\r\n\tgas sensors.
",isbn:"978-1-80356-963-5",printIsbn:"978-1-80356-962-8",pdfIsbn:"978-1-80356-964-2",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"8eeb7ab232fa8d5c723b61e0da251857",bookSignature:"Dr. Soumen Dhara and Dr. Gorachand Dutta",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11513.jpg",keywords:"Fabrication Technologies, Applications, Characterizations, Case Studies, Various Gas Sensors, Improvement of Lifestyle, Societal Benefit, Bio-Sensors, Bioreceptor Molecules, Integration, Packaging, Lab-on-Chip",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 8th 2022",dateEndSecondStepPublish:"June 17th 2022",dateEndThirdStepPublish:"August 16th 2022",dateEndFourthStepPublish:"November 4th 2022",dateEndFifthStepPublish:"January 3rd 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"A pioneering researcher in nanowire heterostructures and laser spectroscopy, recipient of JSPS (Govt. of Japan) and NPDF (Govt. of India) fellowships, and member of MRS(USA), MRS(India), IPA(India).",coeditorOneBiosketch:"Assistant Professor with the School of Medical Science and Technology, Indian Institute of Technology Kharagpur with research interests that include the design and characterization of portable biosensors, biodevices, and sensor interfaces for miniaturized systems and biomedical applications for point-of-care testing.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"196334",title:"Dr.",name:"Soumen",middleName:null,surname:"Dhara",slug:"soumen-dhara",fullName:"Soumen Dhara",profilePictureURL:"https://mts.intechopen.com/storage/users/196334/images/system/196334.jpeg",biography:"Dr. Dhara received his Ph. D in Physics in 2012 from Indian Institute of Technology Guwahati, India. Presently, he is associated with the Faculty of Science, Sri Sri University, India as an Assistant Professor in Physics. Prior to joining the current\naffiliation, he was a postdoctoral fellow at different renowned institutions, Kobe University Japan, S. N. Bose National Centre for Basic Sciences, India and Cardiff University, United Kingdom. He was awarded prestigious JSPS postdoctoral fellowship based on his research contribution on semiconducting nanowires. He has published more than 32 research articles including 1 review article in high profile international journals and 3 book chapters to his credit. His research trust areas of interests are semiconductor nanostructures, optoelectronics, solid state lighting and light sensors, spectroscopy of nanomaterials, thin-film transistors (TFTs) etc.",institutionString:"Sri Sri University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Sri Sri University",institutionURL:null,country:{name:"India"}}}],coeditorOne:{id:"442408",title:"Dr.",name:"Gorachand",middleName:null,surname:"Dutta",slug:"gorachand-dutta",fullName:"Gorachand Dutta",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Dr. Gorachand Dutta, PhD is an Assistant Professor with the School of MedicalScience and Technology, Indian Institute of Technology Kharagpur. His research interests include the design and characterization of portable\r\nbiosensors, biodevices and sensor interfaces for miniaturized systems and biomedical applications for point-of-care testing. He received his Ph.D in Biosensor and Electrochemistry from Pusan National University, South Korea,\r\nwhere he developed different class of electrochemical sensors and studied the electrochemical properties of gold, platinum, and palladium based metal electrodes. He completed his Post-doctoral fellowships in the Department of\r\nMechanical Engineering, Michigan State University, USA and Department of Electronic and Electrical Engineering at University of Bath, UK. He has expertise on label-free multichannel electrochemical biosensors, electronically\r\naddressable biosensor arrays, aptamer- and DNA-based sensors and surface bio-functionalization.",institutionString:"Indian Institute of Technology Kharagpur",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Indian Institute of Technology Kharagpur",institutionURL:null,country:{name:"India"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"429341",firstName:"Paula",lastName:"Gavran",middleName:null,title:"Ms.",imageUrl:"//cdnintech.com/web/frontend/www/assets/author.svg",email:"paula@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"10198",title:"Response Surface Methodology in Engineering Science",subtitle:null,isOpenForSubmission:!1,hash:"1942bec30d40572f519327ca7a6d7aae",slug:"response-surface-methodology-in-engineering-science",bookSignature:"Palanikumar Kayaroganam",coverURL:"https://cdn.intechopen.com/books/images_new/10198.jpg",editedByType:"Edited by",editors:[{id:"321730",title:"Prof.",name:"Palanikumar",surname:"Kayaroganam",slug:"palanikumar-kayaroganam",fullName:"Palanikumar Kayaroganam"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"117",title:"Artificial Neural Networks",subtitle:"Methodological Advances and Biomedical Applications",isOpenForSubmission:!1,hash:null,slug:"artificial-neural-networks-methodological-advances-and-biomedical-applications",bookSignature:"Kenji Suzuki",coverURL:"https://cdn.intechopen.com/books/images_new/117.jpg",editedByType:"Edited by",editors:[{id:"3095",title:"Prof.",name:"Kenji",surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"872",title:"Organic Pollutants Ten Years After the Stockholm Convention",subtitle:"Environmental and Analytical Update",isOpenForSubmission:!1,hash:"f01dc7077e1d23f3d8f5454985cafa0a",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",bookSignature:"Tomasz Puzyn and Aleksandra Mostrag-Szlichtyng",coverURL:"https://cdn.intechopen.com/books/images_new/872.jpg",editedByType:"Edited by",editors:[{id:"84887",title:"Dr.",name:"Tomasz",surname:"Puzyn",slug:"tomasz-puzyn",fullName:"Tomasz Puzyn"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3569",title:"Biodegradation",subtitle:"Life of Science",isOpenForSubmission:!1,hash:"bb737eb528a53e5106c7e218d5f12ec6",slug:"biodegradation-life-of-science",bookSignature:"Rolando Chamy and Francisca Rosenkranz",coverURL:"https://cdn.intechopen.com/books/images_new/3569.jpg",editedByType:"Edited by",editors:[{id:"165784",title:"Dr.",name:"Rolando",surname:"Chamy",slug:"rolando-chamy",fullName:"Rolando Chamy"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"54018",title:"Patient-Controlled Analgesia (PCA) in Acute Pain: Pharmacological and Clinical Aspects",doi:"10.5772/67299",slug:"patient-controlled-analgesia-pca-in-acute-pain-pharmacological-and-clinical-aspects",body:'\n1. Introduction
\n
The International Association for Study of Pain defines pain as an unpleasant experience, with or without tissue damage, which can be related to individual memories, life expectations and emotions [1]. The painful experience involves interpretation of biological aspects of pain and its interaction with social and cultural characteristics [2].
\n
In surgical procedures, moderate to severe pain can be observed in up to 40% of cases [3], representing an important source of complications as well as morbidity and mortality in the postoperative period [4]. Postoperative pain can limit mobility and respiratory function, increasing the incidence of atelectasis, pneumonia and thromboembolic events [5, 6].
\n
Moreover, the lack of adequate pain control in acute situations can lead to chronic pain, with deleterious effects for the patient and health‐related quality of life [7]. Despite these findings, between 50% to 75% of those submitted to major surgery do not receive enough analgesic medication, increasing the risk of complications and length of stay and costs for the health system [8].
\n
Morphine was isolated by a German pharmacist Friedrich Wilhem Sertürner in 1806 and, after that, opioids have become widely used in clinical practice for pain control. Later in 1844, parenteral administration of morphine has started after the introduction of glass syringe [2].
\n
In 1963, Roe demonstrated that administration of small doses of intravenous morphine allowed a better pain control compared to intramuscular injections [9]. Sechzer, in 1968, was the first to evaluate the quality of analgesia after administration of small doses of opioids per patient request, performing the first patient‐controlled analgesia (PCA). Due to complex logistic to meet the requests of many patients, which would require numerous nursing staff, Sechzer and other doctors began to develop equipment prototypes for analgesic administration with reduced costs. The first PCA pump available for marketing was named “Cardiff Palliator” and it was developed in the Welsh National School of Medicine in 1973 [10, 11].
\n
Since then, several drugs and routes of administration have been used in PCA, with differences in analgesic efficacy, tolerability profile, adverse effects, and procedure‐related complications as well as patient satisfaction [12].
\n2. PCA: principles and pharmacological aspects
\n
The principle of intravenous PCA was first described by Austin et al. in 1980, after he administrated small increasing doses of meperidine and measured the plasma levels, demonstrating the dose‐related analgesic effect in patients [13].
\n
Despite being associated with the idea of pump with intravenous opioids, there are several routes of administration, drugs, and equipment that can be used in this mode of analgesia. It is essential that, for the PCA recommendation, individual pain pattern and intensity be considered.
\n
The patients must be previously and duly enlightened on the technical procedure and their consent should be obtained. As desirable characteristics of PCA, we can highlight the adequate pain relief according to individual requirements, the tolerance and safety profile of drugs administered, the high level of patients’ satisfaction and minimal complications related to technological aspects [12].
\n
In order to understand the effectiveness of PCA, we need to understand the concept of “minimal effective analgesic concentration (MEAC).” The MEAC is defined as the smallest concentration at which the pain is relieved [13].
\n
Considering the existence of individuals’ variability, the MEAC cannot be determined from the plasma levels of opioids. It is known that the plasma concentration is a function related to the dose, dosage intervals, gender and age of the patient. It can be calculated based on pharmacokinetic concepts such as volume of distribution and distribution and elimination rates. However, in clinical situations, the plasma levels are not able to predict the pattern of analgesic response [14]. Tamsen et al. showed that the MEAC has a direct correlation with preoperative concentrations of endogenous opioids and substance P in the cerebral spinal fluid. Obviously, the achievement of these measurements is restricted in clinical practice [15].
\n
For the PCA effectiveness, the MEAC should be achieved by titration, which means that the drug is administered as a bolus of small doses until the establishment of an adequate analgesia pattern is obtained. Considering the acute postoperative pain, this can be done in the postanesthetic recovery room, before patient discharge. From this reference dose, the equipment is regulated in order to maintain the plasma concentration of analgesic levels of MEAC or slightly above it, looking for adequate pain control with minimal adverse effects. The goal of this approach is to prevent the occurrence of sharp peaks and troughs in plasma concentrations in a standard that seeks the lowest level of oscillation of concentrations, ideally as close to a continuous infusion [16].
\n
Regardless of the route or administered drug, the two main types of PCA are: the demand dosing (the fixed dose which is self‐administered intermittently) and continuous infusion associated with demand dosing (the constant‐rate fixed background infusion is supplemented by patient demand dosing), whereas the principles of a fixed infusion administration as well as principles of variation of the infusion rates managed by a period of time are considered [17].
\n
Some basic principles and technical parameters are common to several modalities. They are initial loading dose, demand dose, interval lockout, and background infusion rate.
\n
The initial dose usually is not administered by the patient, since the goal of first administration is to promote adequate pain control or prevent the early pain manifestation. This approach allows the establishment of the demand dose, also called PCA dose or bolus dose, which will be administered by the patient when he shoots the demand button.
\n
The lockout interval is a set period in which the equipment does not perform a new infusion of demand. During the interval lockout, if the patient triggers the button, he/she will not receive the medication. Normally, the equipment has a sound signal connected to the drive, regardless of the infusion, so that the patient does not know whether his/her requests were effective. The lockout interval has the primary function of security by preventing the administration of an overdose of analgesic drugs. The background infusion rate is a given infusion rate in a continuous manner, independent of the patient\'s wish (also called continuous infusion). The 1‐h and/or 4‐h limits, depending on the equipment configuration, it has the function to limit the total cumulative dose in the period of 1 or 4 h in order to reduce the adverse effects and ensure the patient safety [11, 18].
\n
Considering the advances in the development of drug delivery systems, the use of infusion pumps for patient‐controlled analgesia (PCA) and analgesia epidural catheter with opioids are considered the most powerful strategies to control of postoperative pain. However, there are doubts about the advantages and limitations of these different forms of PCA.
\n
The basal opioid administration doses may be administered concurrently with the administration of opioids by PCA techniques. However, the basal administration increases the risk of respiratory depression without providing necessarily an additional analgesia pattern [19].
\n
PCA different modalities can minimize the occurrence of gaps in analgesic administration, supplying analgesic dosage immediately after the system activation, providing more uniform analgesia and eliminating painful waiting periods between the patient\'s request and drug administration.
\n3. PCA modalities
\n
Electronic PCA pumps have several models in the market, including small portable devices nowadays. Since the first commercially available PCA pump (“Cardiff Palliator”), PCA devices have evolved enormously in technological sophistication, ease of use, flexibility and portability.
\n
3.1. Intravenous PCA (IV‐PCA)
\n
Currently, IV‐PCA is one of the most used techniques for acute pain control. Its use is suitable for virtually any patient undergoing surgery that are cursed with postoperative pain of moderate or severe intensity [18]. Many studies have demonstrated the efficacy, safety, and patient satisfaction with PCA intravenously. A meta‐analysis involving 115 randomized clinical trials demonstrated that this technique provides greater efficacy when compared to intramuscular administration of analgesics [20]. Another study showed that, among patients who received IV‐PCA, 36% experienced moderate to severe pain in the first 24 h after surgery when compared to 67% of important painful experience among patients who received intramuscular opioids [21]. Moreover, it was verified that the IV‐PCA is associated with a higher rate of patient satisfaction [22].
\n
Despite the possibility that IV‐PCA may be combined to a basal opioids infusion, it was shown that the incidence of respiratory depression with IV‐PCA was much smaller (0.19% versus 0.29%) when compared to the combination of this technique with systemic infusion of opioids (1.09–3% versus 8%) [23].
\n
IV‐PCA is associated with potential complications inherent in the technique, which are operator‐dependent. Errors may occur in the drug administration, usually by programming failures on infusion pump [24] and they may result in inadequate pain control, heavy sedation, respiratory depression, and, eventually, death of the patient [25]. Currently, many infusion pumps feature smart devices that are equipped with an integrated software library on dosing regimens of different drugs, thus avoiding underdosing or overdosing. In these models, the smart bombs are programmed to stop operation or to alert clinicians when doses exceed the limits [26].
\n
However, serious errors can still occur even with smart bombs. According to the Food and Drug Administration (FDA), 56,000 adverse events with these smart bombs during the period 2005–2009 have been reported [27].
\n
Several complications may be observed from the IV‐PCA, such as clogging or dislodgement of catheters, intervals between the administrations of opiates for maintenance of analgesic effect [28]. Still, this technique implies in risk for adverse effects related to opioids [29].
\n
Furthermore, IV‐PCA limits mobility and it reduces the comfort of the patient who is connected to the infusion pump, which can be minimized by using more modern compact equipment. Zafar et al. [30] reported that about 21% of patients who received IV‐PCA complained of reduced mobility. It is worth noting, finally, the economic aspect, as a limitation of the technique, as well as the need of equipment (infusion pump) and the discarding of remaining solutions after the PCA use, causing unnecessary costs for health services [12, 30].
\n
The major drugs used in this system are the opioid analgesics, such as morphine, hydromorphone, fentanyl, sufentanil and tramadol [31]. Meperidine is no longer considered a valid option for PCA as its toxic metabolite may be accumulated, especially in patients with abnormal kidney function [32]. Therefore, meperidine has not been recommended for acute pain [33].
\n
3.1.1. Morphine
\n
Morphine is the most common opioid used for IV-PCA and it is considered the gold standard for this procedure. Although many studies have demonstrated its clinical safety, adverse effects such as nausea, vomiting, itching, urinary retention, sedation and respiratory depression may occur. Its active metabolite morphine‐6‐glucuronide (M6G) have analgesic action but presents risk of adverse effects. As the M6G has renal elimination, the use of morphine should be done with caution in patients with impaired renal function and the elderly [34, 35]. The low therapeutic index of morphine in IV‐PCA was shown in preclinical models, indicating that morphine cannot be the best option for all patients for pain relief in the postoperative period [31].
\n
The usual morphine dose and the recommended parameters are: demand dose: 1–2 mg; lockout period: 6–10 min; continuous basal infusion dose: 0–2 mg/h [11].
\n
3.1.2. Hydromorphone
\n
Hydromorphone has been used in patients with impaired renal function or with a history of allergy to morphine. It is mainly metabolized by the liver and it is, approximately, five times more potent than morphine. Clinical effects of hydromorphone are dose‐dependent and its adverse event profile is morphine‐like [11, 36]. A systematic review of adverse events associated with the postoperatory use of six different opioids (buprenorphine, fentanyl, hydromorphone, meperidine, morphine, and sufentanil) showed that after meperidine (proscribed, 67.9%), the opioid with the highest incidence of central nervous system side effects was hydromorphone (42.7%). Furthermore, at higher doses, hydromorphone can cause excitation [37].
\n
Due to the similarity between morphine and hydromorphone, errors have been reported in programming the IV‐PCA pump. Considering that these agents have significant differences in their clinical potency, inadvertent hydromorphone administration can result in serious complications [38].
\n
Doses and recommended parameters are: demand dose: 0.2–0.4 mg; lockout period: 6–10 min; continuous basal infusion dose: 0–0.4 mg/h [11].
\n
3.1.3. Fentanyl
\n
Fentanyl is 80–100 times more potent than morphine and it may cause less respiratory depression when compared with morphine. It has no active metabolites, and it has a wider therapeutic index than morphine in preclinical models [39].
\n
In a retrospective cohort study of 8955 patients who received one of the three opioids for postoperative pain (morphine, fentanyl or meperidine), the incidence of respiratory depression was 0.6% in the group of patients who received fentanyl, compared to 2.8% among patients who received morphine [40]. Although apparently it may be associated with smaller risk of respiratory depression when compared to morphine, fentanyl can be associated with more device programming errors, since this drug is dosed in micrograms [40, 41].
\n
Because of its high lipid solubility, fentanyl has a pharmacokinetic profile characterized by a rapid onset and short action. Therefore, some patients may need doses too frequently or require a basal infusion rate, which greatly increases the risk of respiratory depression. Due to its high volume of distribution, prolonged administration may result in a significant increase in drug half‐life, with consequent raise in the incidence of adverse effects [42]. Given these pharmacokinetic characteristics, there are complaint reports of patients after fentanyl administration in IV‐PCA [43].
\n
Doses and recommended parameters: demand dose: 20–50 µg; lockout: 5–10 min; Basal continuous: 0–60 µg/h [11].
\n
3.1.4. Sufentanil
\n
Sufentanil is a fentanyl analog, being about 5–10 times more potent than Fentanyl itself. It represents the opioid with greater therapeutic index (25,000) used for postoperative pain in preclinical studies [39]. The high therapeutic index is clinically relevant for evoking a decreased risk of incidence of respiratory depression compared to morphine, fentanyl, and alfentanil [44]. In a randomized clinical trial with 30 volunteers, it was noted that sufentanil provided more effective analgesia and less respiratory depression when compared with fentanyl [44].
\n
Sufentanil is highly lipophilic (twice more lipophilic than fentanyl) and it provides rapid onset of action and shorter effect duration when administered intravenously to PCA, justifying its rare use in this route. However, unlike fentanyl, its half‐life of elimination does not increase with infusion time and it shows paradoxical increase in their concentration during the elimination phase [39]. A randomized clinical trial that compared plasma levels of sufentanil and fentanyl in 41 patients undergoing coronary artery bypass surgery, demonstrated the occurrence of peak plasma concentration (increase of 29–49%) from 4 to 15 h after administration bolus of fentanyl. On the other hand, only one patient had sufentanil treated with this paradoxical effect (43% increase). This peak in plasma concentration explains the occurrence of late respiratory depression in patients treated with fentanyl [45]. Therefore, considering their high therapeutic index and predictable pharmacokinetic profile, sufentanil represents a promising example of opioid that could be used to PCA cases requiring short duration of effect and availability intravenously.
\n
The doses and the usual parameters are: demand dose: 4–6 µg; lockout: 5–10 min; continuous baseline: 0–8 µg/h [11].
\n
3.1.5. Tramadol
\n
Tramadol acts on opioid receptors with higher affinity for κ receptors than δ and μ receptors. It has an active metabolite, mono‐O‐desmethyl (M1), which has analgesic effect. In addition to the opioid agonist activity, tramadol analgesia is also promoted by inhibiting the central norepinephrine and serotonin reuptake. Tramadol potency compared to morphine is approximately 0.1. Several studies have shown that tramadol is a safe and an effective option for PCA, but with a higher incidence of nausea and vomiting [46, 47]. The recommended doses are: demand dose: 10–20 mg; lockout: 6–10 min; continuous baseline: 0–20 mg/h [11].
\n
3.1.6. Oxycodone
\n
Oxycodone is an opioid μ receptor agonist indicated for the treatment of moderate to severe pain. Despite being most frequently used orally, in recent years, its intravenous use has increased. Its potency is about 1/75 of fentanyl, and in some studies has shown great potency up to 1/60 [48, 49].
\n
A randomized clinical trial with 82 patients compared IV‐PCA with oxycodone and fentanyl. In this study, oxycodone demonstrated potency of 1/55 of fentanyl for the same levels of analgesia, being equally safe and the same incidence of adverse effects such as nausea, vomiting and sedation [45]. It is a drug with good efficacy and a promising role in the practice of PCA. Its use must be made on demand associated with basal infusion. The recommended doses are: demand bolus: 1 mg; lockout: 15 min; background infusion rate: 1 mg/h [50].
\n
3.1.7. Other drugs
\n
Other opioids have been less used in IV‐PCA. The alfentanil, probably due to their pharmacokinetic characteristics, did not show good results and a demand dose was not established to present a satisfactory analgesia [51]. The remifentanil, because of their ultrashort half‐life, does not have a favorable profile for PCA with some indication for analgesia for a short period such as during labor [52].
\n
Other drugs have been used by some authors that are normally associated with morphine. Ketamine, which is an agonist of the NMDA receptor, and naloxone, which is an antagonist of opioid receptors, have shown conflicting results regarding the safety or quality of analgesia, and more studies are needed so that they can get their recommended use [18].
\n
3.2. Epidural PCA
\n
Epidural patient‐controlled analgesia (EPCA) is the second most significant method used and studied within the PCA approach. Its use is mainly for control of acute postoperative pain, commonly in patients undergoing orthopedic, abdominal and thoracic surgery [12]. EPCA allows the use of opioids, local anesthetics, or a combination of both. Opioids epidural administered provide greater analgesic potency when compared to equivalent doses of opioid administered intravenously [53].
\n
Although both opioids and local anesthetics represent feasible options, local anesthetics are the most appropriate strategies for patients sensitive to the opioids adverse effects, even though it is associated with a higher incidence of hypotension, motor block and urinary retention compared with the use of opioids [53]. Similarly to the PCA intravenous technique, EPCA allows patients to administer the medication in accordance with analgesic requirements. There is large evidence indicating that the EPCA represents a safe and effective method [46, 54]. A meta‐analysis concluded that, regardless of the drug chosen, epidural provides a better analgesia pattern when compared to intravenous PCA technique [55].
\n
In a population‐based study of 2276 surgical patients, Kim et al. [56] discloses that ropivacaine with fentanyl was able to provide good quality analgesia for up to 48 h after the several surgical procedures, with limited side effects [56].
\n
Unlike IV‐PCA, the use of continuous infusion, coupled with the demand dose, have shown excellent results with minimal complications. Small doses of local anesthetics of long action combined with low doses of opioids (i.e., fentanyl or sufentanil) with continuous infusion rate associated with increments bolus may be combined [57, 58]. The following concentrations are recommended: bupivacaine: 0.05–0.125%; levobupivacaine: 0.05–0.125%; ropivacaine: 0.1–0.2%. Additionally, the following doses are recommended: demand dose: 2–4 ml; lockout: 10–20 min; continuous basal infusion: 4–10 ml/h [11].
\n
Despite many advantages, EPCA also has limitations, especially considering the complexity of the procedure and technical staff training. In addition, there are reports of catheter migration which may lead to failure in the procedure in 17% of cases. It has been suggested that this technique has great effectiveness but it should be used with caution considering individual factors, in order to ensure patient safety [56].
\n
3.3. Patient‐controlled regional analgesia
\n
There are several techniques that use catheters for the purpose of providing postoperative analgesia with little or no opioid use. In this model of patient‐controlled regional analgesia, local anesthetics (ropivacaine, bupivacaine or levobupivacaine) are normally administered through a catheter located in perineural site, intraarticular region or surgical incision site. Eventually, a combination of local anesthetics and opioids can be administered by the infusion pump [12].
\n
Several studies have addressed the effectiveness of this method for postoperative analgesia [59]. Vintar et al. [60] noted that about 80% of patients who received bupivacaine and ropivacaine at the incision site were satisfied with the outcome of the procedure and said they would use this treatment again.
\n
Studies emphasizing the intraarticular administration of opioids and/or local anesthetics are rare. Vintar et al. [60], in a controlled clinical trial, describes that the group which received the combination of ropivacaine/morphine/ketorolac required less use of rescue analgesics in relation to other groups.
\n
It is estimated that, during orthopedic surgery, drug administration by intraarticular can provide 12–15 h of analgesia [61]. In this context, the most efficient strategy would be the infusion of local anesthetics via epidural. Additionally, the brachial plexus, lumbar plexus and femoral nerve and sciatic nerve are examples of sites for drugs infusion. In a clinical trial, the PCRA ropivacaine 0.2% in the brachial plexus region was effective in shoulder orthopedic surgery regarding pain intensity, opioids’ use as rescue medication, and less sleep disorders [61].
\n
In a multicenter study involving orthopedic surgeries, the perineural ropivacaine administration by continuous infusion or PCRA was compared to intravenous morphine. Patients receiving morphine showed higher levels of postoperative pain and required higher consumption of analgesic as rescue medication, significantly increasing the side effects such as nausea, vomiting, dizziness and sleep disturbances [62].
\n
3.4. Other modalities of patient‐controlled analgesia
\n
3.4.1. Transdermal
\n
The iontophoretic fentanyl system (IONSYS; Ortho‐McNeil, Raritan, NJ, USA) is a preprogrammed noninvasive method of PCA, which does not require venous access for drug administration. By adhesively secured to the outside of the arm or chest of the patient, fentanyl is transferred iontophoretically through intact skin. The system allows the transdermal administration of the drug for 10 min and a 10 min lockout interval between administrations [39].
\n
However, the fentanyl dose administered over time is not constant. Whereas the target dose for the desired effect of fentanyl is 40 µg, it is estimated that the average dose is 16 µg after the initial application. Therefore, it would take a long period of time until the optimal dose is reached. Many patients do not receive adequate analgesia for up to 10 h after the start of the application [39].
\n
Although clinical studies have suggested that the use of transdermal fentanyl could show similar efficacy to morphine in PCA intravenously in relation to the overall control of pain [12], there was a need for additional analgesia in 40% of patients involved in the first 3 h of treatment. Moreover, there were local side effects such as skin redness in about 60% of cases. This system was not marketed in the U.S. and it was withdrawn from the European market by the manufacturer due to a manufacturing error in some units [38].
\n
3.4.2. Sublingual
\n
A new sublingual administration system using sufentanil (AcelRx Pharmaceuticals, Redwood City, CA, USA) is designed as a microtablet coupled to a preprogrammed portable device with locking features and radio frequency identification to enable the characterization of a single user. Although intravenous sufentanil present a short half‐life context‐dependent due to its rapid redistribution, pharmacokinetic studies in healthy subjects showed that after sublingual administration, sufentanil has adequate profile for the postoperative analgesia [39].
\n
Sufentanil NanoTabs® shows high bioavailability and plasma half‐life and it is safer than the administration of the drug intravenously to avoid the need for frequent administrations of the lipophilic opioids commonly used for this procedure. Several clinical trials have demonstrated its efficacy in pain relief in different types of orthopedic and abdominal surgery, having been described few side effects to this method [38].
\n
3.4.3. Inhalation
\n
Several products using the inhalation of PCA to opioid administration are described in the literature. Thipphawong et al. [63] tested a morphine inhalation system (System AERx Pain Management; Aradigma Corporation, Hayward, CA, USA), which had desirable characteristics of a drug for PCA (possibility of multiple dosing with lock time between them and observed similar efficacy to morphine IV‐PCA).
\n
Similarly, fentanyl (AeroLEF, YM Biosciences, Mississauga, ON, Canada) also had proven to control postoperative pain following orthopedic surgery. However, further studies are needed to confirm the effectiveness of opioids in this route, especially clinical trials phase III and IV.
\n
3.4.4. Intranasal
\n
The intranasal opioid administration is possible, since the nasal mucosa has an extensive vascularization, providing rapid drug absorption and distribution [12].
\n
The presentation of intranasal morphine (Rylomine®, Javelin Pharmaceuticals Inc., Cambridge, MA, USA) was effective for the control of postoperative pain in orthopedic surgery [64]. However, the single dose after a nasal administration does not have the desirable safety features of PCA models, such as the possibility of multiple dosages and lock scheduled time between applications. Other opioids have been tested for intranasal administration but similar to morphine, these devices also did not have the desirable features of a PCA device. In this context, Toussaint et al. [65] noted that intranasal fentanyl administration showed similar efficacy compared to IV‐PCA fentanyl. Intranasal sufentanil was also successfully used both in adults and pediatric patients [64].
\n
However, this route may have local adverse effects: nasal irritation, nasal congestion, upper respiratory tract infections, sinusitis, rhinitis, pharyngitis, or epistaxis, which may be a limitation of its clinical use [66].
\n
3.4.5. Oral
\n
Oral PCA device (Avancen, Mount Pleasant, SC, USA) is a drug unit coupled to a bracelet programmed to keep out of the drug for a predetermined time interval. After this lockout period, a green light indicates the possibility of new management. The equipment is compact and allows the patient to make the registration of pain on a scale of 0–10, providing feedback to the health team.
\n
In a study of this device with hydromorphone administration, oxycodone and morphine, it was reported better control of pain in 95% of patients who used these devices when compared to the control group. Furthermore, it highlighted the ease of programming of this device by the health team [38].
\n
Although this oral device for PCA is a good alternative, there are few studies regarding its safety. It is noteworthy of some shortcomings: lack of clinical efficacy in cases of moderate to severe pain, management failure in patients in whom oral administration is not available and uncertain absorption in the immediate postoperative period.
\n4. Conclusion
\n
Patient‐controlled analgesia (PCA) is a great option for acute pain control. Several advantages of this technique can be highlighted, such as higher analgesic standard with patient\'s satisfaction, and also minor side effects. However, there is still no consensus regarding which is the best route or drug used since clinical efficacy/safety depends on the complex comprehension of the pharmacokinetic drugs profile through different routes of administration. Additionally, pharmacoeconomic studies are needed to evaluate the cost‐effectiveness of these approaches.
\n',keywords:"patient‐controlled analgesia, opioids, acute pain, analgesic medication, morphine",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/54018.pdf",chapterXML:"https://mts.intechopen.com/source/xml/54018.xml",downloadPdfUrl:"/chapter/pdf-download/54018",previewPdfUrl:"/chapter/pdf-preview/54018",totalDownloads:3140,totalViews:1236,totalCrossrefCites:1,totalDimensionsCites:1,totalAltmetricsMentions:1,introChapter:null,impactScore:1,impactScorePercentile:65,impactScoreQuartile:3,hasAltmetrics:1,dateSubmitted:"May 20th 2016",dateReviewed:"December 19th 2016",datePrePublished:null,datePublished:"May 24th 2017",dateFinished:"January 31st 2017",readingETA:"0",abstract:"Moderate or severe pain are important sources of complications as well as morbidity and mortality in the postoperative period after surgical procedures. Patient‐controlled analgesia (PCA) is an effective strategy for postoperative analgesia, since it may provide suitable analgesic dose just after system activation, with reduced periods of pain and an increase in patients’ satisfaction. Although intravenous and epidural routes are the typical approaches used for PCA, regional patient‐controlled analgesia has been shown to be an effective alternative providing a higher standard of analgesia with lower incidence of adverse effects. New devices and routes of PCA administration (transdermal, sublingual, inhalation, and oral routes) have shown to be promising alternatives in clinical studies. Nowadays, there is still no consensus regarding which is the best route or drug used since clinical efficacy/safety depends on the complex comprehension of the drugs pharmacokinetic profile through different routes of administration. Additionally, pharmacoeconomic studies are needed to evaluate the cost‐effectiveness of these approaches.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/54018",risUrl:"/chapter/ris/54018",book:{id:"5525",slug:"pain-relief-from-analgesics-to-alternative-therapies"},signatures:"Marcos Tadeu Parron Fernandes, Fernanda Bortolanza Hernandes,\nThaís Natália de Almeida, Vitor Pinheiro Sobottka, Regina Célia Poli-\nFrederico and Karen Barros Parron Fernandes",authors:[{id:"192181",title:"Associate Prof.",name:"Karen",middleName:null,surname:"Barros Parron Fernandes",fullName:"Karen Barros Parron Fernandes",slug:"karen-barros-parron-fernandes",email:"karenparron@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"204196",title:"Associate Prof.",name:"Marcos Tadeu",middleName:null,surname:"Parron Fernandes",fullName:"Marcos Tadeu Parron Fernandes",slug:"marcos-tadeu-parron-fernandes",email:"mparron@yahoo.com.br",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"204197",title:"Ph.D. Student",name:"Fernanda",middleName:null,surname:"Bortolanza Hernandes",fullName:"Fernanda Bortolanza Hernandes",slug:"fernanda-bortolanza-hernandes",email:"fernandabortolanza@hotmail.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204197/images/5082_n.jpg",institution:null},{id:"204198",title:"Ph.D. Student",name:"Thais Natália",middleName:null,surname:"de Almeida",fullName:"Thais Natália de Almeida",slug:"thais-natalia-de-almeida",email:"thais_n_almeida@hotmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"204199",title:"Ph.D. Student",name:"Vitor",middleName:null,surname:"Pinheiro Sobottka",fullName:"Vitor Pinheiro Sobottka",slug:"vitor-pinheiro-sobottka",email:"vitor_sobottka@hotmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"204200",title:"Associate Prof.",name:"Regina Célia",middleName:null,surname:"Poli-Frederico",fullName:"Regina Célia Poli-Frederico",slug:"regina-celia-poli-frederico",email:"reginafrederico@yahoo.com.br",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. PCA: principles and pharmacological aspects",level:"1"},{id:"sec_3",title:"3. PCA modalities",level:"1"},{id:"sec_3_2",title:"3.1. Intravenous PCA (IV‐PCA)",level:"2"},{id:"sec_3_3",title:"3.1.1. Morphine",level:"3"},{id:"sec_4_3",title:"3.1.2. Hydromorphone",level:"3"},{id:"sec_5_3",title:"3.1.3. Fentanyl",level:"3"},{id:"sec_6_3",title:"3.1.4. Sufentanil",level:"3"},{id:"sec_7_3",title:"3.1.5. Tramadol",level:"3"},{id:"sec_8_3",title:"3.1.6. Oxycodone",level:"3"},{id:"sec_9_3",title:"3.1.7. Other drugs",level:"3"},{id:"sec_11_2",title:"3.2. Epidural PCA",level:"2"},{id:"sec_12_2",title:"3.3. Patient‐controlled regional analgesia",level:"2"},{id:"sec_13_2",title:"3.4. Other modalities of patient‐controlled analgesia",level:"2"},{id:"sec_13_3",title:"3.4.1. Transdermal",level:"3"},{id:"sec_14_3",title:"3.4.2. Sublingual",level:"3"},{id:"sec_15_3",title:"3.4.3. Inhalation",level:"3"},{id:"sec_16_3",title:"3.4.4. Intranasal",level:"3"},{id:"sec_17_3",title:"3.4.5. Oral",level:"3"},{id:"sec_20",title:"4. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'[Loeser JD, Treede RD. The Kyoto protocol of IASP Basic Pain Terminology. Pain 2008;137:473–77.]'},{id:"B2",body:'[Kopf A, Patel NB, editors. Guide for Pain Management in Low‐Resources Settings. 1st ed. United States: International Association for the Study of Pain – IASP Press; 2010.]'},{id:"B3",body:'[Power I. Recent advances in postoperative pain therapy. Br J Anaesth 2005;95(1):43–51.]'},{id:"B4",body:'[Mueller XM, Tinguely F, Tevaearai HT, et al. Pain location, distribution and intensity after cardiac surgery. Chest 2000;118(2):391–6.]'},{id:"B5",body:'[Johnson D, Kelm C, Thomson D, et al. The effect of physical therapy on respiratory complications following cardiac valve surgery. Chest 1996;109(3):638–44.]'},{id:"B6",body:'[Ulke ZS, Senturk M. Non‐analgesic effects of thoracic epidural anesthesia. 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- Associate Professor, Department of Anesthesiology and Surgery, School of Medicine, Pontifical Catholic University of Parana (PUCPR), Londrina‐PR, Brazil
'},{corresp:null,contributorFullName:"Fernanda Bortolanza Hernandes",address:null,affiliation:'- School of Medicine, Pontifical Catholic University of Parana (PUCPR), Londrina‐PR, Brazil
'},{corresp:null,contributorFullName:"Thaís Natália de Almeida",address:null,affiliation:'- School of Medicine, Pontifical Catholic University of Parana (PUCPR), Londrina‐PR, Brazil
'},{corresp:null,contributorFullName:"Vitor Pinheiro Sobottka",address:null,affiliation:'- Associate Professor, Department of Anesthesiology and Surgery, School of Medicine, Pontifical Catholic University of Parana (PUCPR), Londrina‐PR, Brazil
'},{corresp:null,contributorFullName:"Regina Célia Poli-Frederico",address:null,affiliation:'- Associate Professor, Doctoral Program of Rehabilitation Sciences, University of Northern Parana (UNOPAR), Londrina‐PR, Brazil
'},{corresp:"yes",contributorFullName:"Karen Barros Parron Fernandes",address:"karenparron@gmail.com",affiliation:'- Associate Professor, Doctoral Program of Rehabilitation Sciences, University of Northern Parana (UNOPAR), Londrina‐PR, Brazil
- Institute of Education, Research and Innovation, Irmandade da Santa Casa de Londrina (ISCAL), Londrina‐PR, Brazil
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Then why do we always find it difficult to connect, why is there always some kind of conflict going on with others and more so with oneself? Ironically, we experience this not only with random people in our life, but with people whom we feel close to, with whom we are always together, with whom we don’t wish to hold grudges, i.e. Our Own People!! Are we falling short of vocabulary? Are we showing our true self to them? Are we afraid of something? Are we being insensitive? Our interpersonal relationships are far too perplexing.
1. Introduction
Human beings are social animals and communication between humans is an inevitable component of human life. Without connecting to people or communicating with others, people feel lonely. Every individual is unique in his/her own ways of thinking, perceiving, talking, acting, communicating, etc. It demands a whole lot of patience and understanding to manage differences and conflicts that arise during exchange of communication with others and maintain and nurture healthy relationships. One can compare interpersonal relationships to a garden that is full of different flowers, plants, fruits, vegetables, all growing simultaneously side by side and needing maintenance to help them grow.
Every relationship goes hand in hand with certain extent of expectations. Within social psychology, social exchange theorists documented decades ago how interpersonal relationships are governed by reciprocity concerns [1, 2]. This asserts the ‘give and take’ principle of relationships with varying intensities. Interpersonal relationships as the name suggests cannot be one sided. Interpersonal relationships need to be essentially built through skills like being empathetic, actively listening to others, cooperating, helping others, making the right decision, finding the common ground by negotiation, etc.
2. Violence: an element of communication
Individuals’ social and emotional needs include needs of praise, respect, love, affection, achievement and so on. Strong caring relationships result in healthy and better life, whereas poor relationships may promote depression, drug abuse, and other mental health problems. Daily talk and actions may intentionally or unintentionally reflect a kind of violence that can disrupt relationships and ruin the healthy environment. Violence can be manifested in different forms of communication that inhibits autonomy, fails to recognize one’s and others’ needs, devalues others or be ruthless to both self and others. Other than forms of violence like physical abuse; murder; rape amongst other actions, violence in interpersonal relationships can be manifested in being rude; labelling’ hurting others’ feelings; bullying; not listening; neglecting; criticizing; passive-aggressiveness; violating confidentiality; causing embarrassment, etc. Similar kind of aversive interpersonal behaviors can have negative effects on the emotional, social and psychological well-being of the individual who is at the receiving end [3].
3. Non-violent communication: the key to positive interpersonal relationships
Rosenberg emphasizes the importance of nonviolence in everyday life and brings out the essence of a good interpersonal relationship through non-violent communication (NVC) which includes four components: observation, feelings, needs and appeal/request. Rosenberg conveys that nonviolent communication leads to the transformation of the way we express ourselves and hear others, directs us to honest and clear expression and at the same leads to paying attention to each other with respect and empathy [4].
Do read the poem ‘Words are Windows or They’re Walls’ by Ruth Bebermeyer.
Rosenberg in his book ‘Nonviolent communication: a language of life’ talks about how he identified a specific approach to communicating—both speaking and listening—that leads us to give from the heart, connecting us with ourselves and with each other in a way that allows our natural compassion to flourish. He refers to this approach as Nonviolent Communication, using the term nonviolence as Mahatma Gandhi, the Indian freedom fighter used it—to refer to our natural state of compassion when violence has subsided from the heart. Generally we may not consciously realize that the way we talk may be ‘violent’, but words may often lead to hurt and pain, both for others or ourselves.
Nonviolent communication is not something new or that we are unfamiliar with; it’s a conscious attempt to remind us about how we as humans are meant to relate to one another and assist us in a way of living that manifest this knowledge. This kind of communication assists us in reframing and revisiting our ways of expressions and listening characteristics. It enables individuals to carefully choose words or responses based on awareness of what one is perceiving, feeling, and wanting. Individuals using nonviolent communication tend to express themselves with honesty and clarity, while simultaneously paying others a respectful and empathic attention. Such kind of exchanges drive our awareness towards our own needs and of others. In the course of such exchanges, we are trained to observe carefully, specify the behaviors and conditions that are affecting us and learn to articulate our needs in any given situation. Though this sounds very simple, it is powerfully transformative. NVC fosters respect, attentiveness, and empathy and engenders a mutual desire to give from the heart. It may not be considered as a technique that can complete bring to end arguments or any kind of disagreements in dialog, but rather a method designed to increase empathy and the quality of relationships of individuals who use NVC with people in their environment.
4. The NVC process
Rosenberg refers to NVC as more than a process or a language. One needs to focus the light of consciousness on four areas—referred to as the four components of the NVC model, observation, feeling, need, and request.
Let us understand the presence of awareness of the first three components when we use NVC to clearly and honestly express how we are.
Initially an individual observes the occurrences or happenings in a situation; this observation of others’ words or actions may or may not be as favorable to the individual. The next step is how the individual is able to articulate this observation without judging or evaluating the words and actions by just assuming that whatever is happening is either favorable to the individual or unfavorable to the individual. Further the individual expresses one’s feelings like joy, sadness, irritation, frustration, happiness, etc. when s/he observes the actions. Next the individual may voice out one’s needs that maybe connected to the feelings that s/he expresses.
The fourth component addresses that which the individual wants/needs from the other person and that which will be favorable for the individual and enrich his/her life.
Thus, part of NVC is to express the pieces of information very clearly, whether verbally or by other means. The other part of this communication consists of receiving the same pieces of information from others. One connects with them by first sensing what one is observing, feeling, and needing; then discover what would enrich one’s lives by receiving the final piece—their request.
4.1 NVC process
The concrete actions we observe
How we feel in relation to what we observe
The needs that create our feelings
The concrete actions we request to enrich our lives
The essence of NVC is in one’s consciousness of the four components, not in the actual words that are exchanged.
5. Interpersonal relationships in educational context
Virginia Satir once said, “I see communication as a huge umbrella that covers and affects all that goes on between human beings.” If this is true, why is there so little attention to the umbrella? [5].
Man educates him/herself to live a life appropriate to self and the surroundings. If we consider a formal education setup like a classroom constituted of students and teachers, different types, modes, or styles of communication are embedded in the teacher–student relationships and the routine interpersonal interactions in classrooms form the building block of these relationships. Positive teacher–student relationships also contribute to student learning. Problematic relationships have been found to be detrimental to the attainment of student outcomes and development. Warm and supportive interactions between teacher–student and student–student lead to productive learning environments. Martin and Dowson, while mentioning the context of a student’s life emphasize the need for positive interpersonal attachments to parents, teachers, and peers in fostering healthy social, emotional and intellectual functioning, as well as positive feelings of self-esteem and self-worth [6].
The education system in general is still orchestrated within power dynamics and a culturally appropriated control over the ‘so-called’ superior knowledge. Students enjoy little or no autonomy and learning takes the form of transmission or transfer of knowledge from the teacher as authority to the student as the receiver of knowledge. Such an educational system places harsh demands on the student community which primarily seeks to succeed for survival based on fear of failure or rebuke, thus hindering the overall growth and enrichment of the individual’s life. This strongly demands a need to create a culture of acceptance, support, and mutual respect where true growth can take place for teachers and learners alike.
Strong healthy interpersonal relationships between students and teachers necessitate skills that revolve around the ability of both to create a positive educational setting encompassing conditions of empathy, warmth, mutual respect, amongst others. Teachers in the capacity of being far more educated and experienced than students will need to exercise their agency with an exclusive set of behavioral actions and act as professionals with a different set of responsibilities in the best interest of their students. Given the constraints of time in completing the syllabi prescribed in a loaded curriculum, and the kind of academic and administrative responsibilities that teachers are expected to shoulder, teachers will ideally not have the luxury of time to solely dedicate, to building relationships with students. It is thus essential to focus on how teachers can build positive interpersonal relationships with students into the daily course of their interactions embedded in both routine discourse and pedagogy in the classroom.
6. Teacher: student interpersonal skills
“Children need far more than basic skills in reading, writing, and math, as important as those might be. Children also need to learn how to think for themselves, how to find meaning in what they learn, and how to work and live together.” —Marshall B. Rosenberg, Ph.D. [7]
First and foremost, a student-centered classroom is a primary ingredient of a safe and sound classroom and the quality and type of teacher–student communication determines this type of classroom. The effective teacher in this kind of classroom is able to facilitate the use of student’s ability to express personal experiences and guide the learning to encompass student needs and interests. Carkhuff et al., believe that, good interpersonal skills enable the teacher to enter the learner’s frame of reference and prepare him/her for learning [7]. This further enables to create a situation wherein students feel related to teachers and feel that their needs are satisfied thus allowing for their optimal function and development. Teacher–student interactions are the main determinants of these type of environments.
7. Creating a safe and trustful classroom
What can teachers do to thrive—to engage in joyful learning and compassionate interactions? And how can they contribute to meeting these needs?
A teacher’s relation to self and with others, especially her students, are vital to create a safe and desirable environment for students’ overall development.
7.1 Recognizing students’ needs
In creating a relation with self and others, one needs to mindful of needs of students’ needs.
Discipline is a very traditional hallmark of a classroom. Teachers usually expect strict discipline from students—discipline in being quiet in class, completing tasks on time, listen to their instructions, be obedient most of the times, be well-behaved at all times, take responsibility and more. Disciplinary control practices like punishment, rewards, judgments, comparisons, threats, etc. induce fear in children. Disciplinary measures by teachers often tend to have detrimental effects on students’ outcomes. Besides physical violence, bullying, labelling, taunting, amongst others, that are causes of concern for children’s safety, other daily routine occurrences at school induce fear in students and undermine their emotional safety.
In addition to academic subjects, content knowledge and other related tasks, classroom relationships; safety; trust; student needs; teacher needs; and modes of communication are highly important to create a compassionate learning community where engaged learning flourishes.
In order to create a fearless environment for students, their needs should be acknowledged and met with appropriately. William Glasser refers the basic human needs as needs for survival, power, belonging, freedom, and fun. Abraham Maslow refers to the basic human needs like survival, protection/safety, belonging, competence/learning, and autonomy or self-actualization [5]. The vocabulary of needs is quite vast. Categorizing students’ needs in an educational context, students bring to school needs for belonging, fun, freedom, competence, and autonomy besides learning. Unless these needs are fulfilled to their satisfaction, students will not feel safe enough to fully engage in the learning process.
A classroom setting comprises students from diverse backgrounds and possessing differential capabilities. If a teacher is able to support students’ common needs rather than ranking their academic differences, s/he will be able to create a safe space filled with trust in the school context. This emphasizes the need to shift the focus from disciplining students to meeting their needs.
Acknowledging students’ needs is not sufficient; there is more to it. How one communicates the needs and listens to others’ needs determines the likeliness of fulfillment of the needs. This is all about the language of giving and receiving, which necessitates the practice of the art of empathy. Teachers need to practice a way of language that is not aggressive in nature. Aligned to this, teachers will have to practice skills like guessing students’ feelings from verbal and non-verbal cues; identifying values—one’s own and of students; translating judgments into statements of feelings and needs or strategies for meeting needs; and taking responsibility for one’s own thoughts, feelings, and actions.
7.2 Building relations with self
The curious paradox is that when I accept myself just as I am, then I can change. —Carl Rogers [5]
At the outset, a teacher has to build a relationship with self. This entails taking time out to make deliberate attempts to observe oneself and ask questions to self about self. The questions can range from one’s intention or goal, interests, talents, qualities that one values and would like to cultivate in students, the kind of relationships one would like to nurture and so on.
The teacher should be able to question herself about what s/he thinks about self. Since a tendency to criticize and judge oneself usually results in being critical of others whereas compassion for oneself is more likely to result in compassion for others.
The teacher should be able to recognize one’s own contributions and successes and at the same time also be able to notice one’s mistakes and learn from these mistakes.
The teacher has to be able to identify the moments and activities that s/he enjoys doing and how often s/he encounters such instances.
The teacher should be able to ask for help or support from others without hesitation to be able to cope with one’s own challenges and frustrations and also be able to take time to celebrate one’s successes with others.
True compassion requires us to attend to our own humanity, to come to a deep acceptance of our own life as it is. It requires us to come into right relationship with that which is most human in ourselves. — Rachel Naomi Remen
7.3 Building relationships with students
To be able to connect with students, teachers should be able to let students know that their thoughts and feelings matter, they are listened to and their view points are given importance. A teacher is likely to experience feelings of excitement and joy only if s/he is able to see students as whole human beings with their own thoughts, feelings, needs, talents, interests, and gifts to share. The way students are perceived by teachers through the classroom contexts often communicates louder than words.
Teachers should be able to listen carefully to students and value what they say. This contributes to understanding, connection, and trust. Teacher should question themselves as to how many times do they give an attentive ear to their students.
It is very important to deliberate on the fact that for what is it that you are listening to students. Is it just the academic content, textbook responses, or academic knowledge or something beyond that? The teacher should be able to listen to students’ needs, understand their feelings and encourage them to grow themselves from the inside out.
The teacher should be able to maintain a balance between fulfilling one’s own needs and the students’ needs. At times, when students end up doing something that is against teacher’s expectations or needs, the teacher should be able to let them know that s/he cares about their needs getting met as much as s/he cares about meeting one’s own needs by avoiding any kind of force on students to do as per the teacher’s needs or using any power strategies. Any kind of verbal or non-verbal punishment for not conforming to the teacher’s needs should be avoided. This does not mean that the teacher should sacrifice one’s own needs. S/he should find out ways to ensure that needs of both the teacher and students are fulfilled.
8. NVC: the language of giving and receiving
Nonviolent communication is founded on language and communication skills that strengthen our ability to remain human, even under trying conditions. The language of giving and receiving speaks of our common human needs and what would make life more wonderful for us. This way of communicating makes it easy to give to one another and to receive from one another—to enjoy and enrich life.
However, in our routine daily life, one generally tends to speak a language that makes it difficult for people to give and receive in a joyful manner. This language usually meets superficial needs and results in pain including conflicts that arise every day in classrooms.
Unfortunately, this is not the language most of us learned. It is usually referred to as Jackal Language because (metaphorically) the jackal is low to the ground, and its sight is limited to what is right in front of it.
Say for instance a teacher utters the following statements in the classroom:
“You latecomer, what have you achieved today?” (labelling)
“You are a dumb student, who always gets low scores in exams. You cannot take part in this competition.” (judging)
“You have copied in your paper, I can see the exact same responses in ‘X’s’ paper too.” (blaming)
“You have to complete the assignments by the end of this week, I do not care how you do it.” (demanding)
This language is usually used by teachers who often think about who’s good, who’s bad, who’s right, who’s wrong, and who’s to blame. It is devoid of feelings and needs and just conveys thoughts, beliefs, and opinions. Knowing that this is not what one wishes to communicate, yet it has become so automatic that teachers end up communicating in this way before they know what is happening. Teachers need to relearn a language of giving and receiving, where the above statements can be translated into messages that contribute to meeting the needs of students.
The language of giving and receiving has many names, including: Nonviolent communication, Compassionate Communication, and the Language of the Heart. It is also referred to as the Giraffe Language because (metaphorically) the giraffe perspective includes vision and a big heart—the integration of thinking and feeling.
Let us attempt to translate the above classroom statements into a language of giving and receiving.
“I have been observing that you have been coming late quite often. Is there any way I can help you to keep up with the class sessions?”
“You may not be performing well in your papers, but I feel that you will be able to do well in this competition, so I think you should try and take part in this competition.”
“I see that your responses in the answer sheet seem to be same as ‘X’s’ responses. I need to know if you if you are not able to understand what I am teaching in the class. Only then I will be able to ascertain that my objectives are attained.”
“Can you please complete the assignments by the end of this week, so that the grades can be submitted on time”
As we can see here, the teacher is able to convey via these translated statements, what s/he observes, show concern for both student’s needs and one’s own needs, express his/her feelings and listen to student’s voice. These expressions of the pieces of information given by the teacher enables the teacher to stay motivated solely to give and receive compassionately, and do everything s/he can to let the students know about his/her intention and eventually elicit compassionate responses from students too, thus creating a mutual exchange of compassionate communication resulting in the overall well-being of both the giver and the receiver.
As we glance through these expressions, we can see the four components of ‘Nonviolent Communication’ in the form of giving—observations, feelings, needs, and requests. At the receiving end, students can connect with each component by first sensing what is being observed, felt, and what needs are considered; and then identify what would enrich their lives by receiving the fourth piece of information—the request. Gradually a flow of communication, back and forth, gets internalized until compassion manifests naturally. One needs to be cautious that NVC is not a fixed or agreed upon formula, but it is something that adapts to various situations as well as personal and cultural styles.
As we are familiar, there are a number of different cultures existing on this planet. Each culture comes with a package of its own norms, views, expressions, and beliefs and these elements largely determine the patterns and styles of communication amongst people inhabiting these cultures. Culture also undergoes continuous changes, evolving across time and space, thus adapting to different circumstances and situations. This kind of cultural diversity is strongly influential on ways in which individuals interact with, interpret or understand other individuals. Communication styles are thus subject to discrepancies or conflicts as a result of existing cultural differences.
Say for example we look at two different cultures—the individualist and collectivist cultures. Western culture is generally identified as individualist and the eastern culture as collectivist. The characteristic features of these cultures are independent and interdependent respectively. Individuals from individualist cultures usually follow the norms of exploration, creativity, self-reliance whereas individuals from collectivist cultures follow the norms of conformity and obedience. Thus the principles of tolerance, understanding, conflict management and spirit of mutual co-existence is reflected more in collectivist cultures as compared to individualist cultures. Individuals belonging to individualist societies seem to lack compassion, empathy, mutual respect and expressions of gratitude. These characteristic features of individualist cultures may result in the evolution of unhealthy communication to a large extent [8]. One cannot resort to a fixed strategy of NVC across these cultures. Individuals need to understand the meaning, context and vocabulary of the communication or interaction in that situation to make appropriate use of NVC for the well-being of both the giver and the receiver.
Let us look at another example to understand the dynamic nature of NVC. Family structures or systems also influence the way individuals communicate with each other. Children from a joint family structure demonstrate different value system compared to their peers who come from nuclear family structure. There are a few children who may also belong to broken families. A teacher comes across children from different types of families in the classroom. Dealing with different kinds of children with different value systems can make it quite challenging for teachers to maintain a cordial healthy relationship with students through use of a uniform style or strategy of non-violent communication, since the teacher will have to understand the child’s background, value and belief system to utilize the right kind of language and also teach the child the appropriate way of behavior and language to ensure the well-being of both the child and the teacher. Teachers will have to make deliberate attempts to change old habits of thinking, listening, and talking, but it is not totally impossible. They need to make conscious efforts to learn NVC, the language of giving and receiving, and practice over time to develop fluency and adapt to different situations.
9. Why NVC for teacher: student interpersonal relationships
Teachers using the components of NVC in their communication with students display understanding and caring for students and hence are able to establish good interpersonal relationships with students. As a result, students feel they are being cared for by their teachers and hence students tend to care about what their teachers think about their behaviour. Students’ behaviors start reflecting the behaviour of their teachers (adults).
A positive student–teacher interpersonal relationship is very crucial for the overall development of students. A teacher’s ability to interact with students with warmth, empathy, respect, trust and confidence in his/her students determines the quality of the teacher–student interpersonal relationship and the responsibility of this relationship lies largely with the teacher. Research has widely suggested the importance of interpersonal relationships of students and teachers, and its effect on the outcome of the educational process [9]. Moreover, the positive effects of interpersonal skills do not seem to be limited to student achievement alone, but goes beyond to increased student’s self-concept and reduction of negative student behaviors.
10. Conclusions
The present chapter at the outset introduces us to the nature of interpersonal relationships with a strong emphasis on the ‘give and take’ principle of relationships. It brings to light the social nature of humans who possibly survive through communication and connections with other humans. Having said that, the chapter makes a mention of both implicit and explicit forms of violence that may be manifested in different forms of communication which can have negative effects on the emotional, social and psychological well-being of individuals. In effect to this, the chapter demonstrates the essence of a good interpersonal relationship through non-violent communication (NVC) as proposed by Rosenberg. It elaborates on the transformative power of NVC which is shown as a method designed to increase empathy and the quality of relationships of individuals. The essence of NVC is expressed as one’s consciousness of the four components, namely observation, feelings, needs and appeal/request and not in the actual words that are exchanged. The chapter attempts to use this lens of NVC for interpersonal relationships exclusively in the area of teacher–student relationships in the educational context. It describes NVC as the language of giving and receiving and accentuates the need for teachers to make conscious efforts to learn NVC, the language of giving and receiving and practice over time to develop fluency. It further focusses on how teachers using NVC, can build positive interpersonal relationships with students into the daily course of their interactions embedded in both routine discourse and pedagogy in the classroom. Such an interpersonal relationship can be developed between students and teachers when both of them mutually share needs and feelings of each other and build trust and respect, the two key elements to any relationship.
The chapter further facilitates the reader to explore ways and strategies of non-violent communication that can enable teachers to develop and nurture healthy positive interpersonal relationships with students, to manage student behaviors and make the classroom environment, conducive to effective teaching–learning. The chapter concludes by foregrounding the NVC approach to communication, i.e. a way of communicating that leads one to give from the heart, and underscores the results of NVC in bringing about many positive gains for students and teachers alike, contributing to everyone’s well-being.
\n',keywords:"nonviolent communication, interpersonal relationships, teacher–student relationships, classroom context",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/81633.pdf",chapterXML:"https://mts.intechopen.com/source/xml/81633.xml",downloadPdfUrl:"/chapter/pdf-download/81633",previewPdfUrl:"/chapter/pdf-preview/81633",totalDownloads:26,totalViews:0,totalCrossrefCites:0,dateSubmitted:"January 11th 2022",dateReviewed:"February 18th 2022",datePrePublished:"May 4th 2022",datePublished:null,dateFinished:"May 4th 2022",readingETA:"0",abstract:"Human beings are social animals and communication between humans is an inevitable component of human life. In a formal school setup, the routine interpersonal interactions in classrooms form the building block of the teacher-student relationships. Strong healthy interpersonal relationships between students and teachers necessitate skills that revolve around the ability of both to create a positive educational setting encompassing conditions of empathy, warmth, mutual respect, amongst others. Teachers in the capacity of being far more experienced than students will need to exercise their agency with an exclusive set of behavioral actions and act as professionals with a different set of responsibilities in the best interest of their students. Daily talk and actions may reflect a kind of violence that can disrupt relationships creating unhealthy environment. Violence can be manifested in different forms of communication that inhibits autonomy, fails to recognize one’s and others’ needs, among others. Rosenberg emphasizes the importance of nonviolence in everyday life and brings out the essence of a good interpersonal relationship through non-violent communication (NVC). Within this context, the present chapter will explore ways of non-violent communication that can enable teachers to develop and nurture healthy positive interpersonal relationships with students.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/81633",risUrl:"/chapter/ris/81633",signatures:"Gomathi Jatin Shah",book:{id:"11307",type:"book",title:"Interpersonal Relationships",subtitle:null,fullTitle:"Interpersonal Relationships",slug:null,publishedDate:null,bookSignature:"Prof. Xiaoming Jiang",coverURL:"https://cdn.intechopen.com/books/images_new/11307.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-631-4",printIsbn:"978-1-80355-630-7",pdfIsbn:"978-1-80355-632-1",isAvailableForWebshopOrdering:!0,editors:[{id:"189844",title:"Prof.",name:"Xiaoming",middleName:null,surname:"Jiang",slug:"xiaoming-jiang",fullName:"Xiaoming Jiang"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"",level:"1"},{id:"sec_2",title:"1. Introduction",level:"1"},{id:"sec_3",title:"2. Violence: an element of communication",level:"1"},{id:"sec_4",title:"3. Non-violent communication: the key to positive interpersonal relationships",level:"1"},{id:"sec_5",title:"4. The NVC process",level:"1"},{id:"sec_5_2",title:"4.1 NVC process",level:"2"},{id:"sec_7",title:"5. Interpersonal relationships in educational context",level:"1"},{id:"sec_8",title:"6. Teacher: student interpersonal skills",level:"1"},{id:"sec_9",title:"7. Creating a safe and trustful classroom",level:"1"},{id:"sec_9_2",title:"7.1 Recognizing students’ needs",level:"2"},{id:"sec_10_2",title:"7.2 Building relations with self",level:"2"},{id:"sec_11_2",title:"7.3 Building relationships with students",level:"2"},{id:"sec_13",title:"8. NVC: the language of giving and receiving",level:"1"},{id:"sec_14",title:"9. Why NVC for teacher: student interpersonal relationships",level:"1"},{id:"sec_15",title:"10. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'[Rosenberg M. Nonviolent Communication. 2nd ed. Del Mar, CA: Puddle Dancer Press; 2003]'},{id:"B2",body:'[Buunk B, Schaufeli W. Reciprocity in interpersonal relationships: An evolutionary perspective on its importance for health and well-being. European Review of Social Psychology. 1999;10(1):259-291]'},{id:"B3",body:'[Kovalski RM. Aversive Interpersonal Behaviors: On Being Annoying, Thoughtless, and Mean. In Behaving badly: Aversive behaviors in interpersonal relationships, American Psychological Association. 2001. pp. 3-26]'},{id:"B4",body:'[Dabo K, Bakić-Tomić L, Žunac AG. Nonviolent communication in interpersonal relationships. Contemporary Social Sciences. Scopus; 2015;10(4)]'},{id:"B5",body:'[Hart S, Kindle HV. The Compassionate Classroom—Relationship Based Teaching and Learning. Encinitas, CA: Puddle Dancer Press; 2004]'},{id:"B6",body:'[Zandvliet D, Brok P, Mainhard T, Tartwijk J. Interpersonal Relationships in Education: From Theory to Practice. AW Rotterdam, The Netherlands: Sense Publishers; 2014]'},{id:"B7",body:'[Rosenberg M. Life-Enriching Education Nonviolent Communication Helps Schools Improve Performance, Reduce Conflict, and Enhance Relationships. Encinitas, CA: Puddle Dancer Press; 2003]'},{id:"B8",body:'[Triandis HC. Individualism—Collectivism and personality. Journal of Personality. 2001;69(6):907-924. DOI: 10.1111/1467-6494.696169]'},{id:"B9",body:'[Spivey C. Interpersonal interactions in student–teacher relationships: Types and effect on student achievement. [Internet]. 1985. Available from: https://digitalcommons.unf.edu/etd/708]'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Gomathi Jatin Shah",address:"gomathijatin@gmail.com",affiliation:'- Centre of Excellence in Teacher Education, Tata Institute of Social Sciences, Mumbai, India
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Ruskin",authors:null},{id:"34611",doi:"10.5772/38884",title:"The Evolution and Spatial Dynamics of Coastal Cities in Greece",slug:"the-evolution-and-spatial-dynamics-of-coastal-cities-in-greece",totalDownloads:1971,totalCrossrefCites:1,totalDimensionsCites:5,abstract:null,book:{id:"905",slug:"urban-development",title:"Urban Development",fullTitle:"Urban Development"},signatures:"Serafeim Polyzos and Dimitrios Tsiotas",authors:[{id:"106057",title:"Dr.",name:"Serafeim",middleName:null,surname:"Polyzos",slug:"serafeim-polyzos",fullName:"Serafeim Polyzos"}]}],mostDownloadedChaptersLast30Days:[{id:"69772",title:"Smart Rainwater Management: New Technologies and Innovation",slug:"smart-rainwater-management-new-technologies-and-innovation",totalDownloads:2094,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"In a smart city, the following factors are very vital such as smart grid and e-health. A smart city is one of the burning topics of research. Although there is no particular definition of a smart city, it means smart grid, e-health, e-environmental monitoring, smart home, smart water quality, smart air quality, etc. integrated into a single application. Human civilization can’t be sustained and prosper with shortage of usable water. Hence, water has a vital share in human life even for those living in smart cities. This chapter describes about the smart water quality issues in a smart city and some of the research advances in handling those issues. Among them it investigates the rainwater harvesting technologies and some of their practical applications.",book:{id:"7624",slug:"smart-urban-development",title:"Smart Urban Development",fullTitle:"Smart Urban Development"},signatures:"Raseswari Pradhan and Jayaprakash Sahoo",authors:null},{id:"62066",title:"Urban Planning and Mega-Event Projects: Lessons from Expo 2010, Shanghai",slug:"urban-planning-and-mega-event-projects-lessons-from-expo-2010-shanghai",totalDownloads:1406,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"With the capitalist transformation from Fordist-Keynesianism to neoliberalism, mega-events such as Olympic Games and World Exposition have increasingly been incorporated into urban development plan to boost urban renewal. Seeking the role of mega-event in urban transformation and its related effects have practical significance as mega-event movements have become a worldwide phenomenon. Although the profile of world fairs is reduced and does not have the international impacts that they used to have, Shanghai Expo 2010, the first Expo ever held in a developing country is pinned hope on as the “Turn to Save the World Expo” and is unusually ambitious to bring opportunities in urban transformation. While much attention has been paid to how mega-events can be used in tourism development in previous literature, this research links mega-event to urban development. Specifically, it reviews planning history before Expo 2010, addresses how a mega-event is integrated into city’s overall transformation strategy and what possible challenges a mega-event strategy may encounter related to the ultimate goal of urban transformation. It finds that political added value of mega-events empowers Shanghai to advance its urban agenda and the role of urban planner is vital to deliver a sustainable mega-event.",book:{id:"7470",slug:"an-overview-of-urban-and-regional-planning",title:"An Overview of Urban and Regional Planning",fullTitle:"An Overview of Urban and Regional Planning"},signatures:"Lingyue Li",authors:[{id:"247599",title:"Dr.",name:"Lingyue",middleName:null,surname:"Li",slug:"lingyue-li",fullName:"Lingyue Li"}]},{id:"67808",title:"Understanding Urban Mobility and Pedestrian Movement",slug:"understanding-urban-mobility-and-pedestrian-movement",totalDownloads:1419,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Urban environments continue to expand and mutate, both in terms of size of urban area and number of people commuting daily as well as the number of options for personal mobility. City layouts and infrastructure also change constantly, subject to both short-term and long-term imperatives. Transportation networks have attracted particular attention in recent years, due to efforts to incorporate “green” options, enabling positive lifestyle choices such as walking or cycling commutes. In this chapter we explore the pedestrian viewpoint, aids to familiarity with and ease of navigation in the urban environment, and the impact of novel modes of individual transport (as options such as smart urban bicycles and electric scooters increasingly become the norm). We discuss principal factors influencing rapid transit to daily and leisure destinations, such as schools, offices, parks, and entertainment venues, but also those which facilitate rapid evacuation and movement of large crowds from these locations, characterized by high occupation density or throughput. The focus of the chapter is on understanding and representing pedestrian behavior through the agent-based modeling paradigm, allowing both large numbers of individual actions with active awareness of the environment to be simulated and pedestrian group movements to be modeled on real urban networks, together with congestion and evacuation pattern visualization.",book:{id:"7624",slug:"smart-urban-development",title:"Smart Urban Development",fullTitle:"Smart Urban Development"},signatures:"Marija Bezbradica and Heather J. Ruskin",authors:null},{id:"63405",title:"Restructuring Gauteng City Region in South Africa: Is a Transportation Solution the Answer?",slug:"restructuring-gauteng-city-region-in-south-africa-is-a-transportation-solution-the-answer-",totalDownloads:1907,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"The Gauteng city region forms the economic hub of socio-economic development and growth in South Africa. The province itself includes the Johannesburg metropolitan city, Ekurhuleni metropolitan city as well as Tshwane municipality—key urban growth regions of Gauteng province, South Africa, and by extension Southern Africa. The region exhibits the rapid urbanisation challenges typical in any developing country city. Rural–urban migration, pressure on infrastructure demand, supply and capacity constraints and mismatches in urban governance structures with respect to service delivery have remained stubborn challenges. Initiatives and strategies to resolve urban traffic congestion such as through road construction and highway expansion (physical instrument), e-tolling of roads (financial instrument), innovative housing and waste management technology deployment (technology instruments) as well as presenting advanced spatial planning and development and management systems (planning and regulatory instruments) have been employed with mixed fortunes in attempts to (re)solve the urban problems in the study area. Making use of a thematic approach and technique, the major urbanisation issues are explored and solutions proffered. Recommendations revolve around the need to implement robust and progressive rafts of projects, programmes, activities, measures and actions to reverse spatial fragmentation and spatially inefficient transport induced and perpetuated disadvantages.",book:{id:"7470",slug:"an-overview-of-urban-and-regional-planning",title:"An Overview of Urban and Regional Planning",fullTitle:"An Overview of Urban and Regional Planning"},signatures:"James Chakwizira, Peter Bikam and Thompson A. Adeboyejo",authors:[{id:"250792",title:"Dr.",name:"James",middleName:null,surname:"Chakwizira",slug:"james-chakwizira",fullName:"James Chakwizira"},{id:"265387",title:"Prof.",name:"Peter",middleName:null,surname:"Bikam",slug:"peter-bikam",fullName:"Peter Bikam"},{id:"265388",title:"Prof.",name:"Thompson A",middleName:null,surname:"Adeboyejo",slug:"thompson-a-adeboyejo",fullName:"Thompson A Adeboyejo"}]},{id:"62114",title:"Urban Noise as an Environmental Impact Factor in the Urban Planning Process",slug:"urban-noise-as-an-environmental-impact-factor-in-the-urban-planning-process",totalDownloads:1480,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"This research focuses on an analysis of the perception of urban noise in the daily lives of the residents of two different areas: (1) a residential neighborhood and (2) a city center, respectively, considering (1) an acoustically ideal urban environment and (2) an acoustically polluted urban environment. To this end, a random sample of individuals from both areas was asked to fill out a questionnaire. Sound pressure levels were also measured in each of the evaluated areas. The World Health Organization (WHO) considers a quiet area as one in which the measured sound pressure level is up to 55 dB(A). The average measured sound pressure levels were 53.5 and 72.9 dB(A), respectively, in the quiet area and in the area considered acoustically polluted. Data were subjected to a multivariate factor analysis. The main complaints reported by the interviewees were as follows: headache, irritability, poor concentration and insomnia. Interviewees in the city center stated that street traffic noise was the main source of annoyance, while the residents of the residential area stated that the main source of discomfort was air traffic noise.",book:{id:"7470",slug:"an-overview-of-urban-and-regional-planning",title:"An Overview of Urban and Regional Planning",fullTitle:"An Overview of Urban and Regional Planning"},signatures:"Elaine Carvalho da Paz, Thomas Jeferson Vieira and Paulo Henrique Trombetta Zannin",authors:[{id:"66572",title:"Prof.",name:"Paulo Henrique Trombetta",middleName:null,surname:"Zannin",slug:"paulo-henrique-trombetta-zannin",fullName:"Paulo Henrique Trombetta Zannin"},{id:"257807",title:"MSc.",name:"Elaine Carvalho",middleName:null,surname:"Da Paz",slug:"elaine-carvalho-da-paz",fullName:"Elaine Carvalho Da Paz"},{id:"257814",title:"Mrs.",name:"Thomas Jeferson",middleName:null,surname:"Vieira",slug:"thomas-jeferson-vieira",fullName:"Thomas Jeferson Vieira"}]}],onlineFirstChaptersFilter:{topicId:"80",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:"2753-6580",scope:"\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. 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\r\n\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
\r\n\r\n\t
\r\n\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
\r\n\r\n\t
\r\n\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
\r\n\r\n\t
\r\n\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
\r\n\r\n\t
\r\n\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
",coverUrl:"https://cdn.intechopen.com/series/covers/24.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:1,editor:{id:"262440",title:"Prof.",name:"Usha",middleName:null,surname:"Iyer-Raniga",slug:"usha-iyer-raniga",fullName:"Usha Iyer-Raniga",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRYSXQA4/Profile_Picture_2022-02-28T13:55:36.jpeg",biography:"Usha Iyer-Raniga is a professor in the School of Property and Construction Management at RMIT University. Usha co-leads the One Planet Network’s Sustainable Buildings and Construction Programme (SBC), a United Nations 10 Year Framework of Programmes on Sustainable Consumption and Production (UN 10FYP SCP) aligned with Sustainable Development Goal 12. The work also directly impacts SDG 11 on Sustainable Cities and Communities. She completed her undergraduate degree as an architect before obtaining her Masters degree from Canada and her Doctorate in Australia. Usha has been a keynote speaker as well as an invited speaker at national and international conferences, seminars and workshops. Her teaching experience includes teaching in Asian countries. She has advised Austrade, APEC, national, state and local governments. She serves as a reviewer and a member of the scientific committee for national and international refereed journals and refereed conferences. She is on the editorial board for refereed journals and has worked on Special Issues. Usha has served and continues to serve on the Boards of several not-for-profit organisations and she has also served as panel judge for a number of awards including the Premiers Sustainability Award in Victoria and the International Green Gown Awards. Usha has published over 100 publications, including research and consulting reports. Her publications cover a wide range of scientific and technical research publications that include edited books, book chapters, refereed journals, refereed conference papers and reports for local, state and federal government clients. She has also produced podcasts for various organisations and participated in media interviews. She has received state, national and international funding worth over USD $25 million. Usha has been awarded the Quarterly Franklin Membership by London Journals Press (UK). Her biography has been included in the Marquis Who's Who in the World® 2018, 2016 (33rd Edition), along with approximately 55,000 of the most accomplished men and women from around the world, including luminaries as U.N. Secretary-General Ban Ki-moon. In 2017, Usha was awarded the Marquis Who’s Who Lifetime Achiever Award.",institutionString:null,institution:{name:"RMIT University",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:5,paginationItems:[{id:"91",title:"Sustainable Economy and Fair Society",coverUrl:"https://cdn.intechopen.com/series_topics/covers/91.jpg",isOpenForSubmission:!0,annualVolume:11975,editor:{id:"181603",title:"Dr.",name:"Antonella",middleName:null,surname:"Petrillo",slug:"antonella-petrillo",fullName:"Antonella Petrillo",profilePictureURL:"https://mts.intechopen.com/storage/users/181603/images/system/181603.jpg",biography:"Antonella Petrillo, Ph.D., is a professor in the Department of Engineering, University of Naples “Parthenope,” Italy. She received her Ph.D. in Mechanical Engineering from the University of Cassino and Southern Lazio, Italy. Her research interests include multi-criteria decision analysis, industrial plants, logistics, manufacturing, and safety. She serves as an associate editor for the International Journal of the Analytic Hierarchy Process and is an editorial board member for several other journals. She is also a member of the Analytic Hierarchy Process (AHP) Academy.",institutionString:"Parthenope University of Naples",institution:{name:"Parthenope University of Naples",institutionURL:null,country:{name:"Italy"}}},editorTwo:null,editorThree:null},{id:"92",title:"Health and Wellbeing",coverUrl:"https://cdn.intechopen.com/series_topics/covers/92.jpg",isOpenForSubmission:!0,annualVolume:11976,editor:{id:"348225",title:"Prof.",name:"Ann",middleName:null,surname:"Hemingway",slug:"ann-hemingway",fullName:"Ann Hemingway",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035LZFoQAO/Profile_Picture_2022-04-11T14:55:40.jpg",biography:"Professor Hemingway is a public health researcher, Bournemouth University, undertaking international and UK research focused on reducing inequalities in health outcomes for marginalised and excluded populations and more recently focused on equine assisted interventions.",institutionString:null,institution:{name:"Bournemouth University",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null},{id:"93",title:"Inclusivity and Social Equity",coverUrl:"https://cdn.intechopen.com/series_topics/covers/93.jpg",isOpenForSubmission:!0,annualVolume:11977,editor:{id:"210060",title:"Prof. Dr.",name:"Ebba",middleName:null,surname:"Ossiannilsson",slug:"ebba-ossiannilsson",fullName:"Ebba Ossiannilsson",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6LkBQAU/Profile_Picture_2022-02-28T13:31:48.png",biography:"Professor Dr. Ebba Ossiannilsson is an independent researcher, expert, consultant, quality auditor and influencer in the fields of open, flexible online and distance learning (OFDL) and the 'new normal'. Her focus is on quality, innovation, leadership, and personalised learning. She works primarily at the strategic and policy levels, both nationally and internationally, and with key international organisations. She is committed to promoting and improving OFDL in the context of SDG4 and the future of education. Ossiannilsson has more than 20 years of experience in her current field, but more than 40 years in the education sector. She works as a reviewer and expert for the European Commission and collaborates with the Joint Research Centre for Quality in Open Education. Ossiannilsson also collaborates with ITCILO and ICoBC (International Council on Badges and Credentials). She is a member of the ICDE Board of Directors and has previously served on the boards of EDEN and EUCEN. Ossiannilsson is a quality expert and reviewer for ICDE, EDEN and the EADTU. She chairs the ICDE OER Advocacy Committee and is a member of the ICDE Quality Network. She is regularly invited as a keynote speaker at conferences. She is a guest editor for several special issues and a member of the editorial board of several scientific journals. She has published more than 200 articles and is currently working on book projects in the field of OFDL. Ossiannilsson is a visiting professor at several international universities and was recently appointed Professor and Research Fellow at Victoria University of Wellington, NZ. Ossiannilsson has been awarded the following fellowships: EDEN Fellows, EDEN Council of Fellows, and Open Education Europe. She is a ICDE OER Ambassador, Open Education Europe Ambassador, GIZ Ambassador for Quality in Digital Learning, and part of the Globe-Community of Digital Learning and Champion of SPARC Europe. On a national level, she is a quality developer at the Swedish Institute for Standards (SIS) and for ISO. She is a member of the Digital Skills and Jobs Coalition Sweden and Vice President of the Swedish Association for Distance Education. She is currently working on a government initiative on quality in distance education at the National Council for Higher Education. She holds a Ph.D. from the University of Oulu, Finland.",institutionString:"Swedish Association for Distance Education, Sweden",institution:null},editorTwo:null,editorThree:null},{id:"94",title:"Climate Change and Environmental Sustainability",coverUrl:"https://cdn.intechopen.com/series_topics/covers/94.jpg",isOpenForSubmission:!0,annualVolume:11978,editor:{id:"61855",title:"Dr.",name:"Yixin",middleName:null,surname:"Zhang",slug:"yixin-zhang",fullName:"Yixin Zhang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYWJgQAO/Profile_Picture_2022-06-09T11:36:35.jpg",biography:"Professor Yixin Zhang is an aquatic ecologist with over 30 years of research and teaching experience in three continents (Asia, Europe, and North America) in Stream Ecology, Riparian Ecology, Urban Ecology, and Ecosystem Restoration and Aquatic Conservation, Human-Nature Interactions and Sustainability, Urbanization Impact on Aquatic Ecosystems. He got his Ph.D. in Animal Ecology at Umeå University in Sweden in 1998. He conducted postdoc research in stream ecology at the University of California at Santa Barbara in the USA. After that, he was a postdoc research fellow at the University of British Columbia in Canada to do research on large-scale stream experimental manipulation and watershed ecological survey in temperate rainforests of BC. He was a faculty member at the University of Hong Kong to run ecological research projects on aquatic insects, fishes, and newts in Tropical Asian streams. He also conducted research in streams, rivers, and caves in Texas, USA, to study the ecology of macroinvertebrates, big-claw river shrimp, fish, turtles, and bats. Current research interests include trophic flows across ecosystems; watershed impacts of land-use change on biodiversity and ecosystem functioning; ecological civilization and water resource management; urban ecology and urban/rural sustainable development.",institutionString:null,institution:{name:"Soochow University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"95",title:"Urban Planning and Environmental Management",coverUrl:"https://cdn.intechopen.com/series_topics/covers/95.jpg",isOpenForSubmission:!0,annualVolume:11979,editor:{id:"181079",title:"Dr.",name:"Christoph",middleName:null,surname:"Lüthi",slug:"christoph-luthi",fullName:"Christoph Lüthi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRHSqQAO/Profile_Picture_2022-04-12T15:51:33.png",biography:"Dr. Christoph Lüthi is an urban infrastructure planner with over 25 years of experience in planning and design of urban infrastructure in middle and low-income countries. He holds a Master’s Degree in Urban Development Planning from the University College of London (UCL), and a Ph.D. in Urban Planning & Engineering from TU Berlin. He has conducted applied research on urban planning and infrastructure issues in over 20 countries in Africa and Asia. In 2005 he joined Eawag-Sandec as Leader of the Strategic Environmental Sanitation Planning Group. 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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:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{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. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. 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",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. 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