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Biomedical engineering

Biomedical engineering (BME) or medical engineering is the application of engineering principles and design concepts to medicine and biology for healthcare applications (e.g., diagnostic or therapeutic purposes). BME is also traditionally logical sciences to advance health care treatment, including diagnosis, monitoring, and therapy. Also included under the scope of a biomedical engineer is the management of current medical equipment in hospitals while adhering to relevant industry standards. This involves procurement, routine testing, preventive maintenance, and making equipment recommendations, a role also known as a Biomedical Equipment Technician (BMET) or as a clinical engineer.

Biomedical engineering has recently emerged as its own field of study, as compared to many other engineering fields. Such an evolution is common as a new field transitions from being an interdisciplinary specialization among already-established fields to being considered a field in itself. Much of the work in biomedical engineering consists of research and development, spanning a broad array of subfields (see below). Prominent biomedical engineering applications include the development of biocompatible prostheses, various diagnostic and therapeutic medical devices ranging from clinical equipment to micro-implants, imaging technologies such as MRI and EKG/ECG, regenerative tissue growth, and the development of pharmaceutical drugs including biopharmaceuticals.

Bioinformatics

Bioinformatics is an interdisciplinary field that develops methods and software tools for understanding biological data. As an interdisciplinary field of science, bioinformatics combines computer science, statistics, mathematics, and engineering to analyze and interpret biological data.

Bioinformatics is considered both an umbrella term for the body of biological studies that use computer programming as part of their methodology, as well as a reference to specific analysis "pipelines" that are repeatedly used, particularly in the field of genomics. Common uses of bioinformatics include the identification of candidate genes and nucleotides (SNPs). Often, such identification is made with the aim of better understanding the genetic basis of disease, unique adaptations, desirable properties (esp. in agricultural species), or differences between populations. In a less formal way, bioinformatics also tries to understand the organizational principles within nucleic acid and protein sequences.

Biomechanics

Biomechanics is the study of the structure and function of the mechanical aspects of biological systems, at any level from whole organisms to organs, cells and cell organelles, using the methods of mechanics.

Biomaterials
A biomaterial is any matter, surface, or construct that interacts with living systems. As a science, biomaterials is about fifty years old. The study of biomaterials is called biomaterials science or biomaterials engineering. It has experienced steady and strong growth over its history, with many companies investing large amounts of money into the development of new products. Biomaterials science encompasses elements of medicine, biology, chemistry, tissue engineering and materials science.

Biomedical optics
Biomedical optics combines the principles of physics, engineering, and biology to study the interaction of biological tissue and light, and how this can be exploited for sensing, imaging, and treatment. It has a wide range of applications, including optical imaging, microscopy, ophthalmoscopy, spectroscopy, and therapy. Examples of biomedical optics techniques and technologies include optical coherence tomography (OCT), fluorescence microscopy, confocal microscopy, and photodynamic therapy (PDT). OCT, for example, uses light to create high-resolution, three-dimensional images of internal structures, such as the retina in the eye or the coronary arteries in the heart. Fluorescence microscopy involves labeling specific molecules with fluorescent dyes and visualizing them using light, providing insights into biological processes and disease mechanisms. More recently, adaptive optics is helping imaging by correcting aberrations in biological tissue, enabling higher resolution imaging and improved accuracy in procedures such as laser surgery and retinal imaging.

Tissue engineering
Tissue engineering, like genetic engineering (see below), is a major segment of biotechnology – which overlaps significantly with BME.

One of the goals of tissue engineering is to create artificial organs (via biological material) for patients that need organ transplants. Biomedical engineers are currently researching methods of creating such organs. Researchers have grown solid jawbones and tracheas from human stem cells towards this end. Several artificial urinary bladders have been grown in laboratories and transplanted successfully into human patients. Bioartificial organs, which use both synthetic and biological component, are also a focus area in research, such as with hepatic assist devices that use liver cells within an artificial bioreactor construct.

Genetic engineering
Genetic engineering, recombinant DNA technology, genetic modification/manipulation (GM) and gene splicing are terms that apply to the direct manipulation of an organism's genes. Unlike traditional breeding, an indirect method of genetic manipulation, genetic engineering utilizes modern tools such as molecular cloning and transformation to directly alter the structure and characteristics of target genes. Genetic engineering techniques have found success in numerous applications. Some examples include the improvement of crop technology (not a medical application, but see biological systems engineering), the manufacture of synthetic human insulin through the use of modified bacteria, the manufacture of erythropoietin in hamster ovary cells, and the production of new types of experimental mice such as the oncomouse (cancer mouse) for research.

Neural engineering
Neural engineering (also known as neuroengineering) is a discipline that uses engineering techniques to understand, repair, replace, or enhance neural systems. Neural engineers are uniquely qualified to solve design problems at the interface of living neural tissue and non-living constructs.

Pharmaceutical engineering
Pharmaceutical engineering is an interdisciplinary science that includes drug engineering, novel drug delivery and targeting, pharmaceutical technology, unit operations of Chemical Engineering, and Pharmaceutical Analysis. It may be deemed as a part of pharmacy due to its focus on the use of technology on chemical agents in providing better medicinal treatment.

Hospital and medical devices

This is an extremely broad category—essentially covering all health care products that do not achieve their intended results through predominantly chemical (e.g., pharmaceuticals) or biological (e.g., vaccines) means, and do not involve metabolism.

A medical device is intended for use in:
 * the diagnosis of disease or other conditions
 * in the cure, mitigation, treatment, or prevention of disease.

Some examples include pacemakers, infusion pumps, the heart-lung machine, dialysis machines, artificial organs, implants, artificial limbs, corrective lenses, cochlear implants, ocular prosthetics, facial prosthetics, somato prosthetics, and dental implants.

Stereolithography is a practical example of medical modeling being used to create physical objects. Beyond modeling organs and the human body, emerging engineering techniques are also currently used in the research and development of new devices for innovative therapies, treatments, patient monitoring, of complex diseases.

Medical devices are regulated and classified (in the US) as follows (see also Regulation):
 * Class I devices present minimal potential for harm to the user and are often simpler in design than Class II or Class III devices. Devices in this category include tongue depressors, bedpans, elastic bandages, examination gloves, and hand-held surgical instruments, and other similar types of common equipment.
 * Class II devices are subject to special controls in addition to the general controls of Class I devices. Special controls may include special labeling requirements, mandatory performance standards, and postmarket surveillance. Devices in this class are typically non-invasive and include X-ray machines, PACS, powered wheelchairs, infusion pumps, and surgical drapes.
 * Class III devices generally require premarket approval (PMA) or premarket notification (510k), a scientific review to ensure the device's safety and effectiveness, in addition to the general controls of Class I. Examples include replacement heart valves, hip and knee joint implants, silicone gel-filled breast implants, implanted cerebellar stimulators, implantable pacemaker pulse generators and endosseous (intra-bone) implants.

Medical imaging
Medical/biomedical imaging is a major segment of medical devices. This area deals with enabling clinicians to directly or indirectly "view" things not visible in plain sight (such as due to their size, and/or location). This can involve utilizing ultrasound, magnetism, UV, radiology, and other means.

Alternatively, navigation-guided equipment utilizes electromagnetic tracking technology, such as catheter placement into the brain or feeding tube placement systems. For example, ENvizion Medical's ENvue, an electromagnetic navigation system for enteral feeding tube placement. The system uses an external field generator and several EM passive sensors enabling scaling of the display to the patient's body contour, and a real-time view of the feeding tube tip location and direction, which helps the medical staff ensure the correct placement in the GI tract.

Imaging technologies are often essential to medical diagnosis, and are typically the most complex equipment found in a hospital including: fluoroscopy, magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET), PET-CT scans, projection radiography such as X-rays and CT scans, tomography, ultrasound, optical microscopy, and electron microscopy.

Medical implants
An implant is a kind of medical device made to replace and act as a missing biological structure (as compared with a transplant, which indicates transplanted biomedical tissue). The surface of implants that contact the body might be made of a biomedical material such as titanium, silicone or apatite depending on what is the most functional. In some cases, implants contain electronics, e.g. artificial pacemakers and cochlear implants. Some implants are bioactive, such as subcutaneous drug delivery devices in the form of implantable pills or drug-eluting stents.

Bionics
Artificial body part replacements are one of the many applications of bionics. Concerned with the intricate and thorough study of the properties and function of human body systems, bionics may be applied to solve some engineering problems. Careful study of the different functions and processes of the eyes, ears, and other organs paved the way for improved cameras, television, radio transmitters and receivers, and many other tools.

Biomedical sensors
In recent years biomedical sensors based in microwave technology have gained more attention. Different sensors can be manufactured for specific uses in both diagnosing and monitoring disease conditions, for example microwave sensors can be used as a complementary technique to X-ray to monitor lower extremity trauma. The sensor monitor the dielectric properties and can thus notice change in tissue (bone, muscle, fat etc.) under the skin so when measuring at different times during the healing process the response from the sensor will change as the trauma heals.

Clinical engineering
Clinical engineering is the branch of biomedical engineering dealing with the actual implementation of medical equipment and technologies in hospitals or other clinical settings. Major roles of clinical engineers include training and supervising biomedical equipment technicians (BMETs), selecting technological products/services and logistically managing their implementation, working with governmental regulators on inspections/audits, and serving as technological consultants for other hospital staff (e.g. physicians, administrators, I.T., etc.). Clinical engineers also advise and collaborate with medical device producers regarding prospective design improvements based on clinical experiences, as well as monitor the progression of the state of the art so as to redirect procurement patterns accordingly.

Their inherent focus on practical implementation of technology has tended to keep them oriented more towards incremental-level redesigns and reconfigurations, as opposed to revolutionary research & development or ideas that would be many years from clinical adoption; however, there is a growing effort to expand this time-horizon over which clinical engineers can influence the trajectory of biomedical innovation. In their various roles, they form a "bridge" between the primary designers and the end-users, by combining the perspectives of being both close to the point-of-use, while also trained in product and process engineering. Clinical engineering departments will sometimes hire not just biomedical engineers, but also industrial/systems engineers to help address operations research/optimization, human factors, cost analysis, etc. Also, see safety engineering for a discussion of the procedures used to design safe systems. The clinical engineering department is constructed with a manager, supervisor, engineer, and technician. One engineer per eighty beds in the hospital is the ratio. Clinical engineers are also authorized to audit pharmaceutical and associated stores to monitor FDA recalls of invasive items.

Rehabilitation engineering

Rehabilitation engineering is the systematic application of engineering sciences to design, develop, adapt, test, evaluate, apply, and distribute technological solutions to problems confronted by individuals with disabilities. Functional areas addressed through rehabilitation engineering may include mobility, communications, hearing, vision, and cognition, and activities associated with employment, independent living, education, and integration into the community.

While some rehabilitation engineers have master's degrees in rehabilitation engineering, usually a subspecialty of Biomedical engineering, most rehabilitation engineers have an undergraduate or graduate degrees in biomedical engineering, mechanical engineering, or electrical engineering. A Portuguese university provides an undergraduate degree and a master's degree in Rehabilitation Engineering and Accessibility. Qualification to become a Rehab' Engineer in the UK is possible via a University BSc Honours Degree course such as Health Design & Technology Institute, Coventry University.

The rehabilitation process for people with disabilities often entails the design of assistive devices such as Walking aids intended to promote the inclusion of their users into the mainstream of society, commerce, and recreation.

Regulatory issues
Regulatory issues have been constantly increased in the last decades to respond to the many incidents caused by devices to patients. For example, from 2008 to 2011, in US, there were 119 FDA recalls of medical devices classified as class I. According to U.S. Food and Drug Administration (FDA), Class I recall is associated to "a situation in which there is a reasonable probability that the use of, or exposure to, a product will cause serious adverse health consequences or death"

Regardless of the country-specific legislation, the main regulatory objectives coincide worldwide. For example, in the medical device regulations, a product must be: 1) safe and 2) effective and 3) for all the manufactured devices (why is this part deleted?)

A product is safe if patients, users, and third parties do not run unacceptable risks of physical hazards (death, injuries, ...) in its intended use. Protective measures have to be introduced on the devices to reduce residual risks at an acceptable level if compared with the benefit derived from the use of it.

A product is effective if it performs as specified by the manufacturer in the intended use. Effectiveness is achieved through clinical evaluation, compliance to performance standards or demonstrations of substantial equivalence with an already marketed device.

The previous features have to be ensured for all the manufactured items of the medical device. This requires that a quality system shall be in place for all the relevant entities and processes that may impact safety and effectiveness over the whole medical device lifecycle.

The medical device engineering area is among the most heavily regulated fields of engineering, and practicing biomedical engineers must routinely consult and cooperate with regulatory law attorneys and other experts. The Food and Drug Administration (FDA) is the principal healthcare regulatory authority in the United States, having jurisdiction over medical devices, drugs, biologics, and combination products. The paramount objectives driving policy decisions by the FDA are safety and effectiveness of healthcare products that have to be assured through a quality system in place as specified under 21 CFR 829 regulation. In addition, because biomedical engineers often develop devices and technologies for "consumer" use, such as physical therapy devices (which are also "medical" devices), these may also be governed in some respects by the Consumer Product Safety Commission. The greatest hurdles tend to be 510K "clearance" (typically for Class 2 devices) or pre-market "approval" (typically for drugs and class 3 devices).

In the European context, safety effectiveness and quality is ensured through the "Conformity Assessment" which is defined as "the method by which a manufacturer demonstrates that its device complies with the requirements of the European Medical Device Directive". The directive specifies different procedures according to the class of the device ranging from the simple Declaration of Conformity (Annex VII) for Class I devices to EC verification (Annex IV), Production quality assurance (Annex V), Product quality assurance (Annex VI) and Full quality assurance (Annex II). The Medical Device Directive specifies detailed procedures for Certification. In general terms, these procedures include tests and verifications that are to be contained in specific deliveries such as the risk management file, the technical file, and the quality system deliveries. The risk management file is the first deliverable that conditions the following design and manufacturing steps. The risk management stage shall drive the product so that product risks are reduced at an acceptable level with respect to the benefits expected for the patients for the use of the device. The technical file contains all the documentation data and records supporting medical device certification. FDA technical file has similar content although organized in a different structure. The Quality System deliverables usually include procedures that ensure quality throughout all product life cycles. The same standard (ISO EN 13485) is usually applied for quality management systems in the US and worldwide.

In the European Union, there are certifying entities named "Notified Bodies", accredited by the European Member States. The Notified Bodies must ensure the effectiveness of the certification process for all medical devices apart from the class I devices where a declaration of conformity produced by the manufacturer is sufficient for marketing. Once a product has passed all the steps required by the Medical Device Directive, the device is entitled to bear a CE marking, indicating that the device is believed to be safe and effective when used as intended, and, therefore, it can be marketed within the European Union area.

The different regulatory arrangements sometimes result in particular technologies being developed first for either the U.S. or in Europe depending on the more favorable form of regulation. While nations often strive for substantive harmony to facilitate cross-national distribution, philosophical differences about the optimal extent of regulation can be a hindrance; more restrictive regulations seem appealing on an intuitive level, but critics decry the tradeoff cost in terms of slowing access to life-saving developments.

RoHS II
Directive 2011/65/EU, better known as RoHS 2 is a recast of legislation originally introduced in 2002. The original EU legislation "Restrictions of Certain Hazardous Substances in Electrical and Electronics Devices" (RoHS Directive 2002/95/EC) was replaced and superseded by 2011/65/EU published in July 2011 and commonly known as RoHS 2. RoHS seeks to limit the dangerous substances in circulation in electronics products, in particular toxins and heavy metals, which are subsequently released into the environment when such devices are recycled.

The scope of RoHS 2 is widened to include products previously excluded, such as medical devices and industrial equipment. In addition, manufacturers are now obliged to provide conformity risk assessments and test reports – or explain why they are lacking. For the first time, not only manufacturers but also importers and distributors share a responsibility to ensure Electrical and Electronic Equipment within the scope of RoHS complies with the hazardous substances limits and have a CE mark on their products.

IEC 60601
The new International Standard IEC 60601 for home healthcare electro-medical devices defining the requirements for devices used in the home healthcare environment. IEC 60601-1-11 (2010) must now be incorporated into the design and verification of a wide range of home use and point of care medical devices along with other applicable standards in the IEC 60601 3rd edition series.

The mandatory date for implementation of the EN European version of the standard is June 1, 2013. The US FDA requires the use of the standard on June 30, 2013, while Health Canada recently extended the required date from June 2012 to April 2013. The North American agencies will only require these standards for new device submissions, while the EU will take the more severe approach of requiring all applicable devices being placed on the market to consider the home healthcare standard.

AS/NZS 3551:2012
AS/ANS 3551:2012 is the Australian and New Zealand standards for the management of medical devices. The standard specifies the procedures required to maintain a wide range of medical assets in a clinical setting (e.g. Hospital). The standards are based on the IEC 606101 standards.

The standard covers a wide range of medical equipment management elements including, procurement, acceptance testing, maintenance (electrical safety and preventive maintenance testing) and decommissioning.

Education
Biomedical engineers require considerable knowledge of both engineering and biology, and typically have a Bachelor's (B.Sc., B.S., B.Eng. or B.S.E.) or Master's (M.S., M.Sc., M.S.E., or M.Eng.) or a doctoral (Ph.D., or MD-PhD  ) degree in BME (Biomedical Engineering) or another branch of engineering with considerable potential for BME overlap. As interest in BME increases, many engineering colleges now have a Biomedical Engineering Department or Program, with offerings ranging from the undergraduate (B.Sc., B.S., B.Eng. or B.S.E.) to doctoral levels. Biomedical engineering has only recently been emerging as its own discipline rather than a cross-disciplinary hybrid specialization of other disciplines; and BME programs at all levels are becoming more widespread, including the Bachelor of Science in Biomedical Engineering which includes enough biological science content that many students use it as a "pre-med" major in preparation for medical school. The number of biomedical engineers is expected to rise as both a cause and effect of improvements in medical technology.

In the U.S., an increasing number of undergraduate programs are also becoming recognized by ABET as accredited bioengineering/biomedical engineering programs. As of 2023, 155 programs are currently accredited by ABET.

In Canada and Australia, accredited graduate programs in biomedical engineering are common. For example, McMaster University offers an M.A.Sc, an MD/PhD, and a PhD in Biomedical engineering. The first Canadian undergraduate BME program was offered at University of Guelph as a four-year B.Eng. program. The Polytechnique in Montreal is also offering a bachelors's degree in biomedical engineering as is Flinders University.

As with many degrees, the reputation and ranking of a program may factor into the desirability of a degree holder for either employment or graduate admission. The reputation of many undergraduate degrees is also linked to the institution's graduate or research programs, which have some tangible factors for rating, such as research funding and volume, publications and citations. With BME specifically, the ranking of a university's hospital and medical school can also be a significant factor in the perceived prestige of its BME department/program.

Graduate education is a particularly important aspect in BME. While many engineering fields (such as mechanical or electrical engineering) do not need graduate-level training to obtain an entry-level job in their field, the majority of BME positions do prefer or even require them. Since most BME-related professions involve scientific research, such as in pharmaceutical and medical device development, graduate education is almost a requirement (as undergraduate degrees typically do not involve sufficient research training and experience). This can be either a Masters or Doctoral level degree; while in certain specialties a Ph.D. is notably more common than in others, it is hardly ever the majority (except in academia). In fact, the perceived need for some kind of graduate credential is so strong that some undergraduate BME programs will actively discourage students from majoring in BME without an expressed intention to also obtain a master's degree or apply to medical school afterwards.

Graduate programs in BME, like in other scientific fields, are highly varied, and particular programs may emphasize certain aspects within the field. They may also feature extensive collaborative efforts with programs in other fields (such as the university's Medical School or other engineering divisions), owing again to the interdisciplinary nature of BME. M.S. and Ph.D. programs will typically require applicants to have an undergraduate degree in BME, or another engineering discipline (plus certain life science coursework), or life science (plus certain engineering coursework).

Education in BME also varies greatly around the world. By virtue of its extensive biotechnology sector, its numerous major universities, and relatively few internal barriers, the U.S. has progressed a great deal in its development of BME education and training opportunities. Europe, which also has a large biotechnology sector and an impressive education system, has encountered trouble in creating uniform standards as the European community attempts to supplant some of the national jurisdictional barriers that still exist. Recently, initiatives such as BIOMEDEA have sprung up to develop BME-related education and professional standards. Other countries, such as Australia, are recognizing and moving to correct deficiencies in their BME education. Also, as high technology endeavors are usually marks of developed nations, some areas of the world are prone to slower development in education, including in BME.

Licensure/certification
As with other learned professions, each state has certain (fairly similar) requirements for becoming licensed as a registered Professional Engineer (PE), but, in US, in industry such a license is not required to be an employee as an engineer in the majority of situations (due to an exception known as the industrial exemption, which effectively applies to the vast majority of American engineers). The US model has generally been only to require the practicing engineers offering engineering services that impact the public welfare, safety, safeguarding of life, health, or property to be licensed, while engineers working in private industry without a direct offering of engineering services to the public or other businesses, education, and government need not be licensed. This is notably not the case in many other countries, where a license is as legally necessary to practice engineering as it is for law or medicine.

Biomedical engineering is regulated in some countries, such as Australia, but registration is typically only recommended and not required.

In the UK, mechanical engineers working in the areas of Medical Engineering, Bioengineering or Biomedical engineering can gain Chartered Engineer status through the Institution of Mechanical Engineers. The Institution also runs the Engineering in Medicine and Health Division. The Institute of Physics and Engineering in Medicine (IPEM) has a panel for the accreditation of MSc courses in Biomedical Engineering and Chartered Engineering status can also be sought through IPEM.

The Fundamentals of Engineering exam – the first (and more general) of two licensure examinations for most U.S. jurisdictions—does now cover biology (although technically not BME). For the second exam, called the Principles and Practices, Part 2, or the Professional Engineering exam, candidates may select a particular engineering discipline's content to be tested on; there is currently not an option for BME with this, meaning that any biomedical engineers seeking a license must prepare to take this examination in another category (which does not affect the actual license, since most jurisdictions do not recognize discipline specialties anyway). However, the Biomedical Engineering Society (BMES) is, as of 2009, exploring the possibility of seeking to implement a BME-specific version of this exam to facilitate biomedical engineers pursuing licensure.

Beyond governmental registration, certain private-sector professional/industrial organizations also offer certifications with varying degrees of prominence. One such example is the Certified Clinical Engineer (CCE) certification for Clinical engineers.

Career prospects
In 2012 there were about 19,400 biomedical engineers employed in the US, and the field was predicted to grow by 5% (faster than average) from 2012 to 2022. Biomedical engineering has the highest percentage of female engineers compared to other common engineering professions.

Notable figures

 * Julia Tutelman Apter (deceased) – One of the first specialists in neurophysiological research and a founding member of the Biomedical Engineering Society
 * Earl Bakken (deceased) – Invented the first transistorised pacemaker, co-founder of Medtronic.
 * Forrest Bird (deceased) – aviator and pioneer in the invention of mechanical ventilators

 * Y.C. Fung (deceased) – professor emeritus at the University of California, San Diego, considered by many to be the founder of modern biomechanics
 * Leslie Geddes (deceased) – professor emeritus at Purdue University, electrical engineer, inventor, and educator of over 2000 biomedical engineers, received a National Medal of Technology in 2006 from President George Bush for his more than 50 years of contributions that have spawned innovations ranging from burn treatments to miniature defibrillators, ligament repair to tiny blood pressure monitors for premature infants, as well as a new method for performing cardiopulmonary resuscitation (CPR).

 * Willem Johan Kolff (deceased) – pioneer of hemodialysis as well as in the field of artificial organs
 * Robert Langer – Institute Professor at MIT, runs the largest BME laboratory in the world, pioneer in drug delivery and tissue engineering

 * John Macleod (deceased) – one of the co-discoverers of insulin at Case Western Reserve University.
 * Alfred E. Mann – Physicist, entrepreneur and philanthropist. A pioneer in the field of Biomedical Engineering.
 * J. Thomas Mortimer – Emeritus professor of biomedical engineering at Case Western Reserve University. Pioneer in Functional Electrical Stimulation (FES)
 * Robert M. Nerem – professor emeritus at Georgia Institute of Technology. Pioneer in regenerative tissue, biomechanics, and author of over 300 published works. His works have been cited more than 20,000 times cumulatively.
 * P. Hunter Peckham – Donnell Professor of Biomedical Engineering and Orthopaedics at Case Western Reserve University. Pioneer in Functional Electrical Stimulation (FES)
 * Nicholas A. Peppas – Chaired Professor in Engineering, University of Texas at Austin, pioneer in drug delivery, biomaterials, hydrogels and nanobiotechnology.
 * Robert Plonsey – professor emeritus at Duke University, pioneer of electrophysiology

 * Otto Schmitt (deceased) – biophysicist with significant contributions to BME, working with biomimetics
 * Ascher Shapiro (deceased) – Institute Professor at MIT, contributed to the development of the BME field, medical devices (e.g. intra-aortic balloons)
 * Gordana Vunjak-Novakovic – University Professor at Columbia University, pioneer in tissue engineering and bioreactor design

 * John G. Webster – professor emeritus at the University of Wisconsin–Madison, a pioneer in the field of instrumentation amplifiers for the recording of electrophysiological signals
 * Fred Weibell, coauthor of Biomedical Instrumentation and Measurements
 * U.A. Whitaker (deceased) – provider of the Whitaker Foundation, which supported research and education in BME by providing over $700 million to various universities, helping to create 30 BME programs and helping finance the construction of 13 buildings

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Biomedical engineering


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Talk:British Columbia

updating population estimates
Hey, please remember when you make an update, you also need to provide an updated reference for the change. —Joeyconnick (talk) 02:44, 20 December 2023 (UTC)

B.C. Liberal Party now called "United Party"
See BC United. The Government and politics section needs to be revised. Will-o-the-west (talk) 01:51, 2 January 2024 (UTC)

columbia is Latin American state????
hello page owner Lectitude (talk) 11:17, 11 March 2024 (UTC)

Cancellation of the BC Rail corruption trial
According to this article Campbell cancelled the trial, but British Columbia Legislature raids doesn't say anything like that. The trial ended with convictions, apparently. And does a premier have the authority to 'cancel' a trial? Indefatigable (talk) 20:36, 5 April 2024 (UTC)

title: Talk:British Columbia


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Balkans

The Balkans, corresponding partially with the Balkan Peninsula, is a geographical area in southeastern Europe with various geographical and historical definitions. The region takes its name from the Balkan Mountains that stretch throughout the whole of Bulgaria. The Balkan Peninsula is bordered by the Adriatic Sea in the northwest, the Ionian Sea in the southwest, the Aegean Sea in the south, the Turkish straits in the east, and the Black Sea in the northeast. The northern border of the peninsula is variously defined. The highest point of the Balkans is Musala, 2925 m, in the Rila mountain range, Bulgaria.

The concept of the Balkan Peninsula was created by the German geographer August Zeune in 1808, who mistakenly considered the Balkan Mountains the dominant mountain system of Southeast Europe spanning from the Adriatic Sea to the Black Sea. The term Balkan Peninsula was a synonym for Rumelia in the 19th century, the parts of Europe that were provinces of the Ottoman Empire at the time. It had a geopolitical rather than a geographical definition, which was further promoted during the creation of the Kingdom of Yugoslavia in the early 20th century. The definition of the Balkan Peninsula's natural borders does not coincide with the technical definition of a peninsula; hence modern geographers reject the idea of a Balkan Peninsula, while historical scholars usually discuss the Balkans as a region. The term has acquired a stigmatized and pejorative meaning related to the process of Balkanization. The alternative term used for the region is Southeast Europe.

The borders of the Balkans are, due to many contrasting definitions, disputed. There exists no universal agreement on the region's components. The term by most definitions fully encompasses Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, North Macedonia, European Turkey, the Romanian coast, most of Serbia, and large parts of Croatia. Sometimes the term also includes southern parts of Slovenia. Italy, although by some definitions having a small part of its territory (the Province of Trieste) on the peninsula, is generally excluded.

Etymology
The origin of the word Balkan is obscure; it may be related to Turkish bālk 'mud' (from Proto-Turkic *bal 'mud, clay; thick or gluey substance', cf. also Turkic bal 'honey'), and the Turkish suffix -an 'swampy forest' or Persian bālā-khāna 'big high house'. It was used mainly during the time of the Ottoman Empire. In both Ottoman Turkish and modern Turkish, balkan means 'chain of wooded mountains'.

Classical antiquity and the early Middle Ages
From classical antiquity through the Middle Ages, the Balkan Mountains were called by the local Thracian name Haemus. According to Greek mythology, the Thracian king Haemus was turned into a mountain by Zeus as a punishment and the mountain has remained with his name. A reverse name scheme has also been suggested. D. Dechev considers that Haemus (Αἷμος) is derived from a Thracian word *saimon, 'mountain ridge'. A third possibility is that "Haemus" (Αἵμος) derives from the Greek word haima (αἷμα) meaning 'blood'. The myth relates to a fight between Zeus and the monster/titan Typhon. Zeus injured Typhon with a thunder bolt and Typhon's blood fell on the mountains, giving them their name.

Late Middle Ages and Ottoman period
The earliest mention of the name appears in an early 14th-century Arab map, in which the Haemus Mountains are referred to as Balkan. The first attested time the name "Balkan" was used in the West for the mountain range in Bulgaria was in a letter sent in 1490 to Pope Innocent VIII by Buonaccorsi Callimaco, an Italian humanist, writer and diplomat. The Ottomans first mention it in a document dated from 1565. There has been no other documented usage of the word to refer to the region before that, although other Turkic tribes had already settled in or were passing through the region. There is also a claim about an earlier Bulgar Turkic origin of the word popular in Bulgaria, however it is only an unscholarly assertion. The word was used by the Ottomans in Rumelia in its general meaning of mountain, as in Kod̲j̲a-Balkan, Čatal-Balkan, and Ungurus-Balkani̊, but it was especially applied to the Haemus mountain. The name is still preserved in Central Asia with the Balkan Daglary (Balkan Mountains) and the Balkan Region of Turkmenistan. The English traveler John Bacon Sawrey Morritt introduced this term into English literature at the end of the 18th century, and other authors started applying the name to the wider area between the Adriatic and the Black Sea. The concept of the "Balkans" was created by the German geographer August Zeune in 1808, who mistakenly considered it as the dominant central mountain system of Southeast Europe spanning from the Adriatic Sea to the Black Sea. During the 1820s, "Balkan became the preferred although not yet exclusive term alongside Haemus among British travelers... Among Russian travelers not so burdened by classical toponymy, Balkan was the preferred term". In European books printed until late 1800s it was also known as Illyrian Peninsula or Illyrische Halbinsel in German.

Evolution of meaning in the 19th and 20th centuries
The term was not commonly used in geographical literature until the mid-19th century because, already then, scientists like Carl Ritter warned that only the part south of the Balkan Mountains could be considered as a peninsula and considered it to be renamed as "Greek peninsula". Other prominent geographers who did not agree with Zeune were Hermann Wagner, Theobald Fischer, Marion Newbigin, and Albrecht Penck, while Austrian diplomat Johann Georg von Hahn, in 1869, for the same territory, used the term Südostereuropäische Halbinsel ('southeasterneuropean peninsula'). Another reason it was not commonly accepted as the definition of then European Turkey had a similar land extent. However, after the Congress of Berlin (1878) there was a political need for a new term and gradually "the Balkans" was revitalized, but in the maps, the northern border was in Serbia and Montenegro without Greece (it only depicted the Ottoman occupied parts of Europe), while Yugoslavian maps also included Croatia and Bosnia. The term Balkan Peninsula was a synonym for European Turkey, the political borders of former Ottoman Empire provinces.

The usage of the term changed in the very end of the 19th and beginning of the 20th century, when it was embraced by Serbian geographers, most prominently by Jovan Cvijić. It was done with political reasoning as affirmation for Serbian nationalism on the whole territory of the South Slavs, and also included anthropological and ethnological studies of the South Slavs through which were claimed various nationalistic and racialist theories. Through such policies and Yugoslavian maps the term was elevated to the modern status of a geographical region. The term acquired political nationalistic connotations far from its initial geographic meaning, arising from political changes from the late 19th century to the creation of post–World War I Yugoslavia (initially the Kingdom of Serbs, Croats and Slovenes in 1918). After the dissolution of Yugoslavia beginning in June 1991, the term Balkans acquired a negative political meaning, especially in Croatia and Slovenia, as well in worldwide casual usage for war conflicts and fragmentation of territory (see Balkanization).

Southeast Europe
In part due to the historical and political connotations of the term Balkans, especially since the military conflicts of the 1990s in Yugoslavia in the western half of the region, the term Southeast Europe is becoming increasingly popular. A European Union initiative of 1999 is called the Stability Pact for Southeastern Europe. The online newspaper Balkan Times renamed itself Southeast European Times in 2003.

Current
In other languages of the region, the region is known as:

 * Slavic languages:
 * Bulgarian and Балкански Полуостров, transliterated: Balkanski Poluostrov
 * Bosnian, Montenegrin and Balkansko poluostrvo / Балканско полуострво
 * Bosnian and Balkanski poluotok
 * Balkanski polotok
 * Romance languages:
 * Peninsula Balcanicã or Balcani
 * Peninsula Balcanică or Balcani
 * Penisola balcanica or Balcani
 * Other languages:
 * Gadishulli Ballkanik and Siujdhesa e Ballkanit
 * Βαλκανική χερσόνησος, transliterated: Valkaniki chersonisos
 * Balkan Yarımadası or Balkanlar

Balkan Peninsula
The Balkan Peninsula is bounded by the Adriatic Sea to the west, the Mediterranean Sea (including the Ionian and Aegean seas) and the Sea of Marmara to the south and the Black Sea to the east. Its northern boundary is often given as the Danube, Sava and Kupa Rivers. The Balkan Peninsula has a combined area of about 470000 km2 (slightly smaller than Spain). It is more or less identical to the region known as Southeast Europe.

Italy currently holds a small area around Trieste that is by some older definitions considered a part of the Balkan Peninsula. However, the regions of Trieste and Istria are not usually considered part of the Balkans by Italian geographers, due to their definition of the Balkans that limits its western border to the Kupa River.

Balkans
The borders of the Balkans are due to many contrasting definitions disputed. There exists no universal agreement on the region's components. The term by most definitions fully encompasses Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, North Macedonia, European Turkey, Romanian coast, and a large part of Croatia and Serbia. Sometimes the term also includes Romania as whole and southern parts of Slovenia. Italy, although by some definitions having a small part of its territory on the Peninsula, is generally excluded.

The term Southeast Europe is also used for the region, with various definitions. Individual Balkan states can also be considered part of other regions, including Southern Europe, Eastern Europe, and Central Europe. Turkey, including its European territory, is generally included in Western Asia or the Middle East.

Western Balkans

The Western Balkans is a political neologism coined to refer to Albania and the territory of the former Yugoslavia, except Slovenia, since the early 1990s. The region of the Western Balkans, a coinage exclusively used in pan-European parlance, roughly corresponds to the Dinaric Alps territory.

The institutions of the European Union have generally used the term Western Balkans to mean the Balkan area that includes countries that are not members of the European Union, while others refer to the geographical aspects. Each of these countries aims to be part of the future enlargement of the European Union and reach democracy and transmission scores but, until then, they will be strongly connected with the pre-EU waiting program Central European Free Trade Agreement. Croatia, considered part of the Western Balkans, joined the EU in July 2013.

Criticism of the geographical definition
The term is criticized for having a geopolitical, rather than a geographical meaning and definition, as a multiethnic and political area in the southeastern part of Europe. The geographical term of a peninsula defines that the sea border must be longer than the land border, with the land side being the shortest in the triangle, but that is not the case for the Balkan Peninsula. Both the eastern and western sea catheti from Odesa to Cape Matapan (c. 1230–1350 km) and from Trieste to Cape Matapan (c. 1270–1285 km) are shorter than the land cathetus from Trieste to Odesa (c. 1330–1365 km). The land has too long a land border to qualify as a peninsula – Szczecin (920 km) and Rostock (950 km) at the Baltic Sea are closer to Trieste than Odesa yet it is not considered as another European peninsula. Since the late 19th and early 20th century no exact northern border has been clear, with an issue, whether the rivers are usable for its definition. In studies the Balkans' natural borders, especially the northern border, are often avoided to be addressed, considered as a problème fastidieux (delicate problem) by André Blanc in Géographie des Balkans (1965), while John Lampe and Marvin Jackman in Balkan Economic History (1971) noted that "modern geographers seem agreed in rejecting the old idea of a Balkan Peninsula". Another issue is the name: the Balkan Mountains, mostly in Northern Bulgaria, do not dominate the region by length and area as do the Dinaric Alps. An eventual Balkan peninsula can be considered a territory south of the Balkan Mountains, with a possible name "Greek-Albanian Peninsula." The term influenced the meaning of Southeast Europe which again is not properly defined by geographical factors yet historical borders of the Balkans.

Croatian geographers and academics are highly critical of inclusion of Croatia within the broad geographical, social-political and historical context of the Balkans, while the neologism Western Balkans is perceived as a humiliation of Croatia by the European political powers. According to M. S. Altić, the term has two different meanings, "geographical, ultimately undefined, and cultural, extremely negative, and recently strongly motivated by the contemporary political context". In 2018, President of Croatia Kolinda Grabar-Kitarović stated that the use of the term "Western Balkans" should be avoided because it does not imply only a geographic area, but also negative connotations, and instead must be perceived as and called Southeast Europe because it is part of Europe.

Slovenian philosopher Slavoj Žižek said of the definition,

"This very alibi confronts us with the first of many paradoxes concerning Balkan: its geographic delimitation was never precise. It is as if one can never receive a definitive answer to the question, 'Where does it begin?' For Serbs, it begins down there in Kosovo or Bosnia, and they defend the Christian civilization against this Europe's Other. For Croats, it begins with the Orthodox, despotic, Byzantine Serbia, against which Croatia defends the values of democratic Western civilization. For Slovenes, it begins with Croatia, and we Slovenes are the last outpost of the peaceful Mitteleuropa. For Italians and Austrians, it begins with Slovenia, where the reign of the Slavic hordes starts. For Germans, Austria itself, on account of its historic connections, is already tainted by Balkanic corruption and inefficiency. For some arrogant Frenchmen, Germany is associated with the Balkanian Eastern savagery—up to the extreme case of some conservative anti-European-Union Englishmen for whom, in an implicit way, it is ultimately the whole of continental Europe itself that functions as a kind of Balkan Turkish global empire with Brussels as the new Constantinople, the capricious despotic center threatening English freedom and sovereignty. So Balkan is always the Other: it lies somewhere else, always a little bit more to the southeast, with the paradox that, when we reach the very bottom of the Balkan peninsula, we again magically escape Balkan. Greece is no longer Balkan proper, but the cradle of our Western civilization."

Nature and natural resources

Most of the area is covered by mountain ranges running from the northwest to southeast. The main ranges are the Balkan Mountains (Stara Planina in Bulgarian language), running from the Black Sea coast in Bulgaria to the border with Serbia, the Rila-Rhodope massif in southern Bulgaria, the Dinaric Alps in Bosnia and Herzegovina, Croatia and Montenegro, the Korab-Šar mountains which spreads from Kosovo to Albania and North Macedonia, and the Pindus range, spanning from southern Albania into central Greece and the Albanian Alps, and the Alps at the northwestern border. The highest mountain of the region is Rila in Bulgaria, with Musala at 2,925 m, second being Mount Olympus in Greece, with Mytikas at 2,917 m, and Pirin mountain with Vihren, also in Bulgaria, being the third at 2915 m. The karst field or polje is a common feature of the landscape.

On the Adriatic and Aegean coasts the climate is Mediterranean, on the Black Sea coast the climate is humid subtropical and oceanic, and inland it is humid continental. In the northern part of the peninsula and on the mountains, winters are frosty and snowy, while summers are hot and dry. In the southern part, winters are milder. The humid continental climate is predominant in Bosnia and Herzegovina, northern Croatia, Bulgaria, Kosovo, northern Montenegro, the Republic of North Macedonia, and the interior of Albania and Serbia. Meanwhile, the other less common climates, the humid subtropical and oceanic climates, are seen on the Black Sea coast of Bulgaria and Balkan Turkey (European Turkey). The Mediterranean climate is seen on the Adriatic coasts of Albania, Croatia and Montenegro, as well as the Ionian coasts of Albania and Greece, in addition to the Aegean coasts of Greece and Balkan Turkey (European Turkey).

Over the centuries forests have been cut down and replaced with bush. In the southern part and on the coast there is evergreen vegetation. Inland there are woods typical of Central Europe (oak and beech, and in the mountains, spruce, fir and pine). The tree line in the mountains lies at the height of 1800–2300 m. The land provides habitats for numerous endemic species, including extraordinarily abundant insects and reptiles that serve as food for a variety of birds of prey and rare vultures.

The soils are generally poor, except on the plains, where areas with natural grass, fertile soils and warm summers provide an opportunity for tillage. Elsewhere, land cultivation is mostly unsuccessful because of the mountains, hot summers and poor soils, although certain cultures such as olive and grape flourish.

Resources of energy are scarce, except in Kosovo, where considerable coal, lead, zinc, chromium and silver deposits are located. Other deposits of coal, especially in Bulgaria, Serbia and Bosnia, also exist. Lignite deposits are widespread in Greece. Petroleum scarce reserves exist in Greece, Serbia and Albania. Natural gas deposits are scarce. Hydropower is in wide use, from over 1,000 dams. The often relentless bora wind is also being harnessed for power generation.

Metal ores are more usual than other raw materials. Iron ore is rare, but in some countries there is a considerable amount of copper, zinc, tin, chromite, manganese, magnesite and bauxite. Some metals are exported.

Antiquity

The Balkan region was the first area in Europe to experience the arrival of farming cultures in the Neolithic era. The Balkans have been inhabited since the Paleolithic and are the route by which farming from the Middle East spread to Europe during the Neolithic (7th millennium BC). The practices of growing grain and raising livestock arrived in the Balkans from the Fertile Crescent by way of Anatolia and spread west and north into Central Europe, particularly through Pannonia. Two early culture-complexes have developed in the region, Starčevo culture and Vinča culture. The Balkans are also the location of the first advanced civilizations. Vinča culture developed a form of proto-writing before the Sumerians and Minoans, known as the Old European script, while the bulk of the symbols had been created in the period between 4500 and 4000 BC, with the ones on the Tărtăria clay tablets even dating back to around 5300 BC.

The identity of the Balkans is dominated by its geographical position; historically the area was known as a crossroads of cultures. It has been a juncture between the Latin and Greek bodies of the Roman Empire, the destination of a massive influx of pagan Bulgars and Slavs, an area where Orthodox and Catholic Christianity met, as well as the meeting point between Islam and Christianity.

Albanic, Hellenic, and other Palaeo-Balkan languages, had their formative core in the Balkans after the Indo-European migrations in the region. In pre-classical and classical antiquity, this region was home to Greeks, Illyrians, Paeonians, Thracians, Dacians, and other ancient groups. The Achaemenid Persian Empire incorporated parts of the Balkans comprising Macedonia, Thrace (parts of present-day eastern Bulgaria), and the Black Sea coastal region of Romania beginning in 512 BC. Following the Persian defeat in the Greco-Persian Wars in 479 BC, they abandoned all of their European territories, which regained their independence. During the reign of Philip II of Macedon (359-336 BC), Macedonia rose to become the most powerful state in the Balkans. In the second century BC, the Roman Empire conquered the region and spread Roman culture and the Latin language, but significant parts still remained under classical Greek influence. The only Paleo-Balkan languages that survived are Albanian and Greek. The Romans considered the Rhodope Mountains to be the northern limit of the Peninsula of Haemus and the same limit applied approximately to the border between Greek and Latin use in the region (later called the Jireček Line). However large spaces south of Jireček Line were and are inhabited by Vlachs (Aromanians), the Romance-speaking heirs of Roman Empire.

The Bulgars and Slavs arrived in the sixth-century and began assimilating and displacing already-assimilated (through Romanization and Hellenization) older inhabitants of the northern and central Balkans. This migration brought about the formation of distinct ethnic groups amongst the South Slavs, which included the Bulgarians, Croats and Serbs and Slovenes. Prior to the Slavic landing, parts of the western peninsula have been home to the Proto-Albanians. Including cities like Nish, Shtip. This can be proven through the development of the names, for example Naissos > Nish and Astibos > Shtip follow Albanian phonetic sound rules and have entered Slavic, indicating that Proto-Albanian was spoken prior to the Slavic invasion of the Balkans.

Middle Ages and Early modern period

During the Early Middle Ages, The Byzantine Empire was the dominant state in the region, both military and culturally. Their cultural strength became particularly evident in the second half of the 9th century when the Byzantine missionaries Cyril and Methodius managed to spread the Byzantine variant of Christianity to the majority of the Balkans inhabitants who were pagan beforehand. Initially, it was adopted by the Bulgarians and Serbs, with the Romanians joining a bit later. The Albanians, on the other hand due to their isolation in their mountain settlements, were not immediately affected by the spread of Christianity.

The emergence of the First Bulgarian Empire and the constant conflicts between the Byzantine Empire and the First Bulgarian Empire significantly weakened the Byzantine control over the Balkans by the end of the 10th century. The Byzantines further lost power in the Balkans after the resurgence of the Bulgarians in the late 12th century, with the forming of their Second Bulgarian Empire. After the collapse of the Second Bulgarian Empire, the Byzantine's Empire grip on power was prolonged by the inability of the Slavs to unite, which was caused by frequent infighting amongst themselves. Bulgaria in the first half of the 14th century was then overshadowed by the new rising regional power of Serbia, which was a result of Stefan Dušan rising up and conquering much of the Balkans to create the Serbian Empire. The Serbian and Byzantine empires continued to be the dominant forces in the region until the arrival of the Ottomans several decades later.

Ottoman expansion in the region began in the second half of the 14th century, as the Byzantine Empire continued to lose its grip on the region after several defeats to the Ottomans. In 1362, the Ottoman Turks conquered Adrianople (now Edirne, Turkey). This was the start of their conquest of the Balkan Peninsula, which lasted for more than a century. Other states in the area starting falling like Serbia after the Battle of Kosovo in 1389, Bulgaria in 1396, Constantinople in 1453, Bosnia in 1463, Herzegovina in 1482, and Montenegro in 1499. The conquest was made easier for the Ottomans due to existing divisions among the Orthodox peoples and by the even deeper rift that had existed at the time between the Eastern and Western Christians of Europe.

The Albanians under Skanderbeg's leadership resisted the Ottomans for a time (1443–1468) by using guerilla warfare. Skanderbeg's achievements, in particular the Battle of Albulena and the First Siege of Krujë won him fame across Europe. The Ottomans eventually conquered the near entirety of the Balkans and reached central Europe by the early 16th century. Some smaller countries, such as Montenegro managed to retain some autonomy by managing their own internal affairs, since the territory was too mountainous to completely subdue. Another small country that retained its independence, both de facto and de jure in this case, was the Adriatic trading hub of Ragusa (now Dubrovnik, Croatia).

By the end of the 16th century, the Ottoman Empire had become the controlling force in the region after expanding from Anatolia through Thrace to the Balkans. Many people in the Balkans place their greatest folk heroes in the era of either the onslaught or the retreat of the Ottoman Empire. As examples, for Greeks, Constantine XI Palaiologos and Kolokotronis; and for Serbs, Miloš Obilić, Tsar Lazar and Karadjordje; for Albanians, George Kastrioti Skanderbeg; for ethnic Macedonians, Nikola Karev and Goce Delčev; for Bulgarians, Vasil Levski, Georgi Sava Rakovski and Hristo Botev and for Croats, Nikola Šubić Zrinjski.

In the past several centuries, because of the frequent Ottoman wars in Europe fought in and around the Balkans and the comparative Ottoman isolation from the mainstream of economic advance (reflecting the shift of Europe's commercial and political centre of gravity towards the Atlantic), the Balkans have been the least developed part of Europe. According to Halil İnalcık, "The population of the Balkans, according to one estimate, fell from a high of 8 million in the late 16th-century to only 3 million by the mid-eighteenth. This estimate is based on Ottoman documentary evidence."

Most of the Balkan nation-states emerged during the 19th and early 20th centuries as they gained independence from the Ottoman Empire or the Austro-Hungarian Empire: Greece in 1821, Serbia, and Montenegro in 1878, Romania in 1881, Bulgaria in 1908 and Albania in 1912.

World wars
In 1912–1913 the First Balkan War broke out when the nation-states of Bulgaria, Serbia, Greece and Montenegro united in an alliance against the Ottoman Empire. As a result of the war, almost all remaining European territories of the Ottoman Empire were captured and partitioned among the allies. Ensuing events also led to the creation of an independent Albanian state. Bulgaria insisted on its status quo territorial integrity, divided and shared by the Great Powers next to the Russo-Turkish War (1877–78) in other boundaries and on the pre-war Bulgarian-Serbian agreement. Bulgaria was provoked by the backstage deals between its former allies, Serbia and Greece, on the allocation of the spoils at the end of the First Balkan War. At the time, Bulgaria was fighting at the main Thracian Front. Bulgaria marks the beginning of Second Balkan War when it attacked them. The Serbs and the Greeks repulsed single attacks, but when the Greek army invaded Bulgaria together with an unprovoked Romanian intervention in the back, Bulgaria collapsed. The Ottoman Empire used the opportunity to recapture Eastern Thrace, establishing its new western borders that still stand today as part of modern Turkey.

World War I was sparked in the Balkans in 1914 when members of Young Bosnia, a revolutionary organization with predominantly Serb and pro-Yugoslav members, assassinated the Austro-Hungarian heir Archduke Franz Ferdinand of Austria in Bosnia and Herzegovina's capital, Sarajevo. That caused a war between Austria-Hungary and Serbia, which—through the existing chains of alliances—led to the World War I. The Ottoman Empire soon joined the Central Powers becoming one of the three empires participating in that alliance. The next year Bulgaria joined the Central Powers attacking Serbia, which was successfully fighting Austro-Hungary to the north for a year. That led to Serbia's defeat and the intervention of the Entente in the Balkans which sent an expeditionary force to establish a new front, the third one of that war, which soon also became static. The participation of Greece in the war three years later, in 1918, on the part of the Entente finally altered the balance between the opponents leading to the collapse of the common German-Bulgarian front there, which caused the exit of Bulgaria from the war, and in turn, the collapse of the Austro-Hungarian Empire, ending the First World War.

Between the two wars, in order to maintain the geopolitical status quo in the region after the end of World War I, the Balkan Pact, or Balkan Entente, was formed by a treaty between Greece, Romania, Turkey and Yugoslavia on 9 February 1934 in Athens.

With the start of the World War II, all Balkan countries, with the exception of Greece, were allies of Nazi Germany, having bilateral military agreements or being part of the Axis Pact. Fascist Italy expanded the war in the Balkans by using its protectorate Albania to invade Greece. After repelling the attack, the Greeks counterattacked, invading Italy-held Albania and causing Nazi Germany's intervention in the Balkans to help its ally. Days before the German invasion, a successful coup d'état in Belgrade by neutral military personnel seized power.

Although the new government reaffirmed its intentions to fulfill its obligations as a member of the Axis, Germany, with Bulgaria, invaded both Greece and Yugoslavia. Yugoslavia immediately disintegrated when those loyal to the Serbian King and the Croatian units mutinied. Greece resisted, but, after two months of fighting, collapsed and was occupied. The two countries were partitioned between the three Axis allies, Bulgaria, Germany and Italy, and the Independent State of Croatia, a puppet state of Italy and Germany.

During the occupation, the population suffered considerable hardship due to repression and starvation, to which the population reacted by creating a mass resistance movement. Together with the early and extremely heavy winter of that year (which caused hundreds of thousands of deaths among the poorly fed population), the German invasion had disastrous effects in the timetable of the planned invasion in Russia causing a significant delay, which had major consequences during the course of the war.

Finally, at the end of 1944, the Soviets entered Romania and Bulgaria forcing the Germans out of the Balkans. They left behind a region largely ruined as a result of wartime exploitation.

Cold War
During the Cold War, most of the countries on the Balkans were governed by communist governments. Greece became the first battleground of the emerging Cold War. The Truman Doctrine was the US response to the civil war, which raged from 1944 to 1949. This civil war, unleashed by the Communist Party of Greece, backed by communist volunteers from neighboring countries (Albania, Bulgaria and Yugoslavia), led to massive American assistance for the non-communist Greek government. With this backing, Greece managed to defeat the partisans and, ultimately, remained one of the two only non-communist countries in the region with Turkey.

However, despite being under communist governments, Yugoslavia (1948) and Albania (1961) fell out with the Soviet Union. Yugoslavia, led by Marshal Josip Broz Tito (1892–1980), first propped up then rejected the idea of merging with Bulgaria and instead sought closer relations with the West, later even spearheaded, together with India and Egypt the Non-Aligned Movement. Albania on the other hand gravitated toward Communist China, later adopting an isolationist position.

On 28 February 1953, Greece, Turkey and Yugoslavia signed the treaty of Agreement of Friendship and Cooperation in Ankara to form the Balkan Pact of 1953. The treaty's aim was to deter Soviet expansion in the Balkans and eventual creation of a joint military staff for the three countries. When the pact was signed, Turkey and Greece were members of the North Atlantic Treaty Organization (NATO), while Yugoslavia was a non-aligned communist state. With the Pact, Yugoslavia was able to indirectly associate itself with NATO. Though, it was planned for the pact to remain in force for 20 years, it dissolved in 1960.

As the only non-communist countries, Greece and Turkey were (and still are) part of NATO composing the southeastern wing of the alliance.

Post–Cold War
In the 1990s, the transition of the regions' ex-Eastern bloc countries towards democratic free-market societies went peacefully. While in the non-aligned Yugoslavia, Wars between the former Yugoslav republics broke out after Slovenia and Croatia held free elections and their people voted for independence on their respective countries' referendums. Serbia, in turn, declared the dissolution of the union as unconstitutional and the Yugoslav People's Army unsuccessfully tried to maintain the status quo. Slovenia and Croatia declared independence on 25 June 1991, which prompted the Croatian War of Independence in Croatia and the Ten-Day War in Slovenia. The Yugoslav forces eventually withdrew from Slovenia in 1991 while the war in Croatia continued until late 1995. The two were followed by Macedonia and later Bosnia and Herzegovina, with Bosnia being the most affected by the fighting. The wars prompted the United Nations' intervention and NATO ground and air forces took action against Serb forces in Bosnia and Herzegovina and FR Yugoslavia (i.e. Serbia and Montenegro).

From the dissolution of Yugoslavia six states achieved internationally recognized sovereignty: Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia; all of them are traditionally included in the Balkans which is often a controversial matter of dispute. In 2008, while under UN administration, Kosovo declared independence (according to the official Serbian policy, Kosovo is still an internal autonomous region). In July 2010, the International Court of Justice, ruled that the declaration of independence was legal. Most UN member states recognise Kosovo. After the end of the wars a revolution broke in Serbia and Slobodan Milošević, the Serbian communist leader (elected president between 1989 and 2000), was overthrown and handed for a trial to the International Criminal Tribunal for crimes against the International Humanitarian Law during the Yugoslav wars. Milošević died of a heart attack in 2006 before a verdict could have been released. Ιn 2001 an Albanian uprising in Macedonia (North Macedonia) forced the country to give local autonomy to the ethnic Albanians in the areas where they predominate.

With the dissolution of Yugoslavia, an issue emerged over the name under which the former (federated) republic of Macedonia would internationally be recognized, between the new country and Greece. Being the Macedonian part of Yugoslavia (see Vardar Macedonia), the federated republic under the Yugoslav identity had the name (Socialist) Republic of Macedonia on which it declared its sovereignty in 1991. Greece, having a large homonymous region (see Macedonia), opposed the usage of the name as an indication of a nationality and ethnicity. Thus dubbed Macedonia naming dispute was resolved under UN mediation in the June 2018 Prespa agreement was reached, which saw the country's renaming into North Macedonia in 2019.

Balkan countries control the direct land routes between Western Europe and South-West Asia (Asia Minor and the Middle East). Since 2000, all Balkan countries are friendly towards the EU and the US.

Greece has been a member of the European Union since 1981, while Slovenia is a member since 2004, Bulgaria and Romania are members since 2007, and Croatia is a member since 2013. In 2005, the European Union decided to start accession negotiations with candidate countries; Turkey, and North Macedonia were accepted as candidates for EU membership. In 2012, Montenegro started accession negotiations with the EU. In 2014, Albania is an official candidate for accession to the EU. In 2015, Serbia was expected to start accession negotiations with the EU, however this process has been stalled over the recognition of Kosovo as an independent state by existing EU member states.

Greece and Turkey have been NATO members since 1952. In March 2004, Bulgaria, Romania and Slovenia have become members of NATO. As of April 2009, Albania and Croatia are members of NATO. Montenegro joined in June 2017. The most recent member state to be added to NATO was North Macedonia on 27 March 2020.

Almost all other countries have expressed a desire to join the EU, NATO, or both at some point in the future.

Politics and economy

Currently, all of the states are republics, but until World War II all countries were monarchies. Most of the republics are parliamentary, excluding Romania and Bosnia which are semi-presidential. All the states have open market economies, most of which are in the upper-middle-income range ($4,000–12,000 p.c.), except Croatia, Romania, Greece, and Slovenia that have high income economies (over $12,000 p.c.), and are classified with very high HDI, along with Bulgaria, in contrast to the remaining states, which are classified with high HDI. The states from the former Eastern Bloc that formerly had planned economy system and Turkey mark gradual economic growth each year. The gross domestic product per capita is highest in Slovenia (over $29,000), followed by Croatia and Greece (~$20,000), Romania, Bulgaria (over $11,000), Turkey, Montenegro, Serbia (between $10,000 and $9,000), and Bosnia and Herzegovina, Albania, North Macedonia (~$7,000) and Kosovo ($5,000). The Gini coefficient, which indicates the level of difference by monetary welfare of the layers, is on the second level at the highest monetary equality in Albania, Bulgaria, and Serbia, on the third level in Greece, Montenegro and Romania, on the fourth level in North Macedonia, on the fifth level in Turkey, and the most unequal by Gini coefficient is Bosnia at the eighth level which is the penultimate level and one of the highest in the world. The unemployment is lowest in Romania and Bulgaria (around 5%), followed by Serbia and Albania (11–12%), Turkey, Greece, Bosnia, North Macedonia (13–16%), Montenegro (~18%), and Kosovo (~25%).

As nations in the Western Balkans opened up to private investment in the 1990s, newly created enterprises (mostly SMEs) fueled regional economic development by facilitating the transition from a massive state-owned structure to a market economy. SMEs now account for 99% of all active businesses, up to 81% of total value created, and 72% of total employment in the Western Balkans.

The Western Balkans are mostly bank-based economies, with bank credit serving as the primary source of external capital for all enterprises, including SMEs. Despite this, the region's bank credit supply is limited and undeveloped. A recent analysis from the European Investment Bank estimated the funding deficit to be at US$2.8 billion, or around 2.5% of nominal GDP.

In most Western Balkan markets, international banks have a market share of 70% to 90%. At the end of 2023, the macroeconomic environment in the Western Balkans indicates that risks are increasing, threatening to worsen the financial imbalance. Recent survey findings give conflicting data on enterprises' funding circumstances. While supply has fallen as a result of the COVID-19 pandemic and interest rate increasers, it has showed progressive recovery.
 * On political, social and economic criteria the divisions are as follows:
 * Territories members of the European Union: Bulgaria, Croatia, Greece, Romania, Slovenia
 * Territories currently in negotiation process for EU membership: Albania, North Macedonia, Montenegro, Serbia, Turkey
 * Territories with "candidate " status for EU membership: Bosnia and Herzegovina
 * Territories with "potential candidates" status for EU membership: Kosovo
 * On border control and trade criteria the divisions are as follows:
 * Territories in the Schengen Area: Croatia, Greece, Slovenia
 * Territories that are legally bound to join the Schengen Area: Bulgaria, Romania
 * Territories in a customs union with the EU: Turkey
 * Territories members of the Central European Free Trade Agreement: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia, Serbia.
 * On currency criteria, the divisions are as follows:
 * Territories that are members of the Eurozone: Croatia, Greece, and Slovenia
 * Territories using the euro without authorization by the EU: Kosovo, Montenegro
 * Territories using national currencies that are candidates for the Eurozone: Bulgaria (lev), Romania (leu)
 * Territories using national currencies: Albania (lek), Bosnia and Herzegovina (convertible mark), North Macedonia (denar), Serbia (dinar), Turkey (lira).
 * On military criteria the divisions are as follows:
 * Member territories of NATO: Albania, Bulgaria, Croatia, Greece, Montenegro, North Macedonia, Romania, Slovenia, Turkey
 * Member territories of the Partnership for Peace with Individual Partnership Action Plan and Membership Action Plan for joining NATO: Bosnia and Herzegovina
 * Member territories of the Partnership for Peace: Serbia
 * On the recent political, social and economic criteria there are two groups of countries:
 * Former communist territories: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo, Montenegro, North Macedonia, Romania, Serbia, Slovenia
 * Capitalist and aligned to the West during the Cold War: Greece, Turkey
 * During the Cold War the Balkans were disputed between the two blocks. Greece and Turkey were members of NATO, Bulgaria and Romania of the Warsaw Pact, while Yugoslavia was a proponent of a third way and was a founding member of the Non-Aligned Movement. After the dissolution of Yugoslavia, Serbia and Bosnia and Herzegovina kept an observer status within the organization.

Regional organizations
See also the Black Sea regional organizations

Demographics
The region is inhabited by Albanians, Aromanians, Bulgarians, Bosniaks, Croats, Gorani, Greeks, Istro-Romanians, Macedonians, Magyars, Megleno-Romanians, Montenegrins, Serbs, Slovenes, Romanians, Turks, and other ethnic groups which present minorities in certain countries like the Romani and Ashkali.

Religion
The region is a meeting point of Orthodox Christianity, Islam and Roman Catholic Christianity. Eastern Orthodoxy is the majority religion in both the Balkan Peninsula and the Balkan region, The Eastern Orthodox Church has played a prominent role in the history and culture of Eastern and Southeastern Europe. A variety of different traditions of each faith are practiced, with each of the Eastern Orthodox countries having its own national church. A part of the population in the Balkans defines itself as irreligious.

Islam has a significant history in the region where Muslims make up a large percentage of the population. A 2013 estimate placed the total Muslim population of the Balkans at around eight million. Islam is the largest religion in nations like Albania, Bosnia-Herzegovina, and Kosovo with significant minorities in Bulgaria, North Macedonia and Montenegro. Smaller populations of Muslims are also found in Romania, Serbia and Greece.

The Jewish communities of the Balkans were some of the oldest in Europe and date back to ancient times. These communities were Sephardi Jews, except in Croatia and Slovenia, where the Jewish communities were mainly Ashkenazi Jews. In Bosnia and Herzegovina, the small and close-knit Jewish community is 90% Sephardic, and Ladino is still spoken among the elderly. The Sephardi Jewish cemetery in Sarajevo has tombstones of a unique shape and inscribed in ancient Ladino. Sephardi Jews used to have a large presence in the city of Thessaloniki, and by 1900, some 80,000, or more than half of the population, were Jews. The Jewish communities in the Balkans suffered immensely during World War II, and the vast majority were killed during the Holocaust. An exception were the Bulgarian Jews who Boris III of Bulgaria sent to forced labor camps instead of Nazi concentration camps. Almost all of the few survivors have emigrated to the (then) newly founded state of Israel and elsewhere. Almost no Balkan country today has a significant Jewish minority.

Languages
The Balkan region today is a very diverse ethnolinguistic region, being home to multiple Slavic and Romance languages, as well as Albanian, Greek, Turkish, Hungarian and others. Romani is spoken by a large portion of the Romanis living throughout the Balkan countries. Throughout history, many other ethnic groups with their own languages lived in the area, among them Thracians, Illyrians, Romans, Celts and various Germanic tribes. All of the aforementioned languages from the present and from the past belong to the wider Indo-European language family, with the exception of the Turkic languages (e.g., Turkish and Gagauz) and Hungarian.

Urbanization
Most of the states in the Balkans are predominantly urbanized, with the lowest number of urban population as % of the total population found in Bosnia and Herzegovina at 49%, Kosovo at 50% and Slovenia at 55%.

A list of largest cities:

Only the European part of Istanbul is a part of the Balkans. It is home to two-thirds of the city's 15,519,267 inhabitants.

Time zones
The time zones in the Balkans are defined as the following:
 * Territories in the time zone of UTC+01:00: Albania, Bosnia and Herzegovina, Croatia, Kosovo, Montenegro, North Macedonia, Serbia and Slovenia
 * Territories in the time zone of UTC+02:00: Bulgaria, Greece, and Romania
 * Territories in the time zone of UTC+03:00: Turkey

Culture

 * Cuisine of the Balkans
 * Balkan music
 * Balkan Athletics Championships
 * Balkan Athletics Indoor Championships
 * Imagining the Balkans

title: Balkans