\r\n\t(i) Quantum dots of very high-quality optical applications, Quantum dot light-emitting diodes (QD-LED) and ‘QD-White LED’, Quantum dot photodetectors (QDPs), Quantum dot solar cells (Photovoltaics).
\r\n\r\n\t(ii) Quantum Computing (quantum bits or ‘qubits’), (vii) The Future of Quantum Dots (broad range of real-time applications, magnetic quantum dots & graphene quantum dots), Superconducting Loop, Quantum Entanglement, Quantum Fingerprints.
\r\n\r\n\t(iii) Biomedical and Environmental Applications (to study intracellular processes, tumor targeting, in vivo observation of cell trafficking, diagnostics and cellular imaging at high resolutions), Bioconjugation, Cell Imaging, Photoelectrochemical Immunosensor, Membranes and Bacterial Cells, Resonance Energy-Transfer Processes, Evaluation of Drinking Water Quality, Water and Wastewater Treatment, Pollutant Control.
",isbn:"978-1-80356-594-1",printIsbn:"978-1-80356-593-4",pdfIsbn:"978-1-80356-595-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"0dd5611c62c91569bd2819e68852002a",bookSignature:"Prof. Jagannathan Thirumalai",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11756.jpg",keywords:"LED, Organic LEDs, Dyes & Pigments, Solar Cells, Laser Photonics, Electronic Switching Devices, Qubits, Josephson Junction, Bioconjugation, Cell Imaging, Photoelectrochemical Immunosensor, Membranes, and Bacterial Cells",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 16th 2022",dateEndSecondStepPublish:"May 27th 2022",dateEndThirdStepPublish:"July 26th 2022",dateEndFourthStepPublish:"October 14th 2022",dateEndFifthStepPublish:"December 13th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"3 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. J. Thirumalai received his Ph.D. from Alagappa University, Karaikudi, He was also awarded the Post-doctoral Fellowship from Pohang University of Science and Technology (POSTECH), the Republic of Korea. His research interests focus on luminescence, self-assembled nanomaterials, and thin-film optoelectronic devices. He has published more than 60 SCOPUS/ISI indexed papers and 11 book chapters, edited 4 books, and member of several national and international societies like RSC, OSA, etc. His h-index is 19.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"99242",title:"Prof.",name:"Jagannathan",middleName:null,surname:"Thirumalai",slug:"jagannathan-thirumalai",fullName:"Jagannathan Thirumalai",profilePictureURL:"https://mts.intechopen.com/storage/users/99242/images/system/99242.png",biography:"Dr. J. Thirumalai received his Ph.D. from Alagappa University, Karaikudi in 2010. He was also awarded the Post-doctoral Fellowship from Pohang University of Science and Technology (POSTECH), Republic of Korea, in 2013. He worked as Assistant Professor of Physics, B.S. Abdur Rahman University, Chennai, India (2011 to 2016). Currently, he is working as Senior Assistant Professor of Physics, Srinivasa Ramanujan Centre, SASTRA Deemed University, Kumbakonam (T.N.), India. His research interests focus on luminescence, self-assembled nanomaterials, and thin film opto-electronic devices. He has published more than 60 SCOPUS/ISI indexed papers and 11 book chapters, edited 4 books and member in several national and international societies like RSC, OSA, etc. Currently, he served as a principal investigator for a funded project towards the application of luminescence based thin film opto-electronic devices, funded by the Science and Engineering Research Board (SERB), India. As an expert in opto-electronics and nanotechnology area, he has been invited as external and internal examiners to MSc and PhD theses, invited to give talk in some forum, review papers for international and national journals.",institutionString:"SASTRA University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"10",totalChapterViews:"0",totalEditedBooks:"6",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"17",title:"Nanotechnology and Nanomaterials",slug:"nanotechnology-and-nanomaterials"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"347258",firstName:"Marica",lastName:"Novakovic",middleName:null,title:"Ms.",imageUrl:"//cdnintech.com/web/frontend/www/assets/author.svg",email:"marica@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"5348",title:"Luminescence",subtitle:"An 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Gomes and Marisa P. Sarria",coverURL:"https://cdn.intechopen.com/books/images_new/5884.jpg",editedByType:"Edited by",editors:[{id:"146466",title:"Prof.",name:"Andreia",surname:"Ferreira de Castro Gomes",slug:"andreia-ferreira-de-castro-gomes",fullName:"Andreia Ferreira de Castro Gomes"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7325",title:"Nanostructures in Energy Generation, Transmission and Storage",subtitle:null,isOpenForSubmission:!1,hash:"8e49924dd2c3e28c82fdc115ce04f925",slug:"nanostructures-in-energy-generation-transmission-and-storage",bookSignature:"Yanina Fedorenko",coverURL:"https://cdn.intechopen.com/books/images_new/7325.jpg",editedByType:"Edited by",editors:[{id:"199149",title:"Dr.",name:"Yanina",surname:"Fedorenko",slug:"yanina-fedorenko",fullName:"Yanina Fedorenko"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9322",title:"Hybrid Nanomaterials",subtitle:"Flexible Electronics Materials",isOpenForSubmission:!1,hash:"beff6cce44f54582ee8a828759d24f19",slug:"hybrid-nanomaterials-flexible-electronics-materials",bookSignature:"Rafael Vargas-Bernal, Peng He and Shuye Zhang",coverURL:"https://cdn.intechopen.com/books/images_new/9322.jpg",editedByType:"Edited by",editors:[{id:"182114",title:"D.Sc.",name:"Rafael",surname:"Vargas-Bernal",slug:"rafael-vargas-bernal",fullName:"Rafael Vargas-Bernal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9230",title:"Smart Nanosystems for Biomedicine, Optoelectronics and Catalysis",subtitle:null,isOpenForSubmission:!1,hash:"1d1af591d87490c9ad728a1352e62d96",slug:"smart-nanosystems-for-biomedicine-optoelectronics-and-catalysis",bookSignature:"Tatyana Shabatina and Vladimir Bochenkov",coverURL:"https://cdn.intechopen.com/books/images_new/9230.jpg",editedByType:"Edited by",editors:[{id:"237988",title:"Prof.",name:"Tatyana",surname:"Shabatina",slug:"tatyana-shabatina",fullName:"Tatyana Shabatina"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"78267",title:"Guarding the Gait: Evaluating Forensic Gait Analysis Evidence",doi:"10.5772/intechopen.99491",slug:"guarding-the-gait-evaluating-forensic-gait-analysis-evidence",body:'Forensic gait analysis is one of a number of novel areas of scientific evidence that have troubled the courts in recent years and led to conflicting curial decisions in relation to admissibility and probative value. In this regard it takes its place alongside facial mapping and body mapping evidence, psychological autopsy evidence, polygraph evidence, lip-reading evidence and ear print comparison evidence [1] as a form of evidence that carries the potential to appear to be more scientifically reliable than it is and therefore which carries a risk of misevaluation if not critically scrutinised. Such evidence is particularly problematic in criminal trials when verdicts are determined by lay jurors. This is because of the danger that decision-makers will invest overmuch trust in evidence that appears to be scientifically rigorous when it may not be [2].
Forensic gait analysis functions as an example of a dangerous category of apparently scientific evidence that is beguilingly probative but which has the potential to lead to miscarriages of justice. It challenges decision-making by courts and attempts by law reformers to formulate criteria for determining admissibility or at least indicia for safeguards so that misimpressions are not given about evidentiary reliability which may lead to miscarriages of justice. Further, it raises questions about those who are prepared to hold themselves out as forensic experts in the area.
This chapter reviews the current status of knowledge about forensic gait analysis. It identifies significant judicial decisions about the area and it reflects on measures that need to be adopted to minimise the risks that inappropriate reliance will be placed upon problematic application of this form of evidence in criminal trials before it is developed further and acquires the attributes of scientific reliability.
Gait is the way in which a person takes steps when walking or running. It consists of a series of largely repetitive, cyclical movements that are generally symmetrical. It can be observed at a distance, without the knowledge of a person of interest and cannot easily be concealed or dissimulated. Gait analysis has been defined as ‘the systematic study of human walking, using the eye and brain of experienced observers, augmented by instrumentation for measuring body movements, body mechanics, and the activity of the muscles’ [3, 4, 5]. It can be undertaken by observations that a person is bow-legged or has knock-knees or a has a foot that points in or out. It can include consideration of the joints and segments of various parts of the body, including the hips. A variety of tools can be employed to enable calculation of lengths or angles.
Forensic gait analysis is the analysis of the style or manner in which a person walks, as applied to legal issues, including in the context of criminal trials. It has emerged as an important aspect of forensic podiatry, which has been defined as ‘the application of sound and researched podiatric knowledge and experience in forensic investigations to show the association of an individual with a scene of crime, or to answer any other legal question concerned with the foot or footwear that requires knowledge of the functioning foot’ [6, 7, 8]. The area of forensic gait analysis is an evolving and controversial area of scientific controversy [5, 9, 10, 11, 12] that generally involves the use of closed circuit television (‘CCTV’) footage that can be of variable quality in which a comparison is made of a criminal perpetrator’s gait with that of the accused. A number of judicial decisions on the issue of admissibility have been handed down, including on appeal in Canada (
In
The first expert was Hayden Kelly who held a degree in podiatric medicine and had been practising since 1987 in the United Kingdom. He had seen approximately 38,000 patients. In 2002 he became a podiatric surgeon. From 2006 to the time of the trial in 2008 he had been a researcher in forensic gait analysis identification at Barts College, which is part of the University of London. He had been consulted in approximately 150 legal cases and written over 50 expert opinions. He had testified in the English criminal courts over twenty times.
The second expert was Dr. Vernon Brugge who held a doctorate in biology and was held out by the prosecution as an expert in examining photographic evidence. He joined the Federal Bureau of Investigation as a forensic scientist who examined photographic evidence in the technological digital evidence laboratory in Virginia. He had given expert evidence in forensic image analysis, including photographic comparisons, photogrammetry, image and video authentication on some two dozen occasions. He had performed facial and clothing comparisons hundreds to thousands of times. Dr. Brugge’s evidence included photogrammetric evidence and facial and clothing comparisons. In his work undertaking photographic comparison, Dr. Brugge compared features on an object or person depicted in a questioned image with a known image to identify or exclude from similarity, utilising ‘class characteristics’ -those that are common to a group or class of people - and ‘individual characteristics’ identifying characteristics that separate someone from the class.
Mr. Kelly described his forensic gait analysis procedure as having three steps:
He views video footage (or stills) of an individual to determine:
If the quality of the film is sufficiently clear, and
If there is a particularly distinctive gait or feature of gait shown.
If he finds distinctive features, then he views other footage of an individual(s) to see if the same features or gait exist;
Following that, the analysis is performed on a control, which is footage of a known individual(s) ([13] at [10]).
His view was that the person of interest, the shooter, and the accused shared a “very strong likeness” in that they all had ‘very abducted left and right feet and an everted left foot’ ([13] at [13]). He expressed the view that he ‘would not expect to see this in more than one percent of the population. He did not observe anything in the material with which he was provided that suggested that the accused could not have been the person of interest or the shooter depicted in the videos ([13] at [13]). Thus his testimony amounted to identification of points of similarity and no points of dissimilarity.
Dr. Brugge used Photoshop techniques and a power point program to enhance and overlay known images on enhanced questioned images to detect similarities and differences. He compared still photographs from the video outside the Chelsea apartment where the murder took place with photographs of the accused. His evidence was he could not identify the accused as the person of interest or the shooter, but he could not exclude him either. Dr. Brugge could find no ‘individualizers’, such as scars, marks, moles, etc., that could lead to positive identification or exclusion of any of the individuals depicted in the photographs. Similarly, the clothing worn by the person of interest or the shooter bore no individual identifiers such as rips, tears or stains. The defence accepted that Dr. Brugge could testify as to how the video and video stills were processed to improve details by adjusting brightness and contrast and image enhancement but not the photographic comparisons.
Justice Satanove applied the Canadian tests in relation to expert evidence admissibility set out by the Supreme Court in
Relevance;
Necessity in assisting the trier of fact;
The absence of any exclusionary rule; and.
A properly qualified expert.
She found the evidence of Mr. Kelly to have ‘high probative value’ in that it tended to establish a fact in issue, the identity of the killer ([13] at [19]). However, she concluded that Dr. Brugge’s evidence was not admissible although she permitted his evidence on the technological enhancements he made to the videos and stills that were shown to the jury.
Justice Satanove accepted that: ‘Evidence that is otherwise logically relevant may be excluded if its probative value is overborne by its prejudicial effect; if it involves an inordinate amount of time that is not commensurate with its value; or if it is misleading in the sense that its effect on the trier of facts, particularly a jury, is out of proportion to its reliability. There is a danger that expert evidence will be misused and will distort the fact-finding process. Dressed up in scientific language that the jury does not easily understand, and submitted through a witness of impressive credentials, the evidence may lie be accepted by the jury as being virtually infallible and, thus, given more weight than it deserves’ ([13] at [19]). She observed that the potentially prejudicial effect of the experts’ evidence may in their impressive credentials and their aura of infallibility ([13] at [19]).
Tellingly, she noted that Mr. Kelly drew a conclusion as to the degree of prevalence of gait characteristics in the general population ‘that appears significant, yet lacks a scientific basis’ ([13] at [23]). To address this risk, she allowed Mr. Kelly’s evidence but not his opinion about the extent of abduction and eversion in the general population. However, Justice Satanove was not satisfied that Dr. Brugge’s evidence was ‘necessary’, as that term is understood under Canadian law, namely that such evidence is outside the experience and knowledge of a judge or jury. She accepted that it may be ‘“helpful” as an experienced person’s observation of facial features and clothing, but the jury will be able to form their own conclusions without this help. In my opinion, Dr. Vorder Brugge’s comparison evidence does not offer any information outside of the purview of the ordinary jury, and therefore does not meet the test of necessity’ ([13] at [24]).
She was not satisfied that the evidence of Mr. Kelly constituted “novel science”: “podiatry has been in existence for a thousand years and the expertise of a podiatrist to analyze an individual’s gait has long been accepted and practiced in a clinical setting. After carefully viewing the video frame by frame, many, many times, with his trained and practiced eye, he is able to point out fairly unique characteristics of the gait and stance of the individuals depicted in the video. The features are akin to individual identifiers to some extent. I do not think there is a danger of the jury being mesmerized by what is quite simply an exercise of expertise in observation and diagnosis” ([13] at [34]). The result was that Justice Satanove admitted the gait analysis evidence of Mr. Kelly, save the part which referred to a mathematically expressed degree of prevalence but excluded the evidence of Dr. Brugge insofar as it related to technological enhancements he made to videos and stills, but excluded his comparison evidence.
Cunliffe and Edmond [10] have criticised the ruling by Justice Satanove as an ‘admissibility compromise. However, on appeal (
the proposed opinion must relate to a subject matter that is properly the subject of expert opinion evidence;
the witness must be qualified to give the opinion;
the proposed opinion must not run afoul of any exclusionary rule apart entirely from the expert opinion rule; and
the proposed opinion must be logically relevant to a material issue.
The Court of Appeal agreed with Justice Satanove that the evidence of Mr. Kelly was not ‘novel’ for the purposes of the
In important respects, the most contentious aspect of the Court of Appeal’s judgement was its endorsement in the context of forensic gait analysis ([14] at [85]) of the comments of Justice of Appeal Doherty in
... I doubt that the jury would have difficulty critically evaluating [the expert’s] opinion. There was nothing complex or obscure about his methodology, the material he relied on in forming his opinion or the language in which he framed and explained his opinion. As when measuring the benefits flowing from the admission of expert evidence, the trial judge as “gatekeeper” must go beyond truisms about the risks inherent in expert evidence and come to grips with those risks as they apply to the particular circumstances of the individual case.
The Court of Appeal found no error in the evidence of Mr. Kelly being placed before the jury to provide assistance in their evaluation of the images so that the jurors might utilise the knowledge acquired by Mr. Kelly through his training and experience in arriving at their own conclusions regarding the identity of the shooter ([14] at [86]). The Court of Appeal reviewed English decisions on the issue, including that of
While Cunliffe and Edmond [10] have been critical of the latitude extended by the trial and appellate decisions as to the admissibility of forensic gait analysis in the
Although gait analysis evidence was permitted in the 1839 case of
In
The witness who gave the gait analysis evidence was a Mr. David Blake, who described himself as a ‘podiatrist and specialist in lower limb gait, pathomechanics and biomechanics’ ([6] at [10]). He said that he routinely used video camera equipment to analyse gait clinically to assess and diagnose anatomical and skeletal conditions. He described the practice of gait analysis ([6] at [10]) as follows:
Gait analysis is the examination of walking or running. The gait, or walking cycle, skeletal movement in general can have recognised anatomical movements or reference points during a walking cycle. Biomechanics is the examination and analysis of body movement. Specifically in this case to humans the skeleton can at times give an anatomical signature that if not unique, can be a relatively rare anatomical position or movement to a few individuals. A person’s walking cycle or his skeletal anatomy is difficult to hide as it is part of their body’s anatomy. The science of gait analysis was introduced into the UK and the profession of podiatry in the early 1970s. The gait cycle can be broken down into factors such as the position of feet and other parts of the lower limb. Thus features of gait can be identified and sometimes quantified. Podiatrists use gait analysis virtually every day in their practice. Recently that science has been applied forensically. The Council for the Registration of Forensic Practitioners recognises gait analysis and footprint identification as important components in identification of individuals. A podiatric section has recently been set up … some clinicians may suggest that certain key elements of gait cycle or biomechanical (body) position and movement can leave a unique signature confirming that an individual in comparison is one of the same …
Mr. Blake stated that he saw approximately 2,000 patients per year in his practice as a podiatrist and that it was highly unusual to see a skeletal structure that has a linear spine without some scoliosis or lordosis, namely one form or another of curvature. He concluded that Otway, in common with the driver of a motor vehicle observed on CCTV, had an unusually erect posture. Mr. Blake estimated that only in about 7% of his practice population did he find ‘the slight neck flexion or head poke where the head is projected excessively forward’ which he observed in the recordings of the offender and of Otway.
At trial it was argued for the defence that the analysis offered by Mr. Blake could be undertaken by the jurors themselves unassisted by expert evidence ([6] at [11]) and that there was no statistical database against which the jury could judge the significance of his evidence. In addition, it was contended that there was no scientific basis, and no measurement, to support Mr. Blake’s methodology. The trial judge ruled that Mr. Blake should be permitted to give evidence in which he identified the similarities between the walking gait of the appellant and the walking gait of the suspect. It was for the jurors to assess that evidence having viewed the recorded material for themselves. Mr. Blake, however, was not permitted to give evidence relating to the facial features of the appellant or the suspect, and was not permitted to evaluate his comparison of walking gait by reference to the chance that the driver of the motor vehicle at the petrol filling station was someone other than the appellant.
The Court of Appeal received evidence from a professor who was an expert in biology and genetics and who argued that there was an absence of evidence about whether the technique employed by Mr. Blake had been tested in field conditions, subjected to peer review and publication or known rate of error, or subjected to verifiable standards. The Court of Appeal observed that the professor was not a podiatrist and not in a position to express an opinion as to whether Mr. Blake had the expertise which he purported to employ in his analysis. It observed too that in
Nevertheless the evidence of evaluation, founded upon and explained to be the consequence of personal experience, was properly admitted. The proposition that evidence of a comparison cannot be admitted if its evaluation is expressed in terms subjective experience is simply wrong in law (at [20]).
The Court of Appeal applied the reasoning in
An expert who spends years studying this kind of comparison can properly form a judgement as to the significance of what he has found in any particular case. It is a judgement based on his experience. A jury is entitled to be informed of his assessment. The alternative, of simply leaving the jury to make up its own mind about similarities and dissimilarities, with no assistance at all about their significance, would be to give the jury raw material with no means of evaluating it.
It noted the words of Lord Justice Rose in the 2004 decision of the English Court of Appeal in
“32. For expert evidence to be admissible, two conditions must be satisfied: first, that study or experience will give a witness’s opinion an authority which the opinion of one not so qualified will lack; and secondly the witness must be so qualified to express the opinion. The first was elucidated in
33. If these two conditions are met and the evidence of the witness is admissible, although the weight to be attached to his opinion must of course be assessed by the tribunal of fact:
34. As we have indicated, the appellants argued that evidence should not be admitted unless it passes a certain test, that the evidence can seen to be reliable because the methods used are sufficiently explained to be tested in cross-examination and so to be verifiable or falsifiable. Where, as here, the Crown is seeking to adduce the evidence in a criminal trial, this could properly be considered by the court when deciding whether to refuse to allow the evidence, under Section 78 of the Police and Criminal Evidence Act 1984 or otherwise, in order to ensure a fair trial. We cannot accept that this is a requirement of admissibility. In established fields of science, the court may take the view that expert evidence would fall beyond the recognised limits of the field or that methods are too unconventional to be regarded as subject to the scientific discipline. But a skill or expertise can be recognised and respected, and thus satisfy the conditions for admissible expert evidence, although the discipline is not susceptible to this sort of scientific discipline...”
Ultimately, the Court of Appeal in
in a comparison exercise based upon facial mapping or walking gait, it is a necessary condition of admissibility that the witness is able to demonstrate to the court the features of comparison upon which his opinion is formed. Since the comparison is visual, an inability by the witness to explain and demonstrate the features upon which his opinion is formed not only places in doubt the existence of the science or technique claimed; it undermines the foundation of reliability required. We have read a transcript of Mr. Blake’s evidence and we have viewed the recorded material from which he demonstrated the foundation for his opinion. We entertain no doubt that the jury was in a position to follow and assess the value of his evidence. There is no danger here that the jury was being invited simply to take Mr. Blake’s comparison on trust. We agree with Maddison J, however, that Mr. Blake’s ability safely to express his ultimate conclusion in terms of probability of a match, even probability based on Mr. Blake’s clinical experience, was insufficiently established. It is important that juries are not misled to an over-valuation of comparison evidence.
While the Court declined leave to appeal, it was circumspect in its expression of its reasons and concerned not to be seen to be accepting of this novel form of evidence ([6] at [23]):
We do not wish it to be thought that we are endorsing the use of podiatric evidence in general. Upon the evidence before him and the argument addressed to this court, we conclude that Maddison J was right to rule the evidence admissible. However, each such application must be considered on its own merits. It may well be, as in the present case, that the trial judge will need to be astute when such evidence is admitted that it is strictly confined within the expertise established and that the proper limits of evaluation are identified from the outset. We endorse, with respect, the views of the court in
In
Mr. Francis found six common features between the gait of the suspect and the accused:
On the left side the toe was turned inwards;
Knee-knock;
The stance was upright without head-poke (that is, without the head being thrust forward);
There was a long stride with ankle movement in the stride;
There was a narrow base of gait (that is, the legs passed close together in the stride);
When the suspect turned, he did so from the waist rather than the neck ([15] at [56]).
Of these features the most prominent was the turning inwards of the left foot. Mr. Francis looked for any dissimilarities between the features of the walking gait of the suspect and the accused man in the recordings and found none. He stated that there was no database against which he could make an assessment of frequency and could only refer to his own clinical experience. This led him to express the view that the left-sided inward turn would be found in under 5% of the population. In his view it could only be caused by injury or by one-sided hypermobility, itself an unusual trait. In the absence of trauma, Mr. Francis stated that he would expect to see knee-knock in less than 10% of the population. He stated that there was no predisposition to the presence of one factor in the presence of the other – they were unconnected so it followed that ‘a combination of features was more significant than the presence of any one of them ([15] at [57]).
Hashi relied upon the expert evidence of Mr. Blake, the expert who testified in
The Court of Appeal was provided with background material, including published material in relation to the effect of frame rate on the ability to identify characteristics of gait from CCTV [22] and a Home Office Manual [23] in relation to the screen height on CCTV necessary to discern characteristic detail. It noted that at trial no challenge was made to Mr. Francis’ evidence, notwithstanding the view of Mr. Blake. The argument was mounted, though, that Mr. Francis’ evidence was unreliable because:
he provided his opinion ‘in a manner that was overconfident having regard to the material on which it was founded’;
the material itself was inadequate for the purpose of identifying features of gait;
the expert was not qualified to make the ‘allowances’ he claimed to be able to make and was unable to explain what allowances he had made; and
the value of the evidence was overstated by references to population ([15] at [73]).
The Court of Appeal accepted that the quality of the CCTV images ‘is at times indifferent’ and that care is required to ensure that the feature demonstrated is reliably demonstrated ([15] at [74]). The Court did not accept that Mr. Francis’ inability to specify in scientific terms how he made allowances for an imperfect image rendered his opinion unreliable or unsafe:
He and the jury were viewing moving and still images. Mr. Francis was showing to the jury the images in which he saw features of gait and either those features could be seen by the jury or they could not. The jury was directed that they could act on the presence of features only if they could observe the features for themselves. Mr. Francis was saying that he had taken account of the imperfection in the image before declaring his identification of a feature. He showed the jury the image on which he relied to make the identification. He was not saying that, although the feature might not be seen by the jury, he, relying on his expertise, was sure it was present. In any instance in which it was argued that the quality of the image was insufficient to be sure that the feature was present the jury had the means to make the assessment for themselves with the assistance of the evidence of Mr. Blake and the cross-examination of Mr. Francis ([15] at [74]).
This led the Court of Appeal to conclude that with appropriate judicial instructions the jurors could follow the evidence, evaluate its cogency and make their own decision as to whether the features demonstrated were present in each of the recordings. The Court did not agree with the argument that Mr. Francis should not have been permitted to refer to the frequency with which the features or abnormalities he found in the recordings occurred in the course of his clinical practice: ‘It was for the jury to evaluate Mr Francis’ evidence in the light of the criticisms levelled at him ([15] at [74]). Thus, it concluded that it was not necessary for the judge to have withdrawn the case from the jury at the close of the prosecution case – ‘The jury had been provided with the tools with which to make that assessment: in the case of each image on which Mr Francis relied they had their attention drawn to the factors relevant to it, in particular to the quality of the images and the time lapse by which they were recorded. Mr Francis was closely cross-examined on each feature and each significant image’ ([15] at [75]).
Both the
The most significant Australian authority on forensic gait analysis is the 2020 ruling by Justice Beale in the murder case of
On the basis of the first report by Professor Pandy, he was asked to offer a further opinion as to whether ‘a person recorded in any of the CCTV footage contained in clips 1 to 36 is the same as a person recorded in any of the CCTV footage contained in clips 37 to 95’. Police also provided more precise measurements between various geographical features shown in the clips so that Professor Pandy could calculate the relevant spatio-temporal gait features of the subjects more accurately, rather than relying on the Google Earth measuring tool. Professor Pandy concluded that the subjects walked with a gait pattern ‘more consistent with that exhibited by older adults, who take shorter steps and walk more slowly than healthy young adults’ (at [26]).
The cross-examination of Professor Pandy proved important. He disavowed being an expert on whether persons were similar or dissimilar and said he had never done any research regarding the pitfalls in making such a comparison. He said he was not familiar with the concept of confirmation bias ([16] at [29]). Professor Pandy said he was not a statistician but had sufficient knowledge of statistics to calculate standard deviations. He said there was no way of assessing whether the subjects in any of the clips were walking at their preferred speed and agreed that sometimes he had had to round down the number of steps taken between the relevant locations. He also conceded that he sometimes had to make a judgement as to when a subject’s heel struck the ground ([16] at [32]) and that the subjects did not always walk in a straight line between the points. He sometimes observed excessive lateral movement in the gait of the subjects ([16] at [33]).
Professor Pandy said he had never previously been asked to compare CCTV clips of subjects, that he knew nothing about the make or model of the CCTV cameras capturing the relevant images or whether they distorted the images. He conceded he had no information about the frame rates of the CCTV clips and agreed that the frame rates could affect the accuracy of his judgements as to when the heel of the subjects struck the ground (at [34]). Importantly, Professor Pandy was not able to shed any light on the statistical significance of his findings compared with the population at large, and did not purport to do so, instead stating that the mean step lengths of the subjects in the two groups of clips were ‘remarkably similar’ ([16] at [35]). He refrained from attributing any specific age estimate to the subjects.
He observed that both feet of the subjects exhibited toe-out gait, although he did not make measurements of it. He stated that it appeared greater than normal for healthy young adults but he did not know the prevalence of a greater than normal toe-out gait in the community ([16] at [37]).
Justice Beale declined to admit the evidence of Professor Pandy. He reviewed the relevance of the evidence by evaluating the potential for a jury to have rationally accepted the reliability of Professor Pandy’s calculations. He noted the defects in his evidence about ‘rounding-offs’ and observed that they may have been concentrated in one group (at [85]) and noted too that Professor Pandy had conceded that the CCTV frame rates, about which he said he knew nothing, may have affected the accuracy of his subjective judgements. He was troubled too that Professor Pandy used the time stamps on the CCTV clip to make his calculations but did not check the accuracy of the various stamps for the various CCTV cameras, as well as the fact that the subjects did not always walk in straight lines between points A and B and that at times there was excessive lateral movement by the subjects. He agreed with the submission from the prosecution that none of these matters may have significantly affected the accuracy of Professor Pandy’s calculations but found that ‘there is no way of knowing whether that is the case’ (at [86]). That led Justice Beale to conclude: ‘If the jury is to act rationally, there must be a proper basis for the jury to conclude that the accuracy of his calculations were not significantly affected by these matters. The evidence fails to provide a proper basis for such a conclusion’ ([16] at [86]). He was also troubled by what he described as the difficulty of concluding rationally that Professor Pandy was ‘comparing apples with apples’:
He conceded in cross-examination that there was no way of knowing whether the subjects in clips 1–95 were walking at their preferred speed. And yet he based his opinion that the subjects had gait patterns more consistent with older persons primarily on a comparison of the data with results obtained in gait studies of young and old adults whom it was known were walking at their preferred speed ([16] at [87]).
These issues led him to rule that the evidence of Professor Pandy failed the relevance test under s55 of Australia’s ‘uniform evidence legislation’ and this made it inadmissible. The test in this regard was whether it had the potential to rationally affect the existence of a fact in issue between the prosecution and the defence.
In addition, Justice Beale was at pains to identify the area of specialised knowledge that the prosecution was seeking to adduce. He concluded that it was ‘forensic gait analysis of subjects recorded on CCTV footage’, this descriptor ultimately being important. He found that the fact that Professor Pandy conceded he was a novice in relation to the task of comparison – whether any of the subjects were the same – and also the CCTV aspect was significant. Professor Pandy conceded that had never undertaken gait analysis using CCTV recordings ([16] at [94]). Justice Beale found Professor Pandy’s failure to discuss dissimilarities of gait to be a significant omission in his evidence and that it called into question his expertise to undertake comparative gait analysis. In addition, Justice Beale emphasised that Professor Pandy had conceded that it was the first time that he had conducted forensic gait comparison of subjects recorded on CCTV footage – ‘it is difficult to see how Professor Pandy can be considered an expert in that field when this is the first time he has performed the task. For all his undoubted learning and experience, I am not satisfied that Professor Pandy is an expert in the relevant area of FGA ([16] at [97]). Thus, he found that even if Professor Pandy’s evidence passed the test of relevance, it engaged the exclusionary opinion rule (‘Evidence of an opinion is not admissible to prove the existence of a fact about the existence of which the opinion was expressed’: s76) and was not saved by the exception for opinions based on specialised knowledge (s 79).
Significantly too Justice Beale found that the evidence by Professor Pandy constituted tendency evidence:
First, clips 1–36 and 95 show D walking. Second, Professor Pandy’s analysis of D’s gait in those clips shows that D has a tendency to walk a certain way. Third, because D has such a tendency, he can be expected to walk that way on other occasions. Fourth, clips 37–94 show the shooter walking. Fifth, the way he walks is closely similar to the gait tendency exhibited by D. Taken together, the evidence of D’s gait tendency, and its close similarity to the shooter’s gait, support P’s case that D was the shooter ([16] at [103]).
This meant that it engaged the exclusionary rules in s97 of the uniform rules of evidence in Australia, requiring evidence to have significant probative value to be admitted. He found that it did not and therefore it constituted inadmissible tendency evidence.
Justice Beale also considered whether the evidence, if it was relevant, which he had found it was not, should be excluded on the basis that its probative value was outweighed by the danger of its constituting evidence that was unfair to the accused. He concluded that the probative value of his evidence was modest because, taken at its highest, it was evidence of similarity, not identity ([16] at [118]). In addition:
there is no evidence as to how common or uncommon in the general population are the mean step length, step frequency and walking speed of the subjects in the clips. Further, Professor Pandy does not assert that the subjects of the relevant clips are elderly, just that the spatio-temporal gait features are more consistent with the gait of older persons ([16] at [118]).
Justice Beale identified two ways in which Professor Pandy’s evidence had the potential to be misused – by the jury attaching more weight to it than it deserved, especially in light of his using the phrase, ‘remarkably similar’ and by reason of the jury engaging in tendency reasoning, a risk that he considered ‘very real.’ This led him to exclude the evidence as more prejudicial than probative.
Importantly, in 2020 the Chartered Society of Forensic Science and the College of Podiatry [24] published a ‘Code of Practice for Forensic Gait Analysis’. It stipulated that the method used for the preliminary assessment in forensic gait analysis should include assessment of fact such as (but not limited to):
distortions of the image inherent in the footage;
the resolution (sharpness), lighting and frame rate of the footage;
the locomotor activity being undertaken by the figure/subject;
the number of consecutive mid gait steps seen in the footage;
the position of the camera relative to the figure/subject;
the direction in which the figure/subject is moving relative to the camera;
the relative size of the image of the figure/subject in the field of view;
the possible impact on gait associated with the figure/subject’s footwear or lack of footwear; and
the possible impact on gait associated with the figure/subject’s environment.
The Code also stated that features of gait should only be compared if the locomotor activity being undertaken in the questioned footage is the same as that being undertaken in the reference footage – walking footage should be compared with walking footage. The comparison should consider features of gait that:
are exhibited by both the figure in the questioned footage and the subject in the reference footage;
would preclude the figure in the questioned footage from being the subject in the reference footage;
are exhibited by the figure in the questioned footage, but not the subject in the reference footage, but do not preclude the figure in the questioned footage from being the subject in the reference footage; and
are exhibited by the subject in the reference footage, but not the figure in the questioned footage, but do not preclude the subject in the reference footage from being the figure in the questioned footage.
In addition, the Code of Practice ([24] at [18.63]–[18.68]) stated that:
A database can be used to assist in the determination of the strength of evidence by the forensic gait analysis; however, its admissibility may be questioned if the database does not meet all of the following criteria:
It is available for use by both the prosecution and defence.
States the size of the population used.
States the appropriateness to the case of the population used.
The likelihood of such a database being deemed admissible may be boosted if:
it is also in the public domain; and/or
has been peer reviewed and published.
If a database has been used to assist in the determination of the strength of evidence provided by the forensic gait analysis this shall be made clear in the final report, and the database identified.
In the absence of the use of a database the final report shall contain a statement to the effect that the determination of the strength of evidence provided by the forensic gait analysis is an opinion based conclusion, and is not predicated on numerical data or statistical calculation.
Where the expert provides an opinion based solely on their experience it is important that the statement make clear, in detail, the experience which allows the expert to proffer that opinion.
The strength of evidence provided by the forensic gait analysis should be expressed using a published scale of verbal expressions of strength of evidence in support of one of two opposing propositions. Generally, the prosecution’s proposition would take the form of ‘the figure in the questioned footage is the subject in the reference footage’. The alternative proposition is determined by the defence but in the majority of cases takes the form of ‘the figure in the questioned footage is not the subject in the reference footage’.
The Code of Practice for Forensic Gait Analysis is not binding outside the United Kingdom but it constitutes a sound articulation of responsible practice in a period when the area of forensic gait analysis is moving toward a sounder scientific basis.
For the present the area of forensic gait analysis poses significant risks in terms of its reliability and the danger that it will be invested with greater respect than its current scientific status deserves in light of the subjectivity inherent in most of its evaluations and the absence of rigorous databases which might enable a statement of the statistical significance of any finding of similarity.
In addition, it is significant that the quality of CCTV footage varies considerably. This can affect the ability of forensic gait analysts to undertake their evaluations informedly. For instance, frame rates on CCTV footage vary markedly, from one frame every 4 seconds to 25 frames per second. The work of Birch et al. [22] has shown that this variation has a major impact upon the ability of even experienced professionals to identify characteristics of gait with accuracy. While they have commented that, ‘Every effort should therefore be made to ensure that CCTV footage likely to be used in criminal proceedings is captured at as high a frame rate as possible’ ([22] at 169), this has not resolved the point at which such analysis ceases or commences to be reliable. A further issue potentially affecting such capacity goes to the extent to which the figure targeted occupies screen height [23].
Lynnerup and Larsen [25] have contended that: ‘exact photogrammetric measurements may be made from CCTV material of perpetrators and at the scene of the crime, but that care must be taken to ensure that error ranges, especially connected to measuring the human (clothed and masked) body in motion, are critically estimated and evaluated.’
The decisions in the Canadian
A 2017 report by the Royal Society and the Royal Society of Edinburgh, in conjunction with the Judicial College, the Judicial Institute and the Judicial Studies Board for Northern Ireland ([5] at p6) supported the more cautious approach embraced by Justice Beale, warning that:
Its underpinning science is sparse and largely translated from the more developed fields of clinical gait analysis and biomechanics, with more recent insights from biometrics. Care is required, however, in assuming that techniques developed in one field can be applied in another with quite different objectives. The scientific evidence supporting forensic gait analysis, as currently practised, is thus extremely limited.
When forensic gait analysis is used as an aid to positive identification of a suspect, the following matters should be borne in mind:
There is no evidence to support the assertion that gait is unique within current or foreseeable limitations of measurements used in forensic gait analysis.
There is no credible database currently that permits assessment of the frequency of either normal or abnormal gait characteristics.
There are no published and verified error rates associated with the current methodology.
There are no published black-box studies of analyst reliability and repeatability.
There is no standardised methodology for analysis, comparison and reporting of gait characteristics.
Cunliffe and Edmond [10, 26] have been particularly concerned about the current state of the art of forensic gait analysis and of forensic podiatry in general. They have argued powerfully that for the present the evidence is inherently unreliable and urged application of stringent tests to exclude it in most cases from jurors’ consideration. They have contended ([24] at 279) that it
might be useful as a technology capable of assisting with identification or exclusion. This, however, assumes that technical problems associated with validation, image quality, duration of view, frame rates, different types of movement (e.g., walking, running, dancing, carrying objects, moving with injuries, moving while intoxicated, trying to disguise gait, or walking toward somebody with the intention of shooting), frequency and interrelatedness of features, and cognitive bias can be overcome. As things stand, forensic gait analysis can merely suggest that a person could be included within a set of similar persons where the apparent or alleged similarities are of unknown frequency, so the size of the set is unknown.
Van Matrigt et al. [11] have correctly identified that: ‘To improve clarity on admission of gait as evidence and assessing its evidential value, method validity and reliability and expert proficiency should be reported’, a position supported by Cunliffe and Edmond. Van Matrigt et al. [11] have also argued that forensic gait analysts should:
join forces to create an international standard forensic gait analysis method with known validity, reliability and proficiency tests. We propose to focus on designing and publishing on large (inter)national gait databases and methods for likelihood calculation taking into account interdependent features. We also hope for (inter)national guidelines for the admission of forensic gait analysis in court. This is especially important since forensic gait analyst is not a protected professional title.
Macoveciuc et al. [27] have emphasised the increasing role of digitisation of matching procedures within forensic podiatry and usefully argued that: ‘A collaboration should be established between the gait analyst and the biometric specialist where the analyst inputs their own expertise to assess the match concluded by the biometric system and also advises (from a clinical and forensic perspective) on the data collection procedures and algorithm development.’
While forensic podiatry in particular and forensic gait analysis have enthusiasts [28] and have the potential to provide assistance to investigators and potentially to the courts, the harder question is as to the appropriateness of forensic gait analysis as expert opinion evidence until further development in the discipline takes place. Undeniably, there are risks in the subjectivity of the comparison process which has the potential to be distorted by cognitive and contextual biases. There is an urgent need for the development of relevant databases so that subjective identification of what is unusual, out-of-the-ordinary or remarkable can be contextualised objectively and, in particular, numerically [29]. Work in this regard has commenced but as yet has some distance to travel. It remains to be seen whether the area remains the principal preserve of forensic podiatrists and whether medical practitioners have a constructive contribution that they can make to its development. In all probability, though, as in a number of areas of forensic science, contributions can be made by practitioners from diverse disciplines, including biometric experts and forensic statisticians, to evaluate the accurate interpretation of results.
For the present what needs to be observed is that there are real questions about the probative value of most forensic gait analysis evidence, that expert evidence in respect of comparison of images needs to be undertaken with temperance and circumspection and that the prejudicial value of such evidence needs to be subjected to rigorous evaluation, including by reference to the Code of Practice for Forensic Gait Analysis published in 2020 by the Chartered Society of Forensic Science and the College of Podiatry [24] to determine whether it should be admitted in criminal trials.
The author declares no conflict of interest.
Few infectious agents can cause a broad variety of clinical presentations, including scenarios that mimic other infections, systemic inflammatory diseases, and even localized and metastatic cancer. The pathogenic characteristics of
Actinomyces is a prokaryotic bacterium that belongs to the family
As this organism constitutes part of the human flora, disease manifestation depends on the site of invasion. Several anatomical sites have been identified and include cervicofacial, pulmonary, abdominal, genitourinary, cutaneous, extra facial and joint, central nervous system and disseminated infection. More than 30 species of Actinomycosis have been identified and the most common human pathogen is
Actinomycosis has a worldwide distribution and usually affects middle age individuals. It is two to four times more common in males than in females [1]. The condition is usually considered as infrequent, however the epidemiologic data is very limited and probable underreported [7]. Infection involving the cervicofacial area is the most commonly known, representing 60% of the cases [8]. This occurs after dental or oral procedure, or in a patient with poor dental care. The second most common presentation of actinomycosis is abdominal involvement, constituting 20% of the reported cases [6]. The organism can invade any abdominal tissue, most commonly the bowel, causing appendicitis in 65% of the cases, but also, gastrointestinal perforation and upper and lower bowel obstruction have been reported. The third most common presentation is thoracic actinomycosis (15–20% of the reported cases) [6]. Infection develop after aspiration of the oropharyngeal secretions or perforation of the esophagus. Some cases develop from progression from cervicofacial or abdominal actinomycosis, or after hematogenous spread in disseminated disease [1].
The rarest cases of actinomycosis include musculoskeletal, central nervous system or joint actinomycosis. Central nervous system actinomycosis infection develops from hematogenous spread or extension of a cervicofacial actinomycosis [9]. In one study, the distribution of presentations included brain abscess (67%), meningitis or meningoencephalitis (13%), actinomycoma (7%), subdural empyema (6%), and epidural abscess (6%) [10]. Musculoskeletal actinomycotic infections of hip and knee prostheses have been described, with early presentation suggesting introduction of the organism perioperatively, and late presentation usually indicating hematogenous spread from an extra-articular site [6]. Disseminated Actinomycosis, is a rare presentation, but can be seen after extensive use of antibiotics.
The pathological damage cause by these organisms are secondary to direct tissue invasion and damage by the bacterial population. Also, actinomyces is often found cohabitating with other bacteria as
Actinomycosis is considered an endogenous infection. This organism can affect immunocompromise and immunocompetent hosts. Risk factors associated with the acquisition of actinomycosis include: male sex between 20 and 60 years old, diabetics, poor oral hygiene, implanted foreign bodies as occurs during aspiration, or intrauterine implantable contraceptive device (IUD) [4]. Also, the use of immunosuppressive therapy, as systemic steroids or chemotherapy, has also being identified as possible risk factor for localized and disseminated infection. Other identified factors to acquire the infection include history of HIV, active hematogenous and solid malignancy, organ transplant, alcohol abuse, and accidental or intentional tissue trauma, as tissue radiation or surgery [4].
Diagnosis of Actinomycosis is quite challenging and requires high clinical suspicion. Prolonged time for work up and invasive testing is often part of the diagnostic process in an actinomyces infection. A definitive diagnosis is made from identification of the organism from a collected specimen.
Blood tests are often unspecific, with normochromic anemia and mild leukocytosis with predominance of polymorphonuclear cells as most common finding [4]. Others nonspecific laboratory findings include elevation of alkaline phosphate (ALP) and erythrocyte sedimentation rate (ERS), representing the nonspecific inflammatory nature of the illness. The most common laboratory pattern of the infection is related to the organ and tissue involved.
Imaging studies such as CT scan and MRI are nonspecific and nondiagnostic, specially at the earlier stages of the disease as other inflammatory diseases and neoplastic processes such as lung and intestinal cancer may show similar findings. In cases of thoracic actinomyces infections, the findings are more predominant at the peripheral and lower lobes, reflecting the role of aspiration in the pathogenesis of the disease [3]. Common findings include nodules, masses, cavitations, infected bronchiectasis, segment collapses, tissue calcifications and foreign bodies [3]. All those findings mimicking other infectious or malignant diseases. At latter stages, infiltration to surrounding tissues at different planes and sinus tract formation and fistulas may be identified in radiological images. Mucosal involvement as occurs in the bowel track can mimic cancer and other inflammatory conditions such as Ulcerative Colitis and Chron’s disease.
Histopathological findings strongly support the diagnosis of Actinomycosis. The use of Hematoxylin stain (H&E stain) will show the sulfur granules which represent colonies of eosinophilic oval or round basophilic masses, which characterized actinomycosis infection [4]. Giemsa, Gram Stain and Gomori methanamine silver staining are need for identification of Gram-positive filamentous branching organisms. This filamentous organisms can be confused with other bacterias as Nocardia u other branching organisms as fungus. Actinomyces is distinguished from Nocardia as nocardia is acid fast positive and aerobic, and actino is acid fast negative and grow in anaerobic medium.
Identification of the organism from a sterile specimen confirms diagnosis, but failure rates are high due to inhibition of Actinomycosis growth by a coexistent/contaminant organism, the previous use of antibiotic therapy or inadequate incubation period. Culture growth is slow, with the earliest identification done as a minimum of 5 days, but may take up to 20 days to be identified. Allowing cultures to take at least 10 days is necessary to confirm a negative diagnosis. Actinomycosis culture should be performed on chocolate agar media at 37 degrees Celsius, as well as brain heart infusion broth and Brucella Blood Agar with vitamin K and hemin [4]. Serological assays have a low clinical yield and are still under investigation.
Several anatomical areas have been identified where invasion with actinomycosis can led to acute/chronic pathological findings. Most of the presenting symptoms are not specific, making diagnosis challenging. The following presentations will describe the clinical manifestations, diagnosis and general treatment of actinomycosis according to anatomical site.
Cervicofacial actinomycosis is the most frequent clinical form of actinomycosis. Actinomyces is part of the normal flora of the mouth, which tends to cause infections when the oral mucosa barrier is breach, and poor oral hygiene exists. This clinical presentation usually involves tissues surrounding the upper and lower mandible, cheek, chin, and submaxillary area [6]. Patients may present with a fever and slowly progressive painless indurated mass, in the peri-mandibular region, that can evolve to abscess formation and osteomyelitis. A typical thick yellow exudate can be seen in tissues [4]. This mass lesions usually are misdiagnosed as a malignant lesion, and is some cases as a granulomatous disease [12]. Head and neck lymphadenopathy is usually seen related to the infection. In a retrospective study of 317 patient with cervicofacial actinomycosis, disease progress to bone and muscle leading to bone infection [4]. Diagnosis of the infection is mainly thorough fine needle aspiration of the mass like structure with identification of actinomyces.
Extra facial and joint actinomycosis is not as common as cervicofacial actinomycosis. Few data is available on the incidence of the disease. Reported cases are mostly secondary to hematogenous spread. Other causes include polymicrobial bone infection after bone exposition, continuous spread to the spine after pulmonary actinomycosis [6]. Patients who develop extra facial and joint actinomycosis usually present symptoms months after suspected bacteremia, and symptoms are usually insidious and similar to other chronic bone infections or malignancies [6].
Pulmonary actinomycosis is a rare and challenging disease to diagnose. It mainly results from aspiration of oropharyngeal or gastrointestinal secretions. Individuals with history of poor oral hygiene, preexisting dental disease, and alcoholism have an increased risk for developing pulmonary actinomycosis. Patients with pulmonary disease like COPD and bronchiectasis are at increased risk of infection [6]. Other risk factors include disease that have high risk of aspirations, such as neurological and psychiatric diseases, drug abuse and severe reflux with hernias. In the 1950s pulmonary actinomycosis presented similar to tuberculosis, as a empyema necessitans, with a sharp chest pain and cutaneous fistulation [3]. In the post antibiotic era, the most common presentation is a focal pulmonary consolidation, mimicking persistent bacterial pneumonia or lung malignancy. It is recommended that in patients with persistent symptoms of cough or hemoptysis refractory to antibiotic therapy, for actinomycosis to become a possible differential diagnosis.
Most cases of pulmonary actinomycoses are misdiagnosed. Differential diagnosis includes other lung pathologies such lung malignancy, pneumonia, mycobacterium infection, aspergillosis and lung abscess. Pulmonary actinomycosis is commonly subdivided depending on the radiological findings, into the airway type including bronchiectasis, the endobronchial, mediastinum and that involving the chest wall [3]. Imaging allows for proper localization and extension of the disease. Patchy air space consolidation, ground glass opacity, cavitation, pleural thickening, atelectasis, pleural effusion, nodular and the appearance of mediastinal and hilar lymphadenopathies may be seen in CT imaging of pulmonary actinomycosis [13]. Parenchymal involvement have an extensive range of presentations from a pulmonary nodule to extensive space consolidation, to the most invasive spreading involving pleural and chest wall invasion with pleural effusions and empyema [13].
Colonization and infection of preexisting bronchial dilations or causing the bronchial changes to develop bronchiectasis, is another presentation. This form may coexist with parenchymal actinomycosis infection. Aspergillus infection can cause similar findings and should also be ruled out. Finally, endobronchial actinomycosis, develops after colonization of broncholiths or foreign bodies in the airway, by actinomyces. These broncholiths are form from eroded and calcified lymph nodes into the airway, which are commonly seen in patient suffering from granulomatous infections such as
Fiberoptic bronchoscopy help in diagnosis when an endobronchial lesion is biopsied and the organism colonies are identified in the tissue obtained, but it may just represent colonization, so clinical correlation must be done and other diagnosis as malignancy should be rule out.
The central nervous system can also be affected by actinomyces. It is most seen as brain and epidural abscess, meningitis, meningoencephalitis, and as subdural empyema after hematogenous spread most likely from lung or cervicofacial infection or from a penetrating head injury. Its signs and symptoms are non-specific but tend to be similar to other central nervous system infections.
Cutaneous Actinomycosis has been poorly describe in literature. Most cases present as a soft tissue inflammation that develops into an abscess, nodules mass like lesions.
Abdominal Actinomycosis usually affects the appendix and ileus [15]. Factors that predispose to infection, include trauma, neoplasia, recent surgery, perforated viscus, as well as the use of intrauterine contraceptive devices [16]. Patient with presents with an indolent course of symptoms such as fever weight loss, fatigue and associated abdominal pain. Physical findings may show a palpable mass, fistula or sinus tract [6]. Laboratory work up often is not specific. Clinical presentation can be similar to clinical Chron’s disease, malignancy and extrapulmonary tuberculosis, making diagnosis difficult. The lack of extra intestinal manifestation, as well as the lack of improvement with anti-inflammatory or immunosuppressive drugs may help differentiate form Chron’s disease and consider other possible diagnosis, as actinomycosis infection [17].
Radiological findings are nonspecific for the diagnosis of abdominal actinomycosis. Ct Scan may help localized the infection and extension of the disease for tissue diagnosis. Endoscopic evaluation are also nonspecific and remarkable for engrossment and inflammation of mucosa, and bowel wall ulcer formation and nodular and mass like lesions. Definitive diagnosis is obtained with biopsies showing and growing the organism.
After cervicofacial actinomycosis, the genitourinary tract is the system most affected by actinomycosis [6] It is most seen in women using an intrauterine implantable devices [18]. This is most likely due to disruption of the endothelium of the uterus, facilitating microbial invasion. It is recommended to change the intrauterine device every 5 years as it is mostly seen with prolonged use [19].
Bladder actinomycosis can be confused with bladder carcinoma, and it is important to diagnosed accordingly to avoid unnecessary treatment and procedure thought to be from carcinoma. Findings are usually the identification of a genital mass associated with abdominal pain, and genital infections. Macroscopic hematuria can be seen if bladder wall is invaded by actinomyces. Imaging usually show a mass like lesion with associated lymphadenopathy.An abscess of the tubulo-ovarian structures include actinomycosis in the differential diagnosis [6].
Hematogenous spread to distant multiple organs is uncommon with Actinomycosis infection, but has been reported. Disseminated actinomycosis have been documented in 15.9% of the reported cases [20]. In many cases, the presenting symptoms do not correlate with the extension of the disease. According to Weese, the diagnosis is properly identified at admission in only 7% of the cases [21]. Disseminated disease may involve any organ, but the most common include lung, skin, brain, liver, bone and muscle.
The management of actinomycosis infection consists of prolong antimicrobial therapy, but surgical debridement and resection may be indicated in some cases. The use of antimicrobials has greatly improved the prognosis. Drug resistance is not considered a problem in actinomycosis and tends to be susceptible to beta-lactams antibiotics [22]. For patients with monomicrobial infections, treatment can be divided base on mild versuss severe disease. If the infection involves an organ causing a life threatening disease or multiple organs, it is considered severe. For mild actinomycosis, initial oral therapy with penicillin V (divided in four daily doses) is recommended [23]. For severe infection, initial course of 10 to 20 million units daily of intravenous penicillin G (divided into four to six hours) is recommended [22]. If the patient has penicillin allergy, a cephalosporin or doxycycline can be use [24].
As mentioned before, Actinomyces can grow with other organisms in tissue and sample cultures in almost 75 to 95% of cases [10]. The other organisms are usually anaerobic from the oral flora, and they can produce beta-lactamases that can protect actinomyces from penicillin.In those cases a combination of a beta-lactam plus beta-lactamase inhibitor is recommended as treatment.
Antimicrobial treatment should be continued until resolution of infection, usually between 6 and 12 months [25]. Actinomycosis infection can recur, especially in thoracic infections without surgical debridement [25]. Therapy duration of less than 3 months should be avoided in those cases. When infection complicates with abscess and fistula formation, surgical management and drainage is warranted, especially in life threatening presentations.
Actinomycosis is a chronic bacterial infection able to cause pathological invasion and destruction of multiple tissue mimicking other conditions as systemic and inflammatory diseases, other infections and cancer. Diagnosis is difficult and often take prolonged time, with the need of invasive procedures, and the requirement of tissue samples for diagnosis. From the microscopic to the macroscopic findings, this bacteria is capable of simulating being other that what really is, and has a unique physical and pathogenic characteristics that allow it to survive and resist in inhospitable environments, making its identification a real challenge when invading the human host.
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Levine",coverURL:"https://cdn.intechopen.com/books/images_new/7827.jpg",editedByType:"Edited by",editors:[{id:"186919",title:"Dr.",name:"Martha",middleName:null,surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10450",title:"Evolutionary Psychology Meets Social Neuroscience",subtitle:null,isOpenForSubmission:!1,hash:"bd4df54e3fb185306ec3899db7044efb",slug:"evolutionary-psychology-meets-social-neuroscience",bookSignature:"Rosalba Morese, Vincenzo Auriemma and Sara Palermo",coverURL:"https://cdn.intechopen.com/books/images_new/10450.jpg",editedByType:"Edited by",editors:[{id:"214435",title:"Dr.",name:"Rosalba",middleName:null,surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba 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Life",subtitle:null,isOpenForSubmission:!1,hash:"f6000bc0eeed7fcf0277a2f8d75907d9",slug:"quality-of-life-and-quality-of-working-life",bookSignature:"Ana Alice Vilas Boas",coverURL:"https://cdn.intechopen.com/books/images_new/5761.jpg",editedByType:"Edited by",editors:[{id:"175373",title:"Dr.",name:"Ana Alice",middleName:null,surname:"Vilas Boas",slug:"ana-alice-vilas-boas",fullName:"Ana Alice Vilas Boas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:7,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"66422",doi:"10.5772/intechopen.85463",title:"Vulnerability and Social Exclusion: Risk in Adolescence and Old Age",slug:"vulnerability-and-social-exclusion-risk-in-adolescence-and-old-age",totalDownloads:1162,totalCrossrefCites:8,totalDimensionsCites:11,abstract:"Vulnerability can be defined as the quality or state of being exposed to the possibility of being attacked or harmed, either physically or emotionally. In this chapter, it is defined as a possible ability of an individual or a group to face, manage, and anticipate a possible problem. This concept of vulnerability is associated with that of risk factor for social isolation, and therefore to situations that can also lead to illness and lack of mental and physical health. It can have its roots in poverty, in social exclusion, in ethnicity, in disability or simply in disease or specific developmental phases in life. All these aspects reflect very important vulnerability factors among biological, psychological, social, and behavioral variables. To date, no one has highlighted together two critical moments in life in which this brain area undergoes important variations: adolescence, in which its development occurs, and old age, in which this area goes into cognitive decline with the relative loss of many higher cognitive functions. This knowledge can help to better understand the forms of exclusion due to vulnerability in order to develop new forms of social inclusion.",book:{id:"8262",slug:"the-new-forms-of-social-exclusion",title:"The New Forms of Social Exclusion",fullTitle:"The New Forms of Social Exclusion"},signatures:"Rosalba Morese, Sara Palermo, Matteo Defedele, Juri Nervo and Alberto Borraccino",authors:[{id:"214435",title:"Dr.",name:"Rosalba",middleName:null,surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba Morese"},{id:"218983",title:"BSc.",name:"Juri",middleName:null,surname:"Nervo",slug:"juri-nervo",fullName:"Juri Nervo"},{id:"218984",title:"MSc.",name:"Matteo",middleName:null,surname:"Defedele",slug:"matteo-defedele",fullName:"Matteo Defedele"},{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"},{id:"266453",title:"Prof.",name:"Alberto",middleName:null,surname:"Borraccino",slug:"alberto-borraccino",fullName:"Alberto Borraccino"}]},{id:"74550",doi:"10.5772/intechopen.95395",title:"School Conflicts: Causes and Management Strategies in Classroom Relationships",slug:"school-conflicts-causes-and-management-strategies-in-classroom-relationships",totalDownloads:2333,totalCrossrefCites:1,totalDimensionsCites:10,abstract:"Conflicts cannot cease to exist, as they are intrinsic to human beings, forming an integral part of their moral and emotional growth. Likewise, they exist in all schools. The school is inserted in a space where the conflict manifests itself daily and assumes relevance, being the result of the multiple interpersonal relationships that occur in the school context. Thus, conflict is part of school life, which implies that teachers must have the skills to manage conflict constructively. Recognizing the diversity of school conflicts, this chapter aimed to present its causes, highlighting the main ones in the classroom, in the teacher-student relationship. It is important to conflict face and resolve it with skills to manage it properly and constructively, establishing cooperative relationships, and producing integrative solutions. Harmony and appreciation should coexist in a classroom environment and conflict should not interfere, negatively, in the teaching and learning process. This bibliography review underscore the need for during the teachers’ initial training the conflict management skills development.",book:{id:"7827",slug:"interpersonal-relationships",title:"Interpersonal Relationships",fullTitle:"Interpersonal Relationships"},signatures:"Sabina Valente, Abílio Afonso Lourenço and Zsolt Németh",authors:[{id:"324514",title:"Ph.D.",name:"Sabina",middleName:"N.",surname:"Valente",slug:"sabina-valente",fullName:"Sabina Valente"},{id:"326375",title:"Prof.",name:"Abílio Afonso",middleName:"Afonso",surname:"Lourenço",slug:"abilio-afonso-lourenco",fullName:"Abílio Afonso Lourenço"},{id:"329177",title:"Dr.",name:"Zsolt",middleName:null,surname:"Németh",slug:"zsolt-nemeth",fullName:"Zsolt Németh"}]},{id:"55323",doi:"10.5772/intechopen.68873",title:"Positive Psychology: The Use of the Framework of Achievement Bests to Facilitate Personal Flourishing",slug:"positive-psychology-the-use-of-the-framework-of-achievement-bests-to-facilitate-personal-flourishing",totalDownloads:1748,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"The Framework of Achievement Bests, which was recently published in Educational Psychology Review, makes a theoretical contribution to the study of positive psychology. The Framework of Achievement Bests provides an explanatory account of a person’s optimal best practice from his/her actual best. Another aspect emphasizes on the saliency of the psychological process of optimization, which is central to our understanding of person’s optimal functioning in a subject matter. Achieving an exceptional level of best practice (e.g. achieving excellent grades in mathematics) does not exist in isolation, but rather depends on the potent impact of optimization. This chapter, theoretical in nature, focuses on an in‐depth examination of the expansion of the Framework of Achievement Bests. Our discussion of the Framework of Achievement Bests, reflecting a methodical conceptualization, is benchmarked against another notable theory for understanding, namely: Martin Seligman’s PERMA theory. For example, for consideration, one aspect that we examine entails the extent to which the Framework of Achievement Bests could explain the optimization of each of the five components of PERMA (e.g. how does the Framework of Achievement Bests explain the optimization of engagement?).",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Huy P. Phan and Bing H. Ngu",authors:[{id:"196435",title:"Prof.",name:"Huy",middleName:"P",surname:"Phan",slug:"huy-phan",fullName:"Huy Phan"}]},{id:"55349",doi:"10.5772/intechopen.68596",title:"The Development of a Human Well-Being Index for the United States",slug:"the-development-of-a-human-well-being-index-for-the-united-states",totalDownloads:2049,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"The US Environmental Protection Agency (EPA) has developed a human well-being index (HWBI) that assesses the over-all well-being of its population at the county level. The HWBI contains eight domains representing social, economic and environmental well-being. These domains include 25 indicators comprised of 80 metrics and 22 social, economic and environmental services. The application of the HWBI has been made for the nation as a whole at the county level and two alternative applications have been made to represent key populations within the overall US population—Native Americans and children. A number of advances have been made to estimate the values of metrics for counties where no data is available and one such estimator—MERLIN—is discussed. Finally, efforts to make the index into an interactive web site are described.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"J. Kevin Summers, Lisa M. Smith, Linda C. Harwell and Kyle D. Buck",authors:[{id:"197485",title:"Dr.",name:"J. Kevin",middleName:null,surname:"Summers",slug:"j.-kevin-summers",fullName:"J. Kevin Summers"},{id:"197486",title:"Ms.",name:"Lisa",middleName:null,surname:"Smith",slug:"lisa-smith",fullName:"Lisa Smith"},{id:"197487",title:"Ms.",name:"Linda",middleName:null,surname:"Harwell",slug:"linda-harwell",fullName:"Linda Harwell"},{id:"197488",title:"Dr.",name:"Kyle",middleName:null,surname:"Buck",slug:"kyle-buck",fullName:"Kyle Buck"}]},{id:"56529",doi:"10.5772/intechopen.70237",title:"Well-being and Quality of Working Life of University Professors in Brazil",slug:"well-being-and-quality-of-working-life-of-university-professors-in-brazil",totalDownloads:1682,totalCrossrefCites:2,totalDimensionsCites:6,abstract:"This chapter presents a study about the perceptions on quality of working life (QWL) regarding factors and indicator in two public universities in Brazil. It aimed also to analyze their perceptions about university working conditions. This exploratory study is based on quantitative and qualitative analyses. A sample of 715 university professors participated on the research. Data collection was carried out in two steps: online survey and focus groups. There is a moderate negative correlation between psychological well-being and work-related stress. Emotional charge also presents a moderate positive correlation with work-related stress, as well as physical charge and psychological distress. Work-life balance is negatively correlated with physical charge, emotional charge, work-related stress, psychological distress, and burnout. We observed also that 43.6% of the professors reported high levels of work-related stress in their everyday work. The precariousness of university teaching is associated with three main elements, which we defined as the tripod of the precarization of university teaching work. It consists of academic productivism, excess of administrative work and bureaucratic activities, and inadequate working conditions. The operating dynamics of this tripod effect professors’ well-being, their QWL, and even the quality of the work they develop in public universities.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Alessandro Vinicius de Paula and Ana Alice Vilas Boas",authors:[{id:"175373",title:"Dr.",name:"Ana Alice",middleName:null,surname:"Vilas Boas",slug:"ana-alice-vilas-boas",fullName:"Ana Alice Vilas Boas"},{id:"196534",title:"Dr.",name:"Alessandro Vinicius",middleName:null,surname:"De Paula",slug:"alessandro-vinicius-de-paula",fullName:"Alessandro Vinicius De Paula"}]}],mostDownloadedChaptersLast30Days:[{id:"74550",title:"School Conflicts: Causes and Management Strategies in Classroom Relationships",slug:"school-conflicts-causes-and-management-strategies-in-classroom-relationships",totalDownloads:2328,totalCrossrefCites:1,totalDimensionsCites:10,abstract:"Conflicts cannot cease to exist, as they are intrinsic to human beings, forming an integral part of their moral and emotional growth. Likewise, they exist in all schools. The school is inserted in a space where the conflict manifests itself daily and assumes relevance, being the result of the multiple interpersonal relationships that occur in the school context. Thus, conflict is part of school life, which implies that teachers must have the skills to manage conflict constructively. Recognizing the diversity of school conflicts, this chapter aimed to present its causes, highlighting the main ones in the classroom, in the teacher-student relationship. It is important to conflict face and resolve it with skills to manage it properly and constructively, establishing cooperative relationships, and producing integrative solutions. Harmony and appreciation should coexist in a classroom environment and conflict should not interfere, negatively, in the teaching and learning process. This bibliography review underscore the need for during the teachers’ initial training the conflict management skills development.",book:{id:"7827",slug:"interpersonal-relationships",title:"Interpersonal Relationships",fullTitle:"Interpersonal Relationships"},signatures:"Sabina Valente, Abílio Afonso Lourenço and Zsolt Németh",authors:[{id:"324514",title:"Ph.D.",name:"Sabina",middleName:"N.",surname:"Valente",slug:"sabina-valente",fullName:"Sabina Valente"},{id:"326375",title:"Prof.",name:"Abílio Afonso",middleName:"Afonso",surname:"Lourenço",slug:"abilio-afonso-lourenco",fullName:"Abílio Afonso Lourenço"},{id:"329177",title:"Dr.",name:"Zsolt",middleName:null,surname:"Németh",slug:"zsolt-nemeth",fullName:"Zsolt Németh"}]},{id:"76968",title:"In the Darkness of This Time: Wittgenstein and Freud on Uncertainty",slug:"in-the-darkness-of-this-time-wittgenstein-and-freud-on-uncertainty",totalDownloads:461,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Both Wittgenstein and Freud experienced the crisis of humanism resulting from the first and second world wars. Although they were both considered to be influential figures, they hardly investigated the ways in which people could cope with the consequences of these crises. However, Wittgenstein and Freud did suggest ways of understanding uncertainties caused by real life events, as well as by the nature of human thought processes. This article will explore the therapeutic ways of dealing with uncertainties common to both thinkers and the different concepts facilitating their methodologies. The central contention of this article is that both Wittgenstein and Freud developed a complex methodology, acknowledging the constant and unexpected changes humans have deal with, whilst also offering the possibility of defining “hinge propositions” and “language-games” which can stabilize our consciousness.",book:{id:"10814",slug:"anxiety-uncertainty-and-resilience-during-the-pandemic-period-anthropological-and-psychological-perspectives",title:"Anxiety, Uncertainty, and Resilience During the Pandemic Period",fullTitle:"Anxiety, Uncertainty, and Resilience During the Pandemic Period - Anthropological and Psychological Perspectives"},signatures:"Dorit Lemberger",authors:[{id:"325725",title:"Dr.",name:"Dorit",middleName:null,surname:"Lemberger",slug:"dorit-lemberger",fullName:"Dorit Lemberger"}]},{id:"76565",title:"Introductory Chapter: The Transition from Distress to Acceptance of Human Frailty - Anthropology and Psychology of the Pandemic Era",slug:"introductory-chapter-the-transition-from-distress-to-acceptance-of-human-frailty-anthropology-and-ps",totalDownloads:393,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"10814",slug:"anxiety-uncertainty-and-resilience-during-the-pandemic-period-anthropological-and-psychological-perspectives",title:"Anxiety, Uncertainty, and Resilience During the Pandemic Period",fullTitle:"Anxiety, Uncertainty, and Resilience During the Pandemic Period - Anthropological and Psychological Perspectives"},signatures:"Fabio Gabrielli and Floriana Irtelli",authors:[{id:"174641",title:"Dr.",name:"Floriana",middleName:null,surname:"Irtelli",slug:"floriana-irtelli",fullName:"Floriana Irtelli"},{id:"259407",title:"Prof.",name:"Fabio",middleName:null,surname:"Gabrielli",slug:"fabio-gabrielli",fullName:"Fabio Gabrielli"}]},{id:"77214",title:"The Impact of the COVID-19 Pandemic on the Mental Health of Dentists",slug:"the-impact-of-the-covid-19-pandemic-on-the-mental-health-of-dentists",totalDownloads:390,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Since March 2020, the COVID-19 disease has declared a pandemic producing a worldwide containment. For months, many people were subjected to strict social isolation away from family and loved ones to prevent disease transmission, leading to anxiety, fear, and depression. On the other hand, many had to close down their businesses and stop working, resulting in financial issues. Previous studies have reported that pandemics, epidemics, and some diseases can lead to mental disorders such as fear, anxiety, stress, and depression. Among those most affected, healthcare workers (HCWs), especially those on the front line, often develop mental health problems. Although there is data available on the management and care of HCWs, little attention has been paid to the mental health and well-being of dentists during the COVID-19 pandemic. Therefore, this chapter aims to review the impact of the COVID-19 pandemic on dentists’ mental health and mental health-related symptoms. Finally, to recommend specific measures to avoid consequent potential implications for dentists, dental students, and dental patients.",book:{id:"10814",slug:"anxiety-uncertainty-and-resilience-during-the-pandemic-period-anthropological-and-psychological-perspectives",title:"Anxiety, Uncertainty, and Resilience During the Pandemic Period",fullTitle:"Anxiety, Uncertainty, and Resilience During the Pandemic Period - Anthropological and Psychological Perspectives"},signatures:"Andrea Vergara-Buenaventura and Carmen Castro-Ruiz",authors:[{id:"346660",title:"M.Sc.",name:"Andrea",middleName:null,surname:"Vergara-Buenaventura",slug:"andrea-vergara-buenaventura",fullName:"Andrea Vergara-Buenaventura"},{id:"419814",title:"MSc.",name:"Carmen",middleName:null,surname:"Castro-Ruiz",slug:"carmen-castro-ruiz",fullName:"Carmen Castro-Ruiz"}]},{id:"55323",title:"Positive Psychology: The Use of the Framework of Achievement Bests to Facilitate Personal Flourishing",slug:"positive-psychology-the-use-of-the-framework-of-achievement-bests-to-facilitate-personal-flourishing",totalDownloads:1748,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"The Framework of Achievement Bests, which was recently published in Educational Psychology Review, makes a theoretical contribution to the study of positive psychology. The Framework of Achievement Bests provides an explanatory account of a person’s optimal best practice from his/her actual best. Another aspect emphasizes on the saliency of the psychological process of optimization, which is central to our understanding of person’s optimal functioning in a subject matter. Achieving an exceptional level of best practice (e.g. achieving excellent grades in mathematics) does not exist in isolation, but rather depends on the potent impact of optimization. This chapter, theoretical in nature, focuses on an in‐depth examination of the expansion of the Framework of Achievement Bests. Our discussion of the Framework of Achievement Bests, reflecting a methodical conceptualization, is benchmarked against another notable theory for understanding, namely: Martin Seligman’s PERMA theory. 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