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   Publications A-Z
A
»Accounting & Marketing
» Addiction Research & Therapy
» Advanced Chemical Engineering
»Advances in Automobile Engineering
»Advances in Crop Science and Technology
»Advances in Dairy Research
»Advancements in Genetic Engineering
»Advances in Pharmacoepidemiology & Drug Safety
»Advances in Robotics & Automation
»Advanced Techniques in Biology & Medicine
»Advance Research in Meteorological Sciences
»Aeronautics & Aerospace Engineering
»Aging Science
»Agrotechnology
»AIDS & Clinical Research
»Alcoholism and Drug Dependence
»Allergy & Therapy
»Alternative & Integrative Medicine
»Air & Water borne Diseases
»Alzheimers Disease & Parkinsonism
»Analytical & Bioanalytical Techniques
»Anaplastology
»Anatomy & Physiology
»Ancient Diseases & Preventive Remedies
»Andrology-Open Access
»Anesthesia & Clinical Research
»Angiology: Open Access
»Antivirals & Antiretrovirals
»Anthropology
»Applied & Computational Mathematics
»Applied Mechanical Engineering
»Aquaculture Research & Development
» Arabian Journal Business and Management Review
»Architectural Engineering Technology
»Arthritis
»Arts and Social Sciences Journal
» Astrobiology & Outreach
»Astrophysics & Aerospace technology
»Autacoids
»Automatic Control of Physiological State and Function
»Autism-Open Access
  
B
»Bacteriology & Parasitology
»Bioanalysis & Biomedicine
»Bioceramics Development and Applications
»Biochemistry and Analytical Biochemistry
»Biochemistry & Pharmacology: Open Access
»Biochips & Tissue Chips
»Biodiversity & Endangered Species
»Bioenergetics: Open Access
»Bioengineering & Biomedical Science
»Bioequivalence & Bioavailability
»Biosafety & Health Education
»Biofertilizers & Biopesticides
»Biometrics & Biostatistics
»Biomimetics Biomaterials and Tissue Engineering
»Biomolecular Research & Therapeutics
» Biomusical Engineering
»Biochemistry & Physiology: Open Access
»Biological Systems- Open Access
»Biology and Medicine
»Bioprocessing & Biotechniques
»Bioremediation & Biodegradation
»Biosafety
»Biosensors & Bioelectronics
» Biosensors Journal
»Biotechnology & Biomaterials
»Bioterrorism & Biodefense
»Blood Disorders & Transfusion
»Blood & Lymph
»Bone Marrow Research
»Brain Disorders & Therapy
»Business and Economics Journal
»Business and Financial Affairs
  
C
»Cancer Science & Therapy
»Climatology & Weather forecasting
»Carcinogenesis & Mutagenesis
»Cardiovascular Diseases & Diagnosis
»Cardiovascular Pharmacology: Open Access
»Cell & Developmental Biology
»Cell Science & Therapy
»Chemical Engineering & Process Technology
»Chemical Sciences Journal
»Chemotherapy: Open Access
»Child and Adolescent Behavior
»Chromatography & Separation Techniques
»Civil & Environmental Engineering
»Civil & Legal Sciences
»Clinical & Cellular Immunology
»Clinical Case Reports
»Clinical & Experimental Cardiology
»Clinical & Experimental Dermatology Research
»Clinical & Experimental Ophthalmology
»Clinical & Experimental Pathology
»Clinical & Experimental Pharmacology
»Clinical Microbiology: Open Access
»Clinical Pharmacology & Biopharmaceutics
»Clinical Research & Bioethics
»Clinical Research on Foot & Ankle
»Clinical Toxicology
»Clinical Trials
»Clinics in Mother and Child Health
»Cloning & Transgenesis
»Community Medicine & Health Education
»Communication Disorders, Deaf Studies & Hearing Aids
»Computer Science & Systems Biology
» Current Synthetic & Systems Biology
»Cytology & Histology
D
»Data Mining in Genomics & Proteomics
»Defense Management
»Dentistry
»Depression and Anxiety
»Developing Drugs
»Diabetes & Metabolism
»Drug Designing
»Drug Metabolism & Toxicology
  
E
»Earth Science & Climatic Change
»Ecosystem & Ecography
»Endocrinology & Metabolic Syndrome
»Entomology, Ornithology & Herpetology
»Environmental & Analytical Toxicology
»Epidemiology: Open Access
»Emergency Medicine
»Ergonomics
»Electrical & Electronics
»Enzyme Engineering
»Entrepreneurship & Organization Management
  
F
»Family Medicine & Medical Science Research
»Fermentation Technology
»Fertilization: In Vitro - IVF-Worldwide
»Fisheries and Aquaculture Journal
»Fisheries & Livestock Production
»Food Processing & Technology
»Forensic Biomechanics
»Forensic Research
»Forest Research: Open Access
»Fundamentals of Renewable Energy and Applications
»Fungal Genomics & Biology
  
G
»Gastrointestinal & Digestive System
»Genetic Syndromes & Gene Therapy
»Gene Technology
»Generalized Lie Theory and Applications
»Glycobiology
»Glycomics & Lipidomics
»Gynecology& Obstetrics
»General Medicine
»General Practice
»Geography & Natural Disasters
»Geology & Geosciences
»Geophysics & Remote Sensing
»Gerontology & Geriatric Research
»Global Economics
»Global Journal of Technology and Optimization
  
H
»Hair : Therapy & Transplantation
»Hematology & Thromboembolic Diseases
»Health Care : Current Reviews
»Health & Medical Informatics
»Hereditary Genetics
»Homeopathy & Ayurvedic Medicine
»Horticulture
»Hotel & Business Management
»Human Genetics & Embryology
»Hydrology: Current Research
»Hypertension- Open Access
  
I
»Industrial Engineering & Management
»Irrigation and Drainage Systems Engineering
»Infectious Diseases and Therapy
»Information Technology & Software Engineering
»Intellectual Property Rights: Open Access
»Integrative Oncology
»Internal Medicine
»International Journal of Accounting Research
»International Journal of Advanced Innovations, Thoughts & Ideas
»International Journal of Biomedical Data Mining
»International Journal of Economics and Management Science
»International Journal of Sensor Networks and Data Communications
»International Journal of Swarm Intelligence and Evolutionary Computation
»International Journal of waste resources
»International Journal of Genomic Medicine
»International Journal of Physical Medicine & Rehabilitation
»Innovative Energy Policies
»Immunome Research
  
J
»JBR Journal of Interdisciplinary Medicine and Dental Science
»JBR Journal of Clinical Diagnosis and Research
»JBR Journal of Young Scientist
  
L
»Liver
» Leukemia
» Lovotics
  
M
»Marine Science: Research & Development
»Malaria Chemotherapy, Control & Elimination
»Mass Communication & Journalism
»Material Sciences & Engineering
»Medicinal Chemistry
»Medicinal & Aromatic Plants
»Medical Diagnostic Methods
»Medical Microbiology & Diagnosis
»Medical & Surgical Urology
»Membrane Science & Technology
»Metabolic Syndrome
»Metabolomics:Open Access
»Microbial & Biochemical Technology
»Modern Chemistry & Applications
»Molecular Biology
»Molecular Biomarkers & Diagnosis
»Molecular and Genetic Medicine
»Molecular Imaging & Dynamics
»Molecular Pharmaceutics & Organic Process Research
»Mycobacterial Diseases
N
»Natural Products Chemistry & Research
»Nanomedicine & Biotherapeutic Discovery
»Nanomedicine & Nanotechnology
»Neonatal Biology
»Nephrology & Therapeutics
»Neurology & Neurophysiology
»Neuroinfectious Diseases
»Neurological Disorders
»Novel Physiotherapies
»Nuclear Medicine & Radiation Therapy
»Nutrition & Food Sciences
»Nutritional Disorders & Therapy
»Nursing & Care
  
O
»Obesity & Weight Loss Therapy
»Oceanography-Open Access
»Occupational Medicine & Health Affairs
»OMICS Journal of Radiology
»Osteoporosis and Physical Activity
»Oral Health and Dental Management
»Oral Hygiene & Health
»Organic Chemistry: Current Research
»Orthopedic & Muscular System: Current Research
»Otolaryngology
  
P
»Pain & Relief
»Palliative Care & Medicine
»Pancreatic Disorders & Therapy
»Pediatrics & Therapeutics
»Petroleum & Environmental Biotechnology
»Pharmaceutica Analytica Acta
»Pharmaceutical Regulatory Affairs: Open Access
»Pharmacogenomics & Pharmacoproteomics
»Pharmacovigilance
»Physical Chemistry & Biophysics
»Physical Mathematics
»Plant Pathology & Microbiology
»Plant Biochemistry & Physiology
»Pollution Effects & Control
»political Sciences & public affairs
»Poultry, Fisheries & Wildlife Sciences
»Powder Metallurgy & Mining
»Primatology
»Primary Health Care: Open Access
»Probiotics & Health
» Phylogenetics & Evolutionary Biology
»Proteomics & Bioinformatics
»Phylogenetics & Evolutionary Biology
»Psychology & Psychotherapy
»Psychological Abnormalities in Children
»Pulmonary & Respiratory Medicine
  
R
»Reproductive System & Sexual Disorders
»Research and Development
»Review of Public Adminstration and Management
»Rheumatology: Current Research
»Rice Research: Open Access
  
S
» Single Cell Biology
»Sleep Disorders & Therapy
»Socialomics
»Sociology and Criminology-Open Access
»Sports Medicine & Doping Studies
»Spine
»Stem Cell Research & Therapy
»Steroids & Hormonal Science
»Stock & Forex Trading
»Surgery: Current Research
  
T
»Telecommunications System & Management
»Textile Science & Engineering
»Theoretical and Computational Chemistry:Open Access
»Thermodynamics & Catalysis
»Thyroid Disorders & Therapy
»Tissue Science & Engineering
»Translational Medicine
»Transplantation Technologies & Research
»Transcriptomics: Open Access
»Trauma & Treatment
»Tropical Diseases
»Tropical Medicine and Surgery
»Tourism & Hospitality
  
V
»Vaccines & Vaccination
»Vascular Medicine & surgery
»Veterinary Science & Technology
»Virology & Mycology
»Vitamins & Minerals
»Vortex Science and Technology
  
W
»Women's Health Care
  
Y
»Yoga & Physical Therapy
 
   Browse by Subjects
Clinical
» AIDS & Clinical Research
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» Angiology
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» Clinical & Cellular Immunology
» Clinical Case Reports
» Clinical & Experimental Cardiology
» Clinical & Experimental Dermatology Research
» Clinical & Experimental Ophthalmology
» Clinical & Experimental Pharmacology
» Clinical & Experimental Pathology
» Clinical Microbiology: Open Access
» Clinical Research & Bioethics
» Clinical Research on Foot & Ankle
» Clinical Toxicology
» Clinical Trials
»Clinics in Mother and Child Health
» Communication Disorders, Deaf Studies & Hearing Aids
» Cytology & Histology
» Forensic Research
»Forensic Biomechanics
» Integrative Oncology
»Immunome Research
»JBR Journal of Clinical Diagnosis and Research
» Neurology & Neurophysiology
» Pulmonary & Respiratory Medicine
» Stem Cell Research & Therapy
» Transplantation Technologies & Research
   
Pharmaceutical Sciences
» Advances in Pharmacoepidemiology & Drug Safety
» Alcoholism and Drug Dependence
» Bioanalysis & Biomedicine
» Biochemical Pharmacology
» Bioequivalence & Bioavailability
» Cardiovascular Pharmacology: Open Access
» Clinical Pharmacology & Biopharmaceutics
» Developing Drugs
» Drug Designing
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» Molecular Pharmaceutics & Organic Process Research
» Pharmaceutica Analytica Acta
» Pharmaceutical Regulatory Affairs
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Chemistry
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Environmental
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» Earth Science & Climatic Change
» Ecosystem & Ecography
» Environmental & Analytical Toxicology
» Fisheries & Livestock Production
»Fundamentals of Renewable Energy and Applications
» Geography & Natural Disasters
» Hydrology: Current Research
»Innovative Energy Policies
»International Journal of waste resources
» Oceanography-Open Access
» Petroleum & Environmental Biotechnology
» Pollution Effects & Control
» Poultry, Fisheries & Wildlife Sciences
   
Omics
» Data Mining in Genomics & Proteomics
»Ergonomics
» Glycomics & Lipidomics
» Health & Medical Informatics
»JBR Journal of Young Scientist
» Metabolomics:Open Access
» OMICS Journal of Radiology
» Pharmacogenomics & Pharmacoproteomics
» Phylogenetics & Evolutionary Biology
» Proteomics & Bioinformatics
» Transcriptomics
   
Life Sciences
» Advanced Techniques in Biology & Medicine
»Advancements in Genetic Engineering
»Advances in Crop Science and Technology
»Advances in Dairy Research
» Aging Science
» Agrotechnology
» Air & Water Borne Diseases
» Antivirals & Antiretrovirals
» Autism-Open Access
» Bacteriology & Parasitology
» Biochemistry & Physiology
» Biochemistry and Analytical Biochemistry
» Bioenergetics
» Bioengineering & Biomedical Science
» Biofertilizers & Biopesticides
» Biological Systems
» Biometrics & Biostatistics
»Biomimetics Biomaterials and Tissue Engineering
» Biomolecular Research & Therapeutics
» Bioremediation & Biodegradation
» Biosafety
» Biosafety & Health Education
» Biosensors & Bioelectronics
» Biosensors Journal
» Biotechnology & Biomaterials
» Bioterrorism & Biodefense
» Cell & Developmental Biology
» Current Synthetic & Systems Biology
» Entomology, Ornithology & Herpetology
» Enzyme Engineering
» Fermentation Technology
» Fertilization: In Vitro - IVF-Worldwide
» Fisheries and Aquaculture Journal
» Forest Research
» Fungal Genomics & Biology
» Gene Technology
» Glycobiology
» Horticulture
» Homeopathy & Ayurvedic Medicine
»International Journal of Swarm Intelligence and Evolutionary Computation
» Marine Science: Research & Development
» Membrane Science & Technology
» Microbial & Biochemical Technology
» Molecular Biology
» Molecular Imaging & Dynamics
» Nanomedicine & Biotherapeutic Discovery
» Nanomedicine & Nanotechnology
» Nutrition & Food Sciences
» Plant Pathology & Microbiology
» Primatology
» Probiotics & Health
» Rice Research: Open Access
» Single Cell Biology
» Sociology and Criminology-Open Access
» Tissue Science & Engineering
» Tropical Diseases
» Veterinary Science & Technology
» Vitamins & Minerals
»Virology & Mycology
   
Engineering
» Advances in Automobile Engineering
» Advances in Robotics & Automation
» Aeronautics & Aerospace Engineering
» Applied & Computational Mathematics
» Applied Mechanical Engineering
» Architectural Engineering Technology
» Astrophysics & Aerospace technology
» Biochips & Tissue Chips
» Bioprocessing & Biotechniques
» Chemical Engineering & Process Technology
» Civil & Environmental Engineering
» Computer Science & Systems Biology
» Electrical & Electronics
» Food Processing & Technology
» Geology and Geosciences
» Geophysics & Remote sensing
»Global Journal of Technology and Optimization
» Industrial Engineering & Management
» Information Technology & Software Engineering
» International Journal of Advance Innovations, Thoughts & Ideas
»International Journal of Sensor Networks and Data Communications
» Irrigation and Drainage Systems Engineering
»Generalized Lie Theory and Applications
» Lovotics
» Material Sciences & Engineering
»Physical Mathematics
» Powder Metallurgy & Mining
» Telecommunications System & Management
» Textile Science & Engineering
»Vortex Science and Technology
   
Medical Sciences
» Addiction Research & Therapy
» Allergy & Therapy
» Alternative & Integrative Medicine
» Alzheimers Disease & Parkinsonism
» Anaplastology
» Anatomy & Physiology
» Ancient Diseases & Preventive Remedies
» Andrology
» Arthritis
» Autacoids
»Automatic Control of Physiological State and Function
» Bioceramics Development and Applications
» Biology and Medicine
» Biomusical Engineering
» Blood & Lymph
» Blood Disorders & Transfusion
» Bone Marrow Research
» Brain Disorders & Therapy
» Cardiovascular Diseases & Diagnosis
» Cloning & Transgenesis
» Community Medicine & Health Education
» Dentistry
» Depression and Anxiety
» Diabetes & Metabolism
» Emergency Medicine
» Endocrinology & Metabolic Syndrome
» Epidemiology: Open Access
» Family Medicine & Medical Science Research
» Gastrointestinal & Digestive System
» General Medicine
» General Practice
» Genetic Syndromes & Gene Therapy
» Gynecology& Obstetrics
» Gerontology & Geriatrics Research
» Hematology & Thromboembolic Diseases
» Hair: Therapy & Transplantation
» Health Care : Current Reviews
» Hereditary Genetics
» Human Genetics & Embryology
» Hypertension-Open Access
» Infectious Diseases & Therapy
» International Journal of Genomic Medicine
» Internal Medicine
»International Journal of Biomedical Data Mining
» International Journal of Physical Medicine & Rehabilitation
»JBR Journal of Interdisciplinary Medicine and Dental Science
» Leukemia
» Liver
»Malaria Chemotherapy, Control & Elimination
» Medical & Surgical Urology
» Medical Diagnostic Methods
» Medical Microbiology & Diagnosis
» Metabolic Syndrome
» Molecular Biomarkers & Diagnosis
» Molecular and Genetic Medicine
» Mycobacterial Diseases
» Neonatal Biology
» Nephrology & Therapeutics
»Neuroinfectious Diseases
» Neurological Disorders
» Novel Physiotherapies
» Nuclear Medicine & Radiation Therapy
» Nursing & Care
» Nutritional Disorders & Therapy
» Obesity & Weight Loss Therapy
» Occupational Medicine & Health Affairs
» Oral Health and Dental Management
» Oral Hygiene & Health
» Orthopedic & Muscular System
» Osteoporosis & Physical Activity
» Otolaryngology
» Pain & Relief
» Palliative Care & Medicine
» Pancreatic Disorders & Therapy
» Pediatrics & Therapeutics
» Primary Health Care
» Psychological Abnormalities in Children
» Psychology & Psychotherapy
» Reproductive System & Sexual Disorders
»Research and Development
» Rheumatology: Current Research
» Sleep Disorders & Therapy
» Spine
» Sports Medicine & Doping Studies
» Steroids & Hormonal Science
» Surgery: Current Research
» Thyroid Disorders & Therapy
» Translational Medicine
» Trauma & Treatment
» Tropical Medicine and Surgery
» Vascular Medicine & surgery
» Women's Health Care
» Yoga & Physical Therapy
 
Management
» Accounting & Marketing
» Arabian Journal Business and Management Review
» Arts and Social Sciences Journal
» Business and Economics Journal
» Business and Financial Affairs
» Civil & Legal Sciences
» Defense Management
» Entrepreneurship & Organization Management
» Global Economics
» Hotel & Business Management
» Intellectual Property Rights: Open Access
»International Journal of Accounting Research
» International Journal of Economics & Management Sciences
» Mass Communication & Journalism
» political Sciences & public affairs
»Review of Public Adminstration and Management
» Socialomics
» Stock & Forex Trading
» Tourism & Hospitality
 
   Conferences
Upcoming Conferences
»4th International Conference on Clinical & Experimental Cardiology April 14-16, 2014 San Antonio, USA
»4th International Conference on Clinical & Experimental Dermatology April 14-16, 2014 San Antonio, USA
»3rd International Conference and Exhibition on Pathology April 14-16, 2014 San Antonio, USA
»5th International Conference on Biomarkers and Clinical Research April 15-17, 2014 University of Oxford, UK
»2nd International Conference on Business Economics and Management April 21-23, 2014 Dubai, UAE
»2nd International Conference on Dental and Oral Health April 21-23, 2014 Dubai, UAE
»4th World Congress on Cell Science & Stem Cell Research June 24-26, 2014 Valencia, Spain
»3rd International Conference on Biodiversity & Sustainable Energy Development June 24-26, 2014 Valencia, Spain
»3rd International Conference and Exhibition on Occupational Health & Safety June 24-25, 2014 Valencia, Spain
»5th World congress on Biotechnology June 25-27, 2014 Valencia, Spain
»3rd International Conference on Nephrology & Therapeutics June 26-27, 2014 Valencia, Spain
»2nd International Conference on Bioprocess and Engineering June 26-27, 2014 Valencia, Spain
»International Conference on Geriatrics & Gerentology July 08-10, 2014 Chicago , USA
»International Conference on Women's Health, Gynecology & Obstetrics July 08-10, 2014 Chicago, USA
»International Conference on Computer Graphics and Media Design July 08-10, 2014 Chicago, USA
»4th International Conference on Clinical & Experimental Ophthalmology July 14-16, 2014 Baltimore, USA
»3rd International Conference & Exhibition on Biometrics & Biostatistics July 14-16, 2014 Baltimore, USA
»2nd International Conference and Exhibition on Physical Medicine & Rehabilitation July 14-16, 2014 Baltimore, USA
»3rd International Conference and Exhibition on Cosmetology & Trichology July 21-23, 2014 Las Vegas, USA
»3rd International Conference and Exhibition on Food Processing & Technology July 21-23, 2014 Las Vegas, USA
»2nd International Conference on Oceanography July 21-23 , 2014 Las Vegas USA
»Health Informatics & Technology Conference July 28-29, 2014 Baltimore, USA
»3rd International Conference on Gastroenterology & Urology July 28-30, 2014 San Francisco, USA
»3rd International Conference on Earth Science & Climate Change July 28-30, 2014 San Francisco, USA
»3rd International Conference and Exhibition on Orthopedics & Rheumatology July 28-30, 2014 San Francisco, USA
»International Conference on Business Economics of Broadcasting Media & Film Industry July 28-30, 2014, Baltimore, USA
»4th International Conference on Proteomics & Bioinformatics August 04-06, 2014 Chicago, USA
»3rd International Conference and Exhibition on Addiction Research & Therapy August 04-06, 2014 Chicago, USA
»2nd International Conference on Integrative Biology Summit August 04-05, 2014 Chicago, USA
»3rd International Conference and Exhibition on Biosensors & Bioelectronics August 11-13, 2014 San Antonio, USA
»2nd World Associations Congress August 11-13, 2014 San Antonio, USA
»International Meeting on Space- Open Debate August 12-13, 2014 San Antonio, USA
»5th International Conference and Exhibition on Analytical & Bioanalytical Techniques August 18-20, 2014 Beijing, China
»2nd International Conference on Epidemiology and Evolutionary Genetics August 18-19, 2014 Beijing, China
»2nd International Conference and Exhibition on Pharmacognosy, Phytochemistry & Natural Products August 25-27, 2014 Beijing, China
»2nd International Conference and Exhibition on Traditional & Alternative Medicine August 25-26, 2014 Beijing, China
»2nd International Conference and Exhibition on Mechanical & Aerospace Engineering September 08-10, 2014 Philadelphia, USA
»2nd International Conference and Exhibition on Lasers, Optics & Photonics September 08-10, 2014 Philadelphia, USA
»3rd International Conference and Exhibition on Neurology & Therapeutics September 08-10, 2014 Philadelphia, USA
»4th International Conference on Pharmaceutical Regulatory Affairs September 08-10, 2014 Raleigh, USA
»2nd International Conference on Radiology and Imaging September 08-09, 2014 Raleigh, USA
»2nd International Conference on Genomics & PharmacogenomicsSeptember 08-09, 2014 Raleigh, USA
»2nd International Conference on Alzheimer's Disease and Dementia September 23-25, 2014 Valencia Convention Centre, Valencia, Spain
»3rd International Conference and Exhibition on Nutrition & Food Sciences September 23-25, 2014 Valencia, Spain
»3rd International Conference on Clinical Microbiology & Microbial Genomics September 24-26, 2014 Valencia, Spain
»3rd International Conference on Tissue Science & Regenerative Medicine September 24-26, 2014 Valencia, Spain
»4th International Conference on Vaccines & Vaccination September 24-26, 2014 Valencia, Spain
»3rd International Summit on GMP, GCP & Quality Control September 25-26, 2014 Valencia, Spain
»5th World Congress on Bioequivalence and Bioavailability: Pharmaceutical R&D Summit September 29-October 01, 2014 Baltimore, USA
»2nd International Conference on Hematology & Blood Disorders September 29-October 01, 2014 Baltimore, USA
»3rd International Conference and Exhibition on Clinical & Cellular Immunology September 29-October 01, 2014 Baltimore, USA
»3rd International Conference and Exhibition on Materials Science & Engineering October 06-08, 2014 San Antonio, USA
»3rd International Conference on Forensic Research and Technology October 06-08, 2014 San Antonio, USA
»4th World Congress on Virology October 06-08, 2014 San Antonio, USA
»2nd International Conference on Endocrinology October 20-22, 2014 Chicago, USA
»3rd 3rd International Summit on Toxicology & Applied Pharmacology October 20-22, 2014 Chicago, USA
»3rd 4th World Congress on Cancer Science and Therapy October 20-22, 2014 Chicago, USA
»3rd 3rd International Conference and Exhibition on Cell & Gene Therapy October 27-29, 2014 Las Vegas, USA
»2nd International Conference on HIV/AIDS, STDs & STIs October 27-29, 2014 Chicago, USA
»2nd World Congress on Petrochemistry and Chemical Engineering October 27-29, 2014 Las Vegas, USA
»3rd International Conference and Exhibition on Pharmacovigilance & Clinical Trials October 27-29, 2014 Hyderabad, India
»3rd International Conference and Exhibition on Biowaivers and Biosimilars October 27-29, 2014 Hyderabad, India
»3rd International Conference on Translational Medicine November 03-05, 2014 Las Vegas, USA
»2nd International Conference on Predictive, Preventive and Personalized Medicine & Molecular Diagnostics November 03-05, 2014 Las Vegas, USA
»5th International Conference on Diabetes & Metabolism November 03-05, 2014 Las Vegas, USA
»2nd International Congress on Bacteriology and Infectious Diseases November 17-19, 2014 Chicago, USA
»2nd International Conference on Nursing & Healthcare November 17-19, 2014 Chicago, USA
»3rd International Conference on Surgery and Anesthesia November 17-19, 2014 Chicago, USA
»4th International Conference on Nanotek & Expo December 01-03, 2014 San Francisco, USA
»3rd International Conference and Exhibition on Obesity & Weight Management December 01-03, 2014 San Francisco, USA
»2nd International Summit on Clinical PharmacyDecember 02-03, 2014 San Francisco, USA
»3rd International Conference on Medicinal Chemistry & Computer Aided Drug Designing December 08-10, 2014 San Francisco, USA
»3rd International Conference and Exhibition on Probiotics & Functional Foods December 08-10, 2014 San Francisco, USA
Previous Conferences Organized/Co-organized
»2nd International Conference on Dental and Oral Health April 21-23, 2014 Dubai, UAE
»5th International Conference on Biomarkers and Clinical Research April 15-17, 2014 University of Oxford, UK
»3rd International Conference and Exhibition on Pathology April 14-16, 2014 San Antonio, USA
»4th International Conference on Clinical & Experimental Dermatology April 14-16, 2014 San Antonio, USA
»4th International Conference on Clinical & Experimental Cardiology April 14-16, 2014 San Antonio, USA
»4th International Conference and Exhibition on Pharmaceutics & Novel Drug Delivery Systems March 24-26, 2014 San Antonio, USA
»3rd International Conference and Exhibition on Metabolomics & Systems Biology March 24-26, 2014 San Antonio, USA
»2nd International Conference on Agricultural & Horticultural Sciences, February 03-05, 2014 Hyderabad, India
»International Conference and Exhibition on Traditional & Alternative Medicine, December 09-11, 2013 Hyderabad, India
»2nd International Conference and Exhibition on Obesity & Weight Management, December 02-04, 2013 Las Vegas, USA
»International Conference on Nursing & Emergency Medicine, December 02-04, 2013 Las Vegas, USA
»3rd International Conference on Nanotek & Expo, December 02-04, 2013 Las Vegas, USA
»3rd World Congress on Virology, November, 20-22, 2013 Baltimore, USA
»International Congress on Bacteriology and Infectious diseases, November 20-22, 2013 Baltimore, USA
»3rd World Congress on Cell Science & Stem Cell Research, November 20-22, 2013 San Antonio, USA
»2nd International Conference and Exhibition on Pharmacovigilance & Clinical Trials, November 18-19, 2013 San Antonio, USA
»International Summit on Clinical Pharmacy & Dispensing, November 18-20, 2013 San Antonio, USA
»World Congress on Petrochemistry and Chemical Engineering, November 18-20, 2013 San Antonio, USA
»International Conference on Functional and Comparative Genomics & Pharmacogenomics, November 12-14, 2013 Chicago, USA
»2nd International Conference and Exhibition on Cosmetology & Trichology, November 12-14, 2013 Chicago, USA
»2nd International Summit on GMP, QA & QC, November 12-14, 2013 Chicago, USA
»2nd International Summit on GLP, GCP & Clinical Pharmacology, November 12-14, 2013 Chicago, USA
» International Conference on Fermentation Technology, Bioprocess and Cell Culture, October 28-30, 2013 Kansas City, USA
»2nd International Conference and Exhibition on Food Processing & Technology, October 28-30, 2013 Kansas City, USA
»International Conference on HIV/AIDS, STDs, & STIs, October 24-25, 2013 Orlando-FL, USA
»2nd International Conference and Exhibition on Cell & Gene Therapy, October 23-25, 2013 Orlando, USA
»2nd International Conference and Exhibition on Probiotics & Functional Foods, October 23-25, 2013 Orlando, USA
»International Conference and Exhibition on Pharmacognosy, Phytochemistry and Natural Products, October 21-23, 2013 Hyderabad, India
» 3rd World Congress on Cancer Science & Therapy, October 21-23, 2013 California, USA
»3rd International Conference on Pharmaceutical Regulatory Affairs, October 21-23, 2013 California, USA
»2nd International Conference on Clinical & Cellular Immunology, October 15-17, 2013 Las Vegas, USA
»2nd International Conference on Medicinal Chemistry & Computer Aided Drug Designing, October 15-17, 2013 Las Vegas, USA
»4th International Conference and Exhibition on Analytical & Bioanalytical Techniques, October 15-17, 2013 Las Vegas, USA
»2nd International Summit on Toxicology, October 07-09, 2013 Las Vegas, USA
»International Conference and Exhibition on Lasers, Optics & Photonics, October 7-9, 2013 San Antonio, USA
»2nd International Conference and Exhibition on Materials Science & Engineering, October 07-09, 2013 Las Vegas, USA
»2nd International Conference on Forensic Research & Technology, October 07-09, 2013 Las Vegas, USA
»International Conference and Exhibition on Biochemical & Molecular Engineering, October 07-08, 2013 San Antonio, USA
»International Conference on Psychology, Autism and Alzheimer's Disease, September 30-October 01, 2013 San Antonio, USA
»International Conference and Exhibition on Mechanical & Aerospace Engineering, September 30-October 02, 2013 San Antonio, USA
»2nd International Conference and Exhibition on Biowaivers & Biosimilars, September 23-25, 2013 Raleigh, USA
»4th World Congress on Biotechnology, September 23-25, 2013 Raliegh, USA
»International Conference on Hematology & Blood Disorders, September 23-25, 2013 Raliegh, USA
»2nd International Conference on Surgery and Anesthesia, September 16-18, 2013 Las Vegas, USA
»2nd International Conference on Clinical Microbiology & Microbial Genomics, September 16-18, 2013 Las Vegas, USA
» International Conference on Omics Studies, September 04-06, 2013 Orlando-FL, USA
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Case Report Open Access
Hazard Detection by Drivers with Paracentral Homonymous Field Loss: A Small Case Series
Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 20 Staniford St, Boston, MA 02114-2500, USA
*Corresponding author: P. Matthew Bronstad
PhD, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School
20 Staniford St, Boston, MA 02114-2500, USA
Tel: 617-912-0213
E-mail: matthew.bronstad@schepens.harvard.edu
 
Received November 04, 2011; Accepted December 04, 2011; Published December 06, 2011
 
Citation: Bronstad PM, Bowers AR, Albu A, Goldstein RB, Peli E (2011) Hazard Detection by Drivers with Paracentral Homonymous Field Loss: A Small Case Series. J Clinic Experiment Ophthalmol S5:001. doi:10.4172/2155-9570.S5-001
 
Copyright: 2011 Bronstad PM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 
Abstract
 
Introduction: Stroke frequently causes homonymous visual field loss. We previously found in a driving simulator that patients with complete homonymous hemianopia had difficulty detecting potential hazards on the side of the field loss. Here we measured the effects of limited paracentral homonymous field loss on detection performance.
 
Methods: Three patients with paracentral homonymous scotomas, yet meeting vision requirements for driving in the United States, performed a pedestrian detection task while driving in a simulator. Pedestrians appeared in a variety of potentially hazardous situations on both sides of the road. Three age- and gender-matched control participants with normal vision participated for comparison purposes.
 
Results: Pedestrians appearing in the scotomatous side of the visual field were less likely to be detected, and when they were, reaction times were longer, frequently too late to respond safely.
 
Conclusions: Although legally permitted to drive in the USA, and possibly in other countries, patients with paracentral homonymous field loss may have impaired hazard detection and may benefit from education about their deficit and a fitness-to-drive evaluation.
 
Keywords
 
Low vision; Driver licensing; Hemianopsia; Quadranopia; Quadranopsia; Quadrantanopia; Sectoranopia
 
Introduction
 
Homonymous visual field defects, commonly caused by brain injury due to stroke, affect the same half of the visual field of each eye [1]. Such visual deficits affect nearly 1% of people over 49, and 2-3% of people over 70 years of age [1]. The majority (at least 60%) of homonymous defects are incomplete with part of the vision in the affected hemifield spared [2].
 
In our prior driving simulator study, participants with complete homonymous hemianopia failed to detect 35-75% of pedestrian hazards in their blind hemi-field (depending on position relative to the driving lane) [3]. However the effect of incomplete homonymous field loss on potential hazard detection while driving has not been systematically evaluated. Here we report three cases with homonymous loss limited to the central area of the affected hemifield (paracentral scotomas). This type of field loss is not uncommon, accounting for at least 20% of incomplete homonymous defects [2]. Visual screening for driver licensing in the USA focuses on visual acuity and peripheral visual field extent, but not paracentral scotomas. By comparison, some other countries, including the UK and Canada [4,5], require screening for paracentral scotomas. As paracentral homonymous field loss is unlikely to be detected by visual screening tests for driver licensing in the USA, these patients are more likely to be on the road than patients with complete hemianopia who are restricted from driving in many states. Yet, they may also have detection deficiencies, as demonstrated by our three cases.
 
Methods
 
Three patients with paracentral homonymous scotomas and three control participants (normal full-field vision and VA 20/25 or better) were recruited. Controls were case-matched to each patient so they were the same gender, a similar age (on average, 3 years older than patients), and had a similar driving history (on average, driving 3 years longer, all were current drivers).
 
All six participants signed an informed consent form approved by the Schepens Institutional Review Board. We measured all participants’ binocular peripheral visual fields using Goldmann perimetry (V4e target) and central visual fields with a custom-designed computerized perimeter [6] using kinetic perimetry (0.7° target, similar to the Goldmann IV3d target). Cognitive status was evaluated using the Short Portable Mental Status Questionnaire (SPMSQ) [7].
 
Driving was evaluated in a high-fidelity driving simulator Model PP-1000 (FAAC Inc., Ann Arbor, MI), over two 2-3 hour sessions conducted a week apart. The simulator has 5 screens that provide a 225° field of view, and an open cab with all controls typical of a car with automatic transmission. During each session all participants completed five test drives, three on city roads (30mph posted speed limit) and two on rural undivided highways (60mph). They were instructed to follow all the normal rules of the road.
 
Pedestrian models were 2m tall in the virtual world and appeared along the road at one of four locations relative to the car’s heading (-14°, -4°, 4°, and 14°); Figure 1 D; [8]). 104 pedestrians were presented over the two sessions. Pedestrians were designed to represent a realistic hazard: they walked or ran toward the participant’s travel lane. The participant’s vehicle and the pedestrian were on a collision course; therefore the pedestrian maintained a relatively stable eccentricity with respect to vehicle heading for up to about 5 seconds after initial appearance [9,10]. Pedestrians stopped just before they reached the participant’s travel lane to avoid collisions. More methodological details are available in Bronstad et al. [8].
 
Participants were instructed to press the horn as soon as they saw a pedestrian; we measured reaction times and detection rates. Given the distance to each pedestrian figure at horn-press time we calculated whether pedestrians were detected in sufficient time to avoid a potential collision (had the pedestrian continued walking into the participant’s travel lane). The calculation was based on the participant’s driving speed and an assumed deceleration of 5m/s2 [11].
 
Case Reports
 
Case 1
 
A 76 year old woman suffered a hemorrhagic cerebrovascular accident 17 months earlier that caused an infarct in her right lateral geniculate nucleus, confirmed by CT scan. There was corresponding sectoranopia [2] in her left hemifield (Figure 1). She showed no evidence of neglect, had binocular visual acuity (VA) of 20/30 (decimal 0.67), and was mentally alert (SPMSQ score of 11/11). She reported driving five times a week to stores, appointments, and the gym, but avoided driving in high traffic and on highways. A family member had expressed concern about her driving performance. She is now deceased, cause unknown to us.
 
Figure 1: (A-C): Binocular central 60° visual field plots for patients withhomonymous paracentral scotomas. Shading represents binocular blindareas; rectangular shape indicates approximate area of a typical carwindshield (right extent ends near 50°). (D): Location and size of pedestrians(-14°, -4°, 4°, & 14°) 3 seconds after appearance on city drives (on highway,pedestrian figures appeared half as large, because they were positioned attwice the distance). Dark polygon shows position of central monitor of drivingsimulator (irregular bottom from view obstructed by car hood).
 
She detected all pedestrians on the non-scotoma right side of her visual field. Her response times on that side were 2 seconds (small eccentricity) to 2.8 seconds (large eccentricity), 0.7 to 1.1 seconds longer than control subjects, respectively (Figure 2). However, she failed to detect 10% of pedestrians that appeared on her scotoma (left) side. These failures were more than twice as likely to be on highway drives. Furthermore, when she detected pedestrians on the left side, her response times were very long, about 6 seconds, 4.7 seconds longer than the response times of age-matched control subjects (Figure 2). These scotoma-side deficits resulted in untimely responses (the pedestrian was not detected or was detected too late) for 23% and 31% of pedestrian appearances on the left side, at small and large eccentricities, respectively (Figure 3). She had untimely responses for 12% of pedestrian appearances at large eccentricities on the nonscotoma right side and none at the small eccentricity. She drove somewhat slowly on highway drives (40mph, rather than the posted 60mph), which would have reduced stopping distances and decreased the number of untimely responses, despite the long reaction times.
 
Figure 2: Reaction times to pedestrians for patients and three age- and gender-matched control participants. Thick lines show median reaction times, whiskers show inter-quartile range (25% and 75% reaction times).
 
Figure 3:Percentages of pedestrian appearances for which reactions were timely or untimely, and detection failures.
 
Case 2
 
A sixty year old man who had a stroke 8 months before driving in our simulator. His stroke caused an infarct in his right occipital lobe, suspected to be embolic in nature due to atrial fibrillation. The patient had a paracentral homonymous scotoma of about 30° in diameter in the left hemifield (Figure 1). His binocular VA was 20/15 (decimal 1.3) and he was mentally alert (SPMSQ of 11/11) with no sign of neglect. He was a current and confident driver and bicyclist, self-reported as driving “somewhat faster” than other drivers, travelling approximately three times a week to stores or restaurants. In a follow-up two years later he said that he increased his driving.
 
This patient also failed to detect about 10% of pedestrians that appeared on his scotoma left side. His response times were longer on his scotoma side by 0.45 (small eccentricity) to 2.3 seconds (large eccentricity) than those of normally-sighted controls (Figure 2). He had untimely responses for 8% (small eccentricity) to 30% (large eccentricity) of pedestrian appearances on his scotoma side compared to 0% on his non-scotoma right side (Figure 3). He drove at an average speed of 52mph on highway drives and 26mph on city drives.
 
Case 3
 
A thirty-eight year old man who suffered a presumed embolic left temporal stroke 9 months before our evaluation with corresponding right superior homonymous quadranopia that affected only the central 30° of the visual field (Figure 1). He had a history of patent foramen ovale, a congenital heart condition that increases risk of stroke in people under 55. Binocular visual acuity was 20/20 (decimal 1.0), and he was mentally alert (SPMSQ of 11/11) with no evidence of neglect. He stopped driving after his stroke but later resumed.
 
This patient failed to detect 5% to 20% of pedestrians (small and large eccentricity, respectively) that appeared in the scotomatous right side of his visual field. His response times were longer on the scotoma side by 0.4 (small eccentricity) to 1.3 seconds (large eccentricity) (Figure 2), and didn’t differ from those of normally-sighted controls on the unaffected left side. Like case 2, he had untimely responses for 8% (small eccentricity) to 31% (large eccentricity) of pedestrian appearances on his scotoma side compared to 0% on his non-scotoma side (Figure 3). He drove at an average speed of 53mph on highway drives and 27mph on city drives.
 
At the time of testing this patient, a 2-camera Smart Eye Pro (Smart Eye AB, Göteborg, Sweden) remote infra-red eye- and head-tracking system had been installed in the driving simulator. Thus, we were able to examine the relationship between gaze behaviors and detection performance for pedestrians that appeared on the scotoma right side. Four of his six pedestrian detection failures on the right side happened when he was either following a lead car or there were other distracting objects in view (e.g., an emergency vehicle with flashing lights); gaze data confirmed that in these situations, gaze was either fixed on the car ahead or the distracting object in the left field such that the pedestrian likely remained within the scotomatous area and was not detected. The two upper plots in Fig 4 show lateral gaze position for two different pedestrians at the large eccentricity on the scotoma right side. During the approach to pedestrian 1 (not detected), lateral gaze position was mostly straight ahead and there were no saccades to the right. By comparison on the approach to pedestrian 2 (detected), he made a rightward saccade of about 15° and the pedestrian was then fixated until the time point at which it disappeared. The horn-press indicated detection occurred soon after the rightward saccade.
 
Also of interest, the gaze data for this patient indicated that he made frequent downward saccades, presumably to examine the speedometer (Figure 4, lower plots). During approaches to pedestrians (~5 seconds before appearance), he made an average of 0.87 downward saccades (median = 1, range = 0 to 4). In comparison three normallysighted participants (different from the control participants, for whom we unfortunately have no eye-tracking data) checked the speedometer using downward saccades on average 0.3, 0.45, and 0.74 times during similar time periods. Case 3 thus made more frequent downward saccades, and in doing so his upper quadranopic scotoma covered the entire right half of the road, including pedestrians appearing in the right hemifield (Figure 4, lower plots). Note that for normally-sighted participants such downward gaze movements would not obscure the pedestrians.
 
Figure 4: Case 3’s eye-gaze data for two pedestrians at the large right eccentricity (median filtered with a 5-frame window, 60 Hz). Left: Lateral (top) and vertical (bottom) eye position for a +14° pedestrian. Bottom left graph shows three distinct downward saccades, the last of which caused his upper quadrant to obscure the pedestrian for approximately two seconds (Pedestrian Envelope shows the vertical angle subtended by the pedestrian). Right: Although making four downward saccades, the pedestrian is detected as illustrated by a rightward saccade (~277 seconds after drive start) and the horn-press that quickly followed.
 
Case 3 wanted to resume driving. We informed him of the detection failures due to his field loss and the need to consider the risks apparent from our results. The patient subsequently had a fitness-todrive evaluation by an independent driving instructor. He was rated safe and resumed driving.
 
Discussion
 
Each patient in this case series had paracentral visual field loss but sufficient horizontal peripheral visual field extent and visual acuity to qualify for an unrestricted driver’s license in the USA [12]. All of them would fail field screening requirements in some countries, including the UK and Canada [4,5]. Cases 1 and 2 were current drivers, and case 3 subsequently resumed driving after an on-road test. All had reaction time and detection deficits to potential pedestrian hazards that appeared on the scotoma side that might be considered unsafe.
 
Case 1 had the longest reaction times on both the non-scotoma and scotoma sides, and the highest proportion of untimely responses. Had she been driving faster she may have been at greater risk; stopping distance is 180 feet at 52mph, whereas it is 107 feet at 40mph. Case 1 had longer reaction times than case 2, despite the fact that case 2 had a more extensive left-sided scotoma (though both are similar once limited by a car windshield: Figure 1). The difference between cases 1 and 2 may result from case 1 being older (76 years old) than case 2 (60 years old). In our previous study of drivers with complete homonymous hemianopia, age was strongly correlated with blindside detection rates: older participants had poorer detection rates than younger participants [3]. It is also known that men speed more than women [13]; case 1 was female and case 2 male. In the control group, the slowest participant was also the oldest and female. In addition, case 1 had the poorest acuity of the three patients, which might account for the delay in detecting the pedestrians appearing on the highway due to their smaller visual angle at appearance.
 
Case 3 might not be expected to have detection failures or reaction time delay to pedestrians on his scotoma side, as his field loss did not extend below the horizontal midline (Figure 1C). However, his reaction times were longer to pedestrians on his scotoma side than his nonscotoma side, and he had poorer scotoma-side detection rates than the other two cases. This suggests that either 1) his gaze was directed low enough to keep the pedestrians in the scotoma for much of the time, or 2) the lower half of the pedestrians did not provide sufficient contrast against the road or sidewalk background to be detected. Gaze tracking data indicates that pedestrians on the right were indeed in the scotoma for much of the time, especially as he made frequent downward saccades to the speedometer such that his upper quadranopic scotoma covered the entire right half of the road (Figure 4.). Similar saccades to the speedometer would not be expected to reduce pedestrian detection much for normally sighted drivers, as was indeed found. Furthermore, when gaze was held either by a distracting object in the left field or by the instruction to follow the car ahead there were no scanning saccades into the scotoma right field and pedestrians on that side were less likely to be detected. These situations could easily occur in real-world driving.
 
Whether people with partial or complete hemianopia can drive safely is an important question, with public safety and patient quality of life in the balance. The findings of this and other recent studies [3,14] indicate the importance of individualized evaluations, as the functional abilities of two people with similar vision loss can differ widely. In recent years the UK [4] and Quebec, Canada [5] have permitted licensing following successful on-road driving evaluations for patients with hemianopia who do not meet minimum horizontal visual field requirements. This policy is similar to that used for many years in The Netherlands [15], Switzerland, and Belgium.
 
With careful visual field measurements, clinicians can determine whether scotomata are present, whether they overlap (and thus affect the binocular field), and based on the extent of field loss decide whether patients meet the screening requirement for driver licensing. If there is complete hemianopia, the individual may not meet the minimum visual field extent for driving in his/her state in the USA [16] and will not meet the minimum 120° field extent in Europe. If the patient has partial hemianopia, however, the individual may meet the minimum visual field requirements in some jurisdictions. Whether the homonymous field loss is complete or incomplete, a fitness-todrive examination, by an experienced examiner on a sufficiently challenging course, is required in jurisdictions that permit driving with hemianopia. A specific recommendation in the recent Driver Fitness Medical Guidelines produced by the USA National Highway and Traffic and Safety Administration [17] states “Drivers with hemianopia or quadrantanopia should be given the opportunity for a comprehensive on-road evaluation by a driving specialist, and if judged fit to drive, should be given the opportunity to take the jurisdiction’s road test” (p. 46).
 
Findings from our previous study [3] and this case series, however, suggest indirectly that an on-road driving test (or actual driving) may not be sufficient to uncover deficits in detection and reaction times to hazardous situations as such events may not occur with sufficient frequency in a typical on-road test. Thus a driving simulator may be an appropriate tool for evaluating responses to blindside hazards as the normally uncommon hazardous situations may be programmed to occur multiple times within a test session. If patients fail to respond in a timely manner in the driving simulator, when they are primed and aware of the possibility and nature of the hazard, they may be even less likely to respond in a timely manner when such hazards appear unexpectedly during on-road driving [18].
 
Acknowledgements
 
This research was supported in part by NIH grants EY12890 (EP), EY018680 (ARB), and P30EY003790. Egor Ananev and Christina Gambacorta helped with manuscript preparation, and Junxiang Chen assisted with eye-tracking analyses. Drs. Concetta Alberti, Kevin Houston, PremNandhini Satgunam, and Alex Hwang made helpful comments on the manuscript. Dr. Joseph Rizzo at the Center for Innovative Visual Rehabilitation, Boston Veterans Administration hospital provided driving simulator facilities.
 
References
 


















 
 
 
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