oriented clinical review made by the anesthesiologist anticipates problems such as difficult airway, spinal anomalies, mental alterations, family environment, and possibility of a lawsuit |
Physical examination | Yes | Yes | |
Specialist consultation | NE | Yes | It is prudent to know the opinion of the geriatrician, pulmonologist, cardiologist, endocrinologist, surgeon, family therapist in search of polypharmacy, drug interactions, etc. |
Electrocardiogram | Only >50 years old | Yes | Arrhythmias, ischemia, growth, or dilatation of heart cavities |
Chest X-ray | NE | Yes | Useful in smokers, suspected tuberculosis, neoplasms, emphysema, and kyphosis |
Echocardiogram | No | R | Compulsory study in patients with severe arterial hypertension, ischemic patients, and patients with dilated cardiomyopathy |
Spirometry | No | R | Its usefulness has not been demonstrated; however, it is recommended in chronic pneumopathy and smokers |
Blood test | Yes | Yes | Diagnosis of subclinical anemia |
Coagulation tests | Yes | Yes | TP, TPT, INR, and bleeding time are mandatory in anticoagulants, hepatocellular damage, severe sepsis, prolonged fasting, and extreme malnutrition |
Complete blood chemistry | Yes | Yes | Kidney, hepatocellular, metabolic and electrolyte evaluation |
Urinalysis | NE | Yes | Loss of blood and proteins, changes in urine density |
HIV, hepatitis, drugs, and pregnancy | R | R | They are requested based on the clinical history and experience data. HIV is prudent for the protection of medical and paramedical personnel |
Complete parameters in the preoperative assessment in plastic surgery.
NE = not essential; R = recommendable.
The patient, his/her relatives, or companions must be properly informed about the technical aspects and risks of surgery and anesthesia. This document is an indicator of communication between patients and their physicians and should be as complete as possible. While it is almost absurd to mention every risk inherent in each procedure, it is vital to mention the most frequent complications and talk about the possibility of catastrophic mishaps, always leaving open communication for any questions they might have. Although a well-informed consent does not exempt us from the responsibility of a serious failure, its absence has been a reason of demand in plastic surgery up to 43.8% [5].
Surgical units located outside hospitals for outpatient and short-stay procedures in plastic surgery started in the 1960s [7] and rapidly expanded. Currently, most plastic surgeons want to have their own surgical unit. In these surgical units, surgical and nonsurgical procedures are performed; from Botox injection, fillers, CO2 laser, minimally invasive surgeries such as hair transplantation to major surgeries such as abdominoplasty, breast reconstruction, body contouring procedures in post bariatric patients, and many more. Safety of each patient is the gold standard [8].
Although this type of surgery/anesthesia is valid from a point of view of functionality, resulting in lower costs and generating a higher income, it is prudent to mention that not these surgical units meet the normative requirements, transforming into surgical taverns [7], which could increase the possibility of considerable risks. Performing anesthesia outside a traditional hospital surgical room has gained popularity, and high-risk surgeries on ASA 2 and even some ASA 3 patients are frequently intervened in this area. Sometimes these scenarios are comparable to performing anesthesia outside the operating room [9, 10, 11], it is normative to have well-equipped anesthesia machines, standard monitoring (noninvasive blood pressure, electrocardiogram, oximetry, capnography, temperature), monitored recovery area, and well-trained nursing personnel, which ensures a morbidity-mortality rate comparable to that expected in a hospital operating room [10]. It is advisable to have equipment to avoid perioperative hypothermia as well as noninvasive ventilatory assistance equipment. Implementing WHO recommendations in relation to a surgical safety checklist allowed Rosenberg et al. [12] to reduce complications from 11.9 to 2.72% (
The staff of ambulatory surgical units must receive continuing education to keep their certification up-to-date: surgeons, anesthesiologists, nurses, secretaries, and well-qualified administrators are required to ensure excellence. Simulation and educational programs enhance safety and make medical-surgical care systems more effective. Shapiro and his group [14] used a high-fidelity simulator mimicking various critical scenarios in a plastic surgery setting with a special regard to equipment training, communication, crisis, adherence to evidence-based protocols, and regulatory standards. They observed a high degree of acceptance and validity, arousing the participant’s interest in the importance of changing processes that improve patient safety and avoid errors. A prospective study on the safety of office-based surgery in Florida and Alabama, USA [15]—where reporting adverse events is mandatory—reviewed complicated events for 10 and 6 years, respectively, and found 46 deaths in Florida and 263 complicated procedures that required moving patients to nearby hospitals; 56.5% (26/46) were deaths and 49.8% (131/263) of the hospital transfers were related to cosmetic surgery. Of these, 67% of deaths and 74% of hospital transfers had been managed under general anesthesia. Liposuction, abdominoplasty with liposuction, and other cosmetic surgeries were related to 10 deaths and 34 hospital transfers. Only 38% of the units reporting adverse events were accredited, 93% of physicians were certified, and 98% had privileges in hospitals. Plastic surgeons reported the most events (45%). In 6 years, in Alabama, there were three deaths and 49 complications and hospital transfers; 42% (22/55) of the transfers and no deaths were associated with cosmetic surgery; 86% were done under general anesthesia. There were only two patients with complicated liposuction who were transferred to the hospital. Unlike units in Florida, 71% of units in Alabama were certified, with 100% certified surgeons. Plastic surgeons reported most events (42.3%). In both states, the complications of dermatologists were minimal or absent because their procedures are less invasive and with local or regional anesthesia. It is desirable that medical groups and health authorities establish a mandatory system that monitors deleterious events in this type of surgical environment to improve current guidelines based on the reality of each country or geographic region studied and can determine the permissible frequency of complicated events in plastic surgery [16].
There are several Government health agencies in charge of the certification of these surgical units that have the common goal of providing a similar and safe environment in this type of establishments. In Mexico, COFEPRIS and the Federal Sanitary System are responsible for verifying the functionality of this type of surgical units; from 2013 to February 2015, verified 1209 clinics provide cosmetic surgery services and found irregularities in 115, and 66 clinics were closed [17]. In the United States of America, the Joint Commission for Accreditation of Hospital Organizations (JCAHO), American Association for Accreditation of Ambulatory Surgery Facility (AAAASF), and American Osteopathic Association’s Healthcare Facilities Accreditation Program (HFAP) [18] are the organizations that regulate these aspects.
Perioperative safety is the primary goal in the comprehensive care of all patients; anesthesiologists, surgeons, nurses, paramedical staff, and health system administrators have developed guidelines aimed at improving safety in this surgical environment by strengthening preventive measures, assessment, pre-trans, and postoperative care to avoid complications. Some groups go beyond the usual recovery time, using pharmacological programs to reduce the incidence of chronic postoperative pain.
In the operating room, patient safety is a shared responsibility between professionals and staff who interact directly or indirectly with patients. As anesthesiologists, our responsibility ranges from patient assessment, anesthesia technique, and immediate recovery, although it can be extended beyond this moment when we use drugs with prolonged pharmacological effects, either as a delayed action or as chronic damage as is the case of arachnoiditis, chronic postoperative pain and perhaps CNS effects of general anesthesia for neonates could be included. Adequate monitoring (cardiorespiratory, temperature, neurological, metabolic, or neuromuscular blocking effects), the position of the patient in the operating table to avoid neurovascular compression injuries, the placement of antiembolic devices, maintenance of normothermia, facial and ocular protection, positioning the head, and avoiding burns and fires are just some of the aspects of which we are responsible during the trans and postoperative period [19, 20, 21]. Proper management of the airway is a challenge since there is always the possibility of anatomical anomalies in a patient, which makes it difficult and even impossible to secure an airway.
WHO began its safe surgery program, where checklists have proven their importance in reducing errors. No matter the surgical procedure—small or large—these recommendations list 10 essential objectives: (1) correct surgery site, (2) safe anesthesia, (3) airway management, (4) bleeding management, (5) avoid known allergies, (6) minimize risk of operative infections, (7) prevent the retention of foreign bodies, (8) correct identification of biopsies, (9) effective communication between the surgical team, and (10) systematic surveillance of surgical results. It is advisable to stick to this simple and very effective list. Its implementation is not easy, and it is necessary to understand the nature of the errors, the dynamics that exist between the systems and the people, as well as to create a culture that stimulates the patient’s safety [22, 23, 24]. In plastic surgery, it should be emphasized that it is important to identify the risks of deep vein thrombosis and pulmonary embolism (DVT/PE) and to establish that patients can benefit from prophylactic anticoagulation. Patients with hypertension should also be identified because of the implications not only in the cardiovascular and CNS systems but also in the perioperative bleeding. Another important factor is to understand the importance of reducing and treating hypothermia [25].
The time a patient remains anesthetized is directly related to the frequency of complications; hypothermia, deep venous thrombosis, pulmonary thromboembolism, changes in coagulation, bleeding, alterations in the immune system, and neurovascular compressions are some of the usual drawbacks in prolonged surgery-anesthesia [26]. In plastic surgery, there are procedures that require prolonged times such as patients with combined surgeries and postbariatric cases with large weight loss. Unfortunately, there is not enough information on these possible complications. Phillips et al. [27] retrospectively studied the relationship between the anesthetic time and the incidence of deleterious effects in 2595 plastic surgery procedures performed under general anesthesia and found that the majority were women with a mean age of 41 years. These authors divided their patients into two groups (less than 4 or more than 4 hours of anesthetic time): nausea and vomiting (2.8 vs. 5.7%,
This is a controversial context where plastic surgeons consider themselves qualified to perform some procedures with local anesthesia and superficial sedation without the presence of an anesthesiologist. Examples to these procedures are variable according to the routines and interests of each surgeon, such as, blepharoplasties, small volume liposuction, coronal and facial rhytidectomies, filler injections, and hair implants, to mention a few. The fact is that each surgical procedure should be properly monitored by the anesthesiologist in charge of patient safety (monitored anesthetic care), and let the surgeon concentrates on his procedures without distracting his attention in monitoring the patient, or administer sedative medications, analgesics, or anesthetics with a very narrow therapeutic window. Although complications are rare, there is no way to predict with certainty when a patient will have a sentinel event or a negative incident, for example, drug toxicity, overdose, drug interaction, hypertensive crisis, anxiety, airway obstruction, and broken heart syndrome, just to mention some of the many possibilities. These are complications that few surgeons are qualified to solve and are part of the anesthesiologist’s usual practice. In a series of catastrophic events in ASA 1 and 2 patients, we found a case of death during a ritidoplasty performed without the presence of the anesthesiologist [29]. The frequency of these events is not known, and it is advisable to avoid surgical procedures without the presence of an anesthesiologist, which is classified as negligence.
People who travel from one country to another to receive medical attention are called tourist-patients, and their characteristics have different aspects that can modify their risks: cultural traditions, language, common diseases in their region of origin, and physiological adjustments from their recent voyage, especially when being by plane longer than 6 hours. Their preanesthetic evaluation is done shortly after they arrive, and there could be special conditions that are not known by the treating doctors. This type of patient has proliferated in plastic surgery. In our practice, we consider them a management challenge, emphasizing an effective communication that facilitates preoperative assessment, professional care, and a safe return to their place of origin [30].
The choice of anesthesia method is the responsibility of the anesthesiologist, although patients and surgeons must be aware and consent with the anesthetic plan. In general terms, we can use any kind of anesthesia, although the anesthesiologist should be adapted to factors such as diverse as his/her own experience and knowledge, the characteristics of the surgical unit and the surgeon, the type and duration of surgery, and in particular the characteristics of each patient. It is noteworthy to mention that the
In our ambulatory and short-stay surgical unit, regional procedures are preferred, especially subarachnoid anesthesia with a lumbar approach for surgeries below T6 segment. We also use spinal anesthesia in some patients with combined surgical procedures up to T4. Single injection of spinal anesthetics and adjuvants is safe, rapid, easy to administer, inexpensive, with a certain degree of postoperative analgesia, and fewer immediate and late residual effects than general anesthesia [32, 33]. We do not use subarachnoid anesthesia with a thoracic approach. In breast, nose, and arm surgeries, we prefer general anesthesia. For facial surgery, we use conscious sedation mixed with local anesthesia [34], and we have just adopted Friedberg’s recommendation [35] with propofol or ketofol for facial surgery and sometimes as a sedative complement at the end of spinal anesthesia. The characteristics of propofol make it a safe drug when administered by an anesthesiologist and BIS (60–70) monitoring is recommended, although the Ramsey scale (3–4) can also be used [33, 35].
Monitored anesthesia care is a safe technique in ambulatory and short-stay units. It must be done by an anesthesiologist and goes from simple monitoring of the patient to the use of intravenous drugs and local anesthetics for longer procedures as rejuvenation facial surgery. The most used drugs are propofol, ketamine, midazolam, fentanyl, sufentanil, remifentanil, and dexmedetomidine always supplemented with nasal oxygen [34, 35, 36, 37, 38, 39].
Figure 1 shows a schema where the difference between alertness, conscious sedation, deep sedation, and general anesthesia are shown. The vertical line delimits the most relevant clinical data and the appropriate management [34]. Attachment to this scheme is a simple guide to avoid anesthesia complications, especially the airway and cardiovascular and central nervous systems.
Scheme showing the differences and limits of alertness, conscious sedation, deep sedation, and general anesthesia.
A patient may be complicated by anesthesia, surgery, or a combination of both, for example, infections, venous thrombosis, thromboembolism, bleeding (anemia or hematomas), inadequate scarring, neural damage, overhydration, postoperative emesis, or burns, just to name a few. It is usually impossible to attribute these complications to one single member of the team; therefore, all professionals should function as a teamwork and must share responsibilities as in those patients complicated with DVT/PE. In this chapter, we review the expected complications in anesthesia-plastic surgery and a group of rare incidents that could occur in this clinical setting of which we have observed some.
Complications of anesthesia can be classified into four different etiological categories: (1) health personnel errors; (2) adverse events to the anesthesia technique; (3) the physical condition of the patients; and (4) sentinel incidents or events. Anesthesia morbidity and mortality rates are approximately the same in countries with a similar life expectancy. The anesthesiologic community of a given country reduces their anesthesia morbidity and mortality data by an acceptable range for their societies using techniques according to their medical culture and historical traditions [40]. Although complications will always exist since erring is human [41], preventive measures are obligatory to reduce complications of anesthesia and to regulate our professional activity to reduce morbidity and mortality statistics [6]. Complications related to anesthesia are rare in plastic surgery, ranging from simple events to catastrophic outcomes, including death.
It is the most frequent complication in plastic surgery. Under normal conditions, human thermoregulation mechanisms maintain body temperature from 36.5 to 37.5°C. This homeostasis is achieved by thermoregulatory defense mechanisms such as vasoconstriction, vasodilation, sweating, or chills. Hypothermia is considered when body temperature drops below 36°C. It can occur in the perioperative period; preoperative phase is defined as 1 hour before induction (when patients are prepared for surgery), during the intraoperative phase (total anesthetic time) and postoperative phase (24 postoperative hours) [42, 43]. Unintentional intraoperative decrease in body temperature occurs in a large percentage of surgeries and is secondary to multiple factors. In anesthetized patients, body temperature usually drops 2°C but can drop up to 6°C due to changes done by general anesthesia at the center of thermoregulation, a thermal decrease depending on the dose of the anesthetic. Other important factors of hypothermia are the exposure of the patient to the cold environment of the operating rooms and the failure to actively warm patients. Hypothermia has negative effects such as increased infections, delayed healing, increased intra and postoperative bleeding, increased blood transfusion requirements, increased cardiac morbidity, prolonged duration of anesthetics, and coagulopathies [44, 45]. Therefore, it is necessary to use different methods to avoid it, to reduce its intensity, and to manage it with opportunity; mattresses with forced air or water heating, electrical devices, heating of the intravenous or irrigation solutions, room temperature, and thermal blankets, among others, have shown different degrees of efficacy [46, 47, 48, 49].
Some body contouring procedures such as liposuction of various regions, extended or circular abdominoplasty, and multiple surgeries expose body surface in a way that facilitate heat loss. If this is added to the fact that some surgeons are accustomed to utilizing antiseptic solutions in the skin area that will be operated minutes before positioning the patients in the operating table, it accelerates and increases the hypothermia and can be an incident that affects the patient outcome.
Perioperative hypothermia is a complication that must be anticipated, detected early, and treated in a timely manner.
Side effects to drugs used during anesthesia are sporadic. A background of allergies or hypersensitivity should be investigated at the time of the anesthetic evaluation and avoid its use. Among other drugs, there have been reports of allergies to local anesthetics, muscle relaxants, sugammadex, and propofol, with the most severe reactions to latex. Opioids, especially remifentanil, may induce hyperalgesia. There are undesirable reactions like malignant hyperthermia secondary to halogenated and succinylcholine. These patients must be managed with total intravenous anesthesia or regional anesthesia because local anesthetics are safer and have rarely been associated with this entity [50].
For a couple of decades, local anesthetic toxicity has been the subject of multiple publications. In plastic surgery, there is a controversy over the total doses accepted as safe. Since the original description by Klein [51, 52], various data on safe doses of lidocaine 0.1–0.05% plus epinephrine 1:1,000,000 in tumescent liposuction have been published. Segmental infiltration of reduced lidocaine concentration 0.02% has been used in broader liposuctions [53]. The latest research done in 14 human volunteers has shown that 28 mg/kg without liposuction and 45 mg/kg (dose range 9.2–52 mg/kg.) after liposuction are safe dosages. The authors reported serum lidocaine concentration below levels associated with mild lidocaine systemic toxicity. The probable risk of lidocaine toxicity without liposuction at a dose of 28 mg/kg and with liposuction at a dose of 45 mg/kg was ≤1 per 2000 [54]. Timely diagnosis and management of local anesthetic toxicity with intravenous lipids in severe cases are essential. Lipids in initial dose of 1.5 mL/kg, followed by infusion of 0.25–0.50 mL/kg for 30–60 min. This infusion can be increased if hypotension or asystole persists [55]. After the infusion of iv lipids is stopped, a recurrence of local anesthetics toxicity can happen, so these patients need to be observed for at least 24 hours more.
Rhinoplasty is a frequent, relatively simple outpatient procedure that can be catastrophically complicated. The trigeminal cardiac reflex is defined as sudden onset of parasympathetic dysrhythmia, bradycardia that can progress to sudden asystole in addition to hypotension, apnea, and gastric hypermotility. This reflex can be initiated with stimulation of the trigeminal nerve during infiltration of the local anesthetic in the nasal columella or during osteotomy [56, 57, 58, 59].
Postoperative emesis is a serious complication in plastic surgery as it may interfere with the results. It occurs after general or neuraxial anesthesia and has been associated with the use of opioids, being more frequent in young women, nonsmokers, and patients with a history of postanesthetic emesis. Prevention is necessary using preoperative medication such as dexamethasone and/or serotonergic antagonists. Metoclopramide has fallen into disuse because of its side effects.
It is associated in tumescent liposuction with large volumes and generous intravenous administration of hydro saline solutions that can induce arterial hypertension, pulmonary edema, and even death.
Although these events are not directly attributable to the anesthetic technique, this is one of the factors that may be involved. They are the most feared complications in surgery and are more frequent in liposuction and abdominoplasty [60]. The embolus can be hematic or fatty. The risk factors are young women, contraceptives, air travel of more than 6–8 hours, prolonged surgeries, and thrombophilic pathologies such as factor V Leiden [61, 62]. Preventive measures with elastic stockings and pneumatic compression, early mobilization, antiplatelet agents, heparins, and/or oral anticoagulants are mandatory in high risk patients since this complication is the leading cause of mortality in plastic surgery. In 1,141,418 outpatient surgery procedures, there were 23 fatal events, being the pulmonary embolism the cause in 13 patients. Abdominoplasty was the surgery most commonly associated with death from pulmonary embolism in an office-based surgery facility [63].
Most of these types of complications are sentinel incidents that make prevention, diagnosis, and management difficult. The following paragraphs describe some patients seen in our professional practice or referred by colleagues.
This entity occurs in ∼1:60,000 to 1:125,000 anesthetics procedures and is more frequent in cardiovascular and orthopedic surgery, although there are cases described in plastic surgery [64, 65]. It has been associated with prolonged prone position with the head positioned lower than the thorax, anemia, use of vasoconstrictors, or glycine [66, 67]. Transient or permanent postoperative blindness has also been described following facial injections of fillers as described later.
In our practice, we had a 38-year-old patient who underwent abdominoplasty, liposuction, and fat transfer in her buttocks under spinal-general anesthesia. She developed total blindness manifested in the immediate postanesthetic recovery. MRI showed occipital cortical edema (Figure 2), establishing the diagnosis of cortical blindness.
Blindness secondary to cerebral occipital cortical edema.
This rare effect has been reported in subarachnoid anesthesia attributing to sudden changes in endolymph. We had a young patient from Russia who lost her auditory acuity during 5 days after spinal anesthesia for liposuction-gluteal lipoinjection.
Takotsubo’s cardiomyopathy or broken heart syndrome is a stress-induced heart disease with sudden left ventricular failure without coronary damage [68]. A young woman developed this syndrome few minutes after nasal infiltration with lidocaine and epinephrine under anesthesia with sevoflurane. The surgery was canceled, and the patient was transferred to a nearby hospital where she was successfully managed.
It is a very rare entity with an estimated incidence of 0.1–0.2% but has the potential to cause adverse evolution in the psychological area inducing posttraumatic stress [69]. A 43-year-old patient who underwent transoperative awakening during general anesthesia with enflurane.
Anecdotal situation has been reported on few occasions. We had a case where the spouse tried to assassinate his wife at the end of conscious sedation for rhytidectomy. He injected her with vecuronium, but the timely resuscitation initiated by the recovery area nurse and the clinical suspicion followed to the administration of neostigmine reversed the respiratory failure. The patient was transferred to intensive care unit where the husband made two failed attempts to reinject muscle relaxants.
Some surgical complications are listed because of their importance and relation to anesthesia.
Infections are frequent in plastic surgery, from 4% up to 14%, including local infections, blood-borne infections, and distal infections such as pneumonia or infective endocarditis. Breast surgery—implants or reconstructions—body contouring procedures such as liposuction and abdominoplasty, or multiple procedures have been described with more risks of postoperative infections, especially if there are predisposing factors such as diabetes, HIV, cancer, or immunosuppressive treatment. Infections in plastic surgery can be minor due to microbial skin flora to severe cases affected with atypical or multiresistant opportunistic bacteria [70, 71]. The type of infection varies depending on the surgery and the patient. Choice of antibiotics must be meticulous based initially on the clinical suspicion, escalating the antimicrobial when the bacterium is isolated, and its sensitivity is known. The most isolated germs in implant-based reconstruction infections are
Necrotizing fasciitis is a rare, potentially fatal, complication in plastic surgery that occurs more in liposuction. It requires extensive, repetitive debridement, and appropriate antimicrobial scheme. The most common germ is
These are uncommon complications, although it does occur in patients undergoing prolonged procedures, especially in the postbariatric ones. A hematoma is present in up to 6% of patients after breast surgery. Facial surgery is rare but compromises long-term results. Most patients are reluctant to hemotransfusion. It is possible to correct moderate anemia without hemodynamic compromise with iron, folic acid, and erythropoietin. Figure 4 shows typical cases of bleeding that may complicate the definitive outcome of surgery.
Transoperative active bleeding and residual postsurgical hematomas.
Nerve ending injuries are common in liposuction and abdominoplasty and manifest as neuropathic pain. Preventive use of gabapentinoids is useful. Major nerve damage can be seen in facial and breast surgery. Inappropriate scarring is an unpredictable risk and sometimes produces neural entrapment with secondary chronic postoperative pain.
Liposuction is one of the procedures that are performed more frequently, and its complications are minimal such as seromas, deformities, and lymphoedema. Serious complications are rare, for example, hematoma (0.15%), pulmonary complications (0.1%), infection (0.1%), and PE (0.06%). When it is combined with other procedures, complication rates are higher. It has also been associated with catastrophic lesions such as pleuropulmonary, abdominal viscera, and vascular damage [81, 82].
Soft tissue volumetric augmentation with filler injections is the second most frequent nonsurgical procedure performed in plastic surgery, being the face and buttocks the areas more frequently injected. The increased use of a wide range of fillers has shown that they are not harmless, so it is crucial to briefly review possible complications. The transfer of autologous fat in the facial regions is the most used filling substance. There are a great variety of synthetic fillers that can be atoxic and nonimmunogenic or act as a foreign body and induce an immune reaction, granulomas, infections, fibrosis, and long-lasting or permanent body deformities [83, 84, 85]. Although very rare, transient or permanent blindness and cerebrovascular emboli are the most devastating complication of forehead and facial injection of synthetic fillers or autologous fat. It is believed that the injected filling can act as a retrograde embolus upon entering the ophthalmic artery or through the normal anastomosis between frontal branch of superficial temporal artery from external carotid artery and supraorbital artery from ophthalmic artery [86]. Cannata et al. [87] described a patient who was injected with polymethylmethacrylate microspheres in the legs, soon after developed infection at the site of injection, followed by postinfectious glomerulonephritis. Kidney biopsy revealed translucent, nonbirefringent microspherical bodies compatible with the injected filler. Figure 5 shows facial deformations secondary to injection of unknown filler, and Figure 6 is an MRI that shows fillers injected in the buttocks, which produce fibrosis and deformations of the region by erratic migration, which are very difficult or impossible to correct.
Severe facial deformities secondary to an unknown illegal filler.
Deformities in the buttocks secondary to unknown substances. Observe extreme fibrosis.
Undoubtedly, the meticulous selection of each patient is the key to success in plastic surgery. When a patient does not have a physical and mental state required to undergo plastic surgery, the procedure should be deferred or canceled regardless of the interests of the patient and/or the medical group. When the complexity and risk of the procedure exceed the capacity of the surgical unit and/or the medical group, it is appropriate to refer the patient to a surgical unit or hospital with adequate resources [9, 86, 87, 88, 89]. No anesthesia procedure should be considered as a minor method, and it is always necessary to work in a safe and effective surgical facility, following established guidelines, and in permanent communication with surgeons and nurses.
A study conducted in Havana Cuba [90] with 26 patients from that country found that personality traits can determine poor choice of people who apply for cosmetic surgery, some with psychosis and dysmorphophobia that induce expectations higher than the real ones.
We live in a society of litigation where the doctors are easy prey to the ambition of the lawyers and some patients, a society where the governments create groups that exaggerate the rights of the patients making them believe that the improper results of the medical procedures are by negligence. There is a social environment—especially in government hospitals—where physicians are forced to work with multiple deficiencies as a routine practice, where health workers do not have adequate equipment and supplies, with long hours of work and few or no rights at all. There are few and inadequate preventive or curative programs [91]. The syndrome of professional exhaustion (burnout syndrome) has not been considered as a professional disease. To err is human and in this inadequate situation, it becomes a potential threat.
Anesthesiology is a science, with a high risk of undesirable events secondary to the use of drugs and techniques with narrow safety margins that facilitate unexpected complications. On the other hand, plastic surgery is a specialty where the unrealistic high expectations of many patients mean that despite adequate results—surgeons and anesthesiologists can trigger demands—when these results are not what the patient expects, and even when there are no complications. A growing number of patients establish negligence or malpractice claims—justified or not—and our practice tends toward an environment with a high incidence of litigation that sometimes forces specialists to search for geographic areas with a lower incidence of lawsuits [92]. Frequently, decisions of the legal system do not depend on the opinions of medical experts, or medical experts are not properly trained to review the events of a lawsuit in all specialties of medicine and surgery. Patients, their families, and lawyers usually make demands that do not progress due to lack of elements that support malpractice. An attorney should not file a lawsuit without the opinion of a physician skilled in the subject [93].
Park et al.’s [94] study of negligence claims in plastic surgery found responsibility between 30 and 100% of the cases, although the courts recognized that the economic compensation should be adjusted according to the victim, especially when there are associated pathologies which limit and make fairer compensation. Paik et al. [5] reviewed 292 cases of verdicts and liquidation reports in cosmetic breast surgery; the most common lesion was breast disfigurement in 53.1%, and negligent misrepresentation was 98% more likely to be resolved in favor of the complainant, while fraud was 92% more amenable to the complainant. The most common causes of citation were negligence in 88.7% and lack of informed consent in 43.8%. About 58.3% of the cases were in favor of the defendant and 41.7% in favor of the plaintiff. The compensation percentage agreed was 33.4 and 8.3% settlement. Payments ranged from $ 245,000 to $ 300,000 USD. A study with 88 cases of demand found in the west legal database [95] examined facial surgery procedures and found that 62.5% were decided in favor of the surgeon, 9.1% made agreements out of court, and 28.4% went to court for damages due to medical malpractice. The average payment was $ 577,437 USD, and the jury average was $ 352,341 USD, with blepharoplasty and rhytidectomy being the most litigated. In 38.6% of these cases, there were faults in the informed consent. There were also quarrels and disfigurements, functional considerations, and postoperative pain. The authors emphasize the importance of communication between patients and physicians regarding expectations as well as document benefits, alternatives, and specific risks. These studies show that negligence favors the demands in this clinical environment and emphasize that adequate transparency and communication are the key in the doctor-patient relationship, as mentioned in a previous publication [6].
Lawyers have promoted the lawsuit as a part of their modus vivendi. “Have you suffered as a result of a cosmetic procedure that you believe is due to the negligence of the surgeon? If you believe that your surgeon acted negligently and outside of his/her duty to care for you as a patient, we can help you.” This type of information is found on the Internet, and it is associated to websites that guide patients on how to formulate their demands. In Colombia, doctors have expressed their concerns about the rigidity of their penal system [96], which temporarily suspended a plastic surgeon, in addition to imposing a prison for less than a year and compensation to the patient for 150,000,000 Colombian pesos (approximately 52,290 USD) in a complicated liposuction with necrotizing fasciitis. The authors discuss different legal, ethical, and surgical, among other topics, and at the end, they argue the possibility to stop practicing surgery due to legal imputations every time a complication occurs. Although this would be an extreme measure, there are many colleagues who have retired after an incident. Well-qualified and experienced anesthesiologists and surgeons are not exempt from perioperative complications.
Perioperative complications of patients undergoing plastic surgery are infrequent when the medical group adheres to established guidelines and recommendations. Although these complications cannot be avoided at 100%, it is mandatory to establish preventive programs, and when these events happen, the diagnosis and timely management are imperative. Preanesthetic assessment is mandatory including meticulous search for risk factors; less than 10% of physicians working in the surgical room have disruptive behavior, and up to 98% of clinicians have observing troublesome conduct. It has been mentioned that this inappropriate behavior can facilitate complications. As in hospitals, ambulatory surgery units and all personnel must be properly certified and maintained on a permanent basis [97, 98].
We would like to thank the images of www.anestesia-dolor.org for allowing us to publish it.
None.
There is an emerging watershed moment that is set to challenge the relationship between dominant text-based instrumentalist imperatives of the last century and visual art and science education in transdisciplinary learning spaces. With the ideas of contemporary post-structural philosophers such as Deleuze and Guattari entering educational discourse, visual performative thinking and semiosis are forging a rethink about knowledge and communicative connections between disciplines [1]. As our artefactual world now centres on the image, what we come to know as experience and learning are being redefined by how we perceive, remember, and imagine the world as images and signs. Educators must now engage with the idea that visual reasoning, as performative action is now the connecting pedagogy in all epistemic fields with the capacities to visualise, transform, and communicate information.
The chapter argues that the concept of visual borderlands has the potential to unmake current constructs of both traditional art and science curriculum and their related pedagogies by exploring the liminal, embodied, and artified knowledge spaces emergent in their borderlands. This has significant resonance as neoliberal ideology, promotes certain student/teacher behaviours in the name of creativity [2], and has become intricately connected to making a scientific workforce and presenting a dogmatic image of thought about scientific knowledge [3]. This chapter seeks to loosen such ways of knowing in science education in the consideration of the role artification plays in contemporary science learning. I write this at a time when pedagogical rhetoric across secondary and higher education is shifting to a focus on the importance of transdisciplinary knowing yet remaining anchored in positivist text-based assessment and teacher-centred content. Ironically, policy and debate on pedagogical futures which speaks to student-centred inquiry and knowledge connections continue to have the side effect of the neglect of the arts generally, and specifically visual contemporary arts practice which accesses all signs and epistemological contributions as artified ways of knowing and being when inquiring and when communicating to audiences.
Current pedagogical challenges are heightened by everyday digital imaged technologies and their semiotic complexities. These imaged technologies provide agency and fluid learning opportunities for all youth. The next education frontier must look to the significance of the visual, its visual learning processes, and its semiotic contribution which grounds personal experience, aesthetic, affective, and performative learning. By drawing on the Deleuzoguattarian method as one of intuition, it is argued that visual boundary learning goes beyond the actual and our limited, or fixed forms of representing life, to recognising that we are always seeing [4] with affective and imaginative potential. Drawing on gifted secondary school visualisers enrolled in a commencing introductory first-year university fine art 2D course, it seeks to provoke accepted constructs of traditional visual art and its more contemporary contribution to learning. Within this course, students were asked to explore a scientific concept of choice and straddle subject borderlands. The inquiry examines the extent to which scientific and arts-based learning has the capacity to de-territorise knowledge. In so doing, it brings to the surface the concept of an artified pedagogical perspective. Artified learning is linked to adaption and aesthetics and, in the spirit of transdisciplinary learning, presents insights into new ways of seeing or imagining future pedagogical connections and possibilities.
There is a coalescing of current educational commentators critical of the current instrumentalist and positivist knowledge perspectives on pedagogical design which will have ripple effects on society into the future. Four key ideas are presented and will be foregrounded in this chapter: (i) scientific commentators who challenge the hegemonic dominance of the contemporary positivist idea of fixed scientific representations and teacher-centred pedagogies; (ii) the performative nature of learning which links percepts and affect, becoming and the multiple ways we make meaning; (iii) the digitisation of social media, dominated by the visual, its fluid processes, unstable meanings, and artful semiotic practices; and (iv) the concept of visual borderlands [1] at the heart of transdisciplinary learning where the learning is affectively driven, relational, and connected. A pedagogy offering imaging as a valued liminal space sees visual borderlands as being able to connect knowledge, identities and employ metaphor across epistemological boundaries for new understandings.
In the first watershed moment, a rupture now exists between our understanding of the need for transdisciplinary knowledge diversity and associated learning assets and a perceived excessive focus on dis-imagination in quest of vocational and science, technology, engineering, and mathematics (STEM) education [5, 6]. Commentators like Yong Zhao [7, 8] speak to the unintended side effects of such economic education policy narrowing society’s skills and talents/interests as non-STEM skills are undervalued. He argues against a focus that educates uselessness to one with a focus on creativity, resilience, and talent diversity. Zhao emphasises specifically the ways of knowing offered in the arts. Ways of knowing that refine interpersonal, intrapersonal ways of knowing, and their intrinsic, aesthetic, critical, and communicative skill sets are central to contemporary subject-objective reality. Lovat [9] further draws attention to the pedagogical challenges of dominant positivist/instrumentalist pedagogies and their learning limitations emphasising that knowledge is never generated in isolation but is dependent on how the learner effectively receives and understands the knowing. Indeed, there is resistance to the assumption that education is just about producing a scientific workforce. Commentators on art-science, creativity, process pedagogy, and learning continue to argue against the marginalisation of some students towards a consideration of the idea of ‘science-linked identities’ [10]. They argue for the removal of subject borders [11, 12]. Given the agency of digital culture, and the way young learners both effectively [13] and cognitively access visual reasoning visual representations are now considered a significant cognitive tool both effectively [13] and cognitively access visual reasoning is now considered a significant cognitive learning tool [14]. The siloed nature of the curriculum and the de-imagination of learning occurring in neoliberal education simply performs the task of using education to train workers for service sector jobs and to be cultural consumers with the rhetoric of being able to straddle the development of self-knowledge and citizenship.
The second current arises from a philosophical and research shift that acknowledges the performative nature of learning that links subjectivity and autopoiesis to machinic ecology [15, 16]. Deleuze and Guattari [17, 18] speak to subjectivities and the multiplicity of ways in which we continuously connect our past and present in future orientations. These ways of knowing are always shifting in a process of learning and becoming. They reference autopoiesis which presents sensemaking or meaning-making in nature as a living machine, continuously replaced in pursuit of a self-referentially organised ecology for adaption [19]. For Guattari [20] autopoiesis operates within a machinic ecology which is greater than our biological being. It is an ensemble of conditions or a machinic assemblage where all the components are relationally and transversely connected. A machinic ecology is defined by Guattari [20] in his book ‘The Three Ecologies’ which speaks to ‘a machinism that has technological, social, semiotic and axiological avatars’ (p. 34). Contemporary communication, education, and culture are also identified in this dynamic ecology and rest on a relational ontology [21, 22, 23] that has no clear boundaries. Furthermore, it has shifted the emphasis in which language and communicative action have typically played a central role towards a performative approach that holds that truths, realities, knowledges, relationships, literacies, agency, and identities as performed in and through material-discursive practices [24]. Milovanovic and Medic-Simic [25] extend these ideas drawing on self-organisation in complex systems physics in their study of neuroaesthetics and artmaking, stating that contemporary art practices, with their postmodern aesthetics, consolidate both art and science. Commentators on Deleuze and art research present contemporary art as a practice that dwells in the transcategorical and transdisciplinary, or liminal spaces between historical and contemporary representational practices [26].
Acceptance of the cognitive and affective work images as meaning-making tools do in both the arts and sciences is required if we are to extend our current limited ideas on transdisciplinary learning. Images are used for visual observation as perceptual and experiential knowledge bridges and include representations, both material and virtual. Both art and science carry multiple common semiotic structures, such as diagrammatical and metaphorical practices which Root-Bernstein et al. [27], sees extends the correlation of thinking skills across art and science.
Art and science have always been close. The images in show how visual representations, across art and science, are historically, relationally, and transversely connected and codependent on the sociocultural and technological skills of the day. Driven by new media and communication imperatives, the representations of knowledge are increasingly digitally enhanced and open to fluid interpretations and uses. Visual communicative competency as sociocultural learning is now an essential skill across all disciplines and significantly in science [28, 29]. Pauwels [30] commenced the discussion around the unstable or interpretive nature of visual scientific communication, the processes and methods by which they are produced, and how scientific images, through their repeated copying, have been normalised as fixed across learning and communication contexts. She draws attention to the inscription, transcription, invention, and fabrication of scientific images across algorithmic and non-algorithmic representation practices such as the use of the camera or X-ray and the role of scientific illustration ([29], p. 149). These ideas have more recently been extended beyond the science of communication to science communication where writers seek to address questions about ontology, such as what is real or true, and how scientific ways of knowing or epistemological points of view or lenses are used to initially capture reality, and then how they are used by social media or the wider society for the communication of ideas [31].
The materiality of things: Takes us beyond words (Grushka, 2019).
The third consideration informs the first two considerations and is driven by the benefits of artified digitisation. Communication and learning are increasingly propelled forward by the new image-based economy with new knowledge in the sciences and arts increasingly conscious of the flow of signs and images destabilising knowledge [32]. All images are now aesthetically curated and culturally situated within social media. Dominated by the visual and its semiotic complexity, we are all participants as actors, producers, and consumers of information [33]. Digital online photo-sharing and videoing acts now creatively and intuitively connect all experiences and representational knowledge from all discipline fields. These images effectively trigger and connect content and contexts to individual learners [34].
Science education has traditionally focused on conceptual or factual understandings when using visual representations and less on visual representations as epistemic objects for scientific identity [35]. There is a renewed focus on how visualisation contributes to knowledge formation in science from the learners’ perspective. It is acknowledged that epistemic representations as boundary objects are incomplete and precipitate an unfolding [36, 37]. Increasingly science educators seek to disrupt the currently accepted normalisation of scientific images as fixed truths or facts. Pauwels [29] asks the science educator or the observer to question what is revealed, obscured, included, or excluded, in these representations. She also asks that we pay attention to how scientific illustrators now readily adapt their images, reframe them for an increasingly wider audience, that of producers or consumers as represented in Figures 1 and 2.
Depictions of the COVID-19 virus.
Science educator-researchers have begun to respond to the shifting demands of new digital communicative and multimodal semiotic realities of the classroom learner. In doing so, they are identifying the limited visual literacy and visual communicative skills of their pre-service teachers [38]. Leßmöllmann and Gloning [39], arguing that there are indeed diverse communicative responses required when seeking to connect multiple relationships between scientific knowledge, audiences, and work. Scientific contemporary communication to the public can inform, influence, and even negotiate the science via new social media platforms. It is inevitable that the social and cultural realities of the world of work and the WWW will collide as the vast world of images and their performative and semiotic intersections cross all subject fields.
Transdisciplinary learning for knowledge production and as a communication enterprise is a process of semiosis. Semiosis is a sign or meaning-making process with a choice to select [40]. It is the continuous production, translation, and interpretation across all societies of everyday signs. Human communication thus engages in dynamic relations formed by the human mind and its cultural artefacts [41, 42]. Semiosis is presented as an assemblage or bricolage of different semiotic codes used to build communicative coherence in the contemporary learning culture. It is increasingly identified as affective as we invest in the world via our intentionality, habits, and prejudices [43].
Scientific representations have entered mainstream media with normalising social and cultural traction, such as the COVID-19 virus.
The media-driven scientific culture acknowledges that the algorithmic image of COVID-19 is aesthetically enhanced through artful acts. In Figure 2, the SARS-CoV2 image describes the antibodies and is enhanced as light blue. It also acknowledges it as an artist’s impression [44]. These images have intentional affective traction as contemporary scientific image makers use artful intuiting representations, such as colour to help in the communication of concepts, abstractions, aesthetic insights, and design orientations that seek to immediately bring forth ‘effects’ from the audience. These ‘effects’ can be passive or active and are dependent on an individual’s ‘seeing’ within their personal, social, and cultural context. This seeing is shaped in part by epistemic insights and multiple learning contexts [45]. Such a shift in thinking about the work of scientific images in learning and understanding their knowledge complexity, their performative nature, and interpretive possibilities, is currently a pedagogical challenge as re-imagining transdisciplinary pedagogies and its assessment continues to prove difficult [38].
The concept of artification, as adaption is an important concept when considering the rapid speed with which images are created, modified, and communicated. Artification, emerged from the work of Dissanayake [46] which was deeply grounded in evolutionary anthropology and psychology. It presents art as behaviour and its verb is to artify. It has been subsequently re-set or redefined in contemporary discourse as a sociocultural process located in time and space [47, 48]. The processes of artification, as defined by Shapiro, within a post-positivist paradigm, carries the attributes of meaning which may include displacement, renaming, the shifting of categories, organisational and institutional change, functional differentiation, redefining time, legal consolidation, patronage, aesthetic formalisation and intellectualisation ([48], p. 267). These processes are not the limit of possibilities and Saito [47] argues that artification must maintain a critical stance if it is to promote new ways of thinking and doing. Ways of thinking and doing that promote creativity, imagination, spontaneity, passion, and innovation towards a re-imagining of learning that can break away from the use of normalised images, goal-centred planning, and text-dominated assessment in curriculum.
The concept of visual borderlands is the fourth and final concept and is presented as a new way of thinking as experimenting about relational and connective concepts in transdisciplinary learning. This has been a key finding of the art-science research previously reported and extended in this chapter. The concept foregrounds the productive and performative role of imaged learning identified by the researchers. Visual borderlands in learning are the liminal spaces that are ever-present when students work with images to represent their knowledge. By their very nature, images dwell between the borderlines of art and science and carry a relational aesthetic. Visual borderlands are fluid spaces where the historical representation practices, all now virtually accessible, can hold past knowledge that can all co-exist with new imaging acts. To give meaning and form to emergent concepts, artists and scientists alike draw heavily on metaphor because metaphor can support this indeterminacy when confronting new ideas. It is in these visual borderlands that the generation and communication of ideas in transdisciplinary learning are shared between students and with teachers.
Indeed, visual borderlands extend the earlier sociocultural claims by Mirzoeff [49] that vision and visuality would shape how we choose to see ourselves and others in the production of subjectivity. Visual borderlands and the skill of visuality, or critical visual literacy, have now spilled over to an educators’ understanding of the way all young learners, ‘capture’ experiences, select images and concepts to be explored and communicated. These imaging acts are performative. In the processes of communicating their lives via mobile and digital devices they continuously engage in a process of image juxtaposition to explore ‘the existence of the encompassed possible’ ([50], p. 347). This student-centred learning is the core of visual art studio classrooms.
Visual borderlands identified in the research to date embed arts-based inquiry pedagogies with the affordances of a fusion of ideas and concepts from many knowledge areas, across the sciences, culture, and society. The skills developed in arts-based learning tolerate and are driven by the conceptual and visual communicative learning process. As identified, they operate at visual borderlands between arts and science, access other semiotic systems, and offer creative and personalised approaches to learning [51].
The ethics-approved longitudinal inquiry looked at the artmaking practices of gifted secondary school students between the ages of 15 and 17 years (n = 108). The students were selected to participate in a first-year 2-D fine art course at an Australian regional university. The course focuses on visual reasoning, arts-based inquiry as a research [52, 53, 54]. Students were selected across a range of regional secondary schools.
Year | Regional secondary schools | Participating students |
---|---|---|
2015 | 4 | 20 |
2016 | 6 | 23 |
2017 | 5 | 21 |
2018 | 6 | 22 |
2019 | 7 | 22 |
Students were given the opportunity to do an individual arts-based research project where they take a personal problem-centred approach to their inquiry. Broadly, this inquiry focuses on the transdisciplinary meaning-making processes of young visual art students and how they approach and explore a scientific concept or phenomenon of choice, through arts-based research. Students have been selected by their art teachers, interviewed, and subsequently invited to enrol in the university course while concurrently doing their school studies. Students keenly accepted the challenge of the additional workload because generally, they saw learning through imaging acts as a preferred way to learn. The inquiry into the art-science learning in the gifted education program has run at the university from 2015 to 2019. The students draw on their school-based science learning and personal scientific interests, but drive their inquiry through individual troubling about self, art, the world, and their own expressive meaning-making processes. This chapter draws on the work previously done on visual borderlands [1] and considers how performative artification operates in the works of two students, Charlotte and Aynsley. They are two of the gifted visualisers.
The inquiry
This section explores the intersections between the student artefacts from the arts-informed interpretive inquiry and embeds the concepts from the literature in seeking to extend the definition of visual borderlands as a liminal art-science transdisciplinary meaning-making space. This lens brings to bear the shifts in thinking about what constitutes a learner’s scientific identity amplifying the voices around the semiotic work that folds across learning assemblages in both visual education and science learning. The analysis looks at Aynsley and Charlotte’s personal inquiry into their selected scientific phenomenon. It considers their unique problem-centred learning processes identified in the artefact analysis. These artefacts provide glimpses into the students’ ideation and incorporeal thinking which Deleuze describes as the process which is indivisible, and ideation brings forth effects transferred into their artmaking. It will look at connections to past and present semiotic meanings with consideration of their future-oriented subjectivities at the boundaries between arts and science.
The work of Ansley connects us immediately to the world of entomology. A study of her final drawing below pulls an audience into considering the connections and relationships between humans and insects. Is the question she wishes the audience to ask or to consider, the evolutionary, ecological, and biodiversity issues that face humanity? Where does this question sit, in science or sociocultural inquiry? Will the evidence offer opportunities to consider what a contemporary learning culture of the science classroom might look like?
Aynsley’s artist statement below sees her dwell on issues of vulnerability for humanity, the world of living things, and the environment.
For Aynsley, there appears to be no separation between humanity and nature, no species hierarchy, all be this is not clearly articulated in her artist statement, but possibly implied by their juxtaposition. She states clearly that human and butterflies are equally vulnerable. Her intertwining of the butterfly and the human eye is bound by the aesthetic materiality and affective rendering of the wings and eye towards an aesthetic likeness, or possible oneness (Figure 3). The observer can see in her diary entries, displayed as an assemblage created by the researcher (Figure 4), that she follows some of the fundamental non-algorithmic scientific observational and experimental methods, such as species identification and classification of insects called lepidoptera, butterflies and moths and drawing as illustration. The processes of artification displayed could be seen as a re-classification, or shifting of classification [48] as she experiments and adapts her drawings. She does demonstrate a strong perceptual bias towards established historical drawing techniques and formal design attributes in her representation of the butterfly and the eye, but it is accompanied by a process of visual editing and manipulation as she worked towards her goal ‘to express the unique nature and vulnerability of each and everyone of us’.
Aynsley artwork, butterfly eyes (2017), drawing.
Visual process learning An assemblage.
Her artified behaviours find her commencing her inquiry with a real photographic representation of the butterfly (a) she has selected to draw (b). Page 2 of Figure 4 sees her create a descriptive illustration of the species following the formal humanist art traditions and using the scientific process of labelling or categorising. However, there is an emergent new space, a liminal space where there is the possibility of a re-classification as seen in the image on the right (c) of Figure 4 or a re-grounding of her subjectivity [57]. Aynsley speaks to the possible interpretive lenses of the viewers, some seeing an insect, others seeing a human. Aynsley, however, has created a new resemblance of difference, a possible de-centering of the traditional humanist-centred world. It speaks to a new generation of youth who are aware of the planet and species vulnerabilities and as such Aynsley’s transdisciplinary study may speak to the ‘disidentification from established patterns of thought (which) is crucial for an ethics and politics of inquiry that demands respect for the complexities of the real-life world we are living in’ ([57], p. 16).
Charlotte, like Aynsley, embeds artified visual representation behaviours that could be seen as informed by both algorithmic representations, brain scans, and mixed media conceptualisations in her installation. Reading from left to right of her installation in Figure 5 we see the set of three painted artworks that illustrate stages of imbalance or disease states in the human brain. The inquiry is related to psychological and emotional well-being from a healthy brain towards a brain in an imbalance, the result of neglect. In front of her paintings are three plinths with a plant pot on top. Each pot carries a resemblance of brain neglect through the analogy of plant growth. Charlotte literally speaks to her performance of neglect in her artist statement.
Memory, Cortical, Brain. Art installation comprising three mixed media ink and printed drawings accompanied by three plants in pots (Charlotte, 2017).
In Figure 6, two pages from Charlotte’s visual diary are displayed. She draws heavily from the scientific epistemic insights and the comparative study of each brain state.
Visual process learning diary page entries.
It contains a strong observational focus with an effective and personalised perspective as she considers the implications of neglect on the individual and society. In addition, you can see her actively bringing together scientific emergent evidence, concepts, and visual communicative ideas. At the interview Charlotte revealed that loved ones surrounding her worked as mental health professionals, so she was both aware of mental health issues and the social consequences of neglect.
Being a critical self-reflective visual art student requires that one writes about one’s artmaking in process, critically reflects on both one’s intentionality and the emergent artwork. This is a continuous process as concepts emerge in progress and must be constantly re-assessed for their potential interpretive outcomes such as those formulated in an artist statement that is specifically for an audience. In the fine art course studied by both Aynsley and Charlotte these material artefacts are measures of the summative assessment course components. So, it was gratifying to be able to see audience statements that confirmed the scientific, social, conceptual, and communicative goals of Charlotte:
Making artworks, describing processes and practices, engaging in critical self-reflective acts through performative subject/object engagements are core in visual art education pedagogies.
There are similarities and differences between both Aynsley and Charlotte’s artworks. Both appear to have started from the position of a school taught deductive scientific investigative approach, gathering facts and visual evidence surrounding their inquiry towards a reasoned and logical conclusion. In Charlotte’s research, she goes directly to algorithmic digital evidence and uses accessible scans of the brain as her starting point as she seeks evidence of brain deterioration related to psychological states in humans. Of course, there are limitations or conditions to the validity of her accessed images [60], given that they may have already gone through an artification process prior to accessibility via the web. However, the images are sufficient to allow Charlotte to commence her thinking as an experiment. Aynsley commences her investigation through the processes of image development and refinement in line with non-algorithmic methods, such as scientific illustration. Aynsley performs her own perceptual and sensory artification when drawing her butterfly. From the outset, her research is a process of knowing-in-being [24]. Both the investigative processual approaches of Charlotte and Aynsley bring into play the need to understand that a more nuanced conceptualisation and empirical operationalisation of materiality in communication, learning, and education needs to be considered.
This section is a discussion about the students learning gathered from 2015 to 2019. All student learning was seen to embody a crossing of the borders between their scientific and artful inquiry lenses. Their artworks can be described as, being visual borderlands, occupied by signs from across our socio-semiotic world. In these spaces, the signs from different epistemologies intersect or intertwine as the students make links from their different lifeworlds. From informal learning to their school formal learning, they draw on personal experiences and the vast world of digital media. This has been a key finding of the longitudinal inquiry and audience responses to each exhibition, all spoke to being able to see both art and science learning. In this chapter, one of the key research findings is that artified visual pedagogies can both transverse and/or facilitate meaning-making across art-science spaces. Visual borderlands are the spaces occupied by the adaptive process of artification. Artification enables the students to embed the traditional humanist world of perception, observation, and illustration with the contemporary algorithmic world of curated digital scientific images. Both can be combined via different pedagogical practices from different subject fields, and as they combine, new ways of thinking and doing emerge to answer real-world inquiry questions.
These key findings are exemplified through the artefactual evidence of both Aynsley and Charlotte. It presents the concept of transdisciplinary visual borderlands learning, and it is argued that the examples presented in this chapter are evidence of how artification processes fit within a transdisciplinary learning construct. A construct where students apply two or more knowledge and skill areas to support their inquiry. The learning experiences have been interpreted by the researcher as being spaces that extend the experience to an encounter with being as becoming, to self as ‘different social formations through very different assemblages, both artistic and scientific. This can be understood as knowing-in-being when learning in a transdisciplinary space. All learning carries transformational potential that is deeply embedded in the personal and ‘consists in genuine learning from signs in the folding experience’ ([61], p. 116). It entails folding acts that for Aynsley commence from the inside as embodied or dependent of percepts and affects [17] which are then folded with scientific understandings from the outside. Charlotte commenced from events in the personal, but her learning as an experiment commenced through the gathering of outward or scientific evidence which she subsequently folded on the inside in the formation of her own concepts grounded in her unique lifeworld experiences. The learning journeys of both are made up of expressive and shifting knowledge relationships. It is possible to see how both Charlotte and Aynsley take on ideas about the world and humanity and fold them deeply into their own sense of self; beyond being a visual art student to the consideration of a science-linked identity [10].
The learning artefacts of Aynsley and Charlotte are entwined with both traditional dichotomies of art/science, nature/culture, natural/artificial, incorporeality/materiality, subjectivity/objectivity, sense/effect, or body/thought and all collide in the performing of their unique learning. Importantly, all of these dichotomies can potentially disassemble and realign, as they intersect and intertwine as a new learning assemblage. Within an arts-based research paradigm, Aynsley and Charlotte were permitted to re-imagine how to learn, to de-territorise the art-science dichotomy. It is not as a crossing over from art to science or vice versa, but an opening up of liminal border assemblages full of possibilities. Indeed, no science was taught at all by the fine art lecturer with an assessment brief to consider only the development of visual artmaking skills and the clarity of the student conceptual visual communication. This left any scientific inquiry to be driven by the student’s past learning about reasoning in and through scientific imaging acts and they were free to imagine any assemblage of a combination of sign systems that best communicated their learning and ideas to an audience. Indeed, some students who had traditionally rejected the sciences were surprised by how much science they had actually learnt.
Beyond the key finding, that contemporary transdisciplinary art-science learning occurs at visual borderlands that facilitate the adaptive process of artification was the identification within the research that:
Science communication is now a significant field of research for science educators and that the artistic visual skills it embeds need to be considered by teachers when requiring students to represent their learning in the digital age.
Ways of knowing in science education must address the communicative goals of scientific images and teach students that all images are created for a particular audience. In so doing they teach students that the world of scientific images is indeed open to interpretation.
Learning emergent in visual borderlands is made up of different assemblages with a range of concepts and forms, dependent on the life world and perceptual focus of the student. The world of signs occupies these spaces and all images within this space are fluid. Each observer (student or teacher) will find new and unique connections or interpretations when they encounter the signs generated in learning.
Artification occurs in-knowledge generation and transversely operates across the visual borderlands of transdisciplinary knowledge. This is true for both visual sociocultural communication as it is for scientific communication.
Transdisciplinary learning is a place where the semiotic and cognitive work of image construction is now centred. Transdisciplinary learning disassembles epistemic boundaries or de-territorises knowledge and allows the imagination to enter all reasoning as science education is increasingly transformed by artified scientific media communication. This argument does not diminish the significant fundamental knowledge learnt within visual art education. Visual art education is a unique form of material knowing and communication. Its contemporary pedagogies reside within a post-structural understanding of knowledge construction offering insights into how the imagination and material knowing are active in personal meaning-making.
Science educators must now engage with the idea that visual reasoning as performative action is now the connecting pedagogy in all epistemic fields. The phenomena of fluid and online visual media communicative practices in youth today should be triggering for educationalists in these COVID times that the new consumption rituals for learning are being re-shaped by multiple manipulations and applications of imaged technologies. The visual habits of knowledge acquisition and production for concepts and communication increasingly contain unique perceptions, affectively, aesthetically, and spontaneously communicated as imaging actions. Art is now being presented as not subject to epistemological boundaries but requiring an expanded ontology [25]. The challenge that now faces teachers wishing to pursue transdisciplinary learning in their schools is that the world of assessment still essentially resides in an outcomes-driven curriculum, which embeds goal-centred planning, normalized images, and text-dominated assessment in the curriculum. This is a focus of future research with teachers.
This chapter argues that visual reasoning (both material and digital) as performative action is now the connecting pedagogy in all epistemic fields. Its artified visual pedagogies can both transverse and/or facilitate meaning-making across art-science visual material and media borderlands in the creation of transdisciplinary ‘science-linked identities’ [10]. Science educators must now engage with the idea that current education dogma and policy gives significant value to vocational and science, technology, engineering, and mathematics (STEM) education over the significant contribution of the arts and all their expressive and communicative forms. Its policy rhetoric speaks to creativity and transdisciplinary futures without acknowledging the non-linear, non-hierarchical, unstable, shifting, and mobile ways knowledge emerges today within both contemporary visual communication and science education.
There is a new science communication project being driven out by a recognition of the multiple lenses through which scientific images are created, interpreted, and communicated across expanding audiences and into popular digital media. Science learning requires a shift away from the objectivist learning position to a space that reconnects the world of signs beyond disciplinary boundaries [61]. This is also true of discipline boundaries within science education. It is images that infiltrate all epistemic fields of knowledge, and the work of images is capable of making the connections across and towards new knowledge constructs. The art-science inquiry on how gifted visualisers encountered and communicated their learning cross semiotic epistemological boundaries in this chapter demonstrates student capacities to use the world of images and be imaginative knowledge generators. Awareness of the complexity of images and their role in learning, assessment, and communication in science now speaks to the skill of visual performative competency where students are scientific, critical, and imaginative thinkers and communicators.
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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The sources related to thyroid surgery show that the success of the neck masses with the surgical intervention was limited until the second half of the nineteenth century. Among the names leading the development of thyroid surgery in contemporary times are Emil Theodor Kocher, Theodor Billroth, William James Mayo, and William Stewart Halsted. 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Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. 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He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. 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His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:58,paginationItems:[{id:"81961",title:"Antioxidants as an Adjuncts to Periodontal Therapy",doi:"10.5772/intechopen.105016",signatures:"Sura Dakhil Jassim and Ali Abbas Abdulkareem",slug:"antioxidants-as-an-adjuncts-to-periodontal-therapy",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}},{id:"82357",title:"Caries Management Aided by Fluorescence-Based Devices",doi:"10.5772/intechopen.105567",signatures:"Atena Galuscan, Daniela Jumanca and Aurora Doris Fratila",slug:"caries-management-aided-by-fluorescence-based-devices",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Caries - The Selection of Restoration Methods and Restorative Materials",coverURL:"https://cdn.intechopen.com/books/images_new/11565.jpg",subseries:{id:"1",title:"Oral Health"}}},{id:"81894",title:"Diet and Nutrition and Their Relationship with Early Childhood Dental Caries",doi:"10.5772/intechopen.105123",signatures:"Luanna Gonçalves Ferreira, Giuliana de Campos Chaves Lamarque and Francisco Wanderley Garcia Paula-Silva",slug:"diet-and-nutrition-and-their-relationship-with-early-childhood-dental-caries",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Caries - The Selection of Restoration Methods and Restorative Materials",coverURL:"https://cdn.intechopen.com/books/images_new/11565.jpg",subseries:{id:"1",title:"Oral Health"}}},{id:"81595",title:"Prosthetic Concepts in Dental Implantology",doi:"10.5772/intechopen.104725",signatures:"Ivica Pelivan",slug:"prosthetic-concepts-in-dental-implantology",totalDownloads:27,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}}]},overviewPagePublishedBooks:{paginationCount:8,paginationItems:[{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}]},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. 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His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. 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Voyich",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Montana State University",country:{name:"United States of America"}}},{id:"330412",title:"Dr.",name:"Muhammad",middleName:null,surname:"Farhab",slug:"muhammad-farhab",fullName:"Muhammad Farhab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"349495",title:"Dr.",name:"Muhammad",middleName:null,surname:"Ijaz",slug:"muhammad-ijaz",fullName:"Muhammad Ijaz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}}]}},subseries:{item:{id:"95",type:"subseries",title:"Urban Planning and Environmental Management",keywords:"Circular economy, Contingency planning and response to disasters, Ecosystem services, Integrated urban water management, Nature-based solutions, Sustainable urban development, Urban green spaces",scope:"