Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
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We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\n
Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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1. Introduction
Traumatic brain injury (TBI) constitutes a public health problem of great significance with importance in both morbidity and mortality, accounting for approximately 15 to 20% of deaths in people between five and 35 years of age and responsible for 1% of all adult deaths.[1-2]
In the United States, about 59 million people every year die following TBI. This represents one third of all injury-related deaths. Furthermore, 90,000 individuals suffer from permanent incapacity related to TBI.[3]
In Brazil, data from the Ministry of Health (2011)[4] shows that 145,842 deaths occurred due to external causes, and amongst all injuries associated with these external causes, TBI stood out in terms of magnitude, as it was one of the most common injuries.[5]
Trauma caused by traffic accidents is one of the most frequent causes of death in individuals aged 10 to 24. There is an imbalance in the prevalence of the risk of traffic-related trauma in developed countries and in developing ones, with the higher risk being found in the latter. Factors include the infrastructure of a country and the accelerated motorization of its population.[6]
The main causes of TBI include violent aggression, transportation accidents, and falls, the former two being the most prevalent. TBI victims are mostly young males.[7-10] TBI-related consequences extend beyond recorded fatalities and can also be observed in victims who survive trauma.
These individuals may present physical, cognitive, communication, and behavioural disabilities and incapacities at several levels, in addition to suffering problems on social and occupational levels.[11-12] The consequences of trauma consequences also touch the victims\' families, who can be considered hidden victims. A crisis in the family system often arises, as well as the emergence of diseases that compromise the family\'s ability to function and recover.[13]
The participation of the speech therapist in the multidisciplinary team providing care to TBI victims is of great importance because this professional will be able to assess the specific needs of the victims at an early stage, regarding their communicative skills and other related problems (eating and swallowing difficulties), in order to prevent, minimize, or eliminate possible trauma sequelae.[14]
According to the American Speech-Language-Hearing Association (ASHA), patients with traumatic brain injury may experience difficulties in finding words to express themselves or in understanding an idea through speech, writing, and/or reading. Additionally, the muscles of the mouth, face, and the respiratory system can present changes in tone and coordination such that a speech motor disorder called dysarthria may result.[15] These language and/or speech and cognitive alterations compromise an individual\'s communication to varying degrees, ranging from minimal to extensive.
Speech and language production processes include distinct activities in the cerebral cortex. Therefore, different types of alterations in the Central Nervous System (CNS) may result in various kinds of language and/or speech disorders.[15]
For better understanding of communication disorders this chapter will address the importance of communication and language, as well as interdisciplinary approach victims of traumatic brain injury.
2. Communication: An essential instrument in human relations
Communication is a method by which the sharing of thoughts, feelings, ideas, and messages occurs, and it can influence the behaviour of those who respond according to their own beliefs, values, cultures, and life stories. Communication can be defined as "the capacity to exchange or discuss ideas, to dialogue, to converse with the aim of an understanding between the parties".[16] Communication, then, is an instrument of great importance in the realization and development of work, leisure, education, relationships, conversation, and negotiation.[17]
Communication, an instrument that is indispensable to interpersonal interaction is not only restricted to verbal language and the utilization of vocabulary. Rather, it also comprises other methods, such as gestures and body language, facial expressions, signs, figures, objects, colours, which is to say, it also includes visual signs, which are responsible for ensuring efficacy in the conversation process.[17] Visual signs are often the only components of certain conversations, a fact which highlights their great importance in the realization of communication.
The linguistic component is characterized by biological and social aspects and it characteristically favours adapting to the surrounding environment. These components include phonological, syntactic, semantic, and pragmatic aspects of language, described below. [18]
The capacity to surpass auditory perception and develop metaphonological abilities constitutes, in effect, a reflection upon the phonological aspects of a language, which is referred to as "phonological conscience", and which is an ability that is an important prerequisite in the development of written language.[19]
Syntax is the part of linguistics that is dedicated to the study of the rules and principles that govern the organization of a sentence\'s constituents. Semantics, on the other hand, examine the meaning of a word and of the relation between signs and its referents.
Pragmatic theories basically focus on two factors: communicative functions and conversational skills. Communicative functions are broad and abstract, and they reflect the communicative intention of the speaker; they involve motivation and the goals the speaker aims to achieve in communicating with the other individual. Conversational skills refers to a subject\'s capacity to participate in an interactive sequence of spoken acts, with the objective of communicative exchange.[19]
The ability to converse involves an interactive sequence of spoken acts and is the result of communicative exchange between two or more interlocutors inserted into a social context.[20] Besides this sequence, efficient conversation requires the interlocutors\' compliance with the rule of taking turns, their commitment to the theme being discussed, and the capacity to adapt to participants and situations.[21]
Language is thus conceptualized as a "privileged instrument of inter-human communication and the privileged vehicle of thought".[22] Its organized use as a social rule and communicative mode of interaction are expressed and perceived in social culture. Social rules are organized by signs that express ideas that are manifested in speech, which makes communication with others possible[18]
The symbol comes from imitation, and representation is the use of the symbolic function of language. During the sensorimotor period, children\'s mental structures improve, and they form new constructions and start to associate and represent new signs. In this stage, the roots of thoughts are found in actions and in the mechanisms overriding linguistic fact, and so the role of language is an accessory in the construction of knowledge. In the transitory period between the sensorimotor and pre-operatory stages, the use of gestures with communicative interaction is accompanied by speech (babbling). Oral expression and the use of gestures develop in parallel with the development of communication. Communication is thereby characterized by the capacity to exchange information, express oneself, and interact with others, developing knowledge bases and expanding one\'s concepts in order to develop language.[23]
In any sphere, communication is necessary, and such communication only occurs with the participation of two or more elements (transmitter and receiver) that transmit information using the means of language both verbal and nonverbal, resulting in an exchange of knowledge, which is to say that in order for the message to be transmitted and understood, it is necessary for the transmitter and receiver to promote mutual interaction.[24]
Among other forms of communication, nonverbal communication is a means of transmitting information. Vivacious gestures elicit responses, and one could almost argue that happens in accordance with an elaborate secret code that remains unwritten, acknowledged by none, but understood by all.[25]
Scholars have sought to demonstrate that children, through symbolic activity, develop instruments of language during their interactions with each other. As the children appropriate this language, they become capable of controlling their environment using gestures, facial expressions, and the emission of sounds, which function as a diffuse communication that constitutes the pre-verbal phase. After that, practical intelligence and speech are integrated, making verbal thought and language more rational.[26]
B. F. Skinner\'s book Verbal Behavior (1957), which deals with verbal behaviour and its function in children\'s acquisition of language, presents the idea of language reduced to a set of verbal responses associated with situations, in accordance with the Stimulus-Response model of conditioned reflexes. According to this theory, children learn language through imitation and reinforcement; in other words, the acquisition of language is considered a process of storing reinforcements.[27]
Interpersonal relations are revealed in thoughts, ideas, and feelings, and they transmit information that permeates the human condition. Scientific evidence suggests that the ability to develop language is innate and that the universal aspects of language acquisition are established in the structure of the human brain and are susceptible to sociocultural influences.[28]
Evidence collected from clinical observation shows how behaviour relates to mental processes and has long aroused interest. Different philosophical trends were instrumental in developing contemporary neurology. In the early 19th century, Franz Joseph Gall (1757-1828) spread the idea of phrenology that claimed an analysis of the skull\'s surface made it possible to determine whether or not a mental function had been developed. Followers of this philosophy attributed 35 different types of "organs" in the brain, each of which corresponded to a certain function. According to the theory, the "sense of language and of the word" was located in the frontal lobe of the brain.[22, 29-31] The scientific community eventually abandoned such ideas due to the lack of substantiated hypotheses.
In the mid-19th century, anthropologist Paul Broca\'s (1824-1880) important discoveries favoured the theory of cerebral localization, as suggested by Gall in his studies. Broca described patients who presented with impairment in the production of speech and in the preservation of language comprehension, and he identified lesions in the frontal lobes of the left cerebral hemisphere, an area which became known as "Broca\'s area" and which is responsible for "the functional center of language" and the syndrome became known as "Broca\'s aphasia".[22,29-30]
The neurologist Carl Wernicke (1848-1904) awoke an interest in types of injuries that were different from those described by Broca, but that also presented impairments in language comprehension. These lesions corresponded to the temporal cortex of the left cerebral hemisphere (referred to as "Wernecke\'s area"), and the syndrome became known as "Wernecke\'s aphasia".[22,29-30] The two areas, Broca\'s and Wernicke\'s, are integrated by bundles of nerve fibres known as the arcuate fasciculus (Figure 1). In the majority of individuals, the cortical language areas are located in the left hemisphere of the brain.
Figure 1.
Language areas of the brain, 1: Broca\'s Area; 2: Wernicke\'s Area; 3: Arcuate Fasciculus. Illustration: Tiago Carvalho
The language process has been described through the neural mechanisms by which its main functions are performed. The sounds produced by speech require the incorporation of various pieces of information so as to generate the pattern of muscular activation necessary for verbal fluency.[31] The parts of the cerebral cortex used in the emission of speech deal with auditory information (temporal lobe), somatosensory information (parietal lobe), and motor information (frontal lobe). Together with the cerebellum, basal ganglia (primarily the thalamus), and the brain stem, interconnections between the brain\'s regions are responsible for the production of speech.[22,31-32]
One of the most studied functions in the field of neurolinguistics is a language and have the cognitive deficits associated with the mastery of this executive function. These deficits are responsible for the communication difficulties of patients who are injured in this cerebral area. Observations to this effect have motivated investigations into the importance of the relationship between cognitive mastery, executive functioning, and semantic knowledge. The use of computer programs in patient rehabilitation has been noteworthy, especially for patients with aphasia.[32]
In the field of healthcare, communication is incredibly relevant. Trauma victims with TBI may have cerebral injuries or may acquire neurological damage, resulting in language disorders that make the patients\' social lives more difficult. It is in this context that communication between patients and healthcare professionals, primarily nonverbal communication, is fundamental and needs to be and understood by health professionals.[33]
Keeping in mind that speech production processes involve different activities in distinct areas of the cortical regions of the brain, it is understandable that disturbances in speech and language mechanisms appear as a consequence to different types of changes in the central nervous system, as in the examples of TBI and cerebrovascular accidents resulting in aphasia, apraxia, and dysarthria.[33]
These disorders can compromise the quality of life for both the patients and their families and therefore should continue to be studied throughout the patient’s life. This will enable healthcare professionals to provide improvements in treatment and better quality of life post-trauma.
The existence of man is only possible because of communication, and we are communicative beings par excellence. Communication permeates every aspect of our lives; from birth we exert influence on and are influenced by the environment in which we live. Over the course of our lives, the development of communication becomes more complex due to the necessity to master language, reading, the reasoning process, and an analysis of the world and of ourselves..[34]
3. Language
Language is an example of a higher brain function whose development is primarily based on a genetically-determined anatomic structure, but also on verbal stimulation from the outside environment. Language development depends not only on a perceptual motor reaction between perception and praxis, but also on a complex act involving cognition.[35-37]
A finite system of principles and rules that permits both the speaker to codify signs into sounds and the listener to decodify sounds into signs is based on the principles of language. This finite system, however, has the potential to be infinitely creative in the sense that it permits the speaker and the listener to create and understand an infinite set of new grammatical sentences.[35,38]
Neurolinguistics is the science of cerebral mechanisms underlying the comprehension, production, and abstract knowledge of language, be it spoken, signed, or written. The majority of studies on the physiology of language have focused on two chief entryways of linguistic information into the cognitive system: auditory input and visual input.[39]
Neurologically speaking, the term "language" seems to be grounded in thought itself, and sometimes it even seems to be synonymous with thought. The moment a new word is acquired has an impact on a child\'s development as this activity becomes a tool for analysis and synthesis and enables both an understanding of the child\'s surroundings and the self-regulation of the child\'s conduct.[40]
An interdisciplinary nature is attributed to language because it is the object of study in various branches of science. Moreover, language is also an instrument used in social interactions between individuals seeking to communicate in different contexts, and it permeates the thoughts of those who use it, mediates relationships between humans, and is responsible for the transmission of sociocultural customs and values.[41-42]
The use of language depends on multiple types of knowledge and includes linguistic, conceptual, and perceptual non-linguistic systems of information. Knowledge is expressed through phonological, syntactic, semantic, and discursive structures. Because it is an elaborate and highly complex process, alterations in language can happen on any of the aforementioned levels and can compromise both oral and graphic communication.[40]
It is through the visual and auditory systems that language reaches the brain, while the motor system produces spoken and written discourse. When speaking, we produce and articulate sounds that have meaning and are vehicles of ideational expression.[35]
Even though the left hemisphere normally dominates language, the right hemisphere has abilities that are significant for language comprehension. Moreover, the corpus callosum allows synergistic interactions between the hemispheres in order to produce language. Besides the interaction between Broca\'s and Wernecke\'s areas, this processing results in many capabilities, such as designation, articulation, comprehension, and the use of grammar.[43]
The left hemisphere analyses sequentially, and so, in the majority of people, it acts as the anatomical and physiological substrate of the language function. The right hemisphere, on the other hand, analyses spatially.[44]
Language is organized around a fundamental dual capacity: a lexical capacity (establishing; retaining in memory; receptively and productively using a significant amount of meaning-signifier-referent associations) and a grammatical capacity having to do with the organization on a sequencing level and structural dependencies between words (enunciated phrases) and sequences (paragraphs and discourse).[1]
This dual capacity is joined by an instrumental social dimension referred to as "the pragmatics of language".[45] Linguistic information can be transmitted in the form of discourse and written text, but it is the content of the message that is essential to the higher levels of language comprehension processes, such as the achievement of inferences and associations between pieces of textual information.[44]
With cranial traumas, what should be emphasized is oral language comprehension, which is defined as being related to that which is remembered from completed communication or from the application of information garnered from what has been heard, or which is connected to casual relationships established between elements in communication so as to give them coherence.[46]
Understanding involves a series of steps that, starting from a statement, allows one to rediscover the original idea. It is the process of [re]constructing meanings from spoken discourse, and through this process, the listener generally acquires information or knowledge through language. However, there is also oral communication with the ultimate goal of establishing and/or maintaining social relationships, of initiating interaction for the purpose of entertainment, seduction, pleasure, or even to confuse or deceive, forging a given understanding.[44]
An important concept in the representation of words is the mental lexicon, i.e., a mental stock of word-related data that includes information about semantics, syntax, pronunciation, and sound patterns. The process of accessing lexical representations (words) in the mental lexicon is influenced by the "auditory neighborhood" of words, which is defined as the number of words that differ from the target word by one phoneme.[47]
Words with more neighbours are identified more slowly, and there can be competition when activating different words during the recognition of discourse. Additionally, it is believed that the mental lexicon is organized into a network of specific information in which the organization of representations involves relationships between words so that words representing similar meanings are connected and tend to be grouped closer together.[48]
In order to understand words, individuals pass through pre-lexical processing stages: decodifying signals that enter acoustically and are translated into a phonological code. Subsequently, the lexical representation that best fits the auditory signal can be chosen from the mental lexicon (lexical selection). The form of the word selected initially activates the theme (storage of grammatical information) and, following that, the meaning of the word.[49]
Comprehension includes the following: the recognition or judicious guesswork of vocabulary; remembering orality-related systems, facts, and details (purposes embedded in the propositions of the speaker); and the identification and interconnections of ideas and the principles therein. In completing these tasks, listeners make use of their ability to draw inferences about content or perceived proposition.[50]
To do this, listeners must grasp, interpret, and evaluate oral information within the communicative context using their knowledge of the world and of vocabulary. Logical relationships, the chain of communicative functions, the use of gestures, and rhetorical resources all significantly influence the comprehension of oral language.[48]
In 1978, DeRenzi and Faglioni,[51] developed the Token Test, a tool widely used to quantify difficulties in listening comprehension in order to assess the receptive function of language. It makes use of short statements, and applying the test is both quick and easy.
This test is composed of 36 verbal instructions that demonstrate an increasing level of linguistic complexity, which are divided into six parts. To administer the test, twenty pieces are needed. These pieces are two different shapes (square and circle), two sizes (small and large), and four colours (black, yellow, green, and white). They are arranged according to the instructions provided by the test’s authors. The participants respond to instructions such as: "Touch the circle"; "Touch the yellow square"; and "Touch the large black circle and small green square”. The scores can range from 0 to 36 points and are obtained by totalling the scores of each test item. A score of 29 to 36 indicates comprehension impairment; a score of 25 to 28, mild impairment; a score of 17 to 24, moderate impairment; a score of 9 to 16, severe impairment; and a score of 0 to 8, very severe impairment.
Few studies[15,52-53] have investigated linguistic alterations in TBI victims, which means that sequelae are underestimated and underdiagnosed. The consequences of these alterations are not only physical but also psychosocial, potentially compromising patients’ social relationships. Furthermore, as we have argued, oral comprehension skills are undoubtedly essential to everyday life, as they determine our ability to understand oral messages, a key feature of communication\'s effectiveness.
There has been confirmation, achieved through the most modern neuroimaging techniques, that the left hemisphere is responsible for the language process in virtually all right-handed individuals, as well as in more than half of left-handed and ambidextrous individuals.[54]
A TBI patient\'s communication can change according to language disorders. Some individuals may have difficulty understanding or producing oral and written language, or they may have difficulty with the more subtle aspects of communication, like body language or emotional and nonverbal cues.
Our study assessed 122 TBI patients between 14 and 83 years old who were admitted into a public trauma referral hospital located in a city in north-eastern Brazil in 2012. It revealed that most TBI victims presented some level of oral comprehension impairment after traumatic brain injury, ranging from mild to moderate alterations.[55]
4. Post-TBI communication disorders
Aphasia, dysarthria, and apraxias are among the chief alterations in communication that are caused by TBI-related disorders or neurological damage.[33]
There are also cognitive-linguistic disorders. These cognitive-communicative impairments were defined and classified by ASHA in 1988 as any change in communication resulting in cognitive deficits (such as memory, attention, and logical reasoning) that produce symptoms and difficulties in communication that are traditionally considered unclassifiable and that present within normal language during formal tests, such as the Boston Test. However, this type of data and the impact of these changes after the cerebral injury remain imprecise.[56-57]
Aphasia is a multimodal disorder that affects reading, writing, auditory comprehension, and orally-expressed language. It should not, however, be regarded as a specific disorder, as other cognitive processes, such as attention and short-term auditory memory, can also be involved.[58]
Thus, aphasia is essentially a linguistic processing disorder in which the mechanisms that transform thought into language are blocked. Furthermore, the disorder compromises initiative, creativity, and the ability to perform calculations, i.e., skills that call on the use of internal speech.[59]
Aphasia\'s cause is neurological in origin and could be associated with several aetiologies (vascular, infection, tumour, cranial trauma, degenerative disease, demyelinating diseases, and toxic disorders).[59-61] Its classification is described in Table 1 below.
\n\t\t
\n\t\t
\n\t\t
\n\t\t
\n\t\t\t
\n\t\t\t\tAPHASIAS\n\t\t\t
\n\t\t\t
Emissive Aphasias
\n\t\t\t
Broca\'s Aphasia
\n\t\t
\n\t\t
\n\t\t\t
Conduction Aphasia
\n\t\t
\n\t\t
\n\t\t\t
Transcortical Motor Aphasia
\n\t\t
\n\t\t
\n\t\t\t
Receptive Aphasias
\n\t\t\t
Wernicke\'s Aphasia
\n\t\t
\n\t\t
\n\t\t\t
Transcortical Sensory Aphasia
\n\t\t
\n\t\t
\n\t\t\t
Anomic Aphasia
\n\t\t
\n\t\t
\n\t\t\t
Mixed Aphasias
\n\t\t\t
Mixed Transcortical Aphasia
\n\t\t
\n\t\t
\n\t\t\t
Global Aphasia
\n\t\t
\n\t
Table 1.
Classification of Aphasias
More common expressive or motor aphasia is associated with injuries involving the frontal language centre in the dominant hemisphere (Broca\'s area) and is therefore mainly associated with an inability to translate spoken concepts into meaningful sounds, or in other words, to produce speech. The result is speech that is not fluent, with pauses between words or phrases.
Conduction aphasia is characterized by phonemic paraphasias, anomies and semantic paraphasias during the conversation. The speech may appear with hesitation and self-corrections. A striking feature of this type of aphasia corresponds to errors found in the repetition test.
Another type of non-fluent aphasia is transcortical motor aphasia, whose main feature is the reduction of speech. Spontaneous language is extremely reduced, and its expression is slow and short.
Receptive or sensorial aphasia is related to injuries to the posterior language area in the dominant hemisphere. Wernicke\'s aphasia is the most serious comprehension aphasia associated with problems in the comprehension and formulation of speech.
In transcortical sensory aphasia, oral expression is fluent; at the same time, severe and moderate comprehension deficits appear; and there are semantic paraphasias, anomies and circumlocutions.
Anomic or amnesic aphasia is primarily characterized by semantic changes, paraphrases and anomies.
The mixed forms of aphasia are conditions that exhibit characteristics of the several manifestations described. As an example, there are: transcortical motor aphasia, in which oral expression is characterized by stereotypes and echolalia; and global aphasia, in which the patient has a severe impairment of oral expression and listening comprehension.
As the expressive aspects of speech depend upon the normal functioning receptive aspects, language expression may also be impaired in individuals with sensory aphasia, who may present with unintelligible words, changing words (paraphasia), and other expressive disorders related to speech production. Thus, the main differences between motor and sensory aphasia are in language comprehension, which is only slightly affected in the former but severely affected in the latter; and in speech, with non-fluent aphasia in motor aphasia and fluent aphasia in the sensory variety.[62]
It is important to emphasize and describe the changes in oral language abilities when dealing with aphasic syndrome.[63]
Verbal fluency: this criterion is mainly used to differentiate between fluent and non-fluent aphasic syndromes. With aphasia in which oral language is fluent, an ease of articulation can be seen even in long sentences; generally, this type of aphasia is the result of a posterior lesion. Non-fluent aphasia is characterized by a difficulty in initiating oral production, which causes strain. This type of aphasia is associated with anterior lesions.[64-66] Muteness would be the most extreme degree of reduction in fluency, whereas, logorrhoea is a marked increase in the number of words produced in a certain amount of time.[66]
Anomia: a difficulty or inability to recall names of objects, leading to a restriction in vocabulary. It is present at different levels in every type of aphasia and has several causes. Attempts to compensate for this difficulty often feature synonyms or circumlocution. While anomia does not exclusively affect substantive words, nouns are the most compromised class of words.[60,61-64] For example, sufferers have difficulty in recalling or retrieving the words in speech. The processes for retrieving the words are the same for aphasic and not aphasic, but for people with the disease, the operation becomes slow, cumbersome and often ineffective.
Paraphrase: occurs when a subject, while trying to say a word, substitutes the word with a phrase,[67] for example, what serves as combing for comb.
Circumlocution: expression which takes place when a patient can neither grasp the main theme of the enunciation nor discuss it. In his statement he touches upon the theme but does not manage to specifically discuss it,[67] for example, a wooden object which has a backrest, four legs and is used to sit on is a chair.
Repetition: one of the most basic mechanisms of human language; however in patients with aphasia, it can be impacted in different ways. The phonemic pathway is used to repeat not-words, while words are repeated by accessing the meaning. Repetition is kept intact in extrasylvian (transcortical) aphasia but harmed in perisylvian aphasia (Broca, Wernicke, conduction, and global).[64] An example of this condition is: "the house, the house, the house".
Auditory comprehension: a complex function resulting from the processing of speech sounds in Wernecke\'s area; occurs when concepts related to a registered word are activated and selected. The process involves several areas with different modalities and hierarchies that are distributed throughout the entire brain. Generally, it is more affected in fluent aphasia.[59,66,68]
Agrammatism: the disorganization of syntactic rules present in language, which leads to a significant reduction in an individual\'s statements. It is characterized by an almost telegraphic style, where prepositions, articles, conjunctions, and pronouns are omitted, but nouns, adjectives, and verbs (almost always in the infinitive) are preserved. A loss of prosody and a lack of declension for gender, time, and number can also be observed. It is a hallmark of Broca\'s aphasia.[60,63-64] An example of agrammatism is: “Father to lead to the college”, note the absence of "my" "will go" "me" "to" and "a".
Stereotyping: perseverative and involuntary repetitions of a certain type of behaviour. Patients will use restricted verbal production, with or without linguistic meaning, every time that they attempt oral or written communication. It is present in Broca\'s aphasia.[60,63-64,66] For example, a patient produces this sound: eeeeeeeeeeee, eeeeeee, eeeee…
Perseveration: maintaining the same response for distinct stimuli. Patients will use a word incorrectly right after it has been used in a different, more appropriate context. This is also associated with Broca\'s aphasia.[60,63-64]
Jargon: discourse that has no message, in which syntax and semantics are absent; it is language that is incomprehensible, without meaning, and spoken at a rapid pace. It is present in the more serious fluent aphasias.[60,63-64] For example, "It’s going to rain upon noodle stones plantation."
Echolalia: the repetition of an interlocutor\'s sounds, in an unsolicited context, with no communicative purpose.[64,66] An example of echolalia is: chair, chair, chair...
Paraphasia: the substitution of letters, syllables, or words during discourse.
Phonological paraphasia: a wrong choice during the act of articulation, characterized by distortion in the production of phonemes. Patients substitute one phoneme for another,[60,64,66-67] for example, plants for pants.
Phonemic paraphasia: a change in the phonological level of language; it consists of substitutions influenced by production context or by similarity of certain traits. It can be manifested as a change, an omission, or an addition of phonemes or syllables and is present in a large number of fluent aphasias.[60,63,66-67] An example is shark for sharp.
Morphemic paraphasia: a change characterized by the substitution of words\' grammatical morphemes,[67] for example: talk for talking.
Formal paraphasia: occurs when a swap, substitution, addition, or omission results in a different word in the language, without being characterized as a semantic swap, for example, goat for coat.
Verbal paraphasia: when the patient makes a substitution in an oral statement and cannot identify its relation to the content or form of the statement, for example, tiger for lion.
Semantic paraphasia: occurs when one word is substituted with another that has the same semantic context,[60] for example, pen for pencil.
Neologism: phonemic or graphemic sequences that obey a language\'s rules and resemble words, but do not exist in that language. When trying to say a word, patients will substitute the word with a sequence of meaningless sounds.[64] An example of this is, “The cake was eatful” instead of eatable.
Reduction: Decrease in the number of enunciations in a certain amount of time,[67] for example: “the girl’s hair is beautiful” for “girl... beautiful hair”.
Suppression: the complete absence of oral or graphic emission. This term can be considered a synonym for muteness when used in the context of oral statements.[67]
The sensorimotor sequelae of TBI can impair an individual\'s communication and affect the ability to produce intelligible speech. This happens when the trauma affects the areas of the brain that are responsible for the execution of movements necessary to produce speech and triggers a neuromotor disorder called dysarthria.[69] Dysarthria is characterized by slowness, weakness, and/or lack of muscle coordination related to the speech function. Its main consequence is a reduction in speech\'s intelligibility, which limits the speaker\'s communicative ability and social participation.[15,70]
It often develops after damage to the central or peripheral nervous system, which mainly affects laryngeal function, causing weakness or lack or muscle coordination during speech, as well as changes in the oral statement.[71]
For production to render intelligible speech, the phonoarticulatory apparatus needs to be working in perfect symphony; along with the oral cavity, the pulmonary, laryngeal, and pharyngeal structures form the apparatus, and any change to any of these will consequently impact speech intelligibility.[71-72] The dysarthria occurs when there is an impairment in the motor apparatuses necessary for oral production (which are: breathing, phonation, resonance, articulation, and prosody) following a central or peripheral neurological change. This fact justifies the emergence of the terms "dysarthrophonia" and "neurological dysphonia" as synonyms for dysarthria in order to describe this condition, which is not just a change in articulation.[73]
There are several types of dysarthria that vary according to the degree and location of the injury: flaccid dysarthria, spastic dysarthria, unilateral upper motor neuron dysarthria, hypokinetic dysarthria, hyperkinetic dysarthria, ataxic dysarthria, and lastly, mixed dysarthria[74]. The most common symptoms range from a decreased rate of speech, vagueness, articulation, slow, irregular speech to a lack of change in pitch or intensity.[75-76]
With TBI, flaccid dysarthria is the most common type. In flaccid dysarthria, the injury is located in the lower motor neuron, which is peripheral, but it can also emerge due to some cranial nerve lesions. Nerve conduction is impaired at a point between the cell body and the muscle, and the resulting changes are flaccidity, weakness, atrophy, and fasciculations.[73] Thus, motor function is changed, potentially resulting in muscle paralysis, a breathier and more monotone voice, hypernasality, imprecise articulation of consonants, diminished volume and predominantly pharyngolaryngeal resonance.[71] Loss of muscle mass is also common for this type of dysarthria.
Spastic dysarthria can also emerge after closed TBI and is caused by a bilateral lesion to the upper motor neuron, which causes an increase in muscle tone, spasticity, and weakness. Among its main characteristics are: a rough, stressed voice; tight, choked sounds; monotone; imprecise articulation of consonants; and hypernasality.[73]
Another type of dysarthria that can occur due to trauma injury is mixed dysarthria, in which changes typical of several types of dysarthria all emerge at the same time and have no sort of pattern. This is because the injuries involve multiple areas of the central and peripheral nervous system. This type can also occur in cases of stroke, degenerative, metabolic, and toxic diseases, and infectious diseases of the central or peripheral nervous system.
Research[77] conducted at the São Paulo Hospital (HSP), Brazil, developed a profile of dysarthric patients which showed that traumatic cranial lesions were the second most frequent aetiology related to dysarthria, with male patients prevailing due to both the higher rate of males in automobile accidents and the higher frequency of flaccid dysarthria in TBI patients. In another Brazilian study,[33] the prevalence of traumatic cranial injury in individuals attended to at the Acquired Neurological Disorders Outpatient Service of the Speech Pathology Department at UNIFESP was 75.6%. The majority of these cases also involved male patients, and 33% of patients were diagnosed with dysarthria.
After a diagnosis of dysarthria has been made and its aetiology determined, it is up to a speech therapist to evaluate the patient and connect phonological signs to neurological changes, so as to better determine short-, mid-, and long-term therapy practices that align with both the patient\'s prognosis and a general clinical view of the case. In severe cases of TBI, the occurrence of dysphagia associated with dysarthria is common. Therefore, it is necessary to have a clear and precise diagnosis so that adequate rehabilitation can be carried out.[73]
Apraxia should also be brought to attention and seen as an articulation disorder that leads to the loss of the ability to perform previously learned motor acts. In apraxia, there is a difficulty in associating the voluntary programming of the position of the muscles that form speech organs with the sequential movement of these muscle groups, which prevents the formation of appropriate language. Apraxic patients present these symptoms, although they exhibit no abnormalities in the motor and sensory systems, or in comprehension, cooperation, and attention skills. It is damage to the primary motor cortex that causes apraxia.[78]
They are, therefore, speech articulation disorders that result in a loss of the ability to programme and organize the position of the speech apparatus to voluntarily produce phonemes, or of the sequence of muscle movements to produce words; a loss which is not, however, accompanied by the weakness, slowness, or lack of coordination that affects these same muscles in reflexive or involuntary movements caused by cerebral lesion.[1]
5. Interdisciplinary approach
Interdisciplinary care for TBI victims performed by a multidisciplinary team is recommended during post-trauma treatment. It is necessary to evaluate the specific needs of the individual, aiming not only for preservation of live, but also for quality of life.
Family participation is vitally important in each treatment phase. A team with a speech therapist, doctor, nurse, occupational therapist, psychologist, physical therapist, social worker, and nutritionist, among other types of professionals, is highly suggested.
A speech therapist has the goal of helping patients improve their communicative abilities, in addition to addressing other concerns such as chewing and swallowing. It is important to start rehabilitation as soon as possible, as this encourages and optimizes the initial spontaneous recovery process.[14]
The main goal of a speech therapist, then, is to maximize a patient\'s communication.[79-80] In the initial phases, the objective of communication rehabilitation is to offer sufficient support in order to facilitate the recovery of the communicative function. Subsequently, the focus of the intervention becomes the generalization of communication skills in activities with varying contexts.[79]
The rehabilitation process involves combining suitable intervention approaches for each case, such as: behavioural approaches; skills and specific process training; guidelines; metacognitive approaches (tasks that require analysis of semantic similarities, main ideas and topics, and narrative schemes, among others); interventions focused on people living with the individual (training in the use of communication strategies and assistive technology, for example); and use of augmentative and alternative communication (AAC) that can be defined as "any resource that can be used to encode and transmit a message without requiring writing skills or vocalization"..[1,73,79,81]
Regarding the use of supplementary systems and alternative communication in the therapeutic process with patients with brain injury, although studies are scarce, the literature indicates these systems as facilitators of communication, i.e., as resources for the rehabilitation of speech and communication facilitation in day-to-day situations. There have also been descriptions of adaptations and the use of high-tech systems, mostly for cases of cerebral palsy.[1, 4-5 ]
In order for a TBI patient\'s communication to be optimized or to be made possible, cognitive stimulation should be started as soon as possible. The goal of an intervention is to maximize patients\' potential and promote faster, more organized evolution through the stimulation of various sensory modalities, using familiar materials and resources.[82] With evolution on a cognitive level, the individual usually begins to communicate better and can start to speak, read, or write again. Such resources should be used in the process of care, as well as in the process of rehabilitating the linguistic and cognitive aspects that changed as a result of TBI.[73]
It is essential that patients in a state of mental confusion are oriented about the circumstantial, spatial, and temporal aspects that can help to contextualize their situation, such as: what happened, where they are, their location in time, what will be done at that moment, and other relevant pieces of information.[83]
When patients can control their attention, even for a limited amount of time, certain strategies can be employed that make message comprehension easier for the patients. These can include: always facing the patient while speaking, using repetition and redundancy, favouring short and direct sentences, speaking more slowly, minimizing the presence of noise or other stimuli, and using warning signals that gear the patient\'s attention towards receiving information.[83] These strategies can also be used by other members of the team and by the patient’s relatives.[73,83]
In dysarthria cases where communication is impacted, rehabilitation should also take into account an intervention concerning specific aspects of speech production, with the aim of optimizing the patient\'s intelligibility.[79,84]
Most neurological damage resulting from TBI does not occur at the time of the injury, but rather over the course of the hours and days after the accident, thus it can be prevented or treated.[85]
Early indicators of a bad prognosis should be identified in the clinical history and, most importantly, during a physical examination of the patient. The doctor should have some knowledge of the patient so that he can try to return to use the window of time between the trauma and the ensuing damage in which to prevent future consequences, and in doing so prevent secondary damage.[86]
The nurse also provides care to these victims and should be able to obtain data on the patient\'s history, perform a physical examination, and provide prompt treatment in order to preserve life and prevent secondary damage.[87] The systematization of nursing care is not only necessary, but almost of utmost importance.
There is little scientific evidence concerning physical therapy intervention and the improvement of communication disorders in individuals with traumatic brain injury, but this area of healthcare has a range of behaviours that complement the treatment of the voice, speech, and language functions within an interdisciplinary context. To achieve adequate vocal performance, it is necessary to teach breathing.
Patients with head trauma commonly suffer losses in respiratory efficiency and effectiveness; when using accessory muscles, more energy is expended per respiratory cycle. The ideal is that the gas exchange process take the least possible toll on their energy reserves, and for this, focus is put on the diaphragm, extensive musculature adapted to breathing. Respiratory therapy is highly recommended for lung restructuring, maintaining the force and strength of respiratory musculature, increasing gas exchange efficiency, and eliminating the use of accessory muscles.[88-89] Techniques vary from manual manoeuvres to release the diaphragm and diaphragmatic breathing to the use of devices known to motivate inspiratory flow and volume.[90]
Another problem for cranial injury victims besides respiratory disorders is aphasia. One method that has evolved over the past decade is Constraint-Induced Language Therapy. This therapy consists of restricting the aphasic patient\'s communication to verbal communication and prohibiting any other method of communication, either gestural or written. The therapy session is long and tiring, held for an average of two or three hours a day over a period of about two weeks. It has been well-received in the clinical setting, and results have been promising.[91] Another advantage is that regardless of whether the aphonic presents with an acute or chronic condition, therapy brings about clinical improvement, and studies have shown changes of 28% to 47% in patients with chronic aphasia.[92]
Communication goes far beyond spoken language. Interaction using gestures and signs is crucial for those who have lost voice function and/or hearing after a traumatic brain injury. An injury to the precentral gyrus of the frontal lobe of the cerebrum, for example, can affect the primary movements, compromising the execution of gestures and signs. Physical therapy works to develop gross and fine motor skills, vision skills, sensory processing skills, movement coordination, and appropriateness of tone – key points for communication.[93] In situations where various muscle groups are affected by spasticity, physical therapists may recommend systemic drug therapy to contribute to the reduction of tone, in addition to recommending physical measurements, exercise and orthotics.[94]
From a psychological perspective, there are several areas that can directly affect communication. For over four decades, psychology has developed, through studies on language acquisition, into different models of theoretical and methodological concepts that serve as linguistic techniques and behaviour. The field of psycholinguistics aims to address conduct or behaviour related to language in the context of a subject\'s psychological and social functioning.
Neuropsychology is an area of psychology that allows greater dialogue between different professionals in the neurosciences for the purpose of establishing knowledge about cognitive functions, behaviour, and the functioning of the Central Nervous System (CNS).
This area holds extensive knowledge about clinical and research practices working mainly with the assessment (neuropsychological tests) and treatment (neuropsychological rehabilitation) of disorders that can occur in the Central Nervous System, such as trauma.[95]
In Neuropsychology, each function of the Central Nervous System is detailed, and this enables more effectively-directed rehabilitation. With TBI, in which most accidents occur in the region of the Frontal Lobe (considered executive functions), there are several studies of the components involved in this area, such as working memory, planning, problem solving, decision making, fluency, and inhibition control, among others.[96]
The main evaluations performed that concern linguistic components are: fluency, repetition, comprehension, and naming. These components can lead to more exact diagnoses about the seriousness of the spoken, written, and comprehended language impairment of a patient who has Central Nervous System dysfunction,[97] and can also help the patient\'s rehabilitation and communication.
Patients with Central Nervous System Dysfunction require more intensive care from their families because, besides having difficulties with motor and cognitive functions, they experience changes in personality and behaviour. It is important that patients and families work in an interdisciplinary way, using humanized reception and the structure provided by help groups in order to supplement the patients\' rehabilitation and the social stability of the family.
6. Conclusion
Communication disorders can occur regardless of the severity of an injury, and they have a major impact on the level of discourse and the social exchanges. They can have a negative effect on the patients\' recovery process, reintegration into the community, independence, familial interactions, and professional and academic success.
In this context, we stress the importance of the interdisciplinary approach in the follow-up treatment of these victims, so that prognosis and rehabilitation, as well as post-TBI quality of life, may improve.
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Introduction",level:"1"},{id:"sec_2",title:"2. Communication: An essential instrument in human relations",level:"1"},{id:"sec_3",title:"3. Language",level:"1"},{id:"sec_4",title:"4. Post-TBI communication disorders",level:"1"},{id:"sec_5",title:"5. Interdisciplinary approach",level:"1"},{id:"sec_6",title:"6. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'World Health Organization. Neurotrauma. 2013. http://www.who.int/violence_injury_prevention/road_traffic/activities/neurotrauma/en (accessed 05 July 2013).'},{id:"B2",body:'Gentile JKA, Himuro HS, Rojas SSO, Veiga VC, Amaya LEC, Carvalho JC. Condutas no paciente com trauma cranioencefálico. Revista da Sociedade Brasileira de Clínica Médica 2011;9(1). http://files.bvs.br/upload/S/1679-1010/2011/v9n1/a1730.pdf (accessed 05 July 2013).'},{id:"B3",body:'Aghakhani N, Azami M, Jasemi M, Khoshsima M, Eghtedar S, Rahbar N. Epidemiology of Traumatic Brain Injury in Urmia, Iran. 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Health Sciences Post-Graduate Programme, Academic Trauma League (LITRAUMA), Federal University of Sergipe, Brazil
Health Sciences Post-Graduate Programme, Academic Trauma League (LITRAUMA), Federal University of Sergipe, Brazil
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1. Introduction
Crohn’s disease or enteritis regionalis is a chronic inflammatory disease of the digestive tract, predominantly of the small intestine. It is the most common small bowel disease in the United States and Europe: (3.1–14.6/100,000 in the United States and 0.7–9.8/100,000 in Europe, respectively) [1]. It occurs more frequently in the White population than in African-American and Asian ones, and is particularly common in certain ethnic groups [2]. The disease is equally present in both sexes and most often occurs between twenty and forty years of age [3].
Research into the epidemiology of IBD in areas with a sharply increased incidence may discover important etiological factors associated with the disease development [4].
Although the process most commonly affects the terminal ileum (60–80% of cases), the disease can occur in any part of the digestive tract, from the mouth to the anus [5].
Crohn’s disease is a disease of segmental nature, in which healthy parts of the intestine are located between the affected ones. The inflammatory process spreads to all layers of the wall and affects the mesentery and local lymph glands [5, 6].
Many patients have lesions on the terminal ileum and the colon; in many cases, it is challenging to distinguish Crohn’s disease from ulcerative colitis by differential diagnosis. Therefore, for ulcerative colitis and Crohn’s disease, there is a common name - inflammatory bowel disease (IBD) [6, 7].
Inflammatory changes in the early stage of the disease are more pronounced in the submucosa than in the mucosa due to lymphedema [8]. The mucosa’s lamina propria is infiltrated by polymorphonuclear leukocytes, forming crypt abscesses as a sign of the earliest lesion; this is followed by an enlargement of the lymphoid follicles surrounded by a red ring. Aphthoid ulceration appears on the mucosa, which progresses to deep, most often longitudinal ulcers in the disease’s further course. As the disease progresses, the inflammation spreads transmurally with the formation of deep fissures and ulcerations along with the entire wall thickness.
In the advanced stage of the disease, fibrous strictures and extramural fistulas and abscesses develop [9].
Complications in Crohn’s disease are common and can be local and extraintestinal [10].
2. Diagnosis of the disease
Inflammatory bowel diseases, especially small bowel diseases, have always posed a diagnostic challenge [11]. The small intestine is a very challenging organ for clinical and radiological evaluation. Detecting the disease and determining its prevalence are two important clinical and diagnostic tasks.
In addition to the above, an important question to be answered is the degree of the disease’s inflammatory activity. Although the medical issue was defined in the last century, diagnostic problems are still present. Advances in technology and the introduction of new diagnostic procedures promise better results.
2.1 Imaging techniques in the diagnosis of Crohn’s disease
Ultrasound, computed tomography, and MRI are the techniques often used in the diagnosis of abdominal disease.
2.1.1 Ultrasound
Ultrasound is a widely used diagnostic modality that, due to its availability, simplicity, absence of harmful effects, and low cost of the examination, is the first diagnostic method used to diagnose abdominal diseases [12].
Ultrasound is generally performed without the use of a contrast agent. Some studies indicate greater sensitivity after the administration of an ultrasound contrast agent [13].
Technological advances and the growing experience of radiologists make ultrasound an increasingly valuable modality in diagnosing diseases of the gastrointestinal tract. The gradual compression technique and high-resolution multifrequency linear probes enable the displaying of changes in the intestinal wall [14]. Ultrasound plays an essential role in diagnosing diseases of the digestive tract, such as inflammatory bowel disease, small bowel obstruction, appendicitis, intussusception, and hypertrophic pyloric stenosis in newborns [15]. Factors that limit ultrasound examination of the abdominal organs, especially assessment of the digestive tract, are pain, pronounced flatulence, low spatial resolution, inability to display the rectum, and the distal part of the sigmoid colon. Recent studies, which compare Ultrasound and MRI in assessing the enlargement and inflammatory activity of Crohn’s disease, indicate that ultrasound can localize the affected intestinal segments to some extent and the complications that accompany them [16, 17].
Sonographic lines of the intestinal wall correspond more to the interfaces than the wall’s real histological layers. The central, thickened layer corresponds to the lamina submucosa, while the outer and inner hypoechoic layers correspond to the lamina mucosa and lamina muscularis respectively [18]. The wall is usually stratified if the lamina mucosa, submucosa, and muscularis propria are visible as separate layers. Loss of stratification is the inability to distinguish these layers or distinguish lamina mucosa from submucosa with visible muscularis.
The stomach wall’s standard thickness is up to 5 mm, the small intestine up to 2 mm, and the large intestine up to 3 mm.
2.1.1.1 Examination technique and ultrasound findings
After the conventional abdominal ultrasound with a convex probe within the range of 2–5 MHz, the gastrointestinal tract examination is continued with high-frequency linear probes in the field of 5–10 MHz.
When inspecting the intestinal vortices, the gradual compression technique is used to expel air from the intestines.
Incompressibility and thickening are vital signs of a pathomorphological change of the wall. The intestine’s pathomorphological altered segment is characterized by concentric wall thickening, absence or reduction of peristalsis, and lack of compressibility under pressure with an ultrasound probe [19] (Figure 1).
Figure 1.
Thickening of the terminal ileum wall.
A wall thickness above 3 mm can be considered a pathological finding [20]. The discovery of a “pseudo-kidney” or “target sign” is the thickened, relatively hypoechoic intestinal wall surrounding the hyperechoic lumen, which is not specific and can be caused by other pathological conditions (neoplasms, intussusception, wall hematomas, hypertrophic pyloric ischemia, appendicitis, diverticulitis, etc.) [21]. A longitudinal view shows the tubular structure.
Some authors report a high percentage of detection of thickened intestinal convolutions (up to 90%) by high-resolution ultrasound, making it more challenging to determine the affected segment’s exact length [22].
Therefore, the determination of the affected segment’s length is estimated more reliably by other radiological methods [20].
An increasing number of authors emphasize the value of ultrasound in detecting and monitoring chronic inflammatory bowel disease, and in evaluating drug therapy effectiveness and presenting extramural complications (fistulas, abscesses, lymph nodes, free fluid) [23, 24] (Figures 2 and 3).
Figure 2.
Enterocutaneous fistula.
Figure 3.
Hypoechogenic, reactively altered lymph nodes.
There are observations related to Crohn’s disease that the loss of stratification due to wall edema correlates with the disease’s active phase. In contrast, in the subacute and chronic phases, due to fibrosis, recognizable stratification from all five layers prevails [25].
2.1.2 CT enterography
It is a fast, non-invasive technique that uses a large amount of intestinal contrast material to better display the small intestine wall and lumen [26, 27].
CT enterography is not as sensitive as standard radiological methods in detecting mucosal damage. In comparison between them, it is superior in showing intramural and extraluminal changes [28] (Figure 4).
Figure 4.
CT enterography - thickening of the terminal ileum wall.
CT-proven mural thickening of the intestinal wall is the most crucial indicator of a pathological finding [29].
In the active inflammatory phase of the disease, contrast imbibition shows CT thickening of the wall and “stratification”, which is indicated by a double halo - the “target sign” [29].
The main limiting factor in CT enterography is ionizing radiation, and it is unsuitable for the follow-up of patients with Crohn’s disease.
2.1.3 Contrast MR enterography
Magnetic resonance imaging was introduced as an alternative method for detecting Crohn’s disease and can be performed as MR enterography, or as MR enteroclysis [30, 31, 32, 33, 34].
MR enteroclysis is more demanding to perform and uncomfortable for the patient because it involves using a nasojejunal tube, and nowadays it is being avoided [35].
Technical advances with rapid sequences (GRE and EPI sequences, particularly HASTE) have minimized artifacts problem due to respiration and peristalsis [36]. Fat signal suppression is one of the technical modifications to better contrast the MR image [37].
The examination involves applying a more considerable amount of fluid orally to ensure the distension of the intestinal vortices, after which the MRI imaging itself is approached. Before the native and contrast sequences, an antispasmodic is administered intravenously to slow down the peristalsis and avoid bowel movement artifacts. After that, axial and coronal T1 and T2 sequences are recorded, as well as dynamic post-contrast recordings.
The fair spatial and temporal resolution of MR images, combined with a large amount of oral contrast agent that provides intestinal curvature distension, allows good visualization of the intestinal wall thickening, and edema thereof, which is useful for assessing Crohn’s disease activity [38] (Figure 5).
Figure 5.
T2 blade coronal mbh sequence: Distended intestinal loops with visible thickening of the terminal ileal wall.
A high signal in the T2 measured image as a well-known indicator of inflammation in human tissue should be a good indicator of inflammation in Crohn’s disease.
The inflamed bowel wall in the T2-weighted image has a low-contrast resolution because the inflamed wall is more difficult to distinguish from the high signal of intraluminal fluid and perivisceral fatty tissue T2W sequence.
Suppression of perivisceral adipose tissue signals with the “fat suppression” technique amplifies signal intensity of the inflamed intestine level. Also, superparamagnetic contrast (iron oxide particles) reduces the high intraluminal signal in the T2W-measured image.
Combining the above (fat suppression and superparamagnetic contrast) maximally improves the intestinal wall’s high T2 signal. In other words, the mesenteric adipose tissue signal and the intraluminal content signal are “subtracted” from the display, which amplifies the inflamed intestinal wall signal in the T2W sequence.
Wall thickening, length of inflamed bowel and mural signal enhancement after intravenous administration of gadolinium correlate with Crohn’s disease activity [39] (Figure 6).
Figure 6.
(A) T2 blade fs axial multi breathe hold (mbh), (B) T1 vibe fs axial mbh, and (C) T1 vibe fs axial mbh postcontrast: Thickening of the ileal wall in Crohn’s disease.
MR enterography is easy to perform and has been proven to be useful for detecting active ileitis, assessing disease activity in the area of anastomoses, and identifying extraenteric complications [40, 41, 42, 43, 44] (Figures 7–13).
Figure 7.
(A) T1 vibe fs coronal mbh native and (B) T1 vibe fs coronal mbh after paramagnetic contrast agent application: Thickening of the ileal wall in the area of ileotransverso anastomosis.
Figure 8.
(A) T2 blade transverse mbh and (B) T1 vibe transverse mbhpostcontrast: Perianal abscesses fused by retroanal fistula.
Figure 9.
(A) T2 blade transverse mbh and (B) T1 vibe transverse mbhpostcontrast: Significant lymph node along the Bauchini valve region.
Figure 10.
T1 vibe coronal mbh postcontrast: Indicated blood vessels (vasa recta) as an indirect sign of inflammation.
Figure 11.
(A) DWI and (B) T1 vibe fs coronal mbhpostcontrast sequence: Stenosis of the ileal segment with consequent distension of the proximal part of the small intestine - an indirect sign of affection.
Figure 12.
(A) T1 vibe fs coronal mbh after and (B) pre-application of paramagnetic contrast agent (B): Perianal fistulas.
One of the earliest papers indicated a high sensitivity of over 90% in detecting fistulas in Crohn’s disease [45].
The advantages of MRI imaging are:
absence of ionizing radiation, which is especially crucial for the young population,
possibility of using different parameters for the evaluation of inflammatory activity (T2 sequence),
potential for making multiplanar and coronal representations,
high signal intensity after the application of gadolinium in pathological changes of the intestinal wall,
fair contrast resolution (display of wall edema) using fat suppression technique,
high reliability to show fistulas.
The disadvantages of MRI imaging are:
high search price, and difficult availability,
prolonged search time, and related claustrophobia,
metal side of the body,
lower spatial resolution.
2.1.4 Diffusion-weighted magnetic resonance imaging (DW MRI) and apparent diffusion coefficient (ADC)
Diffusion-weighted imaging (DWI) provides unique information about the observed tissue because the image contrast between different structures in this technique depends on water molecules’ local diffusion properties (Figure 14).
Figure 14.
(A) T2 blade transverse mbh, (B) T1 vibe fs transverse mbh, (C) DWI and (D) ADC map: Thickening of the ileal wall with visible free water diffusion restriction.
Diffusion-weighted imaging is a method by which we can accurately and non-invasively monitor proton diffusion of water molecules.
Diffusion is a physical term that describes the random movement of molecules without specific transport mechanisms [46].
Diffusion imaging of water is based on the natural sensitivity of MR signals to movement. In the presence of a magnetic field gradient, protons carried by water molecules’ movement receive a phase shift of transverse magnetization.
Since other types of intravoxel incoherent movements, such as capillary perfusion, can produce effects similar to those of real diffusion, it has been proposed that the term ADC (Apparent Diffusion Coefficient) be used to quantify the results of in vivo diffusion imaging experiments.
The apparent diffusion coefficient (ADC) is calculated by comparing images with two or more different b-factor values allowing the diffusion to be quantified.
Images in which the shade of the grayscale of an individual image element (pixel) is proportional to the apparent diffusion coefficient value are ADC maps.
Its high sensitivity limits clinical use of diffusion MR imaging to motion artifacts and limited hardware on conventional MR scanners.
The single-shot technique directly improves diffusion recording because it significantly reduces motion artifacts and increases the measured diffusion coefficient reliability by allowing many diffusion images to be obtained in a brief time interval. Thus, this technique is compatible with the clinical protocol [47].
With this imaging technique, the whole signal from the tissue is canceled, so that only the signal of the molecules moving due to diffusion is displayed. The method is very demanding for the device, and only devices with good, strong, and fast gradients can cancel the signal enough not to see the “illumination of the T2 image”, which can be sensed even with robust devices. These images are used daily to show the brain tissue that has experienced ischemia or stroke. Although the information obtained by diffusion measurements requires new studies, several reports have shown that diffusion imaging could become a powerful principle for the diagnosis of abdominal diseases [48, 49, 50, 51, 52, 53, 54].
3. What is the new gold standard?
Barium contrast tests and isotopes have been used to show inflammatory bowel disease, but they carry a risk of ionizing radiation exposure. Barium use is declining to result in fewer radiologists having the expertise and experience for such examinations - the lack of anatomical localizations limits isotopic studies.
CT is beneficial for assessing Crohn’s disease complications, but it is burdened with high radiation.
CT enterography improves the visualization of the small bowel disease and allows the assessment of the disease activity.
Ultrasound has been increasingly used for the preliminary assessment of patients with potential IBD [55, 56, 57, 58, 59]. Although it is widely available and inexpensive, it depends on the experience of the doctor.
Finally, MRI is the most accurate tool for assessing the disease, its severity, and its prevalence [42, 43, 44, 60]. Pelvic MRI completely suppressed other techniques in the assessment of perianal fistulas [61].
According to the latest ECCO guidelines for the diagnosis of Crohn’s disease, endoscopy and radiology are complementary techniques to define the site and extension of the disease so that optimal therapy can be planned [62].
4. Conclusions
Conventional ultrasound is a suitable orientation method in the initial evaluation of the patients with Crohn’s disease. It can be used as an initial method for the patients who will subsequently undergo MRI enterography. CT is beneficial for assessing Crohn’s disease complications, but it is burdened with high radiation.
Contrast MRI enterography provides an excellent assessment of disease activity, as well as the complications that accompany it. The method has a high sensitivity to changes seen in the patients with Crohn’s disease; it offers detailed morphological and functional data on the small bowel disease and reliable evidence of normalcy; thus, it facilitates the final diagnosis of early or subtle structural abnormalities and helps to guide treatment and decisions on a further follow-up of patients. Contrast MRI enterography, in combination with DWI, is a comprehensive and safe method compared to reference - endoscopic examinations, and it should be considered as the preliminary examination for the detection of lesions in Crohn’s disease, especially in children. Given the convenience and considering the safety and ease of the analysis, MRI enterography combined with DWI is suitable for repeated follow-up examinations, i.e. it can contribute to the follow-up of patients with Crohn’s disease. Contrast MRI enterography combined with DWI is an excellent tool for evaluating complications of the underlying condition, especially for detecting fistulas, perianal fistulas in particular.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"ultrasound, computed tomography, diffusion, inflammatory bowel disease, magnetic resonance imaging",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75175.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75175.xml",downloadPdfUrl:"/chapter/pdf-download/75175",previewPdfUrl:"/chapter/pdf-preview/75175",totalDownloads:380,totalViews:0,totalCrossrefCites:0,dateSubmitted:"October 9th 2020",dateReviewed:"January 19th 2021",datePrePublished:"February 17th 2021",datePublished:"March 24th 2021",dateFinished:"February 10th 2021",readingETA:"0",abstract:"The small intestine is a challenging organ for clinical and radiological evaluation. The introduction of radiological imaging techniques, which do not significantly disturb patients’ comfort and safety, attempts to obtain an adequate diagnosis and valuable information. The aim is to determine the capabilities and potential of ultrasound, computed tomography (CT), diffusion-weighted imaging (DWI), and contrast-enhanced magnetic resonance (MR) enterography to establish the diagnosis and to evaluate the severity and activity of intestinal inflammation. Conventional ultrasound is a suitable orientation method in the initial evaluation of patients with Crohn’s disease. At the same time, contrast-enhanced MR enterography provides an excellent assessment of disease activity, as well as the complications that accompany it. Contrast-enhanced MR enterography, combined with DWI, allows for excellent evaluation of disease activity and problems or difficulties following it. The examination can be repeated, controlled and can monitor patients with this disease.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75175",risUrl:"/chapter/ris/75175",signatures:"Bilal Imširović, Enver Zerem and Emir Gušo",book:{id:"10309",type:"book",title:"Endoscopy in Small Bowel Diseases",subtitle:null,fullTitle:"Endoscopy in Small Bowel Diseases",slug:"endoscopy-in-small-bowel-diseases",publishedDate:"March 24th 2021",bookSignature:"Mahesh Goenka, Usha Goenka and Gajanan A. Rodge",coverURL:"https://cdn.intechopen.com/books/images_new/10309.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83968-780-8",printIsbn:"978-1-83968-779-2",pdfIsbn:"978-1-83968-781-5",isAvailableForWebshopOrdering:!0,editors:[{id:"292494",title:"Dr.",name:"Mahesh",middleName:null,surname:"Goenka",slug:"mahesh-goenka",fullName:"Mahesh Goenka"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"256726",title:"Dr.",name:"Bilal",middleName:null,surname:"Imsirovic",fullName:"Bilal Imsirovic",slug:"bilal-imsirovic",email:"bilal_imsirovic@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"335108",title:"Dr.",name:"Emir",middleName:null,surname:"Gušo",fullName:"Emir Gušo",slug:"emir-guso",email:"e.guso@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"335110",title:"Dr.",name:"Enver",middleName:null,surname:"Zerem",fullName:"Enver Zerem",slug:"enver-zerem",email:"zerem@inet.ba",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. Diagnosis of the disease",level:"1"},{id:"sec_2_2",title:"2.1 Imaging techniques in the diagnosis of Crohn’s disease",level:"2"},{id:"sec_2_3",title:"2.1.1 Ultrasound",level:"3"},{id:"sec_2_4",title:"2.1.1.1 Examination technique and ultrasound findings",level:"4"},{id:"sec_4_3",title:"2.1.2 CT enterography",level:"3"},{id:"sec_5_3",title:"2.1.3 Contrast MR enterography",level:"3"},{id:"sec_6_3",title:"2.1.4 Diffusion-weighted magnetic resonance imaging (DW MRI) and apparent diffusion coefficient (ADC)",level:"3"},{id:"sec_9",title:"3. What is the new gold standard?",level:"1"},{id:"sec_10",title:"4. Conclusions",level:"1"},{id:"sec_14",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004;126:1504-1517'},{id:"B2",body:'Mayberry JF, Judd D, Smart H, Rhodes J, Calcraft B, Morris JS. Crohn\'s disease in Jewishpeople - An epidemiological study in South-East Wales. 1986;35:237-240'},{id:"B3",body:'Achitei D, Gologan E, Stefănescu G, Balan G. Clinical, biological and epidemiological aspects of inflammatory bowel diseases in North-East Romania. Rev Med ChirSoc Med Nat Iasi. 2013;117(1):16-22'},{id:"B4",body:'Ng SC. Epidemiology of inflammatory bowel disease: focus on Asia. Best Pract Res ClinGastroenterol. 2014;28(3):363-372'},{id:"B5",body:'Gore RM, Levine MS, Laufer I. Textbook ofgastroenterology. Philadelphia, Pa: Saunders 1994; 824-844'},{id:"B6",body:'Gribajčević M, Nenad V, Mesihović R. Vodičzaupalnebolesticrijeva. Institutzanaučnoistraživački rad i razvoj KCUS. Sarajevo. 2007'},{id:"B7",body:'Podolsky DK. Inflammatory bowel disease. Current Opinion in Gastroenterology 1995;11:289-291'},{id:"B8",body:'Reeders JW. Inflammatory bowel disease. In: Radiologic-Pathologic Correlations. Eur Radiol 2000;10(Suppl 2):S146–S156'},{id:"B9",body:'Harb WJ.Crohn\'s Disease of the Colon, Rectum, and Anus. Surg Clin North Am. 2015;95(6):1195-1210'},{id:"B10",body:'Lu KC, Hunt SR. Surgical management of Crohn’s disease.Surg Clin North Am. 2013;93(1):167-185'},{id:"B11",body:'Kilcoyne A, Kaplan JL, Gee MS. Inflammatory bowel disease imaging: Current practice and future directions. World J Gastroenterol. 2016;22(3):917-932'},{id:"B12",body:'Zerem E. Comment on the article about the evaluation of transabdominal ultrasonography performed by a gastroenterologist in his office: why should not all clinicians use transabdominal ultrasonography on a routine basis? J Clin Gastroenterol. 2011;45(5): 476-477'},{id:"B13",body:'Parente F, Greco S, Molteni M, Anderloni A, Sampietro GM, Danelli PG, Bianco R, Gallus S, Bianchi Porro G. Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn\'s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy. Gut. 2004;53:1652-1657'},{id:"B14",body:'Brkljacic B. Dopler pri upalama u abdomenu. U: Brkljacic B. Dopler krvnih žila. Medicinska naklada, Zagreb. 2000;171-181'},{id:"B15",body:'Derchi LE, Martinoli C, Valle M, Falchi M. Transabdominal ultrasound in the study of thegastrointestinal tract. In: Gandolfi L, Fukuda M. Current trends in digestive ultrasonography. FrontGastrointest Res. Karger, Basel. 1997;vol 24:56-78'},{id:"B16",body:'Martínez MJ, Ripollés T, Paredes JM, Blanc E, Martí-Bonmatí L. Assessment of the extension and the inflammatory activity in Crohn\'s disease: comparison of ultrasound and MRI. Abdom Imaging. 2009;34:141-148'},{id:"B17",body:'Schreyer GA, Menzel C, Friedrich C, Poschenrieder F, Egger L, Dornia C, Schill G, Dendl ML, Schacherer D, Girlich C,Jung ME. Comparison of high-resolution ultrasound and MR-enterography in patients with inflammatory bowel disease. World J Gastroenterol. 2011;17(8): 1018-1025'},{id:"B18",body:'Kimmey MB, Martin RW, Haggitt RC, Wang KY, Franklin DW, Silverstein FE.Histologic correlates of gastrointestinal ultrasound images. Gastroenterol 1989; 96:433-441'},{id:"B19",body:'Barbaric-Babic V, Sjekavica I, Molnar M, Marinic J, Frkovic M, Dumic E, Krznaric Ž,Razumovic JJ. Sonography of Crohn\'s disease compared with barium study, CT andpatohistological examination. Eur Radiol (suppl.1) 2000;10:313'},{id:"B20",body:'Barbaric-Babic V, Sjekavica I, Molnar M, Marinic J, Frkovic M, Krznaric Ž, Padovan ŠR. Crohn\'s disease-sonography,barium study,CT. Eur Radiol. 2001;11:C42'},{id:"B21",body:'Limberg B. Diagnosis of chronic inflammatory bowel disease by ultrasonography. ZGastroenterol. 1999;37(6):495-508'},{id:"B22",body:'Valette PJ, Rioux M, Pilleul F, Saurin JC, Fouque P, Henry L. Ultrasonography of chronic inflammatory bowel diseases. Eur Radiol. 2001;11(10):1859-1866'},{id:"B23",body:'Andreas GS, Cynthia M, Chris F, Florian P, Lukas E, Christian D, Gabriela S, Lena MD, Doris S, Christl G, Ernst-Michael J. Comparison of high-resolution ultrasound and MR-enterography in patients with inflammatory bowel disease. World J Gastroenterol. 2011; 17(8):1018-1025'},{id:"B24",body:'Dong J, Wang H, Zhao J, Zhu W, Zhang L, Gong J, Li Y, Gu L, Li J. Ultrasound as a diagnostic tool in detecting active Crohn’s disease: a meta-analysis of prospective studies. EurRadiol. 2014;24(1):26-33'},{id:"B25",body:'Tarjan Z, Toth G, Gyorke T, Mester A, Karlinger K, Mako EK. Ultrasound in Crohn\'sdisease of the small bowel. Eur J Radiol. 2000;35(3):176-182'},{id:"B26",body:'Grand DJ, Harris A, Loftus EV Jr. Imaging for luminal disease and complications: CT enterography, MR enterography, small-bowel follow-through, and ultrasound. Gastroenterol Clin North Am. 2012;41(2):497-512'},{id:"B27",body:'Lim BK, Bux SI, Rahmat K, Lam SY, Liew YW. Evaluation of bowel distension and mural visualisation using neutral oralcontrast agents for multidetector-row computed tomography. Singapore Med J. 2012;53(11):732-736'},{id:"B28",body:'Zhu QQ, Wang ZQ, Wu JT, Wang SA. Assessment of the diagnostic value of CT and X-ray enterography for small intestinal Crohn disease. Zhonghua Wei Chang WaiKeZaZhi. 2013;16(5):443-447'},{id:"B29",body:'Amitai MM, Raviv-Zilka L, Hertz M, Erlich Z, Konen E, Ben-Horin S, Apter S. Main imaging features of Crohn\'s disease: Agreement between MR-enterography and CT-enterography. Isr Med Assoc J.2015;17(5):293-297'},{id:"B30",body:'Kayhan A, Oommen J, Dahi F, Oto A. Magnetic resonance enterography in Crohn,s disease: Standard and advanced techniques. World J Radiol. 2010;2(4):113-121'},{id:"B31",body:'Kim YA. Role of computed tomography enterography/magnetic resonance enterography: Is it prime time?.ClinEndosc. 2010;45(3): 269-273'},{id:"B32",body:'Oommen J, Oto A. Contrast-enhancedMRI of the small bowel in Crohn\'s disease. AbdomImaging. 2011;6(2):134-141'},{id:"B33",body:'Ziech ML, Bossuyt PM, Laghi A, Lauenstein TC, Taylor SA, Stoker J. Grading luminal Crohn\'s disease: which MRI features are considered as important?Eur J Radiol. 2012;81(4): e467-72'},{id:"B34",body:'Florie J, Wasser MN, Arts-Cieslik K, Akkerman EM, Siersema PD, Stoker J. Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn\'s disease. AJR Am J Roentgenol. 2006;186:1384-1392'},{id:"B35",body:'Gee MS, Harisinghani MG. MRI in patients with inflammatory bowel disease. J MagnReson Imaging. 2011;33(3):527-534'},{id:"B36",body:'Papanikolaou N, Grammatikakis J, Maris TG, Chrysou E, Prassopoulos P,Gourtsoyiannis N. A comprehensive MRI protocol for small bowel studies. Eur Radiol 2001;11:C15'},{id:"B37",body:'Štern-Padovan R. CT i MR u gastroeneterologiji. U: Vucelic B. i suradnici.Gastroenterologija i hepatologija. Medicinska naklada, Zagreb. 2002; 327-338'},{id:"B38",body:'Tolan DJ, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn disease. Radiographics. 2010;30: 367-384'},{id:"B39",body:'Shoenut JP, Semelka RC, Silverman R, Yaffe CS, Micflikier AB. Magnetic resonance imaging in inflammatory bowel disease. J Clin Gastroenterol. 1993;17:73-78'},{id:"B40",body:'Li W, Yuan F, Zhou Z. Imaging diagnosis of perianal fistula in Crohn disease. Zhonghua Wei Chang WaiKeZaZhi. 2014;17(3):215-218'},{id:"B41",body:'Costa-Silva L, Brandão AC. MR enterography for the assessment of small bowel diseases. MagnReson Imaging Clin N Am. 2013;21(2): 365-383'},{id:"B42",body:'Nieun S, Seong HP, Kyung JK, Bo KK, Yedaun L, Suk KY et al. MR Enterography for the evaluation of small-bowel inflammation in Crohn disease by using diffusion-weighted imaging without intravenous contrast material: a prospective noninferiority study. Radiology. 2016;278(3):762-772'},{id:"B43",body:'Aysegul C, Suleyman B, Sukru O, Eser B, Sami F. Can diffusion weighted imaging be used as an alternative to contrast-enhanced imaging on magnetic resonance enterography for the assessment of active inflammation in Crohn disease? Medicine (Baltimore). 2020;99(8):e19202'},{id:"B44",body:'Gabriele M, Chiara DV, Marina A, Marianna G, Ronerta C, Gaia C, Vittorio M, Roberto G. Detection of Crohn\'s disease with diffusion images versus contrast-enhanced images in pediatric using MR enterography with histopathological correlation. Radiol Med. 2019;124(12):1306-1314'},{id:"B45",body:'Koelbel G, Schmiedl U, Majer MC,et al. diagnosis of fistulae and sinus tracts in patientswith Crohn\'s disease: value of MR imaging. AM J Roentgenol. 1989;152:999-1003'},{id:"B46",body:'Agutter PS, Malone PC, Wheatley DN. Diffusion theory in biology: A relic ofmechanistic materialism. J Hist Biol. 2000; 33:71-111'},{id:"B47",body:'Baltić i saradnici. Nuklearnamagnetnarezonancija u onkologiji. Znamenje, Novi Sad. 2002'},{id:"B48",body:'Mentzel HJ, Reinsch S, Kurzai M, Stenzel M. Magnetic resonance imaging in children and adolescents with chronic inflammatory bowel disease. World J Gastroenterol. 2014;20(5):1180-1191'},{id:"B49",body:'Tajima T, Akahane M, Takao H, Akai H, Kiryu S, Imamura H, Watanabe Y, Kokudo N, Ohtomo K. Detection of liver metastasis: is diffusion-weighted imaging needed in Gd-EOB-DTPA-enhanced MR imaging for evaluation of colorectal liver metastases?Jpn J Radiol. 2012;30(8):648-58'},{id:"B50",body:'Matsuki M, Inada Y, Nakai G, et al. Diffusion-weighed MR imaging of pancreatic carcinoma. Abdom Imaging. 2007;32:481-483'},{id:"B51",body:'Zhang J, Tehrani YM, Wang L, Ishill NM, Schwartz LH, Hricak H. Renal masses: characterization with diffusion-weighted MR imaging—a preliminary experience. Radiology. 2008;247:458-464'},{id:"B52",body:'Koh DM, Sohaib A. Diffusion-weighted imaging of the male pelvis.RadiolClin North Am. 2012;50(6):1127-44'},{id:"B53",body:'Leufkens AM, Kwee TC, van den Bosch MA, Mali WP, Takahara T, Siersema PD. Diffusion-weighted MRI for the detection of colorectal polyps: feasibility study.MagnResonImaging. 2013;31(1):28-35'},{id:"B54",body:'Hosonuma T, Tozaki M, Ichiba N, et al. Clinical usefulness of diffusion-weighted imaging using low and high b-values to detect rectal cancer. MagnReson Med Sci. 2006;5:173-177'},{id:"B55",body:'Clara BC, Mariangela G, Daniele G, Dario C, Mirella F. Role of bowel ultrasound in the diagnosis and follow-up of patients with Crohn\'s disease. Ultrasound Med Biol. 2017;43(4):725-734'},{id:"B56",body:'Rosa C, Helena R, Giovanni M. Bowel thickening in Crohn\'s disease: fibrosis or inflammation? Diagnostic ultrasound imaging tools. Inflamm Bowel Dis. 2017;23(1):23-34'},{id:"B57",body:'Kerri N, Christian M, Rune W, Giovanni M. Diagnostic accuracy of MRE and ultrasound for Crohn\'s disease. Lancet GastroenterolHepatol. 2019;4(2):95-96'},{id:"B58",body:'Kumar S, Hakim A, Alexakis C, Chhaya V, Tzias D, Pilcher J, Vlahos J, Pollok R. Small intestinal contrast ultrasonography for the detection of small bowel complications in Crohn\'s disease: Correlation with intraoperative findings and magnetic resonance enterography. J GastroenterolHepatol. 2015 Jan;30(1):86-91'},{id:"B59",body:'Imsirovic B, Zerem E, Guso E, Djedovic M, Cengic A, Baljic R, Merhemic Z, Efendic A. Comparison of conventional ultrasound and contrast enhanced magnetic resonance (MR) enterography in evaluation patients with Crohn\'s disease. Acta Inform Med. 2018;26(2.000): 93-97'},{id:"B60",body:'Imširović B, Zerem E, Efendić A, Mekić AA, Zerem O, Djedović M. Significance of diffusion weighted imaging (DWI) as an improving factor in contrast enhanced magnetic resonance imaging (MRI) enterography in evaluation of patients with Crohn\'s disease. Med Glas. 2018;15(2):145-151'},{id:"B61",body:'Dambha F, Tanner J, Carroll N. Diagnostic imaging in Crohn\'s disease: what is the new gold standard? Best Pract Res ClinGastroenterol. 2014 Jun;28(3):421-436'},{id:"B62",body:'Fernando G, Axel D, Vito A, Herbert T, Gert VA, James OL et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn\'s disease 2016: Part 1: Diagnosis and medical management. Journal of Crohn\'s and Colitis. 2017:3-25'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Bilal Imširović",address:"bilal_imsirovic@yahoo.com",affiliation:'
Department of Radiology, General Hospital Sarajevo, Bosnia and Herzegovina
Department of Radiology, General Hospital Sarajevo, Bosnia and Herzegovina
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The company was founded in Vienna in 2004 by Alex Lazinica and Vedran Kordic, two PhD students researching robotics. While completing our PhDs, we found it difficult to access the research we needed. So, we decided to create a new Open Access publisher. A better one, where researchers like us could find the information they needed easily. The result is IntechOpen, an Open Access publisher that puts the academic needs of the researchers before the business interests of publishers.
",metaTitle:"Our story",metaDescription:"The company was founded in Vienna in 2004 by Alex Lazinica and Vedran Kordic, two PhD students researching robotics. While completing our PhDs, we found it difficult to access the research we needed. So, we decided to create a new Open Access publisher. A better one, where researchers like us could find the information they needed easily. The result is IntechOpen, an Open Access publisher that puts the academic needs of the researchers before the business interests of publishers.",metaKeywords:null,canonicalURL:"/page/our-story",contentRaw:'[{"type":"htmlEditorComponent","content":"
We started by publishing journals and books from the fields of science we were most familiar with - AI, robotics, manufacturing and operations research. Through our growing network of institutions and authors, we soon expanded into related fields like environmental engineering, nanotechnology, computer science, renewable energy and electrical engineering, Today, we are the world’s largest Open Access publisher of scientific research, with over 4,200 books and 54,000 scientific works including peer-reviewed content from more than 116,000 scientists spanning 161 countries. Our authors range from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery.
\\n\\n
In the same year that IntechOpen was founded, we launched what was at the time the first ever Open Access, peer-reviewed journal in its field: the International Journal of Advanced Robotic Systems (IJARS).
\\n\\n
The IntechOpen timeline
\\n\\n
2004
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Intech Open is founded in Vienna, Austria, by Alex Lazinica and Vedran Kordic, two PhD students, and their first Open Access journals and books are published.
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Alex and Vedran launch the first Open Access, peer-reviewed robotics journal and IntechOpen’s flagship publication, the International Journal of Advanced Robotic Systems (IJARS).
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2005
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IntechOpen publishes its first Open Access book: Cutting Edge Robotics.
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2006
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IntechOpen publishes a special issue of IJARS, featuring contributions from NASA scientists regarding the Mars Exploration Rover missions.
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2008
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Downloads milestone: 200,000 downloads reached
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2009
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Publishing milestone: the first 100 Open Access STM books are published
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2010
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Downloads milestone: one million downloads reached
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IntechOpen expands its book publishing into a new field: medicine.
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2011
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Publishing milestone: More than five million downloads reached
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IntechOpen publishes 1996 Nobel Prize in Chemistry winner Harold W. Kroto’s “Strategies to Successfully Cross-Link Carbon Nanotubes”. Find it here.
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IntechOpen and TBI collaborate on a project to explore the changing needs of researchers and the evolving ways that they discover, publish and exchange information. The result is the survey “Author Attitudes Towards Open Access Publishing: A Market Research Program”.
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IntechOpen hosts SHOW - Share Open Access Worldwide; a series of lectures, debates, round-tables and events to bring people together in discussion of open source principles, intellectual property, content licensing innovations, remixed and shared culture and free knowledge.
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2012
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Publishing milestone: 10 million downloads reached
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IntechOpen holds Interact2012, a free series of workshops held by figureheads of the scientific community including Professor Hiroshi Ishiguro, director of the Intelligent Robotics Laboratory, who took the audience through some of the most impressive human-robot interactions observed in his lab.
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2013
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IntechOpen joins the Committee on Publication Ethics (COPE) as part of a commitment to guaranteeing the highest standards of publishing.
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2014
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IntechOpen turns 10, with more than 30 million downloads to date.
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IntechOpen appoints its first Regional Representatives - members of the team situated around the world dedicated to increasing the visibility of our authors’ published work within their local scientific communities.
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2015
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Downloads milestone: More than 70 million downloads reached, more than doubling since the previous year.
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Publishing milestone: IntechOpen publishes its 2,500th book and 40,000th Open Access chapter, reaching 20,000 citations in Thomson Reuters ISI Web of Science.
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40 IntechOpen authors are included in the top one per cent of the world’s most-cited researchers.
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Thomson Reuters’ ISI Web of Science Book Citation Index begins indexing IntechOpen’s books in its database.
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2016
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IntechOpen is identified as a world leader in Simba Information’s Open Access Book Publishing 2016-2020 report and forecast. IntechOpen came in as the world’s largest Open Access book publisher by title count.
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2017
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Downloads milestone: IntechOpen reaches more than 100 million downloads
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Publishing milestone: IntechOpen publishes its 3,000th Open Access book, making it the largest Open Access book collection in the world
We started by publishing journals and books from the fields of science we were most familiar with - AI, robotics, manufacturing and operations research. Through our growing network of institutions and authors, we soon expanded into related fields like environmental engineering, nanotechnology, computer science, renewable energy and electrical engineering, Today, we are the world’s largest Open Access publisher of scientific research, with over 4,200 books and 54,000 scientific works including peer-reviewed content from more than 116,000 scientists spanning 161 countries. Our authors range from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery.
\n\n
In the same year that IntechOpen was founded, we launched what was at the time the first ever Open Access, peer-reviewed journal in its field: the International Journal of Advanced Robotic Systems (IJARS).
\n\n
The IntechOpen timeline
\n\n
2004
\n\n
\n\t
Intech Open is founded in Vienna, Austria, by Alex Lazinica and Vedran Kordic, two PhD students, and their first Open Access journals and books are published.
\n\t
Alex and Vedran launch the first Open Access, peer-reviewed robotics journal and IntechOpen’s flagship publication, the International Journal of Advanced Robotic Systems (IJARS).
\n
\n\n
2005
\n\n
\n\t
IntechOpen publishes its first Open Access book: Cutting Edge Robotics.
\n
\n\n
2006
\n\n
\n\t
IntechOpen publishes a special issue of IJARS, featuring contributions from NASA scientists regarding the Mars Exploration Rover missions.
\n
\n\n
2008
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\n\t
Downloads milestone: 200,000 downloads reached
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2009
\n\n
\n\t
Publishing milestone: the first 100 Open Access STM books are published
\n
\n\n
2010
\n\n
\n\t
Downloads milestone: one million downloads reached
\n\t
IntechOpen expands its book publishing into a new field: medicine.
\n
\n\n
2011
\n\n
\n\t
Publishing milestone: More than five million downloads reached
\n\t
IntechOpen publishes 1996 Nobel Prize in Chemistry winner Harold W. Kroto’s “Strategies to Successfully Cross-Link Carbon Nanotubes”. Find it here.
\n\t
IntechOpen and TBI collaborate on a project to explore the changing needs of researchers and the evolving ways that they discover, publish and exchange information. The result is the survey “Author Attitudes Towards Open Access Publishing: A Market Research Program”.
\n\t
IntechOpen hosts SHOW - Share Open Access Worldwide; a series of lectures, debates, round-tables and events to bring people together in discussion of open source principles, intellectual property, content licensing innovations, remixed and shared culture and free knowledge.
\n
\n\n
2012
\n\n
\n\t
Publishing milestone: 10 million downloads reached
\n\t
IntechOpen holds Interact2012, a free series of workshops held by figureheads of the scientific community including Professor Hiroshi Ishiguro, director of the Intelligent Robotics Laboratory, who took the audience through some of the most impressive human-robot interactions observed in his lab.
\n
\n\n
2013
\n\n
\n\t
IntechOpen joins the Committee on Publication Ethics (COPE) as part of a commitment to guaranteeing the highest standards of publishing.
\n
\n\n
2014
\n\n
\n\t
IntechOpen turns 10, with more than 30 million downloads to date.
\n\t
IntechOpen appoints its first Regional Representatives - members of the team situated around the world dedicated to increasing the visibility of our authors’ published work within their local scientific communities.
\n
\n\n
2015
\n\n
\n\t
Downloads milestone: More than 70 million downloads reached, more than doubling since the previous year.
\n\t
Publishing milestone: IntechOpen publishes its 2,500th book and 40,000th Open Access chapter, reaching 20,000 citations in Thomson Reuters ISI Web of Science.
\n\t
40 IntechOpen authors are included in the top one per cent of the world’s most-cited researchers.
\n\t
Thomson Reuters’ ISI Web of Science Book Citation Index begins indexing IntechOpen’s books in its database.
\n
\n\n
2016
\n\n
\n\t
IntechOpen is identified as a world leader in Simba Information’s Open Access Book Publishing 2016-2020 report and forecast. IntechOpen came in as the world’s largest Open Access book publisher by title count.
\n
\n\n
2017
\n\n
\n\t
Downloads milestone: IntechOpen reaches more than 100 million downloads
\n\t
Publishing milestone: IntechOpen publishes its 3,000th Open Access book, making it the largest Open Access book collection in the world
\n
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Examples of IKS such as Ayurveda from India and Acupuncture from China are well known. IK covers diverse areas of importance for society, spanning issues concerned with the quality of life - from agriculture and water to health. The IK resident in India and China have high relevance to rural life, especially given the level of engagement with agricultural and health technologies. The goal is to establish a heuristic whereby IK can be reviewed and evaluated within particular contexts to determine if the IKS can lead to the development of appropriate technology (AT) addressing that need sustainably. Although much work on cataloguing and documenting IKS has been completed in these two countries, a paucity of attention has been paid to the scientific rationale and technological content of these IKS. Evaluation of many indigenous technologies reveal that many of these technologies can be classified as ‘appropriate’, focused on basic needs of water, sanitation and agriculture, and many have origins in IKS that survived. 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A total of 350 individuals (comprising farmers, herbalists and charcoal burners) from households were interviewed using a structured questionnaire, 50 in-depth interviews and 35 focus group discussions. The results show that indigenous knowledge and institutions play a significant role in conserving natural resources in the study area. There was gender differentiation in knowledge attitude and practice (KAP) of indigenous knowledge as applied to sustainable land management. It is recommended that deliberate efforts should be put in place by the County Governments to scale up the roles of indigenous institutions in managing natural resources in the study area.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Chris A. 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The result revealed that the Borana herders have time-tested weather forecasting experience of using astrological, intestinal, plant, and animal body language indicators. Astrological and intestinal readings that need special training and local expertise are known as Urgii Elaltus and Uchuu, respectively. Forecast information is disseminated using the Borana sociocultural institutions. Based on the disseminated forecast information, the Borana herders take measures such as strengthening enclosure, storing hay, migrating with animals, destocking, and changing schedules of social and cultural festivities such as wedding. The precision and credibility of traditional weather forecast steadily declined and led to repeated faulty predictions. Poor documentation and knowledge transfer system, influence of religion and modern education, premature death of forecast experts, and expansion of alcoholism were identified as causes undermining the vitality of Borana indigenous weather forecast. It is high time that the tenets of indigenous weather forecasting be assessed scientifically and be integrated into the modern science of weather forecasting before they vanish.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Desalegn Yayeh Ayal",authors:[{id:"198164",title:"Dr.",name:"Desalegn",middleName:"Yayeh",surname:"Ayal",slug:"desalegn-ayal",fullName:"Desalegn Ayal"}]},{id:"67479",doi:"10.5772/intechopen.86677",title:"Exploring Aboriginal Identity in Australia and Building Resilience",slug:"exploring-aboriginal-identity-in-australia-and-building-resilience",totalDownloads:1309,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter will discuss the challenges faced by Aboriginal people seeking recognition of their identity as Indigenous Australians. It will explore government policies, their impact on identity formation and the ongoing impact of colonisation on education and health outcomes for Indigenous people in Australia. The issues raised will include historical and contemporary experiences as well personal values and attitudes. The strategies and programs introduced within educational settings as part of an inclusive practice regime will be highlighted. Aboriginal people have faced many challenges, and continue to do so in postcolonial times, including challenges to their identity.",book:{id:"8522",slug:"indigenous-aboriginal-fugitive-and-ethnic-groups-around-the-globe",title:"Indigenous, Aboriginal, Fugitive and Ethnic Groups Around the Globe",fullTitle:"Indigenous, Aboriginal, Fugitive and Ethnic Groups Around the Globe"},signatures:"Clair Andersen",authors:[{id:"296447",title:"Associate Prof.",name:"Clair",middleName:null,surname:"Andersen",slug:"clair-andersen",fullName:"Clair Andersen"}]},{id:"68484",doi:"10.5772/intechopen.88118",title:"Journey to America: South Asian Diaspora Migration to the United States (1965–2015)",slug:"journey-to-america-south-asian-diaspora-migration-to-the-united-states-1965-2015-",totalDownloads:1196,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter examines the immigration of South Asian and Indian populations to the United States between 1820 and 2015. More specifically, this effort scrutinizes legislative changes in immigration policy enabling this group to become the second largest immigrant group after Mexicans in the United States. These changes include the following: the removal of national origin quotas, the introduction of temporary skilled worker programs, and the creation of employment-based permanent visas. Because of these policy changes, by 2015, South Asian immigrants, primarily Indians, had become the top recipients of high-skilled H-1B temporary visas and were the second-largest group of international students in the United States. All told, this study will answer the following questions: What are the origins and demographics of these emigrants who make up the South Asia diaspora? What fields of endeavor are they drawn to by their prior education and skill sets? To what geographic locations have they migrated? And how successful are they in assimilating into their new surroundings?",book:{id:"8522",slug:"indigenous-aboriginal-fugitive-and-ethnic-groups-around-the-globe",title:"Indigenous, Aboriginal, Fugitive and Ethnic Groups Around the Globe",fullTitle:"Indigenous, Aboriginal, Fugitive and Ethnic Groups Around the Globe"},signatures:"John P. Williams",authors:[{id:"264648",title:"Prof.",name:"John",middleName:null,surname:"Williams",slug:"john-williams",fullName:"John Williams"}]}],mostDownloadedChaptersLast30Days:[{id:"56426",title:"Indigenous Resource Management Practices and the Local Social-Cultural Context: An Insight towards Self-Directed Resource Management by People who ‘Coexist’ with Supernatural Agents",slug:"indigenous-resource-management-practices-and-the-local-social-cultural-context-an-insight-towards-se",totalDownloads:1731,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"In recent arguments in the governance of natural resource management, effectiveness and desirability of collaborative management among various stakeholder including indigenous people has been recognized. In the context of Indonesia, the reformation movement has stimulated the growth of a new perception of indigenous people’s rights to their land in the country. This recent transition presents a growing opportunity for indigenous people who live in nature-rich areas (national parks, etc.) to collaborate with ‘outside stakeholders’ such as governmental agencies, scholars and environmental NGOs in natural resource management. In such situations, it is necessary to deeply understand the value of indigenous resource management (IRM) practices to promote self-directed and effective resource management. This chapter focuses on local forest resource management and its suitability in the local social-cultural context in central Seram, east Indonesia. First, I describe how the well-structured forest resource use is constructed and maintained through the indigenous resource management practices based on ‘supernatural enforce mechanism’. After that, I investigate what social-ecological roles the IRM in Amanioho has, and how IRM practices relate to the social-cultural context of an upland community in central Seram. Then, I discuss the possible future applications for achieving self-directed resource management by people who ‘coexist’ with supernatural agents.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Masatoshi Sasaoka",authors:[{id:"198898",title:"Dr.",name:"Masatoshi",middleName:null,surname:"Sasaoka",slug:"masatoshi-sasaoka",fullName:"Masatoshi Sasaoka"}]},{id:"56259",title:"Indigenous Knowledge Systems for Appropriate Technology Development",slug:"indigenous-knowledge-systems-for-appropriate-technology-development",totalDownloads:4028,totalCrossrefCites:6,totalDimensionsCites:7,abstract:"Indigenous knowledge systems (IKS) comprises knowledge developed within indigenous societies, independent of, and prior to, the advent of the modern scientific knowledge system (MSKS). Examples of IKS such as Ayurveda from India and Acupuncture from China are well known. IK covers diverse areas of importance for society, spanning issues concerned with the quality of life - from agriculture and water to health. The IK resident in India and China have high relevance to rural life, especially given the level of engagement with agricultural and health technologies. The goal is to establish a heuristic whereby IK can be reviewed and evaluated within particular contexts to determine if the IKS can lead to the development of appropriate technology (AT) addressing that need sustainably. Although much work on cataloguing and documenting IKS has been completed in these two countries, a paucity of attention has been paid to the scientific rationale and technological content of these IKS. Evaluation of many indigenous technologies reveal that many of these technologies can be classified as ‘appropriate’, focused on basic needs of water, sanitation and agriculture, and many have origins in IKS that survived. Thus, IKS must be validated, exploited and integrated into AT innovation and development.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"John Tharakan",authors:[{id:"198534",title:"Prof.",name:"John",middleName:null,surname:"Tharakan",slug:"john-tharakan",fullName:"John Tharakan"}]},{id:"56510",title:"Role of Traditional Ethnobotanical Knowledge and Indigenous Institutions in Sustainable Land Management in Western Highlands of Kenya",slug:"role-of-traditional-ethnobotanical-knowledge-and-indigenous-institutions-in-sustainable-land-managem",totalDownloads:2571,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"The objective of this chapter is to elucidate the relevance of indigenous knowledge and institutions in natural resource management using western highlands of Kenya as a case study. The research design was a mixed method, combining qualitative and quantitative methods. A total of 350 individuals (comprising farmers, herbalists and charcoal burners) from households were interviewed using a structured questionnaire, 50 in-depth interviews and 35 focus group discussions. The results show that indigenous knowledge and institutions play a significant role in conserving natural resources in the study area. There was gender differentiation in knowledge attitude and practice (KAP) of indigenous knowledge as applied to sustainable land management. It is recommended that deliberate efforts should be put in place by the County Governments to scale up the roles of indigenous institutions in managing natural resources in the study area.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Chris A. Shisanya",authors:[{id:"200734",title:"Prof.",name:"Chris",middleName:null,surname:"Shisanya",slug:"chris-shisanya",fullName:"Chris Shisanya"}]},{id:"56296",title:"Empowering Namibian Indigenous People through Entrepreneurship: The Case from the Nama People",slug:"empowering-namibian-indigenous-people-through-entrepreneurship-the-case-from-the-nama-people",totalDownloads:1589,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The challenge emanating from the colonial and apartheid regimes on the Nama people of Namibia have not only resulted in them losing nearly half of its population, but they also appeared to have lost their social identity. To that end we continually find convergences and divergences in clothing and accessories, food, traditional dances, homes, and traditional beauty cosmetics, between the past and present. This chapter seeks to explore whether the Nama people have always used money to acquire the aforementioned past? If not, what have they done right in the past to acquire all these items? These are one of the few questions this chapter seeks to explore and understand, and the role Nama entrepreneurial activities play for their own socio-economic advancement. Critical discourse can lead to a better understanding and appreciation of entrepreneurship among indigenous people in Namibia. This will in turn result in an enhanced understanding of the role entrepreneurship and culture can play in both a local and international context. After a brief introduction to Namibia and the Nama people, the cultural values and entrepreneurial initiatives of the Nama people are discussed, followed by discussions, recommendations and conclusions. Research methods employed were in-depth interviews and participant observation.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Wilfred Isak April, Daniel Ileni Itenge, Josef Petrus Van der\nWesthuizen and Lazarus Shimwaningi Emvula",authors:[{id:"110034",title:"Dr.",name:"Wilfred",middleName:"Isak",surname:"April",slug:"wilfred-april",fullName:"Wilfred April"},{id:"204208",title:"Mr.",name:"Daniel",middleName:"Ileni",surname:"Itenge",slug:"daniel-itenge",fullName:"Daniel Itenge"},{id:"204209",title:"Mr.",name:"Lazarus",middleName:null,surname:"Emvula",slug:"lazarus-emvula",fullName:"Lazarus Emvula"},{id:"204916",title:"Mr.",name:"Josef",middleName:"P.",surname:"Van Der Westhuizen",slug:"josef-van-der-westhuizen",fullName:"Josef Van Der Westhuizen"}]},{id:"55689",title:"Usages and Customs of the Indigenous Communities in Favour of the Reduction of the Digital Divide: A Case Study of the Ñuu Savi People",slug:"usages-and-customs-of-the-indigenous-communities-in-favour-of-the-reduction-of-the-digital-divide-a-",totalDownloads:1242,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This research is of ethnographic nature, focusing on the study of the Ñuu Savi people (people of the rain), also called the Mixtec people, of pre-Columbian origin belonging to the Mixteca Region of the state of Oaxaca, Mexico. On the basis of sociocultural theory and the theory of the diffusion and adoption of technological innovations, the study on the cultural identity of the ethnolinguistic group, whose social platform is the “uses and customs,” is carried out. As a result of this research, the descriptive analysis is presented, detailing the effect of information and communication technologies (ICTs) on the situation of the vulnerable and disadvantaged group. Likewise, cultural elements have been identified that allow the formulation of a model for the development and inclusion of the ethnic minority. An educational strategy is designed and implemented through the model. However, in the process of implementing the educational strategy, it was observed that the Ñuu Savi people experience a conjunctural stage where technological adoption coexists with some beliefs, aptitudes, and attitudes, characteristic of its form of government of “uses and customs,” which create sociocultural barriers that make social and digital inclusion difficult.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Olivia Allende-Hernández and Jesús Salinas",authors:[{id:"198235",title:"Dr.",name:"Olivia",middleName:null,surname:"Allende-Hernández",slug:"olivia-allende-hernandez",fullName:"Olivia Allende-Hernández"},{id:"201435",title:"Dr.",name:"Jesús",middleName:null,surname:"Salinas",slug:"jesus-salinas",fullName:"Jesús Salinas"}]}],onlineFirstChaptersFilter:{topicId:"1330",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:86,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:96,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:283,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:138,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:128,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:100,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:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,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:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"
\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. Breakthroughs in computing, molecular biology, ecology, and sustainability science are enhancing our ability to utilize environmental sciences to address real-world problems. \r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.
",coverUrl:"https://cdn.intechopen.com/series/covers/25.jpg",latestPublicationDate:"April 13th, 2022",hasOnlineFirst:!1,numberOfPublishedBooks:1,editor:{id:"197485",title:"Dr.",name:"J. Kevin",middleName:null,surname:"Summers",slug:"j.-kevin-summers",fullName:"J. Kevin Summers",profilePictureURL:"https://mts.intechopen.com/storage/users/197485/images/system/197485.jpg",biography:"J. Kevin Summers is a Senior Research Ecologist at the Environmental Protection Agency’s (EPA) Gulf Ecosystem Measurement and Modeling Division. He is currently working with colleagues in the Sustainable and Healthy Communities Program to develop an index of community resilience to natural hazards, an index of human well-being that can be linked to changes in the ecosystem, social and economic services, and a community sustainability tool for communities with populations under 40,000. He leads research efforts for indicator and indices development. Dr. Summers is a systems ecologist and began his career at the EPA in 1989 and has worked in various programs and capacities. This includes leading the National Coastal Assessment in collaboration with the Office of Water which culminated in the award-winning National Coastal Condition Report series (four volumes between 2001 and 2012), and which integrates water quality, sediment quality, habitat, and biological data to assess the ecosystem condition of the United States estuaries. He was acting National Program Director for Ecology for the EPA between 2004 and 2006. He has authored approximately 150 peer-reviewed journal articles, book chapters, and reports and has received many awards for technical accomplishments from the EPA and from outside of the agency. Dr. Summers holds a BA in Zoology and Psychology, an MA in Ecology, and Ph.D. in Systems Ecology/Biology.",institutionString:null,institution:{name:"Environmental Protection Agency",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"38",title:"Pollution",coverUrl:"https://cdn.intechopen.com/series_topics/covers/38.jpg",isOpenForSubmission:!0,editor:{id:"110740",title:"Dr.",name:"Ismail M.M.",middleName:null,surname:"Rahman",slug:"ismail-m.m.-rahman",fullName:"Ismail M.M. Rahman",profilePictureURL:"https://mts.intechopen.com/storage/users/110740/images/2319_n.jpg",biography:"Ismail Md. Mofizur Rahman (Ismail M. M. Rahman) assumed his current responsibilities as an Associate Professor at the Institute of Environmental Radioactivity, Fukushima University, Japan, in Oct 2015. He also has an honorary appointment to serve as a Collaborative Professor at Kanazawa University, Japan, from Mar 2015 to the present. \nFormerly, Dr. Rahman was a faculty member of the University of Chittagong, Bangladesh, affiliated with the Department of Chemistry (Oct 2002 to Mar 2012) and the Department of Applied Chemistry and Chemical Engineering (Mar 2012 to Sep 2015). Dr. Rahman was also adjunctly attached with Kanazawa University, Japan (Visiting Research Professor, Dec 2014 to Mar 2015; JSPS Postdoctoral Research Fellow, Apr 2012 to Mar 2014), and Tokyo Institute of Technology, Japan (TokyoTech-UNESCO Research Fellow, Oct 2004–Sep 2005). \nHe received his Ph.D. degree in Environmental Analytical Chemistry from Kanazawa University, Japan (2011). He also achieved a Diploma in Environment from the Tokyo Institute of Technology, Japan (2005). Besides, he has an M.Sc. degree in Applied Chemistry and a B.Sc. degree in Chemistry, all from the University of Chittagong, Bangladesh. \nDr. Rahman’s research interest includes the study of the fate and behavior of environmental pollutants in the biosphere; design of low energy and low burden environmental improvement (remediation) technology; implementation of sustainable waste management practices for treatment, handling, reuse, and ultimate residual disposition of solid wastes; nature and type of interactions in organic liquid mixtures for process engineering design applications.",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"201020",title:"Dr.",name:"Zinnat Ara",middleName:null,surname:"Begum",slug:"zinnat-ara-begum",fullName:"Zinnat Ara Begum",profilePictureURL:"https://mts.intechopen.com/storage/users/201020/images/system/201020.jpeg",biography:"Zinnat A. Begum received her Ph.D. in Environmental Analytical Chemistry from Kanazawa University in 2012. She achieved her Master of Science (M.Sc.) degree with a major in Applied Chemistry and a Bachelor of Science (B.Sc.) in Chemistry, all from the University of Chittagong, Bangladesh. Her work affiliations include Fukushima University, Japan (Visiting Research Fellow, Institute of Environmental Radioactivity: Mar 2016 to present), Southern University Bangladesh (Assistant Professor, Department of Civil Engineering: Jan 2015 to present), and Kanazawa University, Japan (Postdoctoral Fellow, Institute of Science and Engineering: Oct 2012 to Mar 2014; Research fellow, Venture Business Laboratory, Advanced Science and Social Co-Creation Promotion Organization: Apr 2018 to Mar 2021). The research focus of Dr. Zinnat includes the effect of the relative stability of metal-chelator complexes in the environmental remediation process designs and the development of eco-friendly soil washing techniques using biodegradable chelators.",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorThree:null},{id:"39",title:"Environmental Resilience and Management",coverUrl:"https://cdn.intechopen.com/series_topics/covers/39.jpg",isOpenForSubmission:!0,editor:{id:"137040",title:"Prof.",name:"Jose",middleName:null,surname:"Navarro-Pedreño",slug:"jose-navarro-pedreno",fullName:"Jose Navarro-Pedreño",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRAXrQAO/Profile_Picture_2022-03-09T15:50:19.jpg",biography:"Full professor at University Miguel Hernández of Elche, Spain, previously working at the University of Alicante, Autonomous University of Madrid and Polytechnic University of Valencia. Graduate in Sciences (Chemist), graduate in Geography and History (Geography), master in Water Management, Treatment, master in Fertilizers and Environment and master in Environmental Management; Ph.D. in Environmental Sciences. His research is focused on soil-water and waste-environment relations, mainly on soil-water and soil-waste interactions under different management and waste reuse. His work is reflected in more than 230 communications presented in national and international conferences and congresses, 29 invited lectures from universities, associations and government agencies. Prof. Navarro-Pedreño is also a director of the Ph.D. Program Environment and Sustainability (2012-present) and a member of several societies among which are the Spanish Society of Soil Science, International Union of Soil Sciences, European Society for Soil Conservation, DessertNet and the Spanish Royal Society of Chemistry.",institutionString:"Miguel Hernández University of Elche, Spain",institution:null},editorTwo:null,editorThree:null},{id:"40",title:"Ecosystems and Biodiversity",coverUrl:"https://cdn.intechopen.com/series_topics/covers/40.jpg",isOpenForSubmission:!0,editor:{id:"209149",title:"Prof.",name:"Salustiano",middleName:null,surname:"Mato",slug:"salustiano-mato",fullName:"Salustiano Mato",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRLREQA4/Profile_Picture_2022-03-31T10:23:50.png",biography:"Salustiano Mato de la Iglesia (Santiago de Compostela, 1960) is a doctor in biology from the University of Santiago and a Professor of zoology at the Department of Ecology and Animal Biology at the University of Vigo. He has developed his research activity in the fields of fauna and soil ecology, and in the treatment of organic waste, having been the founder and principal investigator of the Environmental Biotechnology Group of the University of Vigo.\r\nHis research activity in the field of Environmental Biotechnology has been focused on the development of novel organic waste treatment systems through composting. The result of this line of work are three invention patents and various scientific and technical publications in prestigious international journals.",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorTwo:{id:"60498",title:"Prof.",name:"Josefina",middleName:null,surname:"Garrido",slug:"josefina-garrido",fullName:"Josefina Garrido",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRj1VQAS/Profile_Picture_2022-03-31T10:06:51.jpg",biography:"Josefina Garrido González (Paradela de Abeleda, Ourense 1959), is a doctor in biology from the University of León and a Professor of Zoology at the Department of Ecology and Animal Biology at the University of Vigo. She has focused her research activity on the taxonomy, fauna and ecology of aquatic beetles, in addition to other lines of research such as the conservation of biodiversity in freshwater ecosystems; conservation of protected areas (Red Natura 2000) and assessment of the effectiveness of wetlands as priority areas for the conservation of aquatic invertebrates; studies of water quality in freshwater ecosystems through biological indicators and physicochemical parameters; surveillance and research of vector arthropods and invasive alien species.",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorThree:{id:"464288",title:"Dr.",name:"Francisco",middleName:null,surname:"Ramil",slug:"francisco-ramil",fullName:"Francisco Ramil",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003RI7lHQAT/Profile_Picture_2022-03-31T10:15:35.png",biography:"Fran Ramil Blanco (Porto de Espasante, A Coruña, 1960), is a doctor in biology from the University of Santiago de Compostela and a Professor of Zoology at the Department of Ecology and Animal Biology at the University of Vigo. His research activity is linked to the taxonomy, fauna and ecology of marine benthic invertebrates and especially the Cnidarian group. Since 2004, he has been part of the EcoAfrik project, aimed at the study, protection and conservation of biodiversity and benthic habitats in West Africa. He also participated in the study of vulnerable marine ecosystems associated with seamounts in the South Atlantic and is involved in training young African researchers in the field of marine research.",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}}},{id:"41",title:"Water Science",coverUrl:"https://cdn.intechopen.com/series_topics/covers/41.jpg",isOpenForSubmission:!0,editor:{id:"349630",title:"Dr.",name:"Yizi",middleName:null,surname:"Shang",slug:"yizi-shang",fullName:"Yizi Shang",profilePictureURL:"https://mts.intechopen.com/storage/users/349630/images/system/349630.jpg",biography:"Prof. Dr. Yizi Shang is a pioneering researcher in hydrology and water resources who has devoted his research career to promoting the conservation and protection of water resources for sustainable development. He is presently associate editor of Water International (official journal of the International Water Resources Association). He was also invited to serve as an associate editor for special issues of the Journal of the American Water Resources Association. He has served as an editorial member for international journals such as Hydrology, Journal of Ecology & Natural Resources, and Hydro Science & Marine Engineering, among others. He has chaired or acted as a technical committee member for twenty-five international forums (conferences). Dr. Shang graduated from Tsinghua University, China, in 2010 with a Ph.D. in Engineering. Prior to that, he worked as a research fellow at Harvard University from 2008 to 2009. 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The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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