**2.3 Surgical procedure**

The Femto-ALK surgical technique has been realized in two surgical steps:

The first step was performed in the laser room where a femtosecond laser cut was created on both donor and receiving cornea(Figure 2). In the second step, performed in the surgery room, the donor lamella was sutured into the receiving stromal bed with 16 radial 10/0 nylon stitches.

To realize the donor lamella, the cut was performed on an entire donor cornea, analyzed and delivered by an ocular tissue bank, positioned on an artificial anterior chamber (Moria, France). Mean lamellar diameter was 8.34mm ± 0.28 SD (range: 8.2 - 8.7mm), and mean lamellar thickness was 353.91µm ± 38.82SD (range: 220 - 400µm). The donor button has been planned thicker than the amount of receiving cornea removed, in way to restore a normal corneal thickness (at least 550 micron), and 0.2 mm larger, in way to avoid too much corneal compression with the sutures and to evade the risk of anterior chamber (AC) reduction after surgery.

Fig. 2. Femtosecond laser cut on recipient bed after docking on the cornea of the patient.

Femtosecond Laser Assisted Lamellar Keratoplasties 81

Analyzing all our cases with the confocal microscopy analysis (Confoscan4), we found that this unsatisfactory visual results were mostly related to the excessive thickness of residual stromal bed (150 microns or more), resulting in a irregular stromal interface (Fig. 4) with dark folds before suture removal (published on "Cornea 2008 Jul; 27(6): 668-72"); few months after suture removal, these findings disappeared gradually with a parallel increase of the BSCVA, setting to 0.64 Snellen at 12 months of follow-up. At two years of follow up the mean BSCVA resulted increased to 0.74 ± 0.18SD. After a three years of follow-up, these visual results resulted quite similar (mean UCVA of 0.48 ± 0.13SD and mean BSCVA of 0.78 ± 0.13SD), confirming the stability of the outcomes during time and the validity of the Femto-ALK technique (Figure 3) and confirming that, comparing to penetrating

keratoplasty (PK), lamellar keratoplasty need more time to stabilize the results.

Fig. 4. Femto-ALK results: a. slit lamp examination 3 months after surgery shows a clear graft with sutures still on; b. Confoscan 4 confocal microscopy analysis at three months shows dark folds of the residual bed stroma related to the slow visual recovery; c. Six months postoperatively slit lamp shows a clear graft and confocal analysis (d) shows

After the quite unsatisfactory results obtained with the Femto-ALK technique, in keratoconic cases, We designed a new surgical technique trying to duplicate the superior results obtained with the descemetic and pre-descemetic DALK techniques: the femtolaser-assisted DALK. Deep Anterior Lamellar Keratoplasty (DALK) has the target of removing all the pathological stromal tissue, maintaining only the Descemet/endothelium layers in the recipient bed,

disappearance of the stromal folds and a healthy endothelium.

**3. Deep Anterior Lamellar Keratoplasty (DALK)**

Under topical anaesthesia (Ossibuprocaine 4% drops for 4 times), a disposable suction ring was positioned at the sclero-limbal margin to stabilize the eye. After the docking, the femtosecond laser cut (Figure 2) on receiving corneal stroma was performed to leave at least 200µm residual stromal bed (mean stromal cut deepness of 243.91µm ±51.59SD, with a mean diameter of 8.13mm ±0.37 SD, and mean residual stromal bed of 181.61µm ± 57.78SD).

After stromal laser cut execution, the patient was carried in the surgery room where the corneal button was removed with a blunt spatula leaving the clear stromal residual bed. Then, the donor lamella was first secured in the recipient bed with four 10/0 nylon cardinal sutures at the 6, 12, 9 and 3 o'clock positions, and subsequently it was sutured with twelve more 10/0 nylon radial stitches. Intraoperatively, corneal astigmatism was evaluated with a corneal disposable keratometer, (Janach, Como, Italy) and suture adjustment, if required, was performed. At the end of surgery, a soft contact lens was placed on the eye surface to help restoring of corneal epithelium. Topical antibiotics (Nethylmicine), steroids (Desamethasone 0.18%) and artificial tear drops (Hyaluronate sodium 0.2%) were applied several times a day, and then tapered and titrated, basing on the corneal transparency and scarring of the surgical wound.

The surgical plannings have been realized in all cases basing on the accurate preoperative pachymetric values found with optical pachymetry (Confoscan 4, Nidek technologies, Tokyo, Japan; and Orbscan II, Bausch & Lomb, CA, USA).

In all the cases performed, the surgery restored a clear cornea from the first week after surgery with an interface hard to detect at the slit lamp examination.

The postoperative corneal thickness (mean corneal pachymetry: 542.48µm ± 33.20SD), curvature (mean K reading: 44.32D ± 13.50SD) and shape resulted nearer to physiologic values. Nevertheless, the results in visual acuity obtained with the Femto-ALK were not so brilliant as planned, especially in the keratoconic eyes, with a very slow recovery time. Three months after surgery, mean BSCVA was 0.30, increasing to 0.40 after complete suture removal six months later, and stabilizing 12 months postoperatively to 0.64 (the Figure 3 showed the BSCVA during follow-up).

Fig. 3. Visual acuity results three years after Femto-ALK. The yellow star marks the mean removal suture period.

Under topical anaesthesia (Ossibuprocaine 4% drops for 4 times), a disposable suction ring was positioned at the sclero-limbal margin to stabilize the eye. After the docking, the femtosecond laser cut (Figure 2) on receiving corneal stroma was performed to leave at least 200µm residual stromal bed (mean stromal cut deepness of 243.91µm ±51.59SD, with a mean diameter of 8.13mm ±0.37 SD, and mean residual stromal bed of 181.61µm ± 57.78SD). After stromal laser cut execution, the patient was carried in the surgery room where the corneal button was removed with a blunt spatula leaving the clear stromal residual bed. Then, the donor lamella was first secured in the recipient bed with four 10/0 nylon cardinal sutures at the 6, 12, 9 and 3 o'clock positions, and subsequently it was sutured with twelve more 10/0 nylon radial stitches. Intraoperatively, corneal astigmatism was evaluated with a corneal disposable keratometer, (Janach, Como, Italy) and suture adjustment, if required, was performed. At the end of surgery, a soft contact lens was placed on the eye surface to help restoring of corneal epithelium. Topical antibiotics (Nethylmicine), steroids (Desamethasone 0.18%) and artificial tear drops (Hyaluronate sodium 0.2%) were applied several times a day, and then tapered and titrated, basing on the corneal transparency and

The surgical plannings have been realized in all cases basing on the accurate preoperative pachymetric values found with optical pachymetry (Confoscan 4, Nidek technologies,

In all the cases performed, the surgery restored a clear cornea from the first week after

The postoperative corneal thickness (mean corneal pachymetry: 542.48µm ± 33.20SD), curvature (mean K reading: 44.32D ± 13.50SD) and shape resulted nearer to physiologic values. Nevertheless, the results in visual acuity obtained with the Femto-ALK were not so brilliant as planned, especially in the keratoconic eyes, with a very slow recovery time. Three months after surgery, mean BSCVA was 0.30, increasing to 0.40 after complete suture removal six months later, and stabilizing 12 months postoperatively to 0.64 (the Figure 3

**Mean Visual Acuity**

**0,08**

**0,05 0,09**

**0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 0,9 1**

**Snellen**

removal suture period.

**0,13**

**0,29 0,25**

**0,18**

**Preop 1 3 6 9 12 24 36**

Fig. 3. Visual acuity results three years after Femto-ALK. The yellow star marks the mean

**0,35**

**0,23**

**0,45**

**0,45**

**0,65**

**0,46 0,48**

**0,74 0,78**

**UCVA BCVA**

scarring of the surgical wound.

showed the BSCVA during follow-up).

Tokyo, Japan; and Orbscan II, Bausch & Lomb, CA, USA).

surgery with an interface hard to detect at the slit lamp examination.

Analyzing all our cases with the confocal microscopy analysis (Confoscan4), we found that this unsatisfactory visual results were mostly related to the excessive thickness of residual stromal bed (150 microns or more), resulting in a irregular stromal interface (Fig. 4) with dark folds before suture removal (published on "Cornea 2008 Jul; 27(6): 668-72"); few months after suture removal, these findings disappeared gradually with a parallel increase of the BSCVA, setting to 0.64 Snellen at 12 months of follow-up. At two years of follow up the mean BSCVA resulted increased to 0.74 ± 0.18SD. After a three years of follow-up, these visual results resulted quite similar (mean UCVA of 0.48 ± 0.13SD and mean BSCVA of 0.78 ± 0.13SD), confirming the stability of the outcomes during time and the validity of the Femto-ALK technique (Figure 3) and confirming that, comparing to penetrating keratoplasty (PK), lamellar keratoplasty need more time to stabilize the results.

Fig. 4. Femto-ALK results: a. slit lamp examination 3 months after surgery shows a clear graft with sutures still on; b. Confoscan 4 confocal microscopy analysis at three months shows dark folds of the residual bed stroma related to the slow visual recovery; c. Six months postoperatively slit lamp shows a clear graft and confocal analysis (d) shows disappearance of the stromal folds and a healthy endothelium.


**Author details**

Katherine Dunster

Address all correspondence to<EMAIL_ADDRESS>
School of Horticulture, Urban Ecosystems Program, Kwantlen Polytechnic University, Surrey, BC, Canada


**Solar-Powered Desalination**

## Emrah Deniz

**References**

88 Desalination Updates

3, p. 130.

[1] Korovin, S.S., Bukin, V.I., Federov, P.I., et al., Redkie i rasseyannye elementy (Rare

[2] Zelikman, AN. and Meerson, G.A., Metallurgiya redkikh metallov (Metallurgy of

[3] Krcmenetskii, A.P. and Shaderman, F.I., Two ways to wealth, Met. Evrazii, 2000, no.

[4] Palant, A.A., Troshkina, D., and Chekmarev, A.M., Metallurgiya reniya (Metallurgy

[7] Levin, V.Ya., Antonova, L.G., Samsonov, A.V., et al., Geology and specific features of ore genesis in the Yuzhno-Shamciskoe. molybdenum deposit in the Middle Urals,

[8] Gillerbrand, V.F., Prakticheskoe rukovodstvo po neorganicheskomu analizu (Practi‐

[9] Vatolin, N.A., Khalezov, B.D., Kharin, E.I., and Zelenin, E.A., Rhenium recovery from molybdenum concentrates and industrial products: state of the art and out‐ looks, "Fundamental'nye i prikladnye problemy nauki, " Trudy I Mezhdunarodnogo simpoziuma, (Proc. 1st Int. Symp. on Fundamental and Applied Problems of Sci‐

[10] Vitolin, N.A., Khalezov, B.D., Lobanov, V.G., and Zelenin, E.A., RF Patent 2393253.

[5] Zelikman, AN., Molibden (Molybdenum), Moscow: Metallurgiya, 1970.

[6] Lebedev, K.B., Renii (Rhenium), Moscow: Metallurgizdat, 1963.

cal Guide to Inorganic Analysis), Moscow: Goskhimizdat, 1960.

Geol. Rudn. Mestoroz)\d., 1995, vol. 37, p. 530.

and Dispersed Elements), Moscow: MISiS, 2003, vol. 3.

Rare Metals), Moscow: Metallurgiya, 1973.

of Rhenium), Moscow: Nauka, 2007.

ence), Moscow, 2010, vol. 2, p. 132.

Byull. Izobr., 2010, no. 18.

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/60436

#### **Abstract**

Drinkable fresh water, being a fundamental need of human beings, has become a serious concern for people especially living in crowded cities and countries with limited amount of water resources. Supplying fresh water is an energy intensive task especially when there is need for heating cold water to evaporate for distillation. Most of the big desalination plants around the world use fossil-based fuels as energy source to heat and vaporize the sea water or brackish water in order to produce fresh water.

However, environmental concerns along with decreasing oil reserves and increasing fuel costs call for reconsideration on the fuel types used in many areas as well as in desalination or distillation processes. There are a number of well-known alternative and renewable energy sources in the world like wind, geothermal, solar, biomass, etc. but achievability, availability when needed and energy storage are also very critical issues to operate the distillation plant effectively.

Since most of the desalination processes run on heat, solar energy can be used directly as heat source. Complex desalination systems which are all designed to improve the thermal efficiency and freshwater yield/productivity use many approaches such as multiple stage operation, pre-heating the feed water with the condensation energy, using additional heat sources (waste water from another process), concentrating solar energy to improve the operation temperature of the process, etc.

Solar desalination systems can be a good solution to the water scarcity, especially the Sunbelt region. However, dominant use of clean and renewable energy sources for desalination process and replacing the fossil fuel–based operations require more R&D studies to find more efficient and/or less costly power plants with continuous operation by the means of energy storage solutions.

**Keywords:** Desalination, solar energy, distillation, water scarcity, desalination methods

© 2015 The Author(s). Licensee InTech. 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, provided the original work is properly cited.

### **1. Introduction**

Freshwater and energy are two inseparable and essential commodities for sustaining human life on earth. Rapid population growth and industrialization, especially in developing countries in the recent past, have placed pressing demands for both freshwater and energy [1]. Both are to be conserved and preserved for the sustainable development of the world. On the other hand, there is an acute shortage of both energy and water, especially in the third world countries [2]. Only less than 1% of the water is available for the society for direct use, out of which the maximum fraction has been polluted due to non-manageable industrial develop‐ ments [2].

Due to the fast increase in the world population, the need for the energy increases rapidly. Various studies have been made to meet this extra energy demand. Most of these studies were focused on alternative energy sources. Solar energy is one of the most popular ones of these sources due to relatively less installation cost and long operation time without any need for maintenance [3]. Basically, all forms of the energy in the world, as we know it, are solar in origin. Oil, coal and natural gas is originally produced by photosynthetic processes, followed by complex chemical reactions, in which decaying vegetation was subjected to temperature and pressure over a long period of time [4].

Solar energy is so powerful and abundant that 30 min of solar radiation falling on earth is equal to the world annual energy demand. It is also cheap, environment friendly and nearly inexhaustible. Most of the world receives powerful solar radiation and has a good chance and opportunity to benefit from solar energy [3].

All ecosystems and every field of human activity depend on clean water and it is one of the most precious resources in today's world. Water is a primary need for life, health and sanita‐ tion, which brings it into the international agenda as a very important issue [2]. The lack of potable water poses a big problem in arid regions of the world where freshwater is becoming very scarce and expensive. Clean drinking water is one of the most important international health issues today [5]. Remote and arid to semi-arid regions depend on underground water for drinking. Unfortunately, underground water is not always considered to be fresh drinking water. In some instances, the salinity is too high for being drinkable, and it is called brackish water. In such cases, fresh water has to be either transported for long distances or connected with an expensive distribution water network at extremely high cost for, usually, a small population. Solar desalination can be a good solution for such a problem [6].

Desalination is one of mankind's earliest forms of water treatment, and it is still a popular treatment solution throughout the world today [5]. Distillation is one of the oldest and most rustic desalination techniques. In fact, it reproduces the natural process of the industrial desalination. Solar distillation is a thermal process that represents a sustainable solution to water shortages in the world. The desalination technique by solar energy, based on the principle of greenhouse is not new. Solar energy coupled to desalination offers a promising prospect for covering the fundamental needs of power and water in remote regions, where connection to the public electric grid is either not cost effective or not feasible, and where the water scarcity is severe [5].


**5. Results and Discussion**

*5.1. Performance Analysis of the Harvester*

On obtaining the voltage time-history data through wind tunnel experiments, the root mean square (RMS) value of voltage *VRMS* can be calculated:

$$V\_{RMS} = \sqrt{\frac{1}{T\_2 - T\_1} \int\_{T\_1}^{T\_2} u(t)dt} \tag{12}$$

Accordingly, the mean power *P* can be obtained as:

$$P = \frac{1}{T\_2 - T\_1} \int\_{T\_1}^{T\_2} \frac{u(t)^2}{R\_L} dt \tag{13}$$

in which *T2* and *T1* are the start and end time during the acquisition period, respectively, *RL* is the external load resistance, and *u*(*t*) is the instantaneous voltage.

Figure 6 displays the results of the RMS voltage and mean power output by connecting various load resistances from 10 kΩ to 1 MΩ in the PVDF film in the wind speed range of 3–10 m/s. It can be seen in Figure 6a that under the same load resistance, the wind speed continues to increase, and the output RMS voltage has an obvious upward trend. The minimum RMS voltage recorded under a load resistance of 10 kΩ is 350 mV. In addition, the output RMS voltage of this resistance model is relatively small. In the wind speed range of 3–10 m/s, the output RMS voltage steadily increased from 350 mv to 0.14 V. The highest RMS voltage recorded under the load resistance of 1 MΩ was 2.96 V. It can be found from Figure 6b that in the wind speed range of 3–10 m/s, the rising trend of output power was similar to the rising trend of RMS output voltage. When the wind speed was 10 m/s, the maximum load resistance of 200 kΩ in this experiment was 12.1 μW. The results indicate that when the load resistance is constant, as the input air speed increases, the voltage and power between the load resistances increase almost in advance.

**Figure 6.** (**a**) Output voltage and (**b**) power with different wind speed.

According to the RMS voltage and output power calculated by Formulas (12) and (13), the power density and voltage density per scanning volume, which are defined as the power value and RMS voltage value divided by the volume of piezoelectric film, were calculated. In the analysis that followed, the load resistance first had to be matched to evaluate the harvesting performance. Figure 7 displays the change of output voltage density and power density with load resistance under different wind speeds. Figure 7a shows that the overall output trend of the measured voltage density increases with the increase of resistance within a certain wind speed range, and the maximum voltage density is 29.1 V/mm3. Figure 7b shows that within a certain range, the overall output power trend of the measured power density at all wind speeds increases as the resistance increases. The optimal value of the load resistance for different wind speeds is between 100 kΩ and 430 kΩ. Outside this load resistance range, the average power generated is significantly reduced. After intensive testing, it was found that when the load resistance is about 200 kΩ, it provides the highest output average power. Therefore, *R0* = *RL* = 200 kΩ is the optimal electrical load resistance, and this result will be used for the efficiency of the energy harvester in the subsequent experimental discussion when the load resistance is 200 KΩ, and the power density is 119.7 μW/mm3. Previous studies have pointed out that there is an optimal resistance *R0* for the best collection efficiency. Neglecting the effects of damping and dielectric loss, the optimization resistance can be determined as [36]:

$$R\_0 = \frac{1}{2\pi fC} \tag{14}$$

where *C* is the harvester capacitance and *f* is the vibration frequency.

**Figure 7.** (**a**) Output voltage density and (**b**) power density with different load resistance.

To further explore the working performance of the harvester, it was necessary to analyze the piezoelectric film dynamics characteristics. Figure 8 displays the time history of the output voltage with a load resistance of 300 kΩ at a wind speed of 3–7 m/s. As demonstrated, the voltage signal fluctuates periodically for each case associated with a fixed wind speed, and the amplitude of the voltage increases distinctly as the wind speed increases (from 0.14 V to 1.12 V). Apparently, the periodic variation of output voltage is attributed to the periodic evolution of the strain around the fix end of the cantilever beam. Because the galloping amplitude increases consistently with the increase of wind speed, the strain becomes larger for the cases with stronger incoming wind, which further leads to higher output voltage.

**Figure 8.** Diagram of Voltage time history (*RL* = 100 kΩ).


4. Case study of the application of biomonitoring for the assessment of the ecosystem health in the Swartkops River

This case study illustrates the application of biomonitoring in the Swartkops River using the South African Scoring System version 5.


**3. Perception of soundscapes**

Sound, as a landscape element, has not received much interest in landscape design and planning compared to vision. Listening to an environment is generally not the primary activity or interest of a person (Jennings & Cain, 2012); however information provided by the visual landscape play a great role in realizing our daily activities. The concept of soundscape has recently gained attention of planning and design disciplines where focus is generally on the visual aspect, rather than the acoustic. One of the reasons might be that most of the time designers' and planners' lack of scientific knowledge on acoustics. Concepts like "weighted sound levels", "absorption coefficient", and logarithmic measurements may seem unfamiliar and intimidating. Although noise mapping is quite a popular tool in environmental assessment studies, sound is rarely considered as a design element in landscape. Sound does not literally mean "noise". While some sounds can be disturbing, some sounds can give pleasure to an individual. However, sound as a sensory experience is rather different from vision. Acoustic space does not have obvious boundaries and is less precise in terms of orientation and localization (Porteous, 1996). Therefore assessment of sound as a design element is much complex than the visual dimension. Sound is an important element of a place which affects individual's perception and understanding of an environment. People derive information from sounds, just like visual environment. Sound can act as a guide for way finding or a cautionary signal for alert. In the context of space, soundscape can be defined as the acoustic character of an environment.

Urban environments are diverse and complex acoustic environments. They include different kinds of sound resources. Therefore, outdoor acoustic environment studies are mostly concerned with urban soundscapes. Evaluation of urban soundscapes is crucial not only for noise mitigation but also to assessment of acoustic comfort which is integral to overall environmental quality.

The term of soundscape was first coined by R. Murray Schafer. In his book "The Tuning of the World" (1977), he describes the soundscape as any acoustic field of the study; it may be a musical composition or a radio program or an acoustic environment. Influenced by Gestalt figure-background relationship (see section 2.2.6), Schafer identified three elements of a soundscape; (i) keynote sounds, (ii) sound signals, and (iii) soundmarks. Keynote sounds are background sounds and can be perceived subconsciously. Schafer suggests keynote sounds might have an effect on our behavior and moods since they are permanently there, whether we hear them consciously or not. Traffic sound is often given as a keynote example for contemporary urban environments. Sound signals, are foreground sounds and are listened to consciously (e.g. sirens). Finally, soundmarks (derived from landmark) are unique to that environment or to people in the community, thus they need to be protected. These elements have established a foundation for many soundscape studies so far.

The most noticeable study on the relationship between landscape architecture and soundscape is Hedfors's (2008) book "Site Soundscapes: landscape architecture in the light of sound". In his book, he analyzes sound in context of landscape architecture. He suggests a hypothetical model, named "the model of prominence" as a starting point for

provide landscape architects to improve their place-making strategies in terms of design and

Sound, as a landscape element, has not received much interest in landscape design and planning compared to vision. Listening to an environment is generally not the primary activity or interest of a person (Jennings & Cain, 2012); however information provided by the visual landscape play a great role in realizing our daily activities. The concept of soundscape has recently gained attention of planning and design disciplines where focus is generally on the visual aspect, rather than the acoustic. One of the reasons might be that most of the time designers' and planners' lack of scientific knowledge on acoustics. Concepts like "weighted sound levels", "absorption coefficient", and logarithmic measurements may seem unfamiliar and intimidating. Although noise mapping is quite a popular tool in environmental assessment studies, sound is rarely considered as a design element in landscape. Sound does not literally mean "noise". While some sounds can be disturbing, some sounds can give pleasure to an individual. However, sound as a sensory experience is rather different from vision. Acoustic space does not have obvious boundaries and is less precise in terms of orientation and localization (Porteous, 1996). Therefore assessment of sound as a design element is much complex than the visual dimension. Sound is an important element of a place which affects individual's perception and understanding of an environment. People derive information from sounds, just like visual environment. Sound can act as a guide for way finding or a cautionary signal for alert. In the context of

space, soundscape can be defined as the acoustic character of an environment.

Urban environments are diverse and complex acoustic environments. They include different kinds of sound resources. Therefore, outdoor acoustic environment studies are mostly concerned with urban soundscapes. Evaluation of urban soundscapes is crucial not only for noise mitigation but also to assessment of acoustic comfort which is integral to overall

The term of soundscape was first coined by R. Murray Schafer. In his book "The Tuning of the World" (1977), he describes the soundscape as any acoustic field of the study; it may be a musical composition or a radio program or an acoustic environment. Influenced by Gestalt figure-background relationship (see section 2.2.6), Schafer identified three elements of a soundscape; (i) keynote sounds, (ii) sound signals, and (iii) soundmarks. Keynote sounds are background sounds and can be perceived subconsciously. Schafer suggests keynote sounds might have an effect on our behavior and moods since they are permanently there, whether we hear them consciously or not. Traffic sound is often given as a keynote example for contemporary urban environments. Sound signals, are foreground sounds and are listened to consciously (e.g. sirens). Finally, soundmarks (derived from landmark) are unique to that environment or to people in the community, thus they need to be protected.

These elements have established a foundation for many soundscape studies so far.

The most noticeable study on the relationship between landscape architecture and soundscape is Hedfors's (2008) book "Site Soundscapes: landscape architecture in the light of sound". In his book, he analyzes sound in context of landscape architecture. He suggests a hypothetical model, named "the model of prominence" as a starting point for

planning.

**3. Perception of soundscapes**

environmental quality.

landscape architects. The model is also grounded on Gestalt figure-background relationship, like Schafer's work. It is based on description of the sounds. In Hedford's model figure-ground relationship is combined with two other dimensions; intensity and clarity (Figure 6). According to Hedford, a soundscape can be described as clear if prominent sounds are strongly experienced against a weak background. However, if prominent sounds are weaker than the background, then the soundscape becomes crowded. If both prominent sounds and the background are experienced equally strong, the soundscape can be described as powerful. On the contrary, if both are experienced weak, the soundscape becomes mild.

Fig. 6. The model of prominence (Hedfords, 2008).

Similar to natural landscapes, natural sounds such as bird sound and water sound are highly preferred by people. This may be explained through evolutionary perspective on landscape perception as well as therapeutic effects of natural landscapes (please refer to section 2.4). In fact, relaxation is found to be an important factor for urban open soundscapes (Yang & Kang, 2005). It is known that natural sounds such as bird and water sound can help people feel relaxed (Carles *et al.*, 1999).

Landscape Perception 269

Fig. 7. Soundscape design strategies (Zhang & Kang, 2007).

Besides sound level measurements, perceived acoustic quality and preferences are often evaluated through interviews, questionnaires and soundwalks. During sound level measurements A-weighted equivalent continuous sound level (LAeq) is measured and statistical sound levels (Leq90, Leq50, and Leq10) are calculated. Equivalent continuous sound level presents the average level of noise over a time period, while statistical sound levels are used to define maximum, intrusive, median and background sound levels (Kang, 2007). Identification of the sounds which are perceived by the user is generally the first step of soundscape preference research. This procedure provides researchers an insight to perceived foreground sounds, background sounds and soundmarks. Rating scales are frequently employed in preference research. Participants are asked to rate the acoustic environment or a particular sound. The rating scale generally involves bipolar verbal descriptions such as like-dislike, noisy-quite, favorite-unfavorite etc. Semantic differential analysis is another tool which is commonly used to investigate people's emotional responses

*Research methodology*

Since sound perception is assumed to be a personal and therefore unique phenomenon, most researchers believe that perception of the acoustic environment is affected by personal factors such as demographics and culture. Yu & Kang (2010) found that people preferred natural sounds with increasing age and education level. Their results showed no significant correlation between preferences and occupation, and residence status. They found that gender influenced preference only for some sound types (e.g. bird sound).

Anderson *et al.* (1983) emphasize the importance of expectations in people's sound evaluations (Hedfords, 2008). People might tolerate or appreciate undesirable sounds if they expect to hear them in an environment. For instance some traffic sounds were found to be appreciated in urban environments. Thus, cultural and life-style differences might play role in evaluations of environments with different sound levels.

Sound types have also been found to be related to acoustic comfort evaluations; pleasant sounds, with either high or low sound levels, are perceived to improve the acoustic comfort (Yang & Kang, 2005). The source of the sound type can also affect preference. Zhang & Kang (2007) found that while "music on the street" was rated as favorite by 46% of the participants, 15% rated for music from stores, and only 2% rated for music from cars. Perception of the soundscape is also influenced by the activity involved and hence listening situation (Jennings & Cain, 2012).

Although sound level measurements (e.g. A-weighted levels) are widely used in soundscape research, it is also indicated that perception of the acoustic environment is independent from sound levels (Jennings & Cain, 2012; Szeremeta & Zanin, 2009). Reducing sound levels do not always improve perceived quality of acoustic environment (Yang & Kang, 2005). Furthermore, elimination of negative sounds from the environment does not necessarily make the acoustic environment more positive, may even generate anxiety (Cain *et al.*, 2011). However, Yang & Kang (2005) have found that background sound level is an important factor in evaluating soundscape in urban open public spaces; they suggest that reduced background sound level can help to create comfortable acoustic environments.

Visual perception also affects sound perception; Faburel & Gourlot (2009) found that visual images can reduce the negative effect of a sound, equivalent of up to 10dB decrease in the sound pressure level (SPL) (Solène, M., 2011). Yang and Kang (2005) also concluded that visual factors affect acoustic comfort evaluations and they suggested that interaction of visual and auditory perception work together "*as an aesthetic comfort factor"*. Carles *et al.*'s (1999) study supports this idea. They presented varying combinations of visual and auditory stimuli and participants were asked to rate each image, each sound, and finally each combination. It is found that sounds in the scenes containing vegetation or abundant water were rated higher; hence they concluded that visual and acoustic information can reinforce or interfere with each other. Furthermore, people are less annoyed by the sounds when the source is not visible (Solène, M., 2011). Zhang & Kang (2007) proposed some suggestions for creation of soundscapes in urban environments. They state that if SPL is higher than 65-70 dBA, then people will feel annoyed. Figure 7 shows their design suggestions.

Since sound perception is assumed to be a personal and therefore unique phenomenon, most researchers believe that perception of the acoustic environment is affected by personal factors such as demographics and culture. Yu & Kang (2010) found that people preferred natural sounds with increasing age and education level. Their results showed no significant correlation between preferences and occupation, and residence status. They found that gender influenced preference only for some sound types (e.g. bird

Anderson *et al.* (1983) emphasize the importance of expectations in people's sound evaluations (Hedfords, 2008). People might tolerate or appreciate undesirable sounds if they expect to hear them in an environment. For instance some traffic sounds were found to be appreciated in urban environments. Thus, cultural and life-style differences might play role

Sound types have also been found to be related to acoustic comfort evaluations; pleasant sounds, with either high or low sound levels, are perceived to improve the acoustic comfort (Yang & Kang, 2005). The source of the sound type can also affect preference. Zhang & Kang (2007) found that while "music on the street" was rated as favorite by 46% of the participants, 15% rated for music from stores, and only 2% rated for music from cars. Perception of the soundscape is also influenced by the activity involved and hence listening

Although sound level measurements (e.g. A-weighted levels) are widely used in soundscape research, it is also indicated that perception of the acoustic environment is independent from sound levels (Jennings & Cain, 2012; Szeremeta & Zanin, 2009). Reducing sound levels do not always improve perceived quality of acoustic environment (Yang & Kang, 2005). Furthermore, elimination of negative sounds from the environment does not necessarily make the acoustic environment more positive, may even generate anxiety (Cain *et al.*, 2011). However, Yang & Kang (2005) have found that background sound level is an important factor in evaluating soundscape in urban open public spaces; they suggest that reduced background sound level can help to create comfortable acoustic

Visual perception also affects sound perception; Faburel & Gourlot (2009) found that visual images can reduce the negative effect of a sound, equivalent of up to 10dB decrease in the sound pressure level (SPL) (Solène, M., 2011). Yang and Kang (2005) also concluded that visual factors affect acoustic comfort evaluations and they suggested that interaction of visual and auditory perception work together "*as an aesthetic comfort factor"*. Carles *et al.*'s (1999) study supports this idea. They presented varying combinations of visual and auditory stimuli and participants were asked to rate each image, each sound, and finally each combination. It is found that sounds in the scenes containing vegetation or abundant water were rated higher; hence they concluded that visual and acoustic information can reinforce or interfere with each other. Furthermore, people are less annoyed by the sounds when the source is not visible (Solène, M., 2011). Zhang & Kang (2007) proposed some suggestions for creation of soundscapes in urban environments. They state that if SPL is higher than 65-70 dBA, then people will feel annoyed. Figure 7 shows their design

in evaluations of environments with different sound levels.

situation (Jennings & Cain, 2012).

environments.

suggestions.

sound).

Fig. 7. Soundscape design strategies (Zhang & Kang, 2007).

#### *Research methodology*

Besides sound level measurements, perceived acoustic quality and preferences are often evaluated through interviews, questionnaires and soundwalks. During sound level measurements A-weighted equivalent continuous sound level (LAeq) is measured and statistical sound levels (Leq90, Leq50, and Leq10) are calculated. Equivalent continuous sound level presents the average level of noise over a time period, while statistical sound levels are used to define maximum, intrusive, median and background sound levels (Kang, 2007). Identification of the sounds which are perceived by the user is generally the first step of soundscape preference research. This procedure provides researchers an insight to perceived foreground sounds, background sounds and soundmarks. Rating scales are frequently employed in preference research. Participants are asked to rate the acoustic environment or a particular sound. The rating scale generally involves bipolar verbal descriptions such as like-dislike, noisy-quite, favorite-unfavorite etc. Semantic differential analysis is another tool which is commonly used to investigate people's emotional responses

Landscape Perception 271

authors suggest that culturally significant sounds or sonic art could be introduced to give a unique character and to increase excitement or attractive quality. The authors state that Kano model is successfully used in automobile industry for sound quality assessments. However, this model might seem confusing for spatial designers and planners .The authors also emphasize the need for application of the framework through real-life examples. Please

Solène (2011) applied cognitive mapping technique in her study on urban soundscapes. Participants were asked to draw graphical representations of sonic ambiences of three urban squares. They were also asked to describe their preference for ideal sonic environments in squares. Boundary was found to be an essential element in perceived ideal sonic environments since most participants described closed or semi-open squares. On the contrary, open squares were associated with negative sonic ambiance. Depending on the results, the author inferred that there is a strong bond between urban typology and perceived sonic ambiance. She concluded that sonic mind maps were appropriate for

Despite the short history of soundscape research on outdoor environments, there seems to be a variety of research techniques and methodologies which can be adapted to the researcher's objectives. Still, many issues such as interrelationships between factors that affect soundscape preferences and the effects of spatial design on acoustic comfort need to be further investigated. Spatial designers and planners can contribute to the soundscape research by developing new models and methodologies in order to display and emphasize

Our landscapes are natural and cultural heritage of our societies. With the rapid urbanization and development processes, change has become an inevitable outcome for our landscapes in global scale. Unfortunately, landscape change often occurs in negative ways. Loss of diversity and identity should be the main concern for future design and planning research for landscape architects. However, the role of perception and its effects on spatial

If landscape architecture aims to create livable and effective environments for people in the community, people's perception and interpretation of environments must be investigated. One can argue that landscape assessments should be made by experts because of their knowledge and experiences and general public can't judge environmental quality. On the other hand, environmental quality issues are still on the agenda. To some extent, local, national and even international authorities can be blamed for ignoring knowledge and suggestions of environmental designers and planners in sustainable development. Certainly, professionals have a lot to offer in terms of knowledge and skills. However, knowing and understanding the basic relationships between people and their environments is a necessity. This chapter has summarized basic information and approaches on landscape perception both in visual and auditory context, aiming to provide an insight on perceptual and cognitive dimensions of environmental research. However, there are more to landscape perception research. Reference list can provide readers with valuable resources to read.

see the reference for further details of the framework.

studying psychoacoustics of an urban environment.

their role on creating livable and high quality environments.

behavior and attitudes must be realized first.

**4. Conclusion**

towards sound types and acoustic environments. These techniques can easily be applied any time to anyone without a hearing deficit or disorder. However, the soundwalk technique depends on more conscious listening state. During soundwalks, participants observe and listen to their environments very carefully while walking along a path and make judgments on the acoustic environment.

Previous studies have been carried out either in laboratories or in-situ. Binaural recordings are preferred for laboratory studies. Laboratory conditions are also suitable for assessment of the interaction between visual and auditory stimuli with different characteristics. However, if the soundscape of a particular place is to be assessed, considering primarily that visual perception affects perception of acoustic environment. it is best to carry out the study in-situ. Furthermore, for researchers from design and planning disciplines it might be difficult to establish and maintain laboratory conditions for acoustic evaluations due to lack of technical and scientific knowledge. Therefore, a multidisciplinary approach might be helpful in designing and conducting more effective research on soundscapes.

Zhang & Kang (2007) proposed a detailed system for investigation of urban open space soundscapes. They identified four facets; (i)characteristics of each sound, (ii)acoustic effects of the space, (iii)characteristics of users and (iv)other aspects of physical and environmental conditions. Description of each facet is summarized below.

Sound: For each sound, it is recommended that both steady state and the statistical SPL, spectrum, temporal conditions, source location, source movement and the psychological and social characteristics should be taken into account. Temporal conditions include variation (hour, day, season), duration and impulsive characteristics. Meaning, natural or artificial sounds, relation to activities, soundmarks and listening state (descriptive or holistic) should be considered in context of psychological and social characteristics.

Space: The shape of the space, boundary materials, street and square furniture, landscape elements, reverberation, reflection pattern and/or echogram, general background sound and sounds around the space are the characteristics to be considered related to the space.

People: Social, demographic, cultural characteristics of users and acoustic condition at users' home, work etc. should be assessed.

Environment: Microclimate conditions, lighting, visual, landscape and architectural characteristics are among the environmental characteristics that need to be taken into consideration.

Jennings & Cain (2012) propose a framework which uses Kano model in order to provide designers and planners a tool for predicting impacts of design interventions on soundscape. Kano model is generally used in product development for determination of customer needs and satisfaction. Jennings & Cain (2012) suggest that Kano model can help to clarify thinking, since perception of the soundscapes is a complex process. To summarize their proposal, there are three attributes to be assessed in Kano model; basic requirements, performance requirements and excitement (or attractive) requirements. The first step is to satisfy basic requirements, such as fulfilling legislative requirements for noise control. Then performance requirements need to be assessed in order to find out user needs and expectations. Use of emotional perceptual dimensions, interactive simulations and soundwalks might be helpful in this step. Finally for the excitement requirements, the

towards sound types and acoustic environments. These techniques can easily be applied any time to anyone without a hearing deficit or disorder. However, the soundwalk technique depends on more conscious listening state. During soundwalks, participants observe and listen to their environments very carefully while walking along a path and make judgments

Previous studies have been carried out either in laboratories or in-situ. Binaural recordings are preferred for laboratory studies. Laboratory conditions are also suitable for assessment of the interaction between visual and auditory stimuli with different characteristics. However, if the soundscape of a particular place is to be assessed, considering primarily that visual perception affects perception of acoustic environment. it is best to carry out the study in-situ. Furthermore, for researchers from design and planning disciplines it might be difficult to establish and maintain laboratory conditions for acoustic evaluations due to lack of technical and scientific knowledge. Therefore, a multidisciplinary approach might be

Zhang & Kang (2007) proposed a detailed system for investigation of urban open space soundscapes. They identified four facets; (i)characteristics of each sound, (ii)acoustic effects of the space, (iii)characteristics of users and (iv)other aspects of physical and environmental

Sound: For each sound, it is recommended that both steady state and the statistical SPL, spectrum, temporal conditions, source location, source movement and the psychological and social characteristics should be taken into account. Temporal conditions include variation (hour, day, season), duration and impulsive characteristics. Meaning, natural or artificial sounds, relation to activities, soundmarks and listening state (descriptive or

Space: The shape of the space, boundary materials, street and square furniture, landscape elements, reverberation, reflection pattern and/or echogram, general background sound and sounds around the space are the characteristics to be considered related to the space.

People: Social, demographic, cultural characteristics of users and acoustic condition at users'

Environment: Microclimate conditions, lighting, visual, landscape and architectural characteristics are among the environmental characteristics that need to be taken into

Jennings & Cain (2012) propose a framework which uses Kano model in order to provide designers and planners a tool for predicting impacts of design interventions on soundscape. Kano model is generally used in product development for determination of customer needs and satisfaction. Jennings & Cain (2012) suggest that Kano model can help to clarify thinking, since perception of the soundscapes is a complex process. To summarize their proposal, there are three attributes to be assessed in Kano model; basic requirements, performance requirements and excitement (or attractive) requirements. The first step is to satisfy basic requirements, such as fulfilling legislative requirements for noise control. Then performance requirements need to be assessed in order to find out user needs and expectations. Use of emotional perceptual dimensions, interactive simulations and soundwalks might be helpful in this step. Finally for the excitement requirements, the

holistic) should be considered in context of psychological and social characteristics.

helpful in designing and conducting more effective research on soundscapes.

conditions. Description of each facet is summarized below.

home, work etc. should be assessed.

consideration.

on the acoustic environment.

authors suggest that culturally significant sounds or sonic art could be introduced to give a unique character and to increase excitement or attractive quality. The authors state that Kano model is successfully used in automobile industry for sound quality assessments. However, this model might seem confusing for spatial designers and planners .The authors also emphasize the need for application of the framework through real-life examples. Please see the reference for further details of the framework.

Solène (2011) applied cognitive mapping technique in her study on urban soundscapes. Participants were asked to draw graphical representations of sonic ambiences of three urban squares. They were also asked to describe their preference for ideal sonic environments in squares. Boundary was found to be an essential element in perceived ideal sonic environments since most participants described closed or semi-open squares. On the contrary, open squares were associated with negative sonic ambiance. Depending on the results, the author inferred that there is a strong bond between urban typology and perceived sonic ambiance. She concluded that sonic mind maps were appropriate for studying psychoacoustics of an urban environment.

Despite the short history of soundscape research on outdoor environments, there seems to be a variety of research techniques and methodologies which can be adapted to the researcher's objectives. Still, many issues such as interrelationships between factors that affect soundscape preferences and the effects of spatial design on acoustic comfort need to be further investigated. Spatial designers and planners can contribute to the soundscape research by developing new models and methodologies in order to display and emphasize their role on creating livable and high quality environments.


**4.1 Inherited thrombophilias**

*Innovations in Assisted Reproduction Technology*

(71% vs. 44%) [14].

miscarriage [17].

**4. Thrombophilias**

**3.2 Parental genetic analysis**

New chromosomal tests such as the chromosomal microarray analysis (CMA) have the potential to reduce costs since, in the presence of altered examination, costly and unnecessary evaluations will not be employed [13]. In addition, when a cause is identified, the tendency is to reduce the use of empirical treatments that have no scientific evidence [13]. Research has shown that in couples with previous embryonic aneuploidy, the likelihood of a child's birth during subsequent pregnancies was higher than patients with prior normal karyotype of conception products

The suffering that the couple goes through experiencing abortion episodes without knowing the etiological factor can by itself justify the investigation of the

In about 5% of all couples suffering two or more fetal losses, one partner carries a balanced chromosomal rearrangement, which represents approximately eightfold increase compared to the general population [15]. Guiding this couple for genetic counseling is important, as the likelihood of a healthy child born will depend on the type of rearrangement found and the chromosomes involved—for example, gestational losses are more present in carriers of balanced translocations and inversions than in carriers of Robertsonian translocations [16]. Even with one spouse carrying a chromosomal rearrangement, the cumulative rate of live birth, even in natural conception, is significant—63.4% despite the increased risk for

As for the existing guidelines regarding parental cytogenetic investigation, ESHRE determines that such assessment should not be performed routinely, but in specific cases after individual risk assessment [2]. ASRM, however, recommends routine parental karyotyping as information obtained may assist in counseling on the prognosis of future pregnancies, including guidance for performing preimplan-

tation genetic testing (PGT), amniocentesis, or chorionic villus analysis [3]. Couples with structural cytogenetic changes have an increased number of gametes with chromosomal imbalances, so it would be expected that the implantation of embryos selected by PGT increases the rate of live births. However, in spouses carrying chromosomal rearrangement with RPL, the rate of live births, time to subsequent conception, and miscarriage rates were similar in both naturally conceived and in vitro fertilization associated with preimplantation diagnosis (IVF-PGT) [18]. Other papers showed discordant results. Similar live birth rate and time to new pregnancy were reported; however, the miscarriage rate was significantly lower in the IVF-PGT group [19]. Thus, there is no consensus showing the benefit of such strategy in this population, and no randomized controlled trials have been

Thrombophilias are inherited and/or acquired conditions that predispose individuals to thrombosis, with varied prevalence in the general population [20]. The most common hereditary thrombophilias are methylenetetrahydrofolate reductase (MTHFR) gene polymorphism 4–16%, factor V Leiden mutation 1691G → A (heterozygote, 1–15%; homozygote, <1%), prothrombin mutation 20210G → A (heterozygote, 2–5%; homozygote, <1%), antithrombin deficiency (0.02%), protein C deficiency (0.2–0.4%), protein S deficiency (0.03–0.13%) [21], and serpin gene polymorphism. On the other hand, acquired thrombophilia is mainly represented

conducted to this date to validate possible benefits.

existence of genetic alterations as a cause of the events.

**162**

The screening of inherited thrombophilias even in patients with a thrombosis context is still questioned [2]. The factor V Leiden mutation (1691G→ A) and the prothrombin mutation (20210G→ A) were related to recurrent miscarriage [22]; however, the lack of evidence that the treatment changes the gestational outcome leads to questioning the relevance of investigating such mutations. Other thrombophilias, such as protein C deficiency, protein S deficiency, and antithrombin deficiency, although associated with thromboembolic event, were not associated with RPL [2, 3, 20, 22]. MTHFR gene polymorphisms are no longer considered risk factors for thrombophilias [2].

The association between RPL and inherited thrombophilias is weak or absent [2]. Thus, thrombophilic screening should be restricted to patients with family history of thrombophilias or previous thrombotic event [1, 2]. There is no recommendation to screen inherited thrombophilias in patients with RPL without other risk factors [1, 2, 21, 23]. Screening tests may be influenced by physiological/ pathophysiological changes in the pregnancy-puerperal period, thrombotic event, or use of anticoagulants [21]. It should be performed within 6 weeks or more after delivery, miscarriage, or thrombotic event or early if necessary [2, 21].

The use of anticoagulant therapy with low-molecular-weight heparin and/or aspirin has no benefit in preventing early (<10 weeks) or late (≥10 weeks) RPL [24]. Thus, ineffectiveness of the treatment, the risk exposure, and the increased cost do not justify treatment with anticoagulants in patients with inherited thrombophilias and RPL without other risk factors for thrombosis [2, 20].


**From Quantum Paraelectric/ Ferroelectric Perovskite Oxides to High Temperature Superconducting Copper Oxides In Honor of Professor K.A. Müller for His Lifework**

Printed Edition of the Special Issue Published in *Condensed Matter* Annette Bussmann-Holder, Hugo Keller and Antonio Bianconi Edited by

www.mdpi.com/journal/condensedmatter