Score difference (Δ) after 12 weeks training (T1-T0).
\r\n\t
",isbn:"978-1-83969-347-2",printIsbn:"978-1-83969-346-5",pdfIsbn:"978-1-83969-348-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,hash:"4fc73beb0e4416a20cc70c8163fe436f",bookSignature:"Dr. Pinar Erkekoglu",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9836.jpg",keywords:"KRAS Gene, Oncogene, Tumor Suppressor Gene, Mutation, Cancer, Microtubule-Associated Protein (MAP), GTPase, Pathological Conditions, Epidermal Nevus, Noonan Syndrome, Costello Syndrome, Environmental Chemicals",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 17th 2020",dateEndSecondStepPublish:"December 15th 2020",dateEndThirdStepPublish:"February 13th 2021",dateEndFourthStepPublish:"May 4th 2021",dateEndFifthStepPublish:"July 3rd 2021",remainingDaysToSecondStep:"a month",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"A pioneering researcher in toxicology, vaccinology, cosmetics, and Board Member of Turkish Pharmacists Association Pharmacy Academia and Board Member of Hacettepe Vaccine Institute. Published more than 150 scientific papers in international/national journals. Associate editor of the Turkish Journal of Pharmaceutical Sciences.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"109978",title:"Prof.",name:"Pinar",middleName:null,surname:"Erkekoglu",slug:"pinar-erkekoglu",fullName:"Pinar Erkekoglu",profilePictureURL:"https://mts.intechopen.com/storage/users/109978/images/system/109978.JPG",biography:"Pınar Erkekoglu was born in Ankara, Turkey. She graduated with a BS from Hacettepe University Faculty of Pharmacy. Later, she received an MSci and Ph.D. in Toxicology. She completed a part of her Ph.D. studies in Grenoble, France, at Universite Joseph Fourier and CEA/INAC/LAN after receiving a full scholarship from both the Erasmus Scholarship Program and CEA. She worked as a post-doc and a visiting associate in the Biological Engineering Department at Massachusetts Institute of Technology. She is currently working as a full professor at Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology. Her main study interests are clinical and medical aspects of toxicology, endocrine-disrupting chemicals, and oxidative stress. She has published more than 150 papers in national and international journals. 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Competence",doi:"10.5772/intechopen.89273",slug:"the-role-of-vision-on-spatial-competence",body:'\nSpatial competence is essential in everyday life for numerous human activities, as it entails the ability to understand and internalize the representation of the structure, entities, and relations of space with respect to one’s own body [1, 2]. Despite the fact that spatial competence encompasses a diverse set of skills, research in the field has generally focused on identifying the developmental steps that are necessary to acquire from an early age the ability to reason about spatial properties of the environment.
\nThere is a general consensus on the crucial role of visual experience in guiding the maturation of spatial competence [3]. Vision takes advantages respect to other senses in encoding spatial information because it ensures the simultaneous perception of multiple stimuli in the environment despite the apparent motion of the array on the retina during locomotion enabling us to extract more invariant spatial properties from the surrounding layout [4, 5]. Indeed psychophysical data indicate that when sensorial conflict occurs, audition and touch are strongly biased by simultaneously presented visuospatial information, suggesting that sighted people tend to organize spatial information according to a visual frame of reference [6, 7, 8, 9, 10, 11, 12]. Neurophysiological data further confirm the view by suggesting that the visual feedback is fundamental for spatial learning [13, 14, 15, 16, 17, 18], i.e., visual experience allows the alignment and thus the integration of auditory and visuospatial cortical maps [19, 20, 21, 22]. Thus, research on sighted individuals suggests that vision typically provides the most accurate and reliable information about the spatial properties of the external world, therefore it dominates spatial perception. Consequently, if visual experience is necessary to adequately represent spatial information, we would expect blind people to perform worse than sighted people in spatial tasks. This would be especially true if the visual impairment emerges at birth, when multisensory communication is fundamental for the sensorimotor feedback loop that contributes to the development of spatial representations [23, 24].
\nDespite valuable insights into the important guiding role of vision on spatial development, contrasting results indicate that visually impaired people can manifest or enhanced either impaired skills depending on the spatial aspects investigated, leading to the hypothesis that vision could have an essential or facilitating role depending on the nature of the spatial task that individuals carry out [14]. A clearer definition of the underlying processes involved in spatial competence enhancements and deficits caused by visual loss is important not only to quantify to what extent the perceptual consequences of early blindness translate to real-world settings but also to develop effective rehabilitation tools and technologies to improve their spatial skills [25]. Indeed, scientific findings related to spatial competence development in the absence of visual experience have important implications for clinical outcomes and for the design of new rehabilitation activities meant to activate compensatory strategies since an early age.
\nThe first developmental theory of spatial competence was proposed by Jean Piaget and his colleagues [26, 27, 28], who hypothesized that spatial understanding gradually improves with age thanks to a progressively more conscious interaction with the external world that permits to accumulate sensorimotor experiences such as reaching. Nonetheless, the identification of the starting points for spatial development remains one of the most debated topics within the literature of spatial competence.
\nWhile some researchers argue for innate knowledge of spatial understanding in humans [29] by reporting impressive spatial abilities in infants, other researchers advocate for a gradual acquisition of spatial competence during childhood [30] by reporting significant limitation of early spatial skills during infancy. For instance, several studies have demonstrated that already at 3 months infants are able to represent categorical spatial information by distinguishing between above vs. below and left vs. right [31, 32] and that by 5 months of age babies are sensitive to metric properties of space being able to code spatial object dimensions such as height [33, 34, 35], distance location [36], and angles [37]. Conversely, other studies indicate that while sensitivity to spatial properties appears in early infancy, further refinement of spatial accuracy emerges later during development. For instance, coding of categorical and metrical information improves through the primary school years [38, 39, 40] as well as capabilities of estimating and reproducing object size and location [41, 42].
\nThe question of whether spatial capabilities are innate or acquired is of central importance to understand if an early sensory deprivation can negatively impact on the acquisition of adult-like competences. In the case of blindness, a key developmental acquisition is the ability to code auditory and tactile spatial properties of the environment in order to independently orient and navigate in space. Research on auditory spatial perception has shown that sighted infants already possess the ability to differentiate acoustic information and perform adequate actions in different dimensions [43]. Indeed they can turn their heads toward a sound from the moment they are born [44, 45] and at the age of 4–5 months, head-orientation movements become even faster and more precise than in the neonatal period. Further improvements in the ability to code the location of sonorous objects in space manifest at 6 months of age, when infants are sensitive to changes in the location of sounds as small as 13–19 degrees [46, 47]. Nonetheless, this reflexive orientation to sound sources is present at birth but disappears during the first month if large movements of the head are required [48] to appear again at 4–5 months of age: for this reason, it has been hypothesized that the early orientation reflex represents the activity of lower brain stem and provides an initial stage to acquire spatial competence [49] that is later consolidated through concrete experience.
\nIn the spatial cognition domain, two main distinctions can be made about spatial representations of the environment [50]. The first distinction is between the egocentric and allocentric frame of reference which indicates the strategy to code location of objects, respectively, in a viewer-dependent or a viewer-independent manner. While the egocentric representation is tied to the observer and can be used either when the observer remains stationary or when the observer moves keeping track of the movement (dead reckoning or path integration), the allocentric representation does not depend on the viewer’s current position but on external landmarks that can be adjacent (cue learning) or distal (place learning). Although early spatial representations were originally described as purely egocentric [51], several studies indicated that infants can make use of both intrinsic and external features of the environment to locate objects. There is evidence that infants can update egocentric representations by keeping track of their movement and thus locate objects from novel positions within the first year of life: indeed by 9 months, infants can compensate for simple changes in their position, such as translation along a straight line [52] or rotational movements [53]. Nonetheless, for more complex displacements, infants manifest a general difficulty in keeping track of their changing relation to target location. For example, at 12 months of age, they start to solve complex problems involving both translation and rotation but they perform better when they can make use of adjacent landmarks embedded in the environment [54], and this ability seems to show little improvement between 16 and 36 months [55]. Moreover, previous research has shown that sighted infants reach for sounding objects in the absence of visual clues [47, 56, 57, 58, 59], implying that a sense of auditory space is well consolidated at this stage since sounding objects are localized in relation to one’s body. The allocentric strategy seems to emerge quite early in the development together with the egocentric strategy, but with different maturational rates for cue learning and place learning types of coding. Indeed, studies employing paradigms where the direction of looking from a novel position indicate where infants expect to see an engaging stimulus demonstrate that by 8.5 months of age, infants use an adjacent salient landmark to locate the stimulus, whereas only at 12 months of age, they consistently use relational information of distal landmarks [54]. Several studies confirm the idea that egocentric and allocentric strategies continue to refine during childhood by showing that at 18–24 months of age, toddlers become able to use geometrical cues such as shape to orient themselves [60, 61]. Nonetheless, an important milestone such as the ability to integrate different reference frames within a common system of spatial representation in order to increase accuracy and reduce the variability of spatial judgments emerge only later during the development. Indeed, children aged between 4 and 8 years old are not able to use both self-motion and external landmarks as egocentric and allocentric information, respectively, to reproduce object location because they alternated both strategies instead of combining them as adults usually do [62].
\nThe second distinction in the spatial cognition domain is between categorical and metric spatial representations, which, respectively, represent the coding of spatial information in a relative manner by means of comparisons among entities in space and the coding of spatial information in external coordinates by means of metric cues such as distance or length. It has been shown that at 7 months of age, infants spontaneously show categorical dichotomous discrimination of auditory space by differentiating objects within and beyond reach [57, 58] and by distinguishing spatial categories such as above vs. below and left vs. right [32, 63]. Early sensitivity to metric cues has been observed in 4.5–6.5 months old infants for the dimension of objects [64] and distance [36]. Nonetheless, methodological issues have been raised for the interpretation of such results since experimental paradigms typically used with infants employ observational measures of the infant’s behavior that may reveal more low-level perceptual rather than conceptual representation. Indeed, it has been shown that at the age of 2 years, children are able to match objects by height when these objects are presented in containers of a fixed height, but not when they are presented without containers, indicating that toddlers make use of distance cues only when they can rely on relative cues [65]. A considerable improvement in the ability to code object size and location can be observed between the ages of 4 and 12 [40, 41, 42, 66], for example, in tasks that require to use a configuration of distal landmarks to infer object location [67]. This could be due to the development of a hierarchical coding system, which integrates metrics and categorical information [68]. Given the time course of spatial cognition development and the discrepancy between early and later acquisition of spatial skills, an interactionist approach has been proposed that acknowledges strong potentiality and tries to identify underlying mechanisms implicated in the transformation of early abilities into mature competence [69]. The underlying mechanisms responsible for the refinement of spontaneous spatial orientation skills might be found both in the biological and environmental experiences. Within the biological context, many improvements in spatial functioning have been associated with the maturation of specific brain regions such as the hippocampus. For instance, the maturation of the hippocampus-mediated ability to encode relations among multiple objects may determine an increase in the number of stimuli that children rely on during reorientation and navigation tasks [70]. Within the environmental context, experience involves interactions with objects in the physical world and learning conventional information about symbolic spatial representations, such as maps and models. Spatial competence is strictly dependent on experiential factors such as exploratory activities which are in turn related to the development of locomotor activities. For example, it has been suggested that the emergence of allocentric coding in the form of cue learning might derive from the onset of crawling around 8–9 months, while further locomotor experiences may facilitate place learning by stimulating children to observe and approach object arrays from different directions. Indeed, locomotion is not simply a maturational precursor to psychological changes, but it plays a crucial role in their genesis [71]. For example, crawling provides the infant with concrete experiences that may change his coding strategy, for example, permitting the infant to abandon an egocentric body-oriented localization of objects to one based on the use of environmental landmarks. Recent findings suggest that sighted children acquire spatial capabilities thanks to the reciprocal influence between visual perception and execution of movements [72]: children monitor the success of action through a sensory-motor feedback by matching expected and observed changes of visual information. Indeed, self-generated movements commonly help to perceive the space acoustically because they convey the proprioceptive sensation corresponding to the movement of the ears toward sound sources [73]. In other words, using the dichotomy between the body and its exterior, an individual acquires spatial competence through observation of the body’s actions and the resulting sensory consequences: through self-generated movements, the nervous system learns sensorimotor contingencies [74], which reveal the spatial properties of the auditory space. Moreover, acting successfully entails affordances for action: since affordances change according to action capabilities and bodily characteristics, experiential factors are necessary especially during infancy when new skills are constantly appearing and bodily dimensions are changing rapidly [75].
\nThese results suggest that early interaction between the visual input and other sensory and motor signals provides a powerful background to shape the development of spatial cognition in sighted children. But if vision is so important, how spatial development changes when the visual input is missing?
\nWhile the development of spatial cognition has been extensively studied in sighted individuals [50], less effort has been spent in understanding how the sense of space changes during development in children with visual impairment. Specifically, scientific research on the development of auditory localization skills in visually impaired children has provided contrasting results. For example, it has been shown that children with visual disabilities have an excellent spatial hearing, measured as the ability to discriminate differences in sound localization in the horizontal and vertical plane as well as the ability to reach or walk toward the sound source position [76]. On the contrary, several studies suggested that infants and children with severe congenital blindness have a developmental delay in sound localization abilities [23, 77, 78, 79] and motor responses to sound [80, 81]. For example, blind children do not reach for objects that produced sounds until the end of the first year, while sighted children start around 5 months [82]. Similarly, blind children show worse performances than sighted children in auditory bisection, minimum audible angle tasks [23], and audio depth tasks [78]. Other studies show mixed results, indicating that children with congenital visual disabilities show an initial neuromotor developmental delay but compensate for the lack of vision developing good manipulatory and walking skills thanks to the exploration of sounding objects in the environment [83]. Studies of proprioceptive localization of immediate and memorized targets have been used to compare the proprioceptive performance of sighted and blind individuals. For instance, it has been shown that early visual deprivation does not necessarily prevent the development of spatial representations in both early blind children [84] and adults [85]. Considering that spatial competence emerges gradually thanks to the reciprocal influence between visual perception and execution of movements [72], it is evident that visually impaired children not only lack the visual input necessary to establish the sensorimotor feedback that typically promotes spatial development, but also manifests a general delay in the acquisition of important locomotor and proprioceptive skills, which may cause them to accumulate much less spatial experience compared to their sighted peers [79, 86, 87]. It has long been known that the development of blind infants is delayed in self-initiated postures and locomotion [79, 88, 89]. While sighted children typically start to perform first individual actions and navigation from the first year of age, blind children without cognitive and motor impairments start to walk at about 30–32 months of age [90]. Moreover, from the first month of life, blind infants show delays in the vestibular and proprioceptive functions due to the lack of integration with the visual inputs typically provided during the development [91]. Finally, since visual feedback represents the most important incentive for actions and thus for the development of locomotion and mobility skills, the onset of several motor milestones (e.g., rolling, crawling, standing, and balancing) can be delayed in visually impaired infants [92, 93], suggesting that the visual feedback of the body is fundamental for the development of self-concept.
\nTo perceive space, visually impaired children typically use hearing and touch. Despite the haptic sense provides essential information about the spatial layout of peripersonal space, such as the size, shape, position, and orientation of objects within reach, it typically conveys information only within the scope of the body. The case of hearing is particularly interesting because the auditory sense is not only the main channel for providing distal information but also it might be superior to all other sensory alternatives because it provides spatial information in both active and passive conditions and it does not necessarily involve direct contact with objects [94, 95]. At the same time, the use of hearing to perceive distal information might be particularly difficult for visually impaired children because in this case, they do not have any sensory feedback about sonorous objects in the far space. On the contrary, the haptic-proprioceptive system can provide accurate spatial data only within the scope of the body itself [96], and therefore a blind person must actively move in the environment to sequentially touch all the stimuli embedded in space. Several factors may contribute to increasing the difficulty in interpreting such contrasting results. For example, many studies on spatial hearing have been conducted within the framework of broader research on cognitive and motor skills development [87, 97] and reaching mixing the motor and the perceptual component of the observed behavior [83, 98]. In addition, different methodological approaches and stimuli have been used to assess similar aspects of auditory spatial perception: for instance, studies performed on visually impaired children under 3 years of age do not employ psychophysical procedures but they frequently use the sound of familiar voices or toys to gather information about auditory localization abilities in blind children [97]. In addition, in some cases, sighted and blind groups of children are not perfectly matched for age range and sometimes use also adults as comparison [76]. Finally, the difference between early and later loss of vision has not been often considered: many studies mix data from children with no visual experience with those of children with partial visual experience in the first period of life [76]. Instead, it has been demonstrated that the onset of blindness has a strong impact on spatial performance in adulthood: for example, late blind individuals who lost vision later in life after a normal visual experience during the first year of life perform equally or even better than sighted participants in several auditory spatial tasks (1, 50, 83, and 300). To summarize, although compensatory mechanisms for spatial perception have been demonstrated in blind adults, it is not clear whether an early visual impairment might delay the development of special auditory spatial skills. The development of spatial cognition is strictly related to the development of social cognition: the ability to independently navigate and orient ourselves in space facilitates engagement in social interactions. Indeed, a delay in the acquisition of language, motor or cognitive skills can have a direct impact on a child’s social competence (106, 109, and 246). More recent works highlighted that preschool-age children with visual impairments often have difficulties engaging in positive social interactions, making their assimilation into preschool programs difficult. In fact, many do not display a full range of play behaviors [99, 100, 101, 102, 103] and spend more time engaging in solitary play interacting more with adults than with their sighted peers [81, 87, 89, 102, 103, 104, 105, 106, 107]. Considering that the interaction among peers is essential for the development of cognitive, linguistic, social, and playing skills [108], the aforementioned delay in the acquisition of social competence in visually impaired children gives rise to feelings of frustration, rather than self-efficacy and independence which characterize the social experience of typical children. Indeed, the lack of visual information during early infancy often constitutes a risk for the development of the personality and emotional competence [89]. Nonetheless, when assessing social competence in visually impaired people, some other factors resulting from the loss of vision should be taken into account. For example, it has been shown that parenting style influences the socio-emotional development of sighted children [109, 110, 111, 112, 113] because parents represent the first influential setting that can produce appreciable differences in developmental outcomes in terms of psychological functions [114, 115]. Inconsistent, hostile and nonsensitive parenting behaviors have been associated with adjustment problems and social adversity during childhood [116, 117] and also with anxiety, depression, and other stress-related illnesses during adolescence [118, 119] and adulthood [120]. We speculate that a similar influence of parenting style holds also for blind children, especially because families of children with visual disabilities are more prone to experience various stressors such as concerns about the social acceptance of the child [121] and to face difficulties in initiating and sustaining social interactions [122], thus they might easily develop an overprotective behavior that negatively influences the social development of the visually impaired child. The negative effects of blindness on socio-emotional competence can be observed also in adulthood, with the impoverishment of the ability to perform everyday activities both in private settings like home and in public settings like workplace. Importantly, the decrease of functional abilities has been linked to the emergence of serious psychological problems in the blind population [123]. Indeed adults with visual impairments tend to feel more socially isolated and not properly supported compared to sighted individuals [123, 124, 125, 126] and are at higher risk of developing depressive symptoms [105, 125, 127, 128, 129, 130, 131], principally because social competence depends on the ability to utilize visual cues [132]. Overall, several scientific findings suggest that visual impairments, especially if acquired later in life, can have profound consequences for the physical functioning, psychological well-being, and health service needs of older adults [133]. Consequently, early therapeutic interventions specifically focused on activities fostering the development of perceptual and motor abilities would improve the quality of life of children and adults with visual impairments. In the next section, we will present some tools developed to improve perceptual skills of visually impaired individuals and propose a new solution we recently developed for early intervention in visually impaired children.
\nThe acquisition of spatial competence is typically a good indicator of the future ability to independently navigate in the environment and engage in positive social interaction with peers. While for sighted individuals, the visual feedback represents the most important incentive for actions and thus for the development of mobility and social skills, visually impaired individuals strongly rely on auditory and tactile landmarks to encode spatial and social information. Thus, the creation of technological devices to support visually impaired children in their spatial and social development would be a need. Nonetheless, despite the huge recent advancements in technological industry, most of the devices developed so far to address visually impaired population’s needs are not widely accepted by adults and not easily adaptable to children [134].
\nAs reported in the previous sections, visual impairments can determine spatial and social impairments during development. Technological support for the blind should fulfill two different but complementary tasks: the first is to substitute the absent sensory information (vision) with other sensory signals (audition and touch) for daily activities, and the second is to support the rehabilitation of impaired functions following sensory loss. This latter aspect is particularly important when the visual impairment occurs during the first year of life, because technological devices might represent an opportunity for children to develop perceptual and cognitive abilities by compensating for the sensory deprivation. Most of the technological supports developed to date have fulfilled mainly the first task, namely the substitution of vision with other modalities for everyday tasks such as object recognition.
\nSensory substitution devices (SSDs) convert the stimuli, normally accessed through one sensory modality, into stimuli accessible to another sensory modality. Specifically, sensory substitution devices for visually impaired individuals aim at supplying the missing visual information with visual-to-tactile or visual-to-auditory conversion systems [135]. Typically, substitution systems based on visual-to-tactile conversion transforms images captured by a camera into tactile stimulations directed to users. From the first device developed in the mid-1960s by Bach-y-Rita (Tactile-Visual Sensory Substitution device or TVSS), that converts signals from a video camera into tactile stimulation applied to the back of the subject allowing for the recognition of lines and shapes [136], recent technological progress allowed the development of much smaller, portable, and wearable devices. For instance, wristbands, vests, belts, and shoes which allow hands-free interactions [137] and devices that can be placed on various body surfaces (e.g., fingers, wrist, head, abdomen, and feet) [138, 139]. Conversely, systems based on visual-to-auditory conversion transform the images captured by a camera into sounds transmitted to users via headphones. One of the most famous visual-to-auditory devices is the vOICe developed by Meijer [140] that associates height with pitch and brightness with loudness in a left-to-right scan of the visual image.
\nIn our recent review, we listed the SSDs designed for visually impaired individuals by highlighting their main features and limitations for daily use [134]. In particular, we identified six main limitations that might determine low acceptance rate in adults and low adaptability in children:
Invasiveness: SSDs can be physically invasive in the sense that in order to be used, they must be positioned on crucial body parts (e.g., ears or mouth), thus limiting perceptual functions in users or they must be transported (e.g., in backpacks), thus limiting users’ navigation for weight and size;
Extensive training: SSDs typically require long periods of training in order to be used because users need to learn how to interpret the output of the device, which is typically not immediate (e.g., sound loudness corresponds to pixel brightness in the vOICe [141]);
High cognitive load: SSDs usually require high attentional resources, which makes it difficult for the user to focus on the main task they are performing when using the device;
No clinical validation: SSDs frequently remain prototypes and do not reach the blind users market, principally because they are not validated on large sample patients through standardized clinical trials;
Artificiality: SSDs are generally based on the idea that users can understand the properties of visual stimulus by listening (in the case of visual-to-auditory SSDs) or feeling (in the case of visual-to-tactile SSDs) a stimulus resulting from an artificial transformation code, missing an important aspect of the learning process, which is the association of action and perception.
Therefore, while sensory substitution devices have been shown to provide support for specific perceptual tasks in adults [142], they have never been tested in children principally because their use might too overwhelming for children. Nonetheless, technological development should be addressed especially to visually impaired children needs because cortical plasticity is maximal during the first year of life, therefore the benefit deriving from early interventions should be higher. Moreover, technological development should lead to multimodal stimulation whose benefits have been repeatedly reported compared to unimodal stimulation [143, 144, 145], while most of the SSDs developed so far substitute the visual function with either the auditory or the tactile modality alone.
\nWith this in mind, we developed a new device for visually impaired children (Audio Bracelet for Blind Interaction, ABBI, [146]), which is an audio bracelet that produces an auditory feedback of body movements when positioned on a main effector such as the wrist in order to provide a sensorimotor signal similar to that used by sighted children to construct a sense of space. Indeed, several reports indicate that sighted children typically acquire spatial competence by experiencing visuomotor correspondences [72]. In this sense, our device could be used to align the spatial understanding between one’s own body and the external space through coupling auditory feedback with intentional motor actions. The audio movement created by the bracelet conveys spatial information and allows the blind user to build a representation of the movement in space in an intuitive and direct manner.
\nWe validated the ABBI device with a clinical trial on an Italian sample of 44 visually impaired children aged 6–17 years old assigned to an experimental (ABBI training) or a control (classical training) rehabilitation condition. The experimental training group followed an intensive but entertaining rehabilitation for 12 weeks during which children performed ad-hoc developed audio-spatial exercises with the Audio Bracelet for Blind Interaction (ABBI). The clinical trial consisted of three sessions: pre-evaluation, training, and post-evaluation. Pre- and post-evaluation sessions lasted 60 min during which a battery of spatial and motor tests were performed [147]. The BSP (Blind Spatial Perception) battery comprised six tests: (1) auditory localization: the child listens to the sound produced by a set of loudspeakers positioned horizontally in front of him/her and localizes the sound source by pointing to it with a white cane; (2) auditory bisection: the child listens to a sequence of three sounds presented successively by a set of loudspeakers positioned horizontally in front of him/her and verbally reports whether the second sound is closer in space to the first or to the third one presented; (3) auditory distance: the child listens to two consecutive sounds produced by a set of loudspeakers positioned vertically in front of him/her in depth and verbally reports which of the two stimuli presented is closer in space to his/her own body; (4) auditory reaching: the child listens to a static sound positioned in far space and reaches the position of the sound by walking toward it; (5) proprioceptive reaching: the child repeats a movement trajectory after being presented with it by an external operator; (6) general mobility: the child walks straight on for three meters and then back to the starting position at his/her own pace. The training session lasted 12 weeks and children were assigned to the experimental training condition based on activities with the use of ABBI or to the classical training condition based on psychomotor lessons not necessarily involving sound localization activities. All children enrolled in the ABBI training group performed weekly training exercises with a trained rehabilitator for 45 min (9 h over 12 weeks) and weekly training sessions with a relative at home for 5 h (60 h over 12 weeks) for a total training period of 69 h. All training exercises were developed to train children’ ability to recognize and localize sounds in space according to different levels of difficulty: (a) recognize and localize simple sound movements, such as a straight motion flow performed along the horizontal or sagittal planes in the front peri-personal space (first level); (b) recognize and localize complex sound movements, such as a motion flow performed randomly in space in the front peri-personal space, e.g., composite geometrical and nongeometrical figures (second level); (c) recognize and localize simple and complex sound movements in the back peri-personal space (third level); (d) recognize and localize simple and complex sound movements in the front and back in the extra-personal space (fourth level). The comparison of overall spatial performance before and after the training with a dedicated assessment battery indicated that the ABBI device is effective in improving spatial skills in an intuitive manner (see Table 1 for a summary of results), confirming that in the case of blindness perceptual development can be enhanced with naturally associated auditory feedbacks to body movements [148]. Moreover, the validation of the ABBI device demonstrated that the early introduction of a tailored audio-motor training could potentially prevent spatial developmental delays in visually impaired children [149].
\nScore difference (Δ) after 12 weeks training (T1-T0).
One year follow-up of the ABBI group (T2-T0). In order to evaluate the effects within groups, two-tailed t-tests assuming equal variances were performed between groups at baseline (T0) and post-training period (T1). Changes in the outcome measures were then calculated between baseline (T0) and post-training period (T1) in the ABBI training and classical training group (ΔΑ and ΔC), and between baseline (T0) and follow-up period (T2) in the ABBI training group (ΔΑ2). Data are presented as mean and standard deviation. The stars indicate the statistical significance of the corresponding t-test of the score difference (*p < 0.05; **p < 0.01; ***p < 0.001). Table readapted from [148].
Visual experience is deemed to be fundamental for the acquisition of spatial competence; indeed, visually impaired children tend to manifest impairments in spatial and locomotor skills, causing a general developmental delay. The hearing sense can be boosted since an early age to foster compensatory mechanisms for the development of spatial perception, principally because compared to touch it can provide distal information [150]. There is evidence that multisensory training based on the action-perception link can improve spatial abilities in visually impaired children and prevent the risk of developmental delays and social exclusion [148, 149, 151].
\nWe would like to thank all the children and parents for their willing participation in our studies and the Unit for Visually Impaired People (UVIP) members for their passionate work on visually impaired individuals.
\nThe authors declare no conflict of interest.
There is a noticeable increase in major incidents (MI) of different types affecting the world in the last three decades with increased human and financial losses. There are different types of incidents: natural, man-made, and infectious epidemics. For optimum response to those incidents, there should be multidisciplinary coordinated teams’ response [1].
Shortly after I started writing this chapter, the COVID-19 epidemic in China expanded to be a pandemic, affecting too many countries and hundreds of thousands of people and killing more than 50,000 all over the world. This has a clear effect on my chapter to concentrate on this type of major incidents.
Primary health care (PHC) system scope of service was concentrated on disease consultations and prescription of medication. This scope had been changed in 1978 by the Declaration of Alma-Ata, which considered health care as fundamental human right. Section V in the declaration stated clearly that the primary health care system is the key to achieve the targets of the declaration. This declaration leads to the change of the scope of work of the PHC from giving advice about patients’ symptoms to the comprehensive health care of the community [2]. This aim of comprehensive health care of the PHC was reviewed in WHO report in 2008 [3], which centered on taking the PHC service from hospitals and specialized centers to be nearby people in general walk-in clinics that are easily reached by community. This proved to have many benefits in:
Relief suffering
Prevention of illness and death
Improved health equity
The PHC system, with its distribution in all areas to be near to large population, can play an important role in response to any MI affecting its catchment area. The PHC staff have better knowledge in their area population and the special needs categories. Those abilities enable the PHC system to play a crucial role in response to major incidents in all their stages.
PHC is a whole-of-society approach to health that aims to ensure the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and preferences (as individuals, families, and communities) as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation, and palliative care and as close as feasible to people’s everyday environment [4].
“The practice of continuing comprehensive care is the concurrent prevention and management of multiple physical and emotional health problems of a patient over a period of time in relationship to family, life events and environment” [5].
In health care system, “A major incident can be defined as any incident where the location, number, severity or type of live casualties requires extraordinary resources” [6].
Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured, or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate health care [7].
Work concept: Changing to comprehensive health care of the community makes the PHC responsible to prepare people to a disaster if there is time to and help them during its occurrence and in the post-incident stage.
Community based: The responsibility is for the welfare of the whole community and not for medical advice when asked only.
Easy accessibility: The presence of PHC centers in close proximity to people makes them reachable with little efforts. During a major incident, there are many things people are busy with, or some have lost helpers; the presence of a nearby health care facility will decrease patients and people suffering in attending and getting the proper health advice they need.
Dealing with all types of diseases: The PHC centers are run by family medicine physicians (FP) or general practitioners (GP), and they are trained to deal with all types of diseases and possess the ability to deal with all patients or persons asking different types of consultations in many specialties.
Filtering ability: The doctors in primary care are trained to deal with patients in all specialties. This practice gives them the ability to work in the early step of sorting cases. PHC can deal with simple cases that constitute 50 to 60% of cases and keep hospitals and specialized centers for more severe cases.
Decrease cost: FP/GP use less tools and request less investigations for their work, and this cuts the cost the patient should pay for care. This is exaggerated during major incident circumstances, which enable the health system to deal with larger number of patients in the same cost if the patients have been managed by hospitals only.
Stages of major incidents: Most of the researchers divide the major incidents into four stages:
Mitigation and prevention
Preparedness
Response
Recovery
Although this has many positive implications, Quarantelli in 1980 [8] put major incident phases depending on the time factor. He put three phases as follows:
Pre-impact phase
Trans-impact phase
Post-impact phase
In the coming sections, I will discuss the role of the PHC system according to the phase and regarding the staff, space, stuff, and communication roles. The discussion will be divided into two parts as follows:
Effect of major incident on primary health care. This will be under the title “Challenges.”
Actions by the primary health care in response. This will be under the title “Actions.”
PHC system is the nearest health facility to most people and is easily accessible; therefore, it is, mostly, the first place that the patients will attend to get information and advice for their conditions and worries about any new threat or risk.
The challenges will affect PHC staff and PHC facility. The challenges will depend on the risks more suspected in the geographical area in which the health facility is present.
The PHC staff are holding double personality during major incidents; from one side they are part of families and they have responsibilities for them, and on the other side, they have commitment to work to help people and other community services.
The staff will be under pressure to have answers to the new threat and its relations to the different diseases and medications.
Dealing with major incidents is not part of day-to-day activity of the health sector; therefore, there is lack of knowledge of the major incident response plan (MIRP) to the facility and their specific roles. All staff in the PHC in all levels whether clinical or nonclinical should have specific training on the MIRP and their specific role in it, so everybody will speak the same language during the response and can harmonize work better.
Psychiatric aspect of the major incident will affect both PHC staff and people visiting the health facility. Staff should have basic training to deal with those difficult situations.
There will be an increase in visits to PHC from people for different consultations, which will lead to overcrowding in the PHC.
More medications and stuff are requested by patients to have stocks during the expected incidents. This will impose pressure on the stocks of the medications and consumable stuffs.
How to change the layout of the facility to accommodate more visitors if needed? This is depending on the blue print of the facility and whether it is manageable or not.
Is the facility in danger of the incident or not? This is more applicable in the natural disasters like earthquake, tornados, and hurricanes. What to do if it is affected and cannot provide service?
The infrastructures like electricity, water, or network may be affected by the incident. What are the substitutes or mitigation solutions for this breakdown?
The period before expected incidents is a suitable situation to do improvements in planning, training for staff, and stockpiling stuff. PHC administrators need to achieve the following aims:
Orient the local and national health system on the PHC active involvement in protecting community, and strengthen the skills of risk management in the PHC directors.
Concentrate on efforts to support communities, individuals, and health workers to better respond to major incidents. This is done by providing enough information about the disease and protective measures, vaccinations, and actions to do if any family member or oneself is affected.
Financial investment in the infrastructures of the PHC regarding water, electricity, information, communications, and supply network.
The abovementioned aims will be accomplished through the following:
PHC should work in close collaboration with local health authority and other emergency services in developing response plans.
They should look to the following issues:
Define hazards and risk factors to the area, in collaboration with other emergency services. This will help in predicting expected incidents and their effects on the health of the community they are serving. Also, it will help in preparing the type of medications and consumables.
Make lists with addresses of the vulnerable population and those using regular medications in their area. This will allow the health and other authorities to prepare shelter, medications, and other care plans during MI.
The effect of the expected MI on different diseases should be prepared with the help of the specialized sections in local, state, or federal (or ministerial) health authorities. Information should be relayed to the concerned patients along with best mitigation actions.
Setting agreements with ambulance services to transfer patients (who need hospital transfer) received in PHC during MI.
Information regarding any MI expected, its nature, the expected size, and the need to activate the MI response plan. That critical information should be verified, i.e., the source of information should be trusted and accurate.
Allocate area to be an alternative place, and make pre-arrangement for rapid conversion into PHC facility if the original building became unsuitable for work.
Staff should have training on several aspects of MI response including the needed information to help the community and individuals.
This includes the following:
Training the staff on the MI response plan set for the area. The response plan should be flexible to meet the different types and effects of different incidents. The plan should rhyme with the local and state health response plan.
Training the staff on communication with people including agitated and aggressive people. Communication training should include breaking bad news. They may have to visit families and inform them about their relatives, good or bad news.
Training on working in austere conditions in case there is damage to the infrastructure of the PHC facility and a need to work in small or large teams depending on the incident circumstances and decision of the local authority or state’s incident response leaders.
Training on more than one method of communication including radio communication protocols. Radio communication will be used if other methods are lost by the effect of the incident.
Electricity failure is one of the major failures during MI. It has serious negative effects on patients’ care. Electricity generator working on petrol should be prepared and maintained regularly to be ready anytime electricity cut occurs.
Water loss. Large water reservoir should be ready, and the water should be replaced on a daily basis. In addition, drinking water bottles should be part of stockpiling in preparation to a major incident. Potable drinking water in addition to clean water suitable for different uses in the facility and patients’ care is crucial for work in any place and especially in PHC.
Communications: It is important to have at least two ways to contact the staff. If one method failed, the other will be the backup. A third wireless radio communication should be prepared for extreme loss of any sort of communication.
Network: Failure of network can occur alone or accompanying electricity failure. Server backup should be applied to keep the important information regarding patient, administrative, pharmacy, and store documents.
During daily work, the PHC centers are stocking their expected needs of drugs and consumables for a certain period depending on the chain of supply. If there is a risk or threat of any type that needs special medications or protective equipment, the PHC centers should bring these stocks according to the population supported with the coordination of the local or national health authority.
As mentioned above, the PHC will be the first point people will reach to seek help and advice regarding injuries or information regarding an epidemic infection. This includes many challenges.
The WHO in their briefing about PHC and emergencies [9] mentioned some of the challenges as follows:
Without earlier warning system, case identification and escalation are a challenge that PHC staff face. Most epidemics usually start as patients come to seek medical advice, which is a day-to-day work in PHC. Case definition and raising the suspicion of a disease that may be an early epidemic or even pandemic (like the COVID-19) need to be reported to more central and higher authority with experts in epidemiology and infectious diseases.
Geographical accessibility:
Several types of natural disasters like earthquake, floods, etc. may affect the PHC and its surrounding area, preventing health workers, people, or supply chain from reaching it. This will render the PHC useless, and alternative methods should be placed to mitigate this challenge.
In the same context, geographical accessibility to patients and survivals will be sometimes difficult if not impossible and need special help.
People with special need will face more difficulty in major incidents in accessing the PHC. The rescuers will face more difficulty in moving people with special needs in case there is need for it.
Transferring patients and staff to an alternative place or transferring patients to hospital may be a challenge in certain circumstances.
Skillful health workers are part of the community and may be affected by the incidents either themselves or their families, and in both situations, they cannot be available to treat and help people. PHC may replace them by less skilled staff which will affect the care in this difficult situation.
Health facility infrastructure may be affected by the incident, and loss of water, electricity, and network supply, for example, will also affect the ability of PHC to offer help and services.
The incidents may affect the chain of supply, leading to a decrease in resources and limitations in the numbers and types of medications and services available.
If there is an incident that is big enough to affect large cities and states, the government will distribute the funds and resources to all areas. This mostly will make the amount given to a certain PHC center below its actual needs. This has effects on the availability of staff and supplements and decreases in the PHC center’s effective services.
Ensuring quality of care to be in acceptable level. In day-to-day work, the quality should be in the optimum; this is not applicable in most MI, but there should be an agreed acceptable level of quality during major incident, so the PHC centers do not go below it. This is extremely important to decrease the spread of infectious diseases that follow major incidents and decrease mortality and morbidity for all patients.
There are many actions needed during the response phase. Those actions are classified according to the condition of the facility.
Health facility is intact, accessible, and functioning:
Activate the major incident response plan. This is the decision taken by PHC facility leader in liaison with the local and state health authority.
Change the layout of the facility and the patients’ flow to permit faster management of patients with acceptable standards.
Call the staff who are in their off or vacation to join work in the facility to deal with the increased numbers of patients and visitors.
Stop elective visits of patients, and replace it by telephone or online consultations. If there is a need to see the patient and examine him physically, then go to him/her or call the patient to the center; examine the patient in area away from the incident management venue. This will decrease the number of patients attending to the health center and create surge capacity to examine patients related to the major incidents.
Contact local health authority and nearby hospitals to liaise about the situation and work distribution. The PHC can have an important role in dealing with the well and worried people and patients with mild symptoms to decrease the load on hospitals and minimize people’s need for transportation. The movement restriction is an important factor in controlling epidemics and makes movement of emergency services easy and fast.
Make special documentation for the incident patients and other related issues like questionnaires, asking about relatives, etc. This will help in better preparedness for future incidents.
PHC director and supervisors should observe staff for signs of PTSD. Daily debriefing session should be done by the end of the shift. The management of PTSD staff will depend on the severity of symptoms.
Mild PTSD usually is solved by the support of colleagues and the daily debriefing session.
They may change the type or place of work of the staff if they noticed moderate symptoms of PTSD.
Staff with severe symptoms of PTSD should be stopped from dealing with patients, and psychologist or psychiatrist consultation is requested.
If the primary health facility is not accessible or not functioning:
The alternative site should be activated, and directional signs to the new site, people, and authorities should be informed about the new site.
The concept of emergency medical teams applied in disaster management is well known worldwide and applied by the WHO and other bodies interested in disaster response. We can apply this concept to distribute the primary health staff into small teams and direct them (as forward teams) to different residential areas in conjunction with other emergency services. Their duty is to:
Define the special needs and vulnerable population.
Supply chronic medications to the needed.
Defining affected people and do baseline life support interventions.
Contact health authority or hospitals for patients who need to transfer to higher level of health care.
This concept, going to patients in their residency, can be used even if the facility is accessible and functioning. It is an extra service for people in catchment area aiming to bring health care very near to people and help in stopping the spread of epidemic infections.
Start thinking of recovery for the health centers during a long-lasting major incident, for example, the COVID-19 pandemic, which is affecting the whole world now. There should be regular thinking of how to resume work in the PHC to serve the patients who need regular follow-up. This can be done by telephone or network meeting (as mentioned above), and medications can be delivered to the patient at their homes through the post. Fees can be paid by electronic payment methods.
Live experience on the role of PHC in epidemic.
During the writing of this chapter, there is a COVID-19 epidemic. In the beginning of the epidemic, many people came to the emergency department asking for checkup and PCR test for COVID-19. This issue created overcrowding in emergency departments all over the country, and many people present are requesting the test. This was dangerous for spreading the infection if someone is really infected. Two days later, the PHC sets up centers for dealing with well and worried persons and provided COVID-19 PCR test. This action by the PHC did a huge decompression to emergency departments, decreased mix between well and feverish persons, and gave us opportunity to concentrate on symptomatic patients.
Recovery from the effects of the MI occurs in this phase. Sometimes, when the MI takes long time, the PHC should resume receiving patients other than MI. There is merging between trans-impact and post-impact phases. Recovery of the PHC will be better if it was part of the pre-incident plan [12].
Many times, there are epidemics after major incidents especially if the incident affected the infrastructures of basic services like potable water and electricity. This effect is aggravated if people need to migrate from their area for any reason and assemble in a new area, which is usually less suitable and overcrowded. This permits for disease transmission creating an epidemic between the migrants. Acute respiratory infections and cholera are among the most epidemics that occur in immigrants [13]. Some of these diseases are not present in the PHC area previously.
New patients may be added to the PHC from two sources:
In the first source, there is an epidemic in the area covered by the PHC after the major incident. More patients are presented to PHC for consultations.
The second source is the new people who moved to their area from other places, which rendered unsuitable for living (temporarily or permanently) by the major incident.
New diseases may occur due to loss of infrastructure and sanitation or due to earth changes, leading to bacterial, fungal, and other infectious organisms that are not common in the area. It is found in one study that there was an increase in visits for patients complaining of respiratory symptoms (mostly asthma) and diabetes [14].
In the last 40 years, all the studies showed that there is a significant increase in stress levels of both health care staffs and patients in post-major incident phase [15]. This will decrease the working staff on the one hand and increase the patients visiting the PHC on the other hand.
Delayed appointments for patients already registered in the PHC due to MI response actions. After the end of the incident, work need to be back to normal, and the patients whom appointments were postponed in the response period need to be rescheduled in addition to the regular appointments and providing appointments to the new patients.
Gathering information and statistics about the MI and its effects on the PHC in all aspects. Information regarding response to the major incidents, patients’ flow, number of patients, types of complaints, areas of crowding and delay, etc. all need to be collected, summarized, studied, and used in this phase to prepare the PHC for improved response in the next major incident.
Funding. During the trans-impact phase, the media concentrate on every activity done by all emergency services. This media coverage is a good motivation for providing funds by governments, nongovernmental organizations, and personnel. In the post-impact phase, this media coverage will decrease a lot especially if there is another major incident in other parts of the world.
This stage is an opportunity to improve the PHC and rebuild it better than before, by applying risk reduction and optimizing work protocols [16]. The actions in the post-impact phase can be divided into three stages [17]:
Early recovery stage
In this stage there is emphasis on clinical services; the PHC is trying to go back actively again. It is trying to open its services to people if the facility was closed during the incident’s response phase or increase work if it was working in limited scope during the previous phase. The following are the steps to do this objective:
Maintain the PHC building, especially if it is affected by the incident. If there was an epidemic, then there is a need to deep cleaning and sterilization before allowing entrance and providing service to usual patients.
Debriefing to staff after the trans-impact phase. This may need psychologist or psychiatrist sometimes. The PHC director should evaluate the staff during all the phases. In this phase there is time to deal with the staff who shows mild-to-moderate PTSD.
Rearrange duty roasters for staff in a way that they can work and have time to look after their families.
Education to staff regarding new diseases that occurs in the post-impact phase. This should be arranged with local health authority and hospitals. There will be many questions regarding the new disease and relations to the chronic diseases they have.
Rehabilitation stage
The aim of this stage is to reach the pre-impact stage level of work and go back to normal activity or put a new norm to help in better response in the future. Activities in this stage are the following:
Maintain used equipment and fix the damaged ones. Electricity generators, water tanks, and ultrasound machines all should be checked by specialized teams.
Refill stores with medicines and consumables. When there is MI, there is large number of patients which is more than the present resources. After the end of the trans-impact phase, stores should be rearranged to have enough supply of the previous drugs and stuff for the new emerging diseases.
Rearrange patients’ visits to decrease delay, and catch the condition before the incident.
Make appointments for the new patients added to the PHC facility after the impact. This may need recruitment of new staff to accommodate those patients in addition to the delayed patients mentioned in the previous point.
If an alternative place has been used and proven to be better than the original one, try using it permanently. All actions, official documentations, and addresses should be changed to the new place.
Development stage
This is a long-term stage, and its aim is to prepare the PHC for the next major incident. It will be mixed with the mitigation and preparedness stages in the pre-impact phase. To achieve this stage properly, there is a need to:
Collect data through statistics regarding different aspects of the incident, for example, numbers, diagnosis, age, etc.
Make plans for better facility; this may need change or an increase in facility building. Make plans to divide the facility into sectors if needed to maintain isolation for containing infections and easy sterilization of the parts of the facility. This should include the ventilation system of different areas.
Improve communication plan to the staff. All staff should have their contact addresses including the social media addresses and landlines if present.
Arrange with the local health authority to have any specific PHC plan to be part of a master plan and any PHC capabilities to add to the total state or national health abilities, and there is no need for doubling the work.
Fund raising should be started and requested from the local and state health authority to do all these changes in the facility and train the staff on different aspects of the MI response.
The primary health care system has big and important roles that can be played in response to major incidents. They are the most nearby health care facility and well known to people in each area, making it the nearest health facility that is ready to provide help when people are exposed to a sudden incident.
Their role is not limited to any stage in the incident, but it is in all phases. In some aspects of response, the primary health care staff will guide the state or national efforts to find and help vulnerable population in their catchment area.
More concentration on the primary health care system in terms of staff training, facility floor plans, and stuff stockpiling will yield a remarkable improvement in response to any major incidents.
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\\n\\nOut of all of the publishing options available to researchers, why choose to contribute your research to an IntechOpen Edited Volume? The reasons are simple. IntechOpen has worked exceptionally hard over the past years to fine tune the Open Access book publishing process and we continue to work hard to deliver the best for all of our contributors. The quality of published content is of utmost importance to us, followed closely by speed, and of course, availability and accessibility. To view current Open Access book projects that are Open for Submissions visit us here.
\\n\\nQUALITY CONTENT
\\n\\nOver the years we have learned what is important. What makes a difference to the researchers that work with us, what they value. Something that is very high not only on their lists, but our own, is the quality of the published content.
\\n\\nOur books contain scientific content written by two Nobel Prize winners, two Breakthrough Prize winners and 73 authors who are in the top 1% Most Cited.
\\n\\nWith regular submission for coverage in the single most important database, the Book Citation Index in the Web of Science™ Core Collection (BKCI), and no rejected submissions to date, over 43% of all Open Access books indexed in the BKCI are IntechOpen published books.
\\n\\nIn addition to BKCI, IntechOpen covers a number of important discipline specific databases as well, such as Thomson Reuters’ BIOSIS Previews.
\\n\\nACCESS
\\n\\nThe need for up to date information available at the click of a mouse is one thing that sets IntechOpen apart. By developing our own technologies in order to streamline the publishing process, we are able to minimize the amount of time from initial submission of a manuscript to its final publication date, without compromising the rigor of the editorial and peer review process. This means that the research published stays relevant, and in this fast paced world, this is very important.
\\n\\nYOUR WORK, YOUR COPYRIGHT
\\n\\nThe utilization of CC licenses allow researchers to retain copyright to their work. Researchers are free to use, adapt and share all content they publish with us. You will never have to pay permission fees to reuse a part of an experiment that you worked so hard to complete and are free to build upon your own research and the research of others. The Edited Volume helps bring together research from all over the world and compiles that research into one book - accessible for all. The research presented in chapter one can inspire the author of chapter three to take his or her research to the next level. It is about sharing ideas, insights and knowledge.
\\n\\nCan collaboration be inspired by a publishing format? At IntechOpen, the answer is yes. The way the research is published, the way it is accessed, it’s all part of our mission to help academics make a greater impact by giving readers free access to all published work.
\\n\\nOur Open Access book collection includes:
\\n\\n3,332 OPEN ACCESS BOOKS
\\n\\n107,564 INTERNATIONAL AUTHORS AND ACADEMIC EDITORS
\\n\\n113+ MILLION DOWNLOADS
\\n\\nPUBLISHING PROCESS STEPS
\\n\\nSee a complete overview of all publishing process steps and descriptions here.
\\n\\nCURRENT PROJECTS
\\n\\nTo view current Open Access book projects that are Open for Submissions visit us here.
\\n\\nNot sure if this is the right publishing option for you? Feel free to contact us at book.department@intechopen.com.
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\n\nOut of all of the publishing options available to researchers, why choose to contribute your research to an IntechOpen Edited Volume? The reasons are simple. IntechOpen has worked exceptionally hard over the past years to fine tune the Open Access book publishing process and we continue to work hard to deliver the best for all of our contributors. The quality of published content is of utmost importance to us, followed closely by speed, and of course, availability and accessibility. To view current Open Access book projects that are Open for Submissions visit us here.
\n\nQUALITY CONTENT
\n\nOver the years we have learned what is important. What makes a difference to the researchers that work with us, what they value. Something that is very high not only on their lists, but our own, is the quality of the published content.
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\n\nThe utilization of CC licenses allow researchers to retain copyright to their work. Researchers are free to use, adapt and share all content they publish with us. You will never have to pay permission fees to reuse a part of an experiment that you worked so hard to complete and are free to build upon your own research and the research of others. The Edited Volume helps bring together research from all over the world and compiles that research into one book - accessible for all. The research presented in chapter one can inspire the author of chapter three to take his or her research to the next level. It is about sharing ideas, insights and knowledge.
\n\nCan collaboration be inspired by a publishing format? At IntechOpen, the answer is yes. The way the research is published, the way it is accessed, it’s all part of our mission to help academics make a greater impact by giving readers free access to all published work.
\n\nOur Open Access book collection includes:
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\n\n113+ MILLION DOWNLOADS
\n\nPUBLISHING PROCESS STEPS
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\n\nCURRENT PROJECTS
\n\nTo view current Open Access book projects that are Open for Submissions visit us here.
\n\nNot sure if this is the right publishing option for you? Feel free to contact us at book.department@intechopen.com.
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