*2.1. Study Design and Randomization*

We conducted a cluster randomized control trial on ten (five matched pairs) commercial construction sites (five intervention; five control) across the Boston metropolitan area, Massachusetts, United States between 2014 and 2015. Construction sites were matched within each general contracting company that agreed to participate in the study. Each pair of worksites was matched based on approximate size, scope, and phase of construction. This ensured that each matched pair consisted of similar organizational and worksite factors, such as similar existing company health and safety management systems [36]. Within each matched pair, one site was randomly assigned to either an intervention or a control group. A blocked randomization sequence was generated using a web-based random number generator by a member of the research team, who then allocated the pairs to either intervention or control. All workers within a specific worksite received the same intervention (or control) as allocated. Randomization and allocation of randomization sequence occurred as soon as two construction sites within a general contractor agreed to participate regardless of their assignment to control or intervention. The intervention groups received the intervention, ARM, whilst the control group received no intervention. Due to the pragmatic nature of the intervention, neither interventionists nor participants were blinded.

#### *2.2. Recruitment and Eligibility*

Construction sites were recruited through construction site owners and general contractors. To be eligible to participate in the study, worksites had to be in operation for 4 months or longer, and have 30 or more workers. Before the intervention commenced, a recruitment meeting was conducted with each site owner or general contractor to provide an overview of the study, programmatic activities, and to obtain leadership commitment. These recruitment meetings were conducted by the intervention primary investigator (J.T.D). Once a general contractor agreed, additional meetings with the leadership of each of the selected sites provided further leadership commitment and agreement for the study to take place on their sites.

Workers were introduced to the study by the research team and the general contractor safety manager, at a "safety stand-down" or toolbox talk. During the study, all new workers on a site were oriented to the study at their new-worker onsite safety orientation. Individual construction workers were surveyed within each site after a study launch meeting and at new-hire safety orientations for those workers who started after study commencement. Surveyed workers at each site were eligible if they were aged 18–65, and were English literate. All surveyed workers self-nominated and provided verbal consent during the survey process

All subjects gave their informed consent for inclusion before they participated in any data collection activities. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Harvard T.H. Chan School of Public Health Institutional Review Board (IRB-13-1948).


*3.4. Batches Prediction*

Constructing a bike-sharing system in most cities can be realized in several steps (batches). First, the government sets up a large number of bike station locations in the downtown area where lots of commercial buildings and tourist attractions are located, spreading out to nearby regions in the following months, perhaps with a short lull. However, as the frequency of shared bikes and new users increases, the government needs to distribute a wider range of bike locations to satisfy users' demand, and therefore the area expands to the suburbs and even empty districts in the city center to relieve excessive demand.

**Definition 6.** *Batches Prediction. Our work focuses on batch prediction; in other words, site prediction established in later stages in the suburbs or border zones, which are also defined as*

*expansion areas in this paper. We propose to utilize EMA (Exponential Moving Average) to determine the periods of batches given a continuous time interval. The EMA is a type of average that applies weighting factors that decrease exponentially to the past. We define a batch that exists if the EMA values of month demands are continuously not less than a given threshold for several months. Figure 5 shows the EMA distribution that we perform using 2, 3, and 6 months as the average units. For example, if we define the threshold as 30 using the two months average of EMA for New York City, we can then identify three batches(peaks) from 2013 to 2018. The corresponding periods of the first, second and third batches of NYC are shown in Table 4. Our framework provides the government the estimation of the demands of newly established stations through given locations, and this can also be applied to the expansion of other facilities.*

**Figure 5.** EMA of each month.

**Table 4.** Data source and detailed contents.

In this work, we mainly use XGBoost [15] to make the prediction for each batch. Apart from XGBoost in this work, other machine learning approaches can also be applied under our framework. We will compare their effectiveness in our experiments.


**3. Methodology and calculations of auxiliary services necessary for RES regulation**

The purpose of auxiliary services is provision of steady power balance. On one side there is electricity production starting from traditional sources to RES, on the other side are customers, i.e. final consumers. Production and consumption within the scope of interconnected power system must be in equilibrium at every moment.

A new approach to RES support, embodied in act No. 309/2009 about the support of RES and highly effective combined production [4], brings a quasi new group of producers to the electricity market. Those producers produce electricity not according to market demand but practically any time when climatic (wind, solar flux) conditions allow. Responsibility for sales of produced electricity and for the potential balance from the planned values are transferred primarily to operators of distribution systems who are obliged to buy electricity from RES, but eventually power balanced must be maintained by TSO. Supportive mechanisms for RES are currently only starting and massive capacities of these sources are not installed in SPS yet. The progress in installed capacity of RES in distribution system in 2010 is depicted in Fig. 2. Development trend of installed capacity is soaring confirming relevance of topic of availability and sufficiency of regulative capabilities and possibilities of SPS.

#### **3.1 Methodology of setting necessary auxiliary services**

The setting of necessary range of auxiliary services for securing reliable operation is closely linked to the degree of reliability of the system. The higher the rate of reliability is required, the higher the range of auxiliary services is needed, having a substantial influence on the final electricity price.

When setting the necessary range of auxiliary services important source information include not only expected loads in regulation area but also load diagram for considered interval of time, value of installed capacity of RES and other statistical data associated with system operation. Amount of auxiliary services was calculated according to the methodology published in [1].

Fig. 2. Progress in installed capacity of RES in 2010

#### **3.2 Setting necessary auxiliary services range for RES regulation**

When setting the necessary amount of auxiliary services for SPS needs long term statistics of load and system balance are utilised. Because there is no centralised measurement of power on existing RES, it is not easy to define influence of RES to SPS especially to volumes of auxiliary services. SEPS can only expect that operator of distribution systems will be willing to provide high quality prediction of production from RES and placement of the electricity in the market thus minimising requirements for regulation reserves.

#### **3.3 Impact of powers of RES fluctuations on primary frequency regulation**

The role of primary frequency regulation (PRV) is to avoid the occurrence of impermissible deviation in interconnected power system during few seconds. Resulting from the nature of primary frequency regulation the considerable deviations of balance between production and consumption caused by outages of large electricity sources are compensated within seconds. Overall power reserve of 3 000 MW is necessary to secure functionality of the primary regulation in the interconnected international system RG CE [8].

Primary regulation is of proportional nature and maintains equilibrium of production and consumption in synchronous interconnected area based upon frequency deviation. Aliquot part of the primary regulation reserve of Slovakia for 2010 is *PRV* = ±30 MW. Value of active power is symmetrical, which means 30 MW.

#### **3.4 Impact of powers of RES fluctuations on secondary power regulation**

Secondary power regulation (SRV) maintains equilibrium of production and consumption as well as system frequency in each regulation area taking into account regulation programme without violation of primary regulation, that works concurrently in synchronous interconnected area.

Secondary regulation uses centralised automatic production regulation which maintains setting of active power of production units during seconds up to 15 minutes (typically) after the event. Secondary regulation is based on the secondary regulation reserves controlled automatically. Adequate secondary regulation depends on production sources offered by production companies for disposal for auxiliary services.

Minimal recommended value for secondary regulation reserve within interconnected system RG CE is derived from the expected value of maximum system load in give time period according to the empirical formula [8]:

$$SR\,V\_{\rm RGCE} = \pm \sqrt{a \cdot L\_{\rm max} + b^2} - b \cdot \tag{1}$$

where *a*10 (empirical constant), *b*150 (empirical constant),

*L*max - expected maximum load, *SRV -* secondary power regulation.

The other part of the secondary regulation reserve within the regulation area Slovakia is a component resulting from load changes dynamics of regulation area ( *SRVDYN L*, ). The value of this component can be derived from the statistics monitoring system load during a longer period of time and is within the range of 20 to 40 MW, which means circa 1 % recalculated to average yearly load of SPS.

$$\text{LSR}\,V\_{\text{DYN,L}} = \frac{R\_{\text{sp}}}{2} + \sigma\_{\text{\textdegree}} \tag{2}$$

where *R* – arithmetic average of 10 minute differences of maximal and minimal load values for whole hours,

– standard deviation.

106 Renewable Energy – Trends and Applications

When setting the necessary amount of auxiliary services for SPS needs long term statistics of load and system balance are utilised. Because there is no centralised measurement of power on existing RES, it is not easy to define influence of RES to SPS especially to volumes of auxiliary services. SEPS can only expect that operator of distribution systems will be willing to provide high quality prediction of production from RES and placement of the electricity

The role of primary frequency regulation (PRV) is to avoid the occurrence of impermissible deviation in interconnected power system during few seconds. Resulting from the nature of primary frequency regulation the considerable deviations of balance between production and consumption caused by outages of large electricity sources are compensated within seconds. Overall power reserve of 3 000 MW is necessary to secure functionality of the

Primary regulation is of proportional nature and maintains equilibrium of production and consumption in synchronous interconnected area based upon frequency deviation. Aliquot part of the primary regulation reserve of Slovakia for 2010 is *PRV* = ±30 MW. Value of active

Secondary power regulation (SRV) maintains equilibrium of production and consumption as well as system frequency in each regulation area taking into account regulation programme without violation of primary regulation, that works concurrently in

Secondary regulation uses centralised automatic production regulation which maintains setting of active power of production units during seconds up to 15 minutes (typically) after the event. Secondary regulation is based on the secondary regulation reserves controlled automatically. Adequate secondary regulation depends on production sources offered by

Minimal recommended value for secondary regulation reserve within interconnected system RG CE is derived from the expected value of maximum system load in give time

The other part of the secondary regulation reserve within the regulation area Slovakia is a component resulting from load changes dynamics of regulation area ( *SRVDYN L*, ). The value of this component can be derived from the statistics monitoring system load during a longer period of time and is within the range of 20 to 40 MW, which means circa 1 %

> φ DYN,L σ , 2 *R*

2 *SRV a L b b* RGCE max , (1)

*SRV* (2)

**3.2 Setting necessary auxiliary services range for RES regulation**

in the market thus minimising requirements for regulation reserves.

**3.3 Impact of powers of RES fluctuations on primary frequency regulation**

primary regulation in the interconnected international system RG CE [8].

**3.4 Impact of powers of RES fluctuations on secondary power regulation**

power is symmetrical, which means 30 MW.

production companies for disposal for auxiliary services.

where *a*10 (empirical constant), *b*150 (empirical constant),

*L*max - expected maximum load, *SRV -* secondary power regulation.

period according to the empirical formula [8]:

recalculated to average yearly load of SPS.

synchronous interconnected area.

Resultant value of secondary regulation of regulation area Slovakia then equals to sum of minimal recommended value RG CE and a dynamic component. The value of power is symmetrical.

$$SRV\_{\rm FIN} = \pm \left( SRV\_{\rm RGCE} + SRV\_{\rm DYN,L} \right) \tag{3}$$

With the help of secondary regulation the central controller of regulation area maintains compensation of frequency deviations and compensation of active power balance on the planned level. The value of active power is symmetrical. Minimal offered power for SRV is 2 MW per unit. The whole regulation range must be realised within 15 minutes from the request and has to be symmetrical according to the basic power. Basic power is unit power for DLD coverage determined by provider within the preparation of operation.

Unit has to allow continuous repeated power changes in any direction within offered regulation range for SRV. Offered regulation power has to be available during whole negotiated time period (hour, day, etc.).

When calculating required range of secondary power regulation it is necessary to consider the influence of RES mainly wind and PV plants. RES are causing additional power fluctuations is regulation area. This undesirable phenomenon has a direct impact on secondary regulation reserve increase. Various foreign system analyses proved the fact that after implementing RES dynamic variations and increase/decrease gradient of non-covered load (difference between overall load and RES production) have risen. In view of the secondary frequency regulation mission (whose role is to maintain dynamic unbalance between planned production and expected load, and thus to keep the balance of regulation area) a new component of secondary regulation reserve *SRVDYN RES* , has to be introduced.

Additional components of secondary regulation reserve take into account fluctuation of load and production of RES. As there is neither mutual relation nor dependency between mentioned components, these components cannot be directly arithmetically added. If the arithmetical addition is used the value of overall secondary regulation reserve would rise inadequately. One way how to consider both non-correlating components is the use of the function which calculates geometric sum of the values. Resultant value of secondary regulation reserve is then symmetrical and can be calculated according to the following formula:

$$\text{SRV}\_{\text{VYS}} = \pm \left( \text{SR} \, V\_{\text{RGCE}} + \sqrt{\text{SR} \, V\_{\text{DYN},L}^2 + \text{SR} \, V\_{\text{DYN},RES}^2} \right). \tag{4}$$

Component *SRVDYN RES* , constitutes of two partial components, which consider the influence of wind and PV plants and final value can be calculated according to the following formula:

$$SRV\_{\text{DYNRES}} = \pm \left( SRV\_{\text{DYNMIND}} + SRV\_{\text{DYNPV}} \right). \tag{5}$$

Amounts of secondary regulation reserve for wind plants *SRV*DYN,WIND were specified according to the findings in study [9]. Amounts of secondary regulation reserve for PV plants *SRVDYN PV* , were specified according to the statistical values from PV plants in operation in Czech Republic and Slovakia [23, 24]. However it has to be remarked that considered were only roof applications with low installed capacity and mentioned statistical data did not include long term information.

Table 2. Hourly changes of PV plants power

The basis for the necessary range of the secondary regulation reserve *SRVDYN PV* , determination is hourly sample of expected time changes of overall PV plants' power taking into account hourly power shown given in Table 2. Additional values for secondary regulation reserve were calculated according to the method of *SRVDYN PV* , calculation.

Based on statistics, performed calculations and after adaptation of the values for the conditions in Slovakia the expected volumes of secondary regulation reserve for RES *SRVDYN RES* , were determined and are shown in Table 3.

Table 3. Expected volumes of secondary regulation reserve for RES

#### **3.5 Impact of powers of RES fluctuations on tertiary power regulation**

Tertiary regulation (TRV) uses tertiary reserve, which is usually activated manually by TSO in the case of actual or expected secondary regulation activation.

Tertiary regulation is principally used for secondary reserve's release in the balanced state of the system, but it is also activated as a supplement of the secondary reserve after larger outages for system frequency restoration and following release of primary reserve within the whole system. Tertiary regulation is typically performed within the responsibility of TSO.

The nature of tertiary regulation differs from that of secondary regulation. While secondary regulation maintains dynamic unbalance between planned production and expected consumption, tertiary regulation corrects errors in production programme introduced by larger imperfections in consumption prediction and sources outages – Fig. 3.

This regulation affects the change of active power of generators in the whole range up to their withdrawal or connection into operation. It reacts to overall state of given power system and acts after the secondary power regulation or cannot be activated at all. The sources covering tertiary regulation of active power can use their whole regulation range or its parts for it. When starting from the zero power they have to supply power to the electric system equivalent to the basic regulation range of tertiary regulation (technical

plants *SRVDYN PV* , were specified according to the statistical values from PV plants in operation in Czech Republic and Slovakia [23, 24]. However it has to be remarked that considered were only roof applications with low installed capacity and mentioned statistical

*P*inst (kW) 10 20,1 62,4 68,3 84 *P P* hour inst % 2,8 2,4 1,8 1,7 1,4

The basis for the necessary range of the secondary regulation reserve *SRVDYN PV* , determination is hourly sample of expected time changes of overall PV plants' power taking into account hourly power shown given in Table 2. Additional values for secondary regulation reserve were calculated according to the method of *SRVDYN PV* , calculation. Based on statistics, performed calculations and after adaptation of the values for the conditions in Slovakia the expected volumes of secondary regulation reserve for RES

*P*inst RES (MW) 300 400 500<PHONE_NUMBER> 1200

*SRV*DYN,RES 43 50 58 65 80 95 109

*SRV*DYN,RES (% of *P*inst RES) 14,29 12,57 11,53 10,84 9,98 9,46 9,11

Tertiary regulation (TRV) uses tertiary reserve, which is usually activated manually by TSO

Tertiary regulation is principally used for secondary reserve's release in the balanced state of the system, but it is also activated as a supplement of the secondary reserve after larger outages for system frequency restoration and following release of primary reserve within the whole system. Tertiary regulation is typically performed within the responsibility of

The nature of tertiary regulation differs from that of secondary regulation. While secondary regulation maintains dynamic unbalance between planned production and expected consumption, tertiary regulation corrects errors in production programme introduced by

This regulation affects the change of active power of generators in the whole range up to their withdrawal or connection into operation. It reacts to overall state of given power system and acts after the secondary power regulation or cannot be activated at all. The sources covering tertiary regulation of active power can use their whole regulation range or its parts for it. When starting from the zero power they have to supply power to the electric system equivalent to the basic regulation range of tertiary regulation (technical

data did not include long term information.

Table 2. Hourly changes of PV plants power

*SRVDYN RES* , were determined and are shown in Table 3.

Table 3. Expected volumes of secondary regulation reserve for RES

in the case of actual or expected secondary regulation activation.

TSO.

**3.5 Impact of powers of RES fluctuations on tertiary power regulation**

larger imperfections in consumption prediction and sources outages – Fig. 3.

minimum of source). Reserve of tertiary regulation of active power can be secured with different activation times.

Fig. 3. Impact of RES operation on tertiary regulation reserve

Tertiary regulation *TRV30MIN* provides coverage of load changes caused by temperature, uncertainty in load estimates, outages of sources and electricity demand.

Necessary power reserve for tertiary power regulation coverage *TRV30MIN* can vary for both regulation directions and thus is split to positive and negative reserve.

Positive tertiary power regulation *TRV30MIN+* is calculated according to [1] and consists of several components:

Inaccuracy of load estimation and influence of temperature

$$TRV\_{\text{no}} = \text{NP}\_{\Phi} \cdot \text{MAX} \,/\, 100 \tag{6}$$

(*NP* – inaccuracy of load estimation, *MAX* – maximum load). Stochastic load change:

$$TRV\_{\text{nx}} = \text{NP}\_{\Phi+} \cdot \text{MAX} \,/\, 100 \,\, \text{J} \tag{7}$$

(*NP*+ – positive inaccuracy of load estimation).

Substitution of tertiary power regulation in case of power production facility outage:

$$TR\,V\_{\text{vypbl}} = SR\,V\_{\text{RGCE}}\,\text{.}\tag{8}$$

Adjustment of the electricity market influence (this component can append value *TRV30MIN+* based on the historical data or expected changes depending on the electricity market).

The final value of *TRV30MIN+* is then calculated:

$$\text{TRV30MIN} + \sqrt{\text{(TRV}\_{\text{vypbl}}\text{)}^2 + \left(\text{TRV}\_{\text{raz}}\right)^2 + \left(\text{TRV}\_{\text{no}}\right)^2} \tag{9}$$

Negative tertiary power regulation *TRV30MIN-* is calculated according to [1] and consists of several components:

Inaccuracy of load estimation and influence of temperature

$$TR\,V\_{\text{no}} = \text{NP}\_{\phi} \cdot \text{MAX} \,/\, 100\,\tag{10}$$

(*NP* – inaccuracy of load estimation, *MAX* – maximum load). Stochastic load change:

$$TRV\_{\text{nx-}} = \text{NP}\_{\Phi^-} \cdot \text{MAX} \,/\, 100 \tag{11}$$

(*NP* – negative inaccuracy of load estimation). The final value of *TRV30MIN-* is then calculated:

$$TRV\\$0MIN\text{-}=\sqrt{\left(TRV\_{\text{nx}\text{-}}\right)^{2}+\left(TRV\_{\text{no}}\right)^{2}}\tag{12}$$

In view of some unpredictable fluctuations of RES power that can occur practically in the whole range of installed capacity, it is necessary to have sufficient regulation power of tertiary power regulation available at any time. Currently there are no statistical data for SPS which could be used to set starting values of increased tertiary regulation reserve caused by RES operation. That is why it would be suitable to use meteorological data as one of the supporting inputs for RES electricity production prediction.

Value of 30 minutes tertiary regulation reserve for RES considering a given degree of accuracy of RES production prediction is as follows:

$$TR\,V\_{\rm RES}^{30\,\mathrm{min}\,\pm} = k\_{\mathrm{NP}} \cdot P\_{\mathrm{inst\,RES}}\,\prime\,\tag{13}$$

where 30min *TRVRES* — increased 30 minutes tertiary regulation reserve caused by RES operation. When calculating final values of *TRV30MIN* it is necessary to distinguish winter and summer and also *TRV30MIN+* or *TRV30MIN-* services.

$$TRV\_{\text{Fin}}^{\text{30\,min}+} = TRV\_{\text{RES}}^{\text{30\,min}\pm} + TRV\text{30}MIN + \tag{14}$$

$$TRV\_{\text{Fin}}^{\text{30 min}-} = TRV\_{\text{RES}}^{\text{30 min}} + TRV \text{30}M \text{IN} - \tag{15}$$

Final values of tertiary regulation reserve *TRVFin* for different installed RES capacities and loads are in Table 4.

In view of some unpredictable fluctuations of RES power that can occur practically in the whole range of installed capacity, it is necessary to have sufficient regulation power of tertiary power regulation available at any time. Currently there are no statistical data for SPS which could be used to set starting values of increased tertiary regulation reserve caused by RES operation. That is why it would be suitable to use meteorological data as one

Value of 30 minutes tertiary regulation reserve for RES considering a given degree of

30min *TRV k P* RES NP inst RES

When calculating final values of *TRV30MIN* it is necessary to distinguish winter and

Final values of tertiary regulation reserve *TRVFin* for different installed RES capacities and

*P*inst RES (MW) 300 400 500<PHONE_NUMBER> 1200 *TRV*no (MW) 85 85 85 85 85 85 85 *TRV*nz+ (MW) 82 82 82 82 82 82 82 *TRV*vypbl (MW) 62 62 62 62 62 62 62 *TRV30MIN*+ (MW) 133 133 133 133 133 133 133

(MW) 84 112 140 168 224 280 336

(MW) 217 245 273 301 357 413 469

= 30min *TRV*RES

= 30min *TRV*RES

— increased 30 minutes tertiary regulation reserve caused by RES operation.

(*NP* – inaccuracy of load estimation, *MAX* – maximum load).

of the supporting inputs for RES electricity production prediction.

accuracy of RES production prediction is as follows:

summer and also *TRV30MIN+* or *TRV30MIN-* services.

30min *TRV*Fin

30min *TRV*Fin

(*NP* – negative inaccuracy of load estimation). The final value of *TRV30MIN-* is then calculated:

Stochastic load change:

where 30min *TRVRES*

loads are in Table 4.

30min *TRV*RES

30min *TRV*Fin

*L*max (given) (MW) **1700**  *L*max (calculated) (MW) **2261**  *TRV NP MAX* no /100 (10)

*TRV NP MAX* nz /100 (11)

, (13)

+ *TRV MIN* 30 (14)

+ *TRV MIN* 30 (15)

2 2 nz- no *TRV MIN TRV TRV* 30 - ( ) ( ) (12)

Table 4. Final values of positive 30 minutes tertiary regulation reserve for different installed RES capacities and maximum loads *L*max


**6. Conclusions**

Telemedicine is a helpful tool to improve chronic respiratory patient management. Almost all results shows reduction in Emergency visits and the number of hospitalizations but despite of these results its implementation is troublesome and with different kind of factors relationship with this slowly development. Most users report that the difficult to use the devices or technology platform is the most important factor related to refuse telemedicine by users. We need to work to improve its implementation through educational programs to healthcare professionals and patients.


**Abstract**

After ensuring the food security for over 50 years, the green revolution is eventually reaching its biological limits which are very much reflected by the ongoing stagnancy in yield increased over the past few decades. Meeting the increasing food demands due to increasing population is the greatest challenge for today's plant scientists. Changing climatic conditions are posing additional threats to crop growth, productivity and yield. After successfully deploying gene editing to modify simple traits, scientists are now embarked on more ambitious adventures in genomics to combat challenges of food security in the wake of increasing population and climate change adversaries. The chapter outlines use of new technologies in tailoring crops beyond simple traits aiming to harvest the desired diversity lost during domestication and manipulating complex traits, which evolved over evolutionary timescale with special emphasis on the development of climate smart crops.


**1. Introduction**

With the arrival of the informational age and the rapid development of computer technology, people have higher requirements for the accuracy of biometric identification technology [1]. Compared with other common biometric traits, finger-based traits (e.g., fingerprint [2], finger-vein [3] and finger-knuckle-print [4],) have some advantages in uniqueness, anti-counterfeit, user acceptance, and high security [5–8]. However, affected by the external environment and the inherent differences of individuals, only relying on finger unimodal biometrics for identity authentication still has many security risks, which can no longer achieve the high-performance requirements of a user. Hence, fusing three traits from a finger together should be beneficial to address the person recognition problem [9,10].

However, the quality of three modal finger images is usually degraded seriously due to illumination variation in skin surfaces, which is unhelpful for reliable feature representation [11–13]. In addition, the finger trimodal images vary with the finger in pose rotation during imaging, which reduces the discriminability of images and further decreases the recognition accuracy rate. Therefore, exploring a robust feature representation method is very favorable for finger-based recognition improvement.

Recently, some researchers have developed some coding-based feature expression methods, which were often considered to be able to solve the above two problems [14–21]. Ojala et al. first proposed the classical local binary pattern (LBP) algorithm for facial recognition, which has great rotation invariant and was insensitive to illumination variation [16]. In 2011, Rosdi et al. proposed a local line binary pattern (LLBP) algorithm to effectively make use of the position relationships among surrounding pixels in horizontal and vertical orientations [17]. Meng et al. [19] proposed a local direction coding

(LDC) algorithm, which utilized the gradient relationships to express a venous feature for finger-vein recognition. In 2013, Peng et al. [20] combined the Gabor wavelet and LBP (GLBP) for feature extraction, which could effectively improve the ability of local and global features representation.

Noteworthy, some methods related to local graph have been presented in succession, and their variants have been successfully applied to many biometric fields [22–29]. Abusham et al. first proposed a local graph structure (LGS) algorithm to extract face features, which was insensitive to illumination [22]. However, the structure was non-symmetric, which led to a feature representation with no-equilibrium in the left and right neighborhoods. In order to balance feature representation of neighbor pixels on both sides, Mohd et al. [23] improved the original LGS operator to the SLGS operator by building a symmetrical structure. In 2015, Dong et al. [24] presented a MOW-SLGS operator for the representation of vein networks, and used the ELM to accomplish finger-vein image classification. On the basis of this information, in 2018, Yang et al. [25] put forward the Weber SLGS, which integrated differential direction features by Weber Law and the local graph structure algorithm. However, these algorithms still have some limitations in the application of representing finger multimodal features. On the one hand, the methods above only describe the relationships between the target pixel and its adjacent ones in a fixed neighborhood, while neglecting the hidden relationships among surrounding pixels. On the other hand, the assignment of different weights for symmetric pixels on left and right sides usually results in an imbalance of the feature expression in images.

To effectively overcome these limitations, we propose a Gabor generalized symmetric local graph structure (Gabor-GSLGS) for finger multimodal fusion recognition, as shown in Figure 1. In the image capture part, first, a finger imaging device is designed, and a pose correction algorithm is proposed to reduce pose variations. A robust finger region of interest (ROI) localization approach is then employed. Secondly, a bank of 6-orientation and single-scale Gabor filters are utilized for finger ROI image enhancement. Thirdly, based on the proposed GSLGS operator, a local coding algorithm is developed for finger features representation. The coded trimodal feature images of a finger are then divided evenly into non-overlapping blocks. Thus, for a finger, we can obtain a feature vector by concatenating the histograms of all blocks. Finally, by computing the similarities between the obtained vectors, the matching results can be reported statistically. Experimental results on our established database demonstrated that the proposed feature description approach exhibits better effects than other traditional approaches in finger multimodal fusion recognition.

**Figure 1.** Finger multimodal recognition process based on the Gabor generalized symmetric local graph structure (Gabor-GSLGS).

The reminder of this paper is organized as follows: The finger trimodal imaging device and the proposed posture correction are introduced in Section 2. The enhancement methods used for finger ROI images are described in Section 3. Section 4 details the structure of the proposed local coding algorithm. A feature matching scheme is employed to implement finger multimodal fusion recognition and described in Section 5. Section 6 outlines the extensive experiments conducted and presents the analysis of experimental results in details. Finally, Section 7 presents the summarization.


**3.1 GelPOINT advanced access platform by applied Medical**

The GelPOINT system is a gel topped port combined with Alexis wound retractor technology. The Alexis wound retractor provides 360 degree

**5**

[33, 34].

*Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic…*

retraction of the port site; the rounded retraction allows for better instrument triangulation. Trocars supplied with the device are introduced through the GelSeal cap and may be arranged in any formation. The trocars accommodate instrument diameters from 5 to 12 mm. The device can be used in incisions ranging from 1.5 cm to 7 cm in length. The GelSeal cap has a diameter of 10 cm. The cap can be removed from the Alexis retractor for specimen retrieval

The GelPOINT Mini uses the same GelSeal and Alexis retractor technology but with a smaller footprint. This system accommodates incisions up to 4 cm. Triangulation is reduced further with the GelPOINT Mini system, limiting its util-

The SILS port by Medtronic consists of a blue colored foam, soft, flexible port that maintains pneumoperitoneum by conforming to the body wall. The outer diameter is 49 mm and the inner diameter is 29 mm. The port has an insufflation valve and three instrument placement channels. Three variations of the SILS port are available and can accommodate a range of instrument diameter from 5 mm to

Advanced Surgical Concepts offers three single incision laparoscopy platforms. All three variations are composed of an outer ring connected to an inner ring by a clear retracting sleeve. The distal ring is placed into the abdominal cavity with an introducer which punctures the abdominal wall. After the introducer is removed, the outer ring is passed over the retracting sleeve until it creates a seal. Because of its self adjusting retraction sleeve, this port can be used in abdominal walls up to 10 cm in thickness. The fixed ports are angled in order to minimize instrument crowding. The 10 mm and 15 mm ports are equipped with lip seal valves that allow for the introduction and removal of smaller diameter instruments without losing pneumo-

One model, the Triport+, contains four instrument ports (three 5 mm and one 10 mm) and two insufflation valves, while Triport15 contains three instrument ports (two 5 mm and one 15 mm) and two insufflation valves. Optimal incision length is between 12 mm and 25 mm. QuadPort contains five instrument ports (two 5 mm, one 10 mm, one 12 mm and one 15 mm) and two insufflation valves. It

The Anchorport system uses a set of unique self-adjusting, self-anchoring trocars [38]. The 5 mm trocar is available in three lengths: 75 mm, 100 mm, 135 mm. It has a clear bladeless optical tip for direct entry and a pistol-like grip handle. The distal portion of the cannula system adjusts to the patient's abdominal wall thickness with its accordion-like design, which anchors to the body wall for security. The AnchorPort design allows a minimum amount of the cannula tip inside the abdomen; this assists with laparoscopic instrument range of motion and widening instrument angles inside the abdomen. AnchorPort is uniquely designed for single incision laparoscopy; a single skin incision is made and then the trocars are introduced directly into the fascia, maintaining a bridge of tissue between each trocar

*DOI: http://dx.doi.org/10.5772/intechopen.96953*

ity in more complex single incision laparoscopy [35].

**3.3 TriPort and QuadPort by advanced surgical concepts**

can be used with incisions 20 mm to 60 mm [37].

[33–35].

**3.2 SILS port by Medtronic**

15 mm [33, 34, 36].

peritoneum [33, 34, 37].

**3.4 AnchorPort by Conmed**

**Figure 3.** *(a) GelPOINT system, (b) SILS port, (c) TriPort15, (d) AnchorPort.*

*Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic… DOI: http://dx.doi.org/10.5772/intechopen.96953*

retraction of the port site; the rounded retraction allows for better instrument triangulation. Trocars supplied with the device are introduced through the GelSeal cap and may be arranged in any formation. The trocars accommodate instrument diameters from 5 to 12 mm. The device can be used in incisions ranging from 1.5 cm to 7 cm in length. The GelSeal cap has a diameter of 10 cm. The cap can be removed from the Alexis retractor for specimen retrieval [33–35].

The GelPOINT Mini uses the same GelSeal and Alexis retractor technology but with a smaller footprint. This system accommodates incisions up to 4 cm. Triangulation is reduced further with the GelPOINT Mini system, limiting its utility in more complex single incision laparoscopy [35].

#### **3.2 SILS port by Medtronic**

*Single Port Gynecologic Laparoscopic and Robotic-Assisted Surgery*

**3. Commercially available single incision access systems**

ments through one access point with a single, larger skin incision.

**3.1 GelPOINT advanced access platform by applied Medical**

have played a role in Bush's findings [32].

group [29].

would choose a Pfannenstiel incision while only 31% would choose multiport laparoscopic incisions, indicating that patient familiarity with the incision type may

Data regarding outcomes for single incision non-adnexal surgery is less abundant than that for adnexal procedures. A single RCT with 66 participants undergoing laparoscopic myomectomy by either SILS or multi-port laparoscopy demonstrated no significant differences in surgical outcomes with the exception of more favorable cosmesis and better patient satisfaction in the SILS

A variety of access systems are available for single incision laparoscopic surgery [33, 34] (**Figure 3a-d**). Surgeon preference and comfort level is key when choosing laparoscopic entry. SILS ports were designed to allow the passage of many instru-

The GelPOINT system is a gel topped port combined with Alexis wound

retractor technology. The Alexis wound retractor provides 360 degree

**4**

**Figure 3.**

*(a) GelPOINT system, (b) SILS port, (c) TriPort15, (d) AnchorPort.*

The SILS port by Medtronic consists of a blue colored foam, soft, flexible port that maintains pneumoperitoneum by conforming to the body wall. The outer diameter is 49 mm and the inner diameter is 29 mm. The port has an insufflation valve and three instrument placement channels. Three variations of the SILS port are available and can accommodate a range of instrument diameter from 5 mm to 15 mm [33, 34, 36].

#### **3.3 TriPort and QuadPort by advanced surgical concepts**

Advanced Surgical Concepts offers three single incision laparoscopy platforms. All three variations are composed of an outer ring connected to an inner ring by a clear retracting sleeve. The distal ring is placed into the abdominal cavity with an introducer which punctures the abdominal wall. After the introducer is removed, the outer ring is passed over the retracting sleeve until it creates a seal. Because of its self adjusting retraction sleeve, this port can be used in abdominal walls up to 10 cm in thickness. The fixed ports are angled in order to minimize instrument crowding. The 10 mm and 15 mm ports are equipped with lip seal valves that allow for the introduction and removal of smaller diameter instruments without losing pneumoperitoneum [33, 34, 37].

One model, the Triport+, contains four instrument ports (three 5 mm and one 10 mm) and two insufflation valves, while Triport15 contains three instrument ports (two 5 mm and one 15 mm) and two insufflation valves. Optimal incision length is between 12 mm and 25 mm. QuadPort contains five instrument ports (two 5 mm, one 10 mm, one 12 mm and one 15 mm) and two insufflation valves. It can be used with incisions 20 mm to 60 mm [37].

### **3.4 AnchorPort by Conmed**

The Anchorport system uses a set of unique self-adjusting, self-anchoring trocars [38]. The 5 mm trocar is available in three lengths: 75 mm, 100 mm, 135 mm. It has a clear bladeless optical tip for direct entry and a pistol-like grip handle. The distal portion of the cannula system adjusts to the patient's abdominal wall thickness with its accordion-like design, which anchors to the body wall for security. The AnchorPort design allows a minimum amount of the cannula tip inside the abdomen; this assists with laparoscopic instrument range of motion and widening instrument angles inside the abdomen. AnchorPort is uniquely designed for single incision laparoscopy; a single skin incision is made and then the trocars are introduced directly into the fascia, maintaining a bridge of tissue between each trocar [33, 34].

## **4. Accessory products**

#### **4.1 Laparoscopes**

Traditional lens-based laparoscopes have a rigid shaft and utilize two dimensional views. Laparoscope diameters vary from <1 mm to 15 mm, with the most commonly used diameters being 5 and 10 mm. Classically, laparoscopes utilize charge coupled device (CCD) sensors, in which higher resolution is obtained with larger diameters. In SILS, a smaller diameter, such as 5 mm or less, is often preferred at the expense of resolution in order to maintain maneuverability of surgical instruments [39].

Though flexible tip endoscopy was developed as early as the 1950s, it wasn't until the 2000s that flexible tip laparoscopes with adequate imaging capabilities were developed. The EndoEye Flex video laparoscope with "chip on the tip" design was developed in 2005 by Olympus. It has a deflectable tip that can rotate up to 100 degrees. The latest model allows for high definition video in a 5 mm diameter scope by utilizing complementary metal-oxide semiconductor (CMOS) technology as opposed to CCD. It is also the first autoclavable articulating videoscope, as other designs require chemical sterilization. Stryker has also developed articulating 5 and 10 mm videoscopes, however at the time of this manuscript, the Ideal Eyes HD Articulating Laparoscope does not appear to be available in the current Stryker product catalog. Flexible tip laparoscopes have demonstrated shorter operating times for single incision cholecystectomy, but have not yet been evaluated for gynecologic SILS [39].

Lens angles of rigid laparoscopes can vary. Zero degree scopes are most commonly utilized by gynecologic surgeons in multiport laparoscopy. Angled scopes, however, can be very useful in SILS gynecology by moving the imaging plane out of the line of the operating plane in order to reduce instrument collision. Thirty degree laparoscopes are most commonly used, although 45 degree and 70 degree options are available as well. Variable view laparoscopes developed by Karl Storz allow the surgeon to adjust the lens angle between 0 and 90 degrees without removing the scope from the trocar.

An in-line light cord adapter and low profile camera head are two updates that reduce tangling of cords and instrument collision. Use of a longer laparoscope, as those used in bariatric surgery, may also improve mobility. Future laparoscopes may be cordless and wireless [40].

#### **4.2 Instruments**

Traditional laparoscopic instruments are rigid with an average length of 33 cm. Some instruments allow for rotation of the tip while others are fixed. Prebent instruments have been utilized by other specialties in the past but have not been widely utilized in gynecologic SILS [33, 34].

Articulating instruments have been pivotal in improving triangulation constraints of SILS while also increasing the surgeon's range of motion (**Figure 4a** and **b**). Companies including Medtronic, BD and others manufacture articulating grasping instruments. There are currently 2 articulating 5 mm bipolar instruments on the market. Ethicon's Enseal G2 provides bipolar sealing of vessels up to 7 mm in diameter with 110 degrees of articulation and 360 degree rotation. The Caiman 5 Vessel Sealer by Aesculap offers 80 degrees of articulation, a 26.5 mm sealing length and 23.5 mm cutting length [41, 42].

The ArtiSential line of wristed instruments with 360 degree of freedom was registered with the FDA in 2019. They have yet to be described in single incision gynecology but offer similar range of motion as robotic instruments and may have utility in SILS procedures.

**7**

**Figure 4.**

*Articulating Bipolar Vessel Sealers. (a) Enseal G2, (b) Calman 5.*

*Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic…*

In instances where wider triangulation is necessary, mini laparoscopic instruments can be introduced away from the single incision port site. Many companies promote miniature laparoscopic instruments with diameters 3 mm and under. Some of the smallest diameter instruments are manufactured by Teleflex, which produces instruments with only a 2.4 mm shaft. The instrument is introduced directly through the skin using an integrated needle tip, which eliminates the need for a skin incision or trocar. The product line offers 2 handpieces, 4 types of graspers and 4

The magnetically anchored and guidance system (MAGS) was first described in 2007. This device utilizes magnetic coupling of an external handpiece and an internal instrument or camera. The internal components are inserted through a single incision and paired to their external components via magnetic attraction across the

*DOI: http://dx.doi.org/10.5772/intechopen.96953*

monopolar electrosurgical tools.

#### *Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic… DOI: http://dx.doi.org/10.5772/intechopen.96953*

In instances where wider triangulation is necessary, mini laparoscopic instruments can be introduced away from the single incision port site. Many companies promote miniature laparoscopic instruments with diameters 3 mm and under. Some of the smallest diameter instruments are manufactured by Teleflex, which produces instruments with only a 2.4 mm shaft. The instrument is introduced directly through the skin using an integrated needle tip, which eliminates the need for a skin incision or trocar. The product line offers 2 handpieces, 4 types of graspers and 4 monopolar electrosurgical tools.

The magnetically anchored and guidance system (MAGS) was first described in 2007. This device utilizes magnetic coupling of an external handpiece and an internal instrument or camera. The internal components are inserted through a single incision and paired to their external components via magnetic attraction across the

**Figure 4.** *Articulating Bipolar Vessel Sealers. (a) Enseal G2, (b) Calman 5.*

*Single Port Gynecologic Laparoscopic and Robotic-Assisted Surgery*

Traditional lens-based laparoscopes have a rigid shaft and utilize two dimensional views. Laparoscope diameters vary from <1 mm to 15 mm, with the most commonly used diameters being 5 and 10 mm. Classically, laparoscopes utilize charge coupled device (CCD) sensors, in which higher resolution is obtained with larger diameters. In SILS, a smaller diameter, such as 5 mm or less, is often preferred at the expense of resolution in order to maintain maneuverability of surgical instruments [39]. Though flexible tip endoscopy was developed as early as the 1950s, it wasn't until the 2000s that flexible tip laparoscopes with adequate imaging capabilities were developed. The EndoEye Flex video laparoscope with "chip on the tip" design was developed in 2005 by Olympus. It has a deflectable tip that can rotate up to 100 degrees. The latest model allows for high definition video in a 5 mm diameter scope by utilizing complementary metal-oxide semiconductor (CMOS) technology as opposed to CCD. It is also the first autoclavable articulating videoscope, as other designs require chemical sterilization. Stryker has also developed articulating 5 and 10 mm videoscopes, however at the time of this manuscript, the Ideal Eyes HD Articulating Laparoscope does not appear to be available in the current Stryker product catalog. Flexible tip laparoscopes have demonstrated shorter operating times for single incision cholecystectomy, but have not yet been evaluated for gynecologic SILS [39]. Lens angles of rigid laparoscopes can vary. Zero degree scopes are most commonly utilized by gynecologic surgeons in multiport laparoscopy. Angled scopes, however, can be very useful in SILS gynecology by moving the imaging plane out of the line of the operating plane in order to reduce instrument collision. Thirty degree laparoscopes are most commonly used, although 45 degree and 70 degree options are available as well. Variable view laparoscopes developed by Karl Storz allow the surgeon to adjust the lens angle between 0 and 90 degrees without removing the

An in-line light cord adapter and low profile camera head are two updates that reduce tangling of cords and instrument collision. Use of a longer laparoscope, as those used in bariatric surgery, may also improve mobility. Future laparoscopes may

Traditional laparoscopic instruments are rigid with an average length of 33 cm.

Some instruments allow for rotation of the tip while others are fixed. Prebent instruments have been utilized by other specialties in the past but have not been

Articulating instruments have been pivotal in improving triangulation constraints of SILS while also increasing the surgeon's range of motion (**Figure 4a** and **b**). Companies including Medtronic, BD and others manufacture articulating grasping instruments. There are currently 2 articulating 5 mm bipolar instruments on the market. Ethicon's Enseal G2 provides bipolar sealing of vessels up to 7 mm in diameter with 110 degrees of articulation and 360 degree rotation. The Caiman 5 Vessel Sealer by Aesculap offers 80 degrees of articulation, a 26.5 mm sealing length

The ArtiSential line of wristed instruments with 360 degree of freedom was registered with the FDA in 2019. They have yet to be described in single incision gynecology but offer similar range of motion as robotic instruments and may have

**4. Accessory products**

**4.1 Laparoscopes**

scope from the trocar.

**4.2 Instruments**

be cordless and wireless [40].

widely utilized in gynecologic SILS [33, 34].

and 23.5 mm cutting length [41, 42].

utility in SILS procedures.

**6**

abdominal wall, up to a maximal thickness of 10 cm. The internal components can then be arranged in an ergonomic configuration by moving the external components along the abdominal wall. MAGS has been utilized in urology and thoracic surgery, but has not yet been seen in gynecologic surgery [43].

#### **4.3 Smoke evacuation systems**

The dangers of surgical smoke to the surgical team are well documented. Electrocauterization instruments, lasers, and ultrasonic scalpels all release particulate matter (PM) into the ambient air during both open and laparoscopic surgery. Particles 10 microns or smaller can be inhaled. Studies evaluating the long term effects specific to surgical smoke are insufficient; however the PM found in surgical smoke is associated with coronary artery disease, congestive heart failure, asthma, and chronic obstructive pulmonary disease. Deposits of PM have been found in remote organs, including the brain, and may be associated with increased oxidative stress and systemic inflammation. Long term exposure may be associated with decreased life expectancy [44].

During laparoscopy, surgical smoke also impairs visualization. As simply venting the plume into the ambient air is ill advised, smoke evacuation systems are crucial in providing adequate visualization of structures. Dozens of smoke evacuation systems have been marketed for laparoscopic procedures. ConMed's Airseal, released in 2007, is uniquely beneficial to gynecologic SILS. The Airseal system maintains the pneumoperitoneum, provides constant smoke evacuation and allows valve free port access. The high pressure nozzles of the port's cannula direct recirculated CO2 gas down into the trocar in order to maintain pressure which creates a horizontal gas barrier across the cannula. Thus, introduction of a smaller caliber instrument or even 2 instruments through a single trocar does not result in loss of pneumoperitoneum. AirSeal has 3 operational modes: AirSeal Mode, Smoke Evacuation Mode, and Standard Insufflation Mode. The system filters particles as small as 0.01 microns [33, 34, 44].

### **5. Surgical techniques**

Although traditionally, the least experienced member of the surgical team is often tasked with uterine manipulation, expert uterine manipulation is often key in gynecologic SILS. Introduction of multiple instruments through a single port site reduces mobility, and manipulation of the uterus can enhance or replace retraction usually done through the abdominal wall. Retroversion of the uterus allows access to the vesicouterine space. Anteversion of the uterus exposes the rectouterine space. Rotational uterine manipulation, rather than straight lateral displacement of the uterus, provides better access to the adnexa of surgical interest. The uterus can also be pushed cephalad to displace the ureters laterally or pulled caudad to access the fundus of a larger uterus.

Creation of a posterior colpotomy during a non-hysterectomy SILS procedure can provide a second point of access for instrumentation, passing suture or removing specimens. Vaginal natural orifice transluminal endoscopic surgery (vNOTES), which utilizes the vaginal as the sole entry point for endoscopic surgery, is discussed in a separate chapter. The techniques described for vNOTES may be employed in complex SILS cases as well.

Temporary sutures can be used to provide retraction during SILS procedures. This technique is often called "puppeteering" [1]. Straight needles are useful in that they can be passed through a trocar or inserted directly through the abdominal wall. Curved needles may be introduced through larger caliber trocars or partially

**9**

**Author details**

M. Luann Racher\* and Ann Marie Mercier

provided the original work is properly cited.

\*Address all correspondence to<EMAIL_ADDRESS>
Sciences, Little Rock, AR, USA

Department of Obstetrics and Gynecology, University of Arkansas for Medical

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic…*

straightened to pass through smaller trocars. Choice of suture is based upon surgeon preference as the suture is removed after the procedure is completed. As long as care is taken to avoid vascular structures, the uterus and adnexa can be retracted with puppet sutures. Large bowel should only be retracted by suturing through the epiploica. Small bowel should not be retracted in this manner due to risk of injury.

*DOI: http://dx.doi.org/10.5772/intechopen.96953*

*Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic… DOI: http://dx.doi.org/10.5772/intechopen.96953*

straightened to pass through smaller trocars. Choice of suture is based upon surgeon preference as the suture is removed after the procedure is completed. As long as care is taken to avoid vascular structures, the uterus and adnexa can be retracted with puppet sutures. Large bowel should only be retracted by suturing through the epiploica. Small bowel should not be retracted in this manner due to risk of injury.


*3.5. Participation in Recycling and Waste Separation Practices*

A total of 62% respondents indicated that they were involved in some extent of recycling practice, while 28.0% practised waste separation. The Chi-Square test also indicated the significance between recycling and source separation practices, where about two-fifth of recyclers adopted source separation (Table 11). In addition, a significant association between demographic profile and source separation practice was revealed through the Chi-Square test. These included age group, marriage status, educational level, and duration of stay (Table 12).

**Table 11.** Association between recycling and source separation participation.

**Table 12.** Association between demographic profile and source separation participation.

Tables 13–16 show the statements asked in Section E of the questionnaire, where each respondent was able to choose multiple answers (reason statements) resulting in varying numbers of frequency recorded across the tables. Protecting the environment was rated as the most motivating reason to participate in recycling, consisting of about one quarter of the total frequency. That the ranking was immediately followed by the feeling of satisfaction in anticipating that waste would become a new resource and their continuous effort would influence other household members and neighbours as the reasons for recycling, whereas the skill of handling and sorting the recyclables was rated as the least important reason to participate in recycling (Table 13).

Three reasons voted the most by the majority of the respondents for practising waste separation are as follows (Table 14):

**Table 13.** Reasons to participate in recycling.

**Table 14.** Reasons to participate in source separation.

**Table 15.** Reasons to not participate in recycling.

**Table 16.** Reasons to not participate in source separation.

When asked about the reasons for not practising recycling, time consuming was ranked as the most important consideration. Absence of an influencer at home, issues of convenience, and accessibility to the recycling/collection centre, as well as the lack of knowledge of recyclable wastes were also among the most selected reasons that set the barriers to recycling practice among the respondents (Table 15). A similar ranking of reasons (except for no home influencer) was revealed by respondents who did not participate in waste separation (Table 16).

When asked about action taken when facing uncertainty regarding the waste category, most of the respondents would place the item in the common trash and only a handful would refer to the online resources for reference (Table 17).


**6. Remdesivir (GS-5734)**

In 2009, Gilead Sciences, Inc. (USA) developed an antiviral drug called Remdesivir (RDV) to treat hepatitis B [48]. It did not indicate a desirable act against hepatitis. However, it is effective against other viruses, such as the Nipah virus, hepatitis C, and Marburg [49]. RDV is a broad-spectrum antiviral nucleoside analog, and

#### **Figure 2.**

*Common inhibitory action of antiviral drugs.*

#### *Antiviral Drugs and Their Roles in the Treatment of Coronavirus Infection DOI: http://dx.doi.org/10.5772/intechopen.101717*

now it is used as a treatment option for COVID-19 [50]. It is the class of polymerase inhibitors and showed activity against different RNA viruses, including SARS-CoV, MERS-CoV, Lassa fever virus, Junin virus, respiratory syncytial virus, Nipah virus, Hendra viruses, filoviruses, and Ebola viruses. RDV is a prodrug of its parent adenosine triphosphate analog, (2R,3R,4S,5R)-2-(4-aminopyrrolo(2,1-f)(1,2,4) triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)oxolane-2-carbonitrile (GS-441524), and has similarity to the adenine nucleic acid structurally. Both of these drugs are metabolized into the active component as nucleoside triphosphate (GS-443902) after ingestion and show antiviral activity against SARS-CoV [51]. RDV targets the viral genome replication process by acting as an RdRp inhibitor [52], RDV was used to block the RNA-dependent RNA polymerase of SARS-CoV-2. On metabolization of RDV into active nucleoside triphosphate (NTP), which competes with ATP for incorporation into nascent RNA strands, premature RNA synthesis occurs, resulting in RNA strand termination and cessation of growth [51]. RDV when tested through in vitro studies using the Vero E6 cells showed an EC50 value of 1.76 μM that showed its activity against SARS-CoV-2 [53]. Intravenous remdesivir treatment showed significant improvement for COVID-19. RDV and chloroquine are highly effective in the control of SARS-CoV-2 infection. In severe COVID-19 treated with RDV, improvements in the clinical finding were observed in 68% of patients [54]. However, in October 2020, the WHO removed it from the list of effective drugs in the treatment procedure of COVID-19 patients because it failed in the first trials for the treatment of COVID-19 [42]. There are still controversies regarding the results, no benefit in COVID-19 treatment using RDV; whereas, the company claims it as a promising drug for the same. After penetrating the cell, RDV as a prodrug (GS-5734) and like Favipiravir, binds to the triphosphate group under esterase, kinase, and phosphatase enzymatic reactions. These enzymes modify the structure of RDV and convert it to the active form, RDV-triphosphate (RDV-TP or GS-441524) [55]. After virus entry into the cell cytoplasm, this prodrug gets activated and loses its ability to diffuse to the intercellular space [53]. However, the primary mechanism of action of RDV against SARS-CoV-2 is unclear, and more research is necessary to understand it [56]. In an in vitro study, the combination of RDV and chloroquine (antimalarial drug) effectively inhibited SARS-CoV-2 growth in Vero E6 cells [19]. RDV is used to treat COVID-19 cases.

The combined use of RDV and IFN-β created a higher antiviral activity compared with the lopinavir/ritonavir-IFN-β combination against the MERS-CoV virus. Additionally, RDV could be better pulmonary function, cause fall lung viral loads and severe lung pathology in mice; on the contrary, lopinavir/ritonavir-IFN-β could not [57]. In two clinical studies, the use of RDV has been carried out against severe or mild respiratory infections caused by COVID-19. Recently, RDV for emergency use to treat COVID-19, including five antiviral drugs, ribavirin, RDV, sofosbuvir, galidesivir, and tenofovir, was conducted against SARS-CoV-2 RNA-dependent RNA polymerase (RdRp); these drugs showed promising results against COVID-19. Prominent adverse reactions were an acute respiratory failure, decreased glomerular filtration rate, lymphocytopenia, pyrexia, hyperglycemia, increased anemia, increased creatine, and liver transaminases. RDV given in combination with baricitinib (Janus kinase inhibitor used to hinder intracellular signaling of cytokines) was effective compared with RDV alone in terms of reducing recovery time additionally speeding improvement. RDV's parent nucleotide GS-441524 is superior and less toxic than its prodrug form and has shown efficacy [58].


**3. Strike-slip basins**

Strike-slip faults can accommodate localized compression or extension at continental margins, in island arcs, and also within continents. Sedimentary basins commonly develop where the fault kinematics are divergent with respect to the plate vector along strike-slip faults. Since the 1980s, various classifications of strike-slip basins have been formulated [4, 11, 36–40]. Common characteristics of strike-slip basins [4, 39] include: (1) elongated geometry, (2) asymmetry of both sediment thickness and facies pattern, (3) dominance of axial infilling, (4) coarser-grained marginal facies along the active master fault, (5) finer-grained main facies, (6) depocenter migration opposite to the direction of axial sediment transport, (7) very thick strata relative to the burial depth, (8) high sedimentation rate, (9) abrupt lateral and vertical facies changes and unconformities, (10) compositional changes that reflect horizontal movement of the prove‐ nance, (11) abundant syn-sedimentary slumping and deformation, and (12) rapid subsidence in the initial stage of basin formation.

**Figure 5.** Strike-slip basins at plate convergent margins. Red triangles, trench-linked; black squares, indent-linked; pur‐

Strike-Slip Basin – Its Configuration and Sedimentary Facies

http://dx.doi.org/10.5772/56593

33

**Figure 6.** Geometrical models of (A) a spindle-shaped fault-bend basin and (B) a rhomb-shaped stepover strike-slip basin. Colored areas indicate subsiding basins. (C) Multistage evolution of stepover basins. As a result of step-wise propagation of one of the master faults, a new basin (3) is created, but the pre-existing basins 1 and 2 become inac‐ tive, resulting in a long (high *l*/*w* ratio) strike-slip basin with progressive depocenter migration. Diagrams are modified

from [42]

ple circles, plate-boundary transform faults. Numbers correspond to those in Table 1

There are many strike-slip basins along plate convergent margins (Figure 5 and Table 1). Here I classify strike-slip basins into four types, discussed in turn below.

**Table 1.** Modern and ancient (\*) examples of strike-slip basins according to the types of strike-slip faults. Numbers correspond to those in Figure 5

**2.3. Plate-boundary transform zones**

modern examples of this type (Figure 4).

in the initial stage of basin formation.

Fault-bend basin Vienna Basin1

Fault-termination basin Yinggehai Basin15

correspond to those in Figure 5

**3. Strike-slip basins**

Plate-boundary transform faults develop between two plates rotating around the poles that define the relative motion between them [9]. The San Andreas Fault, Dead Sea Fault, Alpine Fault (New Zealand), and the northern and southern margins of the Caribbean Plate are

32 Mechanism of Sedimentary Basin Formation - Multidisciplinary Approach on Active Plate Margins

Strike-slip faults can accommodate localized compression or extension at continental margins, in island arcs, and also within continents. Sedimentary basins commonly develop where the fault kinematics are divergent with respect to the plate vector along strike-slip faults. Since the 1980s, various classifications of strike-slip basins have been formulated [4, 11, 36–40]. Common characteristics of strike-slip basins [4, 39] include: (1) elongated geometry, (2) asymmetry of both sediment thickness and facies pattern, (3) dominance of axial infilling, (4) coarser-grained marginal facies along the active master fault, (5) finer-grained main facies, (6) depocenter migration opposite to the direction of axial sediment transport, (7) very thick strata relative to the burial depth, (8) high sedimentation rate, (9) abrupt lateral and vertical facies changes and unconformities, (10) compositional changes that reflect horizontal movement of the prove‐ nance, (11) abundant syn-sedimentary slumping and deformation, and (12) rapid subsidence

There are many strike-slip basins along plate convergent margins (Figure 5 and Table 1). Here

Izumi Group\*3 St. George Basin\*4 Suwa Lake5

Salan Grande Basin10

Tokushima Plain20

**Table 1.** Modern and ancient (\*) examples of strike-slip basins according to the types of strike-slip faults. Numbers

**Trench-linked strike-slip faults Plate boundary transform**

Beppu Bay17 Gulf of California18

**faults**

Ridge Basin\*6 Death Valley7

Dead Sea Basin11 Cayman Trough12 Cariaco Basin13 Salton Trough14

I classify strike-slip basins into four types, discussed in turn below.

**Indent-linked strike-slip**

**faults**

Marmara Sea2

Stepover basin Thai Basin8 Matsuyama Plain9

Malay Basin16

Transpressional basin Aceh Basin19

**Figure 5.** Strike-slip basins at plate convergent margins. Red triangles, trench-linked; black squares, indent-linked; pur‐ ple circles, plate-boundary transform faults. Numbers correspond to those in Table 1

**Figure 6.** Geometrical models of (A) a spindle-shaped fault-bend basin and (B) a rhomb-shaped stepover strike-slip basin. Colored areas indicate subsiding basins. (C) Multistage evolution of stepover basins. As a result of step-wise propagation of one of the master faults, a new basin (3) is created, but the pre-existing basins 1 and 2 become inac‐ tive, resulting in a long (high *l*/*w* ratio) strike-slip basin with progressive depocenter migration. Diagrams are modified from [42]

#### **3.1. Fault-bend basins**

Fault-bend basins result from vertical displacement of normal faults in front of releasing bends corresponding to gentle transverse **R** (synthetic Riedel) faults connected to stepped master **Y** (principal displacement) faults (Figures 1 and 6A). The basin geometry is generally spindleshaped or lazy-Z-shaped in plan view [38]. This type is considered to represent an early stage of the evolution of a pull-apart basin [12].

#### **3.2. Stepover basins**

As the master faults continue to propagate, they overlap and pull the crustal blocks farther apart, with lengthening geometries that gradually change from lazy-Z-shaped fault-bend basins to rhomboid-shaped stepover basins (Figure 6B). The basins subside by extension along strike-slip fault systems where the sense of *en échelon* segment stepping coincides with the sense of the slip (i.e., right-stepping faults have dextral displacement). The term 'pull-apart basin' was originally introduced to explain a depression in the Death Valley whose sides were pulled apart along releasing bends or oversteps of faults [41]. According to the pull-apart mechanism, two sides of the basin are bounded by faults with primarily horizontal displace‐ ment, and the other two sides are bounded by listric or transverse faults.

Stepover basins generally maintain their length/width ratio [2], as expressed by the following relationship between the length (*l*) and width (*w*) of a pull-apart basin based on the dimensions of natural pull-apart basins (Figure 6):

$$
\log l = c\_1 \log w + \log c \tag{1}
$$

propagation of the master fault, accompanied by the creation of a new stepover basin, has

Strike-Slip Basin – Its Configuration and Sedimentary Facies

http://dx.doi.org/10.5772/56593

35

Very high *l*/*w* ratios can also result from continuous transtension leading to extreme thinning of the crust and rupture. This process induces magmatic activity, high heat flow, and then the generation of new oceanic crust that may be younger than the overlying sedimentary succes‐

Fault-termination basins are developed in transtensional stress domains at the ends of strikeslip faults where normal or oblique slip faults diffuse or splay off to terminate the deformation field [44]. If a part of a crustal block undergoes translation within the block, it results in shortening/uplift at one end and extension/subsidence at the other (Figure 7). Basins formed by such subsidence are referred to as fault-termination basins or transtensional fault-termi‐

Modern examples include the Yinggehai Basin (Song Hong Basin) along the Red River Fault zone [45], the Malay and Pattani basins in the Gulf of Thailand [46], several segmented basins in the Gulf of California [44, 47], the northern Aegean Sea [48, 49], and Beppu Bay along the

Transpressional basins tend to develop along oblique convergent margins whose subsidence results from flexural loading of the hanging-wall crust, similar to foreland basins adjacent to uplifted blocks [52–54]. Such basins are usually long, narrow structural depressions that lie

The Sumatra forearc basins are modern examples of this type. Uplift of outer arc highs bounded by trench-linked strike-slip faults may cause flexural subsidence on the forearc side and

The wide variability of strike-slip faults makes it difficult to develop a simple model of the formation of strike-slip basins and their sedimentary facies. Although the geometries of such basins depend on the amount of fault displacement, the angle and distance between overstep‐ ped faults, and the depth of detachment of the faults, the basins are generally elongate, narrow, and deep. Several representative examples of the strike-slip basins described in this section

resulted in the basins high *l*/*w* ratio (Figure 6C) [42].

sion (e.g., the Cayman Trough or the Gulf of California).

Median Tectonic Line (Figure 5 and Table 1) [50].

generate elongate wedge-shaped sedimentary basins.

show a range of basin evolutionary paths and filling processes.

**4. Examples of strike-slip basins**

**3.3. Fault-termination basins**

nation basins [44].

**3.4. Transpressional basins**

parallel to the master faults.

The best fitting constants have been found to be c1 = 1.0 and c2 = 3.2, which yield *l*/*w* ≈ 3.2 with a 95% confidence interval about the ratio of 2.4 < *l* / *w* < 4.3.

In sandbox experiments [42], a spindle-shaped basin appears in the first stage of basin evolution and is bounded by master **Y** faults and their synthetic Riedel (**R**) faults. Subsequently, antithetic Riedel (**R'**) faults replace **R** faults, leading to a rhomb-shaped basin. The *l*/*w* ratio depends on the angles α and β (Figure 6):

$$1/w = 1/\tan\alpha + 1/\tan\beta\tag{2}$$

The mean angle between **R** and **Y** faults in the experiments is *a* =*β* =30o ; that is, *l*/*w*=3.5. This value is consistent with those of natural basins.

As overlapped offsets of the master strike-slip faults propagate, basins elongate and finally become long pull-apart basins. The Dead Sea Basin, with a length of 132 km and a width of 18 km (*l*/*w*=7.2), is considered to have been formed by the coalescence of three successive and adjacent sedimentary basins whose depocenters migrated northward with time [43]. Although each sub-basin has a *l*/*w* ratio typical of a pull-apart basin (2.4, 3.3, and 2.6 from south to north), propagation of the master fault, accompanied by the creation of a new stepover basin, has resulted in the basins high *l*/*w* ratio (Figure 6C) [42].

Very high *l*/*w* ratios can also result from continuous transtension leading to extreme thinning of the crust and rupture. This process induces magmatic activity, high heat flow, and then the generation of new oceanic crust that may be younger than the overlying sedimentary succes‐ sion (e.g., the Cayman Trough or the Gulf of California).


*3.4. Anti-IL-17A mAbs*

Increased expression of the Th17-derived cytokine IL-17A has been observed in sputum, airway tissue biopsies, and serum from asthmatic patients [58–62] and was positively associated with a more severe asthma phenotype [59,63,64] and neutrophilic inflammation [65]. Considering that Th17-high patients are less sensitive or even unresponsive to ICS [59,66] and that asthma progression differs from more treatable Th2 types of the disease [67], developing an effective therapy targeting Th17/IL-17A axis would overcome a major unmet need in severe asthma.

A Phase II RCT [22] investigated the subcutaneously administered anti-IL-17A mAb CJM112 300 mg when added to existing therapy in patients with inadequately controlled moderate to severe asthma, with low serum IgE and BEC. The effect of CJM112 treatment on trough FEV1 was not different from PCB, but a significant (*p* < 0.05) improvement was observed in the ACQ6 score (mean difference (MD) −0.22 units (80%CI −0.41–−0.04)) and the ACQ7 score (MD −0.23 units (80%CI −0.40 to −0.06)) vs. PCB. A higher proportion of patients receiving CJM112 had a decrease of ≥0.5 units in the ACQ7 score compared with PCB (71.7% vs. 52.8%) [22].


**Abstract**

The paper considers the objects, subjects, purposes, tools, methods and implementation of information-psychological impact (IPI). It suggests a cellular automata model of the diffusion process of information-psychological impact in social networks, the hierarchy of the changes in the states of the subjects of information-psychological impact and the chart of transitions from state to state used in the cellular automaton algorithm. The suggested cellular automaton takes into account the effect of forgetting the information-psychological impact, as well as social and psychological parameters and probabilistic characteristics of the subjects of the social network. It therefore allows for the modelling of the diffusion of the information-psychological impact in the social network. The model can be used to determine the number of subjects affected by the information-psychological impact and the possibility of successful diffusion of the impact. The modelling of the suggested algorithm was performed. The results of the modelling are analysed in the paper.

**Keywords:** social network, information-psychological impact, negative information-psychological impact, positive information-psychological impact, cellular automata, diffusion, social and psychological parameters


**3.3 Summary**

Hyperlactatemia may be physiologic or pathologic. It can be caused by increased lactate production (i.e., an increase in the rate of glycolysis or unregulated substrate entry into glycolysis) as well as a decrease in its clearance (i.e., liver or renal insufficiency).

Common causes for type A hyperlactatemia include intense exercise or hypoxemia, anemia, systemic or regional hypoperfusion, shock, CO poisoning and impaired liver blood flow below 25%. This type is more common in postoperative patients.


**2. Epidemiology**

The incidence of meningitis in newborn period is so high that is incomparable to any other period in human life. Accurate determinations of incidence may not be possible due to lack of reporting by healthcare personnel and difficulties encountered by patients in access to healthcare institutions in economically underdeveloped countries. Nevertheless, it is estimated that 40,000–900,000 new cases of neonatal meningitis occur annually in these countries [1]. The incidence of neonatal meningitis, which is thought to be roughly one in 1000 live births, was reported to be 0.8–6.1 in 1000 live births in an article in which the results of 32 studies, carried out after 1990, have been reviewed [2].

A great progress has been made in this field of infectious diseases, at least in economically developed countries, with the decline of mortality rate from 50% of the past 40 years to that of 10–15% of today; however, almost no change has occurred in neonatal meningitis in terms of mortality in economically developing countries and morbidity worldwide [3]. The case fatality rate varies between 13 and 59% with respect to country of origin. Neurological sequelae, primarily hearing loss, continue to be an important problem with rates of 20–58% in the neonates who manage to survive this relentless disease [1, 4].

Turkey, once an economically developing country, where meningitis constitutes less than 1% of the reported causes of infant mortality, sets a good example of how natural health indices are affected favorably by slight increases in national income. According to the World Bank data, as of 2015, neonatal mortality rate in Turkey is seven per 1000 live births [an 80% decline from the rate (33) in 1990] [5, 6]. Yapıcıoğlu and colleagues reported the meningitis incidence as 1.4% among healthcare-associated infections in their university hospital's neonatal unit in Turkey [7].


**4. Saphenous vein graft failure**

Studies of saphenous veins harvested for bypass procedures have shown that many have abnormal histological and physical attributes. [23,24] Moreover, the quality of the saphenous vein can have significant clinical consequences. Therefore, vein grafts in the arterial circulation must be considered as a viable, constantly adapting and evolving conduit.

Several intrinsic and extrinsic factors may play a role in the mechanism of SVG failure. At the time of harvest, the quality of the saphenous veins may be poor, demonstrating a spectrum of pre-existing pathological conditions ranging from significantly thickened walls to post phlebitic changes and varicosities. Between 2% and 5% of saphenous veins are unusable and up to 12% can be considered diseased which reduce the patency rate by one half compared to non-diseased veins. [25] In addition, the inevitable vascular trauma that occurs during SVG harvesting itself can also lead to damage to the endothe‐ lium and SMC and thereby contribute to graft failure. Surgical manipulation and highpressure distension to reverse spasm during harvesting leads to loss of endothelial integrity and the antithrombogenic attributes of the endothelium, rendering the SVG prone to subsequent occlusive intimal hyperplasia and/or thrombus formation. [26] Dur‐ ing harvesting the vasa vasorum and nervous network of the SVG are devided, making the graft dependent on diffusion for weeks until adequate circulation is esthablished. [27-32] Ischemic insult and decreased production of nitric oxide and adenosine may cause SMC proliferation. [33] As it has been demonstrated that intimal hyperplasia does not occur in vein-to-vein isografts, it can be stated that pathologic changes seen in SVG in the arterial circulation are predominantly caused by hemodynamic and physiochemical changes. [34]

In a later stage atherosclerotic lesions may be complicated by aneurysmal dilatation which is found to correlate with thrombosed SVG. (66) The occurrence of atheroembo‐ lism form the diseased graft or plaque rupture may cause late thrombosis necessitating revascularization therapy. [57,58] In general, SVG thrombosis is the major cause of mor‐

Treatment of Coronary Artery Bypass Graft Failure

http://dx.doi.org/10.5772/54928

197

Predictors of graft patency 3 years after CABG were evaluated by Veterans Affairs Cooperative Study Group. [59] Multivariable analysis showed that the only factors that were predictive were vein preservation solution temperature ≤5ºC, serum cholesterol, the number of proximal anastomoses ≤2, and recipient artery diameter >5 mm. Thus, predictors of 3-year graft patency are most closely related to operative techniques and the underlying disease. In another study, factors that predict the late progression of SVG atherosclerosis were evaluated in 1248 patients in the Post-CABG trial. [47] Factors independently associated with the progression of disease were maximum stenosis of the graft at baseline angiography, years after CABG, moderate therapy to lower LDL cholesterol, prior MI, high triglyceride levels, small minimum graft diameter, low HDL concentration, high LDL concentration, high mean arterial pressure, low left ventricular ejection fraction, male gender, and current cigarette smoking. Finally, concerns have been raised about the possibility of worse outcomes when a SVG is used for multiple distal anastomosis compared to single anastomosis. In a substudy of the PREVENT IV trial, the use of SVG conduits with multiple distal anastomoses was associated with a significantly higher rate of ≥75 percent stenosis of the SVG on angiography at one year. [60] Moreover, clinical follow-up showed a trend towards a higher rate of the adjusted composite of death,

Noteworthy, the clinical impact of SVG failure is still debated. Not all grafts that have angiographic stenosis or occlusion will cause symptoms, and probably a substantial of SVG

Several arterial conduits are suitable for myocardial revascularization and the arterial conduits can be divided into 3 types according to functional class (Table 1). Type I arterial grafts are the somatic arteries including the IMA, IEA, and subscapular artery. Type II arterial grafts are the splanchnic arteries including the GEA, splenic artery, and inferior mesenteric artery. Type III arterial grafts are the limb arteries including the RA, ulnar artery, and lateral femoral circum‐ flex artery. Compared to functional class type II and III, type I is less spastic. [61] Although the full length of arterial grafts is reactive, the major muscular components are located at the two ends of the artery (muscular regulator). [62] Therefore, in terms of preventing vasospasm of arterial grafts, trimming off the small and highly reactive distal end of the grafts (IMA, GEA,

Studies have demonstrated that there are differences between arterial and venous grafts: 1) arterial grafts are less susceptible to vasoactive substances then veins [63]; 2) the arterial wall

bidity and mortality. [19,41]

MI, or revascularization at five years.

that fail do not impact outcomes.

**5. Histology of arterial grafts**

IEA, or other grafts) may be important and clinically feasible.

SVG failure can be divided into three temporal categories: early (0 to 30 days), midterm (30 days to 1 year) or late (after 1 year). Early SVG failure due to thrombotic complica‐ tions is mainly attributable to technical errors during harvesting, anastomosis or com‐ prised anatomic runoff. [19,35-37] It occurs in 15% to 18% of VG during the 1st month. [38-40] Early thrombotic complications in SVG in the arterial circulation are caused by a reduction of tissue plasminogen activator, attenuation of thrombomudulin and reduced expression of heparin sulphate. [41]

Midterm SVG failure is mainly caused by fibrointimal hyperplasia as it serves as the founda‐ tion for subsequent graft atheroma leading to occlusive stenosis. The release of a variety of mediators, growth factors, and cytokines by the injured endothelium, platelets and activated macrophages will cause migration and proliferation of SMC. Diminished production of endothelial nitric oxide (NO), prostaglandin 12 and adenosine will further contribute to and enhanced SMC proliferation, leading to development of neointimal hyperplasia. [19,33,37,42-44] Changes in the flow pattern within the vessel (shear stress) an ischemic insults may contribute to changes in the SVG at this stage. SVG are exposed to much higher mechanical pressure that they were adapted to (arterial versus venous blood pressure) which can poten‐ tially stimulate SMC proliferation. Moreover, after encountering arterial flow patterns increased levels of intracellular adhesion molecule-1, vascular cell adhesion molecule-1, and monocyte chemotactic protein-1 will facilitate leukocyte-endothelial interactions so that leukocyte infiltration of the lesions will ensue. [34] Finally, the adaptive response to hemody‐ namic factors, i.e. wall shear stress, may affect the distal site of the anastomosis leading to SVG failure. [45,46] Midterm SVG failure accounts for an additional 15% to 30%. [47,48] In the course of vessel remodelling, late SVG failure is characterized by progression of intimal fibrosis at the cost of a reduction in cellularity which may contribute to progression of SMC apoptosis. [19,34,41,44] In addition, perivascular fibroblasts may also be involved in neointimal formation and matrix deposition as these cells may exhibit contractile elements while migrating from the adventitia towards the media. [49] After 1 year most SVG stenosis is due to atherosclerosis but although vein graft atherosclerosis is accelerated compared to arteries, evidence show that a fully evolved plaque appear after 3 to 5 years of implantation. [35,47,50] In SVG there is no focal compensatory enlargement in the stenotic segments which is in contrast to native atherosclerotic arteries in which the development of an atherosclerotic plaque is associated with enlargement of the vessel and preservation of the lumen area until plaque progression exceeds the compensatory mechanism of the vessel. [51] Several studies show that SVG patency at 10 years is no more than 50% to 60%. [19,41,52,53] Finally, several studies have suggested a role of immune cells in neointimal formation as macrophages are found in the intima, while T-lymphocytes are present in the adventitia of neointimal lesions wit a predom‐ inance of CD4+ cells. [54-56]

In a later stage atherosclerotic lesions may be complicated by aneurysmal dilatation which is found to correlate with thrombosed SVG. (66) The occurrence of atheroembo‐ lism form the diseased graft or plaque rupture may cause late thrombosis necessitating revascularization therapy. [57,58] In general, SVG thrombosis is the major cause of mor‐ bidity and mortality. [19,41]

Predictors of graft patency 3 years after CABG were evaluated by Veterans Affairs Cooperative Study Group. [59] Multivariable analysis showed that the only factors that were predictive were vein preservation solution temperature ≤5ºC, serum cholesterol, the number of proximal anastomoses ≤2, and recipient artery diameter >5 mm. Thus, predictors of 3-year graft patency are most closely related to operative techniques and the underlying disease. In another study, factors that predict the late progression of SVG atherosclerosis were evaluated in 1248 patients in the Post-CABG trial. [47] Factors independently associated with the progression of disease were maximum stenosis of the graft at baseline angiography, years after CABG, moderate therapy to lower LDL cholesterol, prior MI, high triglyceride levels, small minimum graft diameter, low HDL concentration, high LDL concentration, high mean arterial pressure, low left ventricular ejection fraction, male gender, and current cigarette smoking. Finally, concerns have been raised about the possibility of worse outcomes when a SVG is used for multiple distal anastomosis compared to single anastomosis. In a substudy of the PREVENT IV trial, the use of SVG conduits with multiple distal anastomoses was associated with a significantly higher rate of ≥75 percent stenosis of the SVG on angiography at one year. [60] Moreover, clinical follow-up showed a trend towards a higher rate of the adjusted composite of death, MI, or revascularization at five years.

Noteworthy, the clinical impact of SVG failure is still debated. Not all grafts that have angiographic stenosis or occlusion will cause symptoms, and probably a substantial of SVG that fail do not impact outcomes.


Cartilage Disorders - Recent Findings and Treatment

*Edited by Karl Almqvist, Ahmed Ebrahim El Hamaky and Taiceer Abdulwahab*

Published in London, United Kingdom

Cartilage Disorders - Recent Findings and Treatment http://dx.doi.org/10.5772/intechopen.100973 Edited by Karl Almqvist, Ahmed Ebrahim El Hamaky and Taiceer Abdulwahab

#### Contributors

Anell Olivos-Meza, Mats Brittberg, Carlos Suárez-Ahedo, Carlos Landa-Solis, N'Dre Jean, Hamideh Salehi, Marie Maumus, Danièle Noël, Yolande Koffi-Gnagne, Frédéric Cuisinier, Chao Zhou, Qi Heng Chen, Zhanzhen Li, Xin Wang, Jiang Peng, Changlong Yu, Alberto Gobbi, Katarzyna Herman, Dawid Szwedowski, Taiceer Abdulwahab, Prashant Meshram, Philippe Landreau, Karl Almqvist, Antoine Catteeuw

#### © The Editor(s) and the Author(s) 2023

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#### Notice

Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book.

First published in London, United Kingdom, 2023 by IntechOpen IntechOpen is the global imprint of INTECHOPEN LIMITED, registered in England and Wales, registration number: 11086078, 5 Princes Gate Court, London, SW7 2QJ, United Kingdom

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Cartilage Disorders - Recent Findings and Treatment Edited by Karl Almqvist, Ahmed Ebrahim El Hamaky and Taiceer Abdulwahab p. cm. Print ISBN 978-1-83769-984-1 Online ISBN 978-1-83768-204-1 eBook (PDF) ISBN 978-1-83768-205-8


*2.4.4 Management*

## *<IP_ADDRESS> Biological control*

The use of predatory mites as biological control agent of citrus thrips is well documented. The most important predacious mites recommended against citrus thrips are phytoseiid mites: *Euseius tularensis* Congdon and *E. hibisci* (Chant) (Acari: Phytoseiidae) and anystid mite: *Anystis agilis* Banks (Acari: Anystidae). These species can be conserved and released in mature citrus orchards and scarring of citrus fruits can be minimized [204–209]. Some other predacious mite species such as *Iphesius* (= *Amblyseius*) *degenerans* Berlese, *Neoseiulus barkeri* (Hughes) (Hughes) (= *Amblyseius mckenziei*), and *N. cucumeris* (Acari: Phytoseiidae) can be used as potential biological control agents against immature thrips in citrus nursery [210]. Another predatory mite *Gaeolaelaps aculeifer* (Acari: Laelapidae) has been shown to successfully reduce the infestation of thrips in commercial citrus orchards of Valencia, eastern Spain after the augmentative release [211].

#### **Figure 3.**

*Citrus fruit (Kinnow mandarin) infested by thrips showing scarring mark as one of the diagnostic damage patterns. Photograph by Bodil N. Cass, Department of Entomology and Nematology, University of California, Davis, USA.*

#### *Ecology, Biology, Damage, and Management of Sucking and Chewing Insect Pests of Citrus DOI: http://dx.doi.org/10.5772/intechopen.109846*

The use of natural insect predators is advocated for the control of thrips in citrus orchards in different regions of the world. Among the generalist predators of thrips, *Orius insidiosus* (Say) (Hemiptera: Anthocoridae) commonly known as minute pirate bug is an aggressive and voracious predator of thrips adults and nymphs in citrus [173, 179, 212, 213]. Some other generalist thrips predators known are chrysopids, coccinellids, and mirids [214]. Two predatory thrips species *Karnyothrips flavipes* (Jones) and *Leptothrips* spp. have been identified and are known to attack thrips in citrus in Florida, USA [215].

#### *<IP_ADDRESS> Chemical control*

Complete thrips control in citrus orchards cannot be obtained merely by biological control agents; therefore, application of different insecticides for the suppression of thrips population below economic damaging levels is unavoidable. The insecticides from organophosphorus (OP), pyrethroids, and new chemical groups are recommended for thrips control. Spray with systemic insecticides at pre-flowering or post-flowering stage is recommended. Dimethoate, a systemic and broad-spectrum OP insecticide, is highly recommended and widely used insecticide against thrips in citrus orchards. It is applied before petal fall when less than 10% buds have opened. Its application on nursery plants is not recommended; however, mature fruits can be sprayed only twice with this insecticide. Among the pyrethroid group insecticides, one application of cyfluthrin or fenpropathrin (broad spectrum) in a year is recommended in the citrus orchards to trees ≤3 years of age. Application of two different pyrethroid insecticides in sequence must be avoided in order to minimize the resistance development. OP and pyrethroid insecticides should be used in rotation as a part of insecticide resistance management tactic. In California, chemical control is initiated when 75 percent petal-fall is complete. In order to minimize the impact of insecticides on natural enemies, and to reduce the resistance development against OP and pyrethroid insecticides, some botanical or microbial nature insecticides such as sabadilla, abamectin, and spinosad should be used for spray. Among the new chemistry insecticides, imidacloprid, acetamiprid, and thiamethoxam from neonicotinoid group and chlorfenapyr from pyrroles group are also recommended against citrus thrips [177, 216–219].


**Preface to "Surface Water Quality Modelling"**

This Special Issue showcases some advanced methodologies used in surface water quality modelling. Its aim is to introduce several topics that are new in the field of surface water quality modelling and help spur new developments in each of the topics. It is intended for a readership consisting of researchers, academicians, consultants and government agency representatives. The editor of this Special Issue wishes to thank all authors, reviewers and academic editors in their contributions, without whom the publishing of this collective work would not have come to pass.

> **Karl-Erich Lindenschmidt** *Editor*