“Organizational Health Literacy Self-Assessment Tool for Primary Care” (OHL self-AsseT).
\r\n\tThe formation and development of seagrass meadows take many years. Among all the plant habitats in the world, the most carbon storage feature belongs to seagrass with 2000 tons/ha. Posidonia oceanica is the most important seagrass species for primary production and is endemic to the Mediterranean. This species is a perennial herb that spreads to a depth of 45 meters on the Mediterranean coast and can live up to 30 years. Their presence is indicative of clean seas.
",isbn:"978-1-83881-972-9",printIsbn:"978-1-83881-971-2",pdfIsbn:"978-1-83962-472-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"174d974e744ab42717bb8da4add5b6b0",bookSignature:"Dr. Irem Deniz",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11618.jpg",keywords:"Macroalgae, Bioplastics, Hydrogen, Food, Bioenergy, Biogas, Bioethanol, Determination, Controlling, Contamination, Structure, Genetics",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 26th 2022",dateEndSecondStepPublish:"July 1st 2022",dateEndThirdStepPublish:"August 30th 2022",dateEndFourthStepPublish:"November 18th 2022",dateEndFifthStepPublish:"January 17th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"6 days",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"A pioneering researcher in bioprocess engineering, appointed Vice Director of MCBU University-Industry Cooperation Technology Application and Research Center (MCBU-USITEM) and Scientific committee member in EU scientific activities.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"204855",title:"Dr.",name:"Irem",middleName:null,surname:"Deniz",slug:"irem-deniz",fullName:"Irem Deniz",profilePictureURL:"https://mts.intechopen.com/storage/users/204855/images/system/204855.jpg",biography:"Dr. Irem Deniz currently works at the Department of Bioengineering, Manisa Celal Bayar University, Turkey. Her research interests include bioprocesses, enzyme technology, scale-up, bioreactors, gasification, biochemical engineering, bioengineering, bioconversion of agricultural raw and waste commodities into value-added products, bioenergy/biofuels, microalgae, novel bioreactors, and downstream processing. She is an editorial board meeting for Biochemical Engineering Journal and a member of the International Bioprocess Association (IBA). 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From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6418",title:"Hyperspectral Imaging in Agriculture, Food and Environment",subtitle:null,isOpenForSubmission:!1,hash:"9005c36534a5dc065577a011aea13d4d",slug:"hyperspectral-imaging-in-agriculture-food-and-environment",bookSignature:"Alejandro Isabel Luna Maldonado, Humberto Rodríguez Fuentes and Juan Antonio Vidales Contreras",coverURL:"https://cdn.intechopen.com/books/images_new/6418.jpg",editedByType:"Edited by",editors:[{id:"105774",title:"Prof.",name:"Alejandro Isabel",surname:"Luna Maldonado",slug:"alejandro-isabel-luna-maldonado",fullName:"Alejandro Isabel Luna Maldonado"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10359",title:"Landraces",subtitle:"Traditional Variety and Natural Breed",isOpenForSubmission:!1,hash:"0600836fb2c422f7b624363d1e854f68",slug:"landraces-traditional-variety-and-natural-breed",bookSignature:"Amr Elkelish",coverURL:"https://cdn.intechopen.com/books/images_new/10359.jpg",editedByType:"Edited by",editors:[{id:"231337",title:"Dr.",name:"Amr",surname:"Elkelish",slug:"amr-elkelish",fullName:"Amr Elkelish"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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There is no definite answer to the question what causes death of cells where such aggregations have been found: is this the cell defence mechanism or plain death? In a normal state, cells that accumulate such aggregations are usually programmed to death or apoptosis. Cell fragments subjected to apoptosis are removed by phagocytic cells. However, aggregations like amyloid fibrils are known to be resistant to the action of different proteases [1] that can impede the effective termination of efferocytosis and, as a result, accumulate in tissues. In any case, there is undoubtedly close association of the formation of aggregations and the development of many fatal diseases. There are several models describing the process of fibril formation. For example, in order to begin aggregation, proteins should be preliminarily unfolded or partially folded [2]. As known, the generation of fibrils is facilitated by denaturing conditions. At the same time, aggregation of peptides and proteins involved in pathogenesis of such types of amyloidosis as type II diabetes, Alzheimer’s, and Parkinson’s diseases does not necessitate preliminary unfolding of a protein molecule. But these data sooner support the general rule, because under physiological conditions most of these proteins have no definite structure, i.e., are natively unstructured [3]. However, most natively unfolded protein in vivo does not aggregate [4]. Moreover, unstructured proteins are resistant to denaturing conditions, i.e., to the factors bringing about stress, and, in the first place, high temperatures [5]. It was demonstrated that the absence of structure does not correlate with the aggregation capacity [6]. Therefore to avoid spontaneous self-assembly of a protein molecule, the evolutionary selection has led to an increased content of such amino acids as proline and glycine that inhibit protein aggregation [7] and to an increased content of charged amino acids [8]. On the contrary, due to a large number of amyloidogenic regions, globular proteins have developed capacity to avoid aggregation because of rapid folding into a globular structure. This shows that protein unfolding is necessary but not sufficient for activation of amyloid fibrils. It is most likely that there should be special motifs of amino acid sequences exposed to the solvent, which are more liable to aggregation than other regions of the amino acid sequences. Experimental data corroborate the hypothesis that there are small regions of a protein molecule responsible to the amyloidogenic behavior [9–11].
\nIt has remained unclear what the mechanism of the earliest stage of initiation of the pathologic irreversible aggregation of proteins is and how this process is triggered in healthy organisms. It is supposed that the key role in the development of systematic amyloidosis belongs to the so-called primes or factors accelerating pathologic aggregation. Such primes can be infectious agents as well protein molecule regions containing motifs of low complexity, especially when these motifs are recurrent. It was shown that the more frequently the repeats occur in a protein sequence, the less structured the protein is. Generally, most homo-repeats are not structured [12–15]. Nevertheless, this is not characteristic of fibrillar proteins [16], the capacity of which to aggregation depends strongly on the amino acid sequence of the protein [17–19]. For example, if the identity of the amino acid sequence of immunoglobulin domains is lower than 30–40%, the proteins lose their capacity to co-aggregation [18]. Using the bioinformatics analysis, it has been established that in a large number of multidomain proteins the identity of amino acid sequences of their domains is below 40%. It suggests a conclusion that in this way the domains avoid mutual aggregation.
\nThe existence of repeats in proteins and the clarification of their special roles are in the focus of attention of researchers. The role of different repeats is studied actively, including repeats such as PGMG (GPGM) and PNN upon biomineralization of PM27 proteins [20], NPNA (NANP) repeats in circumsporozoite protein of
Cell stress can also be an important factor of initiation of aggregation even though each cell has developed an intricate defence system, because it is subjected to destructive stress action at regular intervals. A striking example of waiting till stress is over in the formation of stress granules (SG), when the nontranslated mRNA and RNA-binding proteins are assembled in ribonucleoprotein (RNP) complexes in order to terminate protein synthesis and thereby maintain cell energy. In this case, only those proteins that are synthesized are required for cell survival [23]. This means that after termination of the stress action, SGs disintegrate rapidly and the “released” mRNA resumes its functioning. However, if due to some reasons, the residence time of such proteins in SGs increases or their concentration in SGs exceeds the norm, disintegration of SGs can be impeded, creating favorable conditions for generation of the “center of aggregation initiation” that may induce transition to irreversible pathologic protein aggregation [24]. A detailed analysis of the mechanism of assembly and disassembly of SGs can provide a new insight into the development of diseases associated with this process and suggest novel therapeutic approaches. Since the main function of SGs is protection of cells from stress, many investigations are conducted to reveal factors shifting the balance of reversible aggregation towards pathology after stress termination (Figure 1).
\nSchematic representation of different conformational states of self-assembly and disintegration of prion-like domains and a possible transition to irreversible pathologic aggregation. Modified and adapted from Li et al. [
It is assumed that due to self-assembly, RNA-binding proteins can facilitate formation of SGs using prion-like domains [26–28]. At any rate, it has been established that namely the structured part of RNA-binding proteins is responsible for the formation of hydrogel and binding to it [29]. Thus, protein FUS maintained its capacity to form gel even without the removal of the C-terminal region that corresponds to the RNA-binding domain and lost this capacity upon removal of the N-terminal unstructured region corresponding to the prion-like domain. The capacity to bind to hydrogel has been established for proteins such as hnRNPA2, RBM3 RNA-binding proteins, hnRNPA1, TIA1, CPEB2, FMRP, CIRBP, TDP43, and yeast Sup35. The formation of hydrogel was also demonstrated for the hnRNPA2 protein, and it was shown that proteins are retained to a different degree by hydrogel formed of different proteins [29].
\nStudies of the human genome have allowed isolating a set of RNA-binding proteins with a canonical RNA-binding motif. For example, prion-like domains were predicted for 29 of the 210 RNA-binding proteins for human diseases [30]. Ten of these 29 proteins are associated with neurodegenerative diseases, i.e., proteinopathies [31]. In this chapter, we focus our attention on isolation of repeats in well-studied proteins of the FET/TET family that are included in this group of 10. To elucidate the mechanism of pathologic aggregation of proteins, we have set ourselves the task to determine what repeats of amino acid residues in RNA-binding proteins can be responsible for reversible and irreversible aggregation.
\nThe prion-like domains predicted for TDP-43 and FUS overlap with the region containing a large number of glycine residues. The prion-like domains are critical for aggregation of these proteins associated with human neurodegenerative diseases [32]. It was found that protein TAF15 is also involved in the development of disorder such as amyotrophic lateral sclerosis (ALS) or Lou Gering’s disease [33]. At first, this protein was discovered using a bioinformatics analysis as a possible candidate and later it was revealed in ALS patients. It turned out that this protein has very similar properties to those of TDP-43 and FUS proteins involved in this disease. The only difference is that mutations of the protein associated with this disease are capable of higher aggregation in vitro than the wild-type protein, exert a stronger effect on the lifetime, and lead to incorrect localization of proteins in the spinal cord of mammals [33].
\nAmong 29 candidates of RNA-binding proteins with predicted prion-like domains, the first and second places belong to FUS and TAF15, whereas TDP-43 is the 10th in this list [34]. Probably, it is expedient to pay attention to the first 10 proteins because the third place belongs to protein EWS [35]. They should also be detected in ALS patients.
\nMembers of the FET family are very similar RNA-binding proteins containing the following main domains in their structure: a SYGQ-rich N-terminal prion-like domain enriched with uncharged polar amino acids (asparagine, glutamine, serine, and tyrosine) and glycine [36], an RNA-binding motif (RNA-recognition motif, RRM), a “zinc finger” motif, and several RGG domains rich in glycine [37–39]. Three proteins (FUS, EWS, and TAF15) also have a nuclear location signal (NLS) that is recognized by the nuclear receptor transportin and is responsible for protein transport from the cytoplasm into the nucleus and back [27, 40–43]. Genes of the FET family are expressed practically everywhere. Proteins of this family are involved in regulation of different stages of gene expression, including transcription, pre-mRNA splicing, mRNA transport, and also take part in DNA repair [44–46]. The family name stems from three capital letters of its three members: proteins FUS/TLS (fused in sarcoma or translocated in liposarcoma), EWS (Ewing’s sarcoma), and TAF15 (TATA-binding protein-associated factor 2N) [47]. These RNA-binding proteins participate in many cell processes, including transcription, pre-mRNA splicing, DNA repair, and mRNA transport in neurons [44–46]. As a rule, under stress conditions such RNA-binding proteins shift from the nucleus into the cytoplasm and take part in the formation of SGs, after which they return to the nucleus. This cycle is multiply repeated during the cell lifetime, and it is not excluded that under such conditions errors may occur in its functioning. The mechanism of activity of FET proteins, their cellular localization, and determination of domains involved in different processes are to be clarified.
\nPrion-like domains of these proteins associated with human neurodegenerative diseases are critical for their aggregation [32]. Proteins of this family are involved not only in neurodegenerative diseases, such as ALS [33], Huntington’s disease, spinocerebellar ataxia, and dentatorubral cerebellar atrophy [48], but also in the development of human mixoid liposarcoma [49–51].
\nA member of the FET family is the RNA-binding protein FUS, for which a number of mutations associated with ALS have been revealed [27, 40–43, 52]. Under normal conditions, this protein is localized mostly in the nucleus, whereas under pathologic conditions its aggregations are accumulated in the cytoplasm. It was demonstrated on several cell models that FUS delocalized in the cytoplasm was accumulated in SGs. This permitted a conclusion that a high concentration of the protein facilitates generation of protein aggregations under FUS pathology [53, 54]. Nonetheless an exact mechanism by which this transformation occurs remains unclear. It is not excluded that prion-like domains affect aggregation-like prions or fibril formation analogous to amyloidogenesis. It is also possible that FUS, accumulated in large amounts, aggregates in the cytoplasm independently of its capacity to sequestration in SGs. The protein accumulation can also facilitate dysfunction of the protein intracellular degradation systems that frequently occurs parallel to neurodegenerative disorders [55]. It should be noted that under sporadic ALS diseases, the control of splicing of a large amount of genes is violated [56]. The FUS protein also regulates alternative splicing, as a rule binding to transcripts containing large introns. Therefore, accumulation of FUS in the cytoplasm can result in the loss of its function in the nucleus and consequently violation of the alternative splicing of a number of genes, e.g., coding proteins associated with the growth and development of axons and the cell cytoskeleton [57]. This version is in agreement with the results obtained on a drosophila model, when an increased FUS concentration in the cell was extremely toxic for organisms that can also cause dysfunction during splicing. In addition, enhanced expression of the gaz gene of the fus ortholog caused death at the pupal stage [58].
\nIn transgenic
To verify the hypothesis that dislocation of FUS from the nucleus into the cytoplasm leads to the loss of its function in the nucleus, Murakami et al. created transgenic animals with double gene expression. One of these genes (fus) having the N-terminus, labeled with red fluorescent protein RFP, could not move into the cytoplasm under the action of stress, and the other gene (mutant GFP-fus-P525L) was uniformly distributed both over the nucleus and the cytoplasm. After heat shock, most of GFP-FUS-P525L moved into the SGs, whereas GFP-RUS remained in the cytoplasm. Therewith, the damaging effect was the same as in the experiment with expression of only GFP-fus-P525L. Therefore, the authors concluded that accumulation and aggregation of FUS in the cytoplasm are more neurotoxic than that when FUS lost its function in the nucleus [62].
\nIn any case, formation of such aggregations is the reason for apoptosis, i.e., the process of programmed cell death. Apoptosis is characterized by retaining fragmentation of intracellular components with retention of the integrity of the plasmatic membrane that facilitates fast phagocytosis.
\nTo understand the mechanism of assembly and disassembly of SGs, it is necessary to know what regions of the chain of RNA-binding proteins can perform the function of a prime and what the role of unstructured regions of simple complexity is. It is worth noting that in many respects protein FUS is a perfect model for studying processes involved in the formation of protein aggregations by the prion mechanism. To search for and reveal properties of prion-like domains, we have chosen three proteins from the FET/TET family of 29 RNA-binding proteins of the human proteome, the structures of which included prion-like domains [31]. The prediction was made using the algorithm developed by Alberti et al. [63], which is based on the choice of protein regions of 60 amino acid residues, similar in the amino acid content to the prion domains of yeast proteins, such as Sup35, Ure2p, and Rnq1p [64]. As a rule, these regions are rich in hydrophilic amino acid residues such as glutamine, asparagine, and tyrosine. In the range of proteins used in the prediction of prion-like domains, the first and second places belonged to FUS and TAF15 among 29 candidates of RNA-binding proteins, and the third was protein EWS [35].
\nThe experiments, devoted to disclosing the capacity of protein FUS to aggregate, demonstrated that upon deletion of the most part of the predicted prion-like domain the protein lost its capacity to self-assemble; however, the formed aggregations did not reveal toxicity (Figure 2) [67]. Some components of SGs, such as translation initiation factors and poly-A-binding proteins, suppress toxicity of FUS aggregation [67]. It is important that proteins associated with RNA metabolism can affect the toxicity of FUS aggregations. Prion-like (1–239) and RGG2 (374–422) domains are also required for aggregation and toxicity of yeasts, although FUS (1–359) is sufficient for simulations on the neuroblastoma cell culture [68]. Domain RGG3 does not affect aggregation, and mutations at (502–526) result only in accumulation of the protein in the cytoplasm and its insertion in SGs [24, 69]. It should be mentioned that in contrast to mammalian cells, in yeast cells protein FUS is accumulated largely in the cytoplasm [61]. This may be connected with the fact that NLS FUS is not recognized by nuclear receptors of yeasts [65]. In mammalian cells, protein FUS is accumulated in the cytoplasm only when it has mutations distorting the reverse transport into the nucleus [69].
\nEffect of different constructions of FUS on aggregation and toxicity in yeasts and aggregation and localization in SGs in cell culture of the SH-SY5Y neuroblastoma [
The N-terminal domain of FUS has 27 different variants of GYG, GYS, SYG, and SYS triplets (that can be designated as [G/S]Y[G/S] repeats) [70]. Four mutants were obtained with a different number of substituted tyrosine residues for serine ones to demonstrate that namely tyrosine residues are responsible for the formation of hydrogel. There were 5, 9, 15 substitutions and all 27. Neither of the mutants could form hydrogel, however, all of them could equally well bind to it. Mutants with substituted residues 5 and 9 could bind to hydrogel, but the remaining mutants could not [70].
\nFor all three proteins, the IsUnstruct program [15] predicts the presence of unstructured domains, as a rule, at the N and C termini of the polypeptide chain. Unstructured proteins often play the role of hubs, i.e., have a capacity to concentrate a large number of partners around them (it is accepted that when there are more than five partners, it is a hub) [71]. To what extent is this role validated? To answer this question, it is necessary to determine the presence of functional sites in the protein considered. The search for the number of partners in the STRING database revealed that it exceeds 5 [72] (see Figure 3). Usually upon binding to a partner, natively unfolded proteins can acquire a structure that imparts a certain function to them. In other words, the conformation of unstructured proteins is “dictated” by the interaction partners. This explains their capacity to perform different functions both in the cell and in the extracellular space. For example, the analyzed RNA-binding proteins have regions with large amounts of glycine in addition to large amounts of asparagine, glutamine, and tyrosine, which also facilitates their unfolded state and performance of various functions in the cell because these proteins are involved in the formation of RNP complexes, control of DNA transcription, pre-mRNA splicing, protein posttranslational modification, and many other vital functions [73]. According to the STRING database (version 10), the number of partners is 44 for TAF15, 132 for EWS (Figure 3), and 218 for FUS.
\nThe list of partners for EWS has been obtained from the STRING database using the information from the data bases, data about homologies, possible co-expression, experimental confirmation about interactions, etc. The boundary condition for entry in the list of partners is probability of interactions equal to 0.4. Transparency of edges connecting vertices in the graph designates probability of interaction. The more transparent of edge, the less probability of interaction.
These proteins contain many motifs of simple complexity. As shown, the portion of proteins, included in periodic fragments or homorepeats, is an order of magnitude lower in eukaryotic proteomes than in bacterial ones [74, 75]. The proteins with periodic fragments are extremely nonuniformly distributed both over the kingdoms and over organisms within each kingdom [74, 75]. It is worth underlining that these repeated motifs can be located in the region not predicted as prion-like. It is known that protein Ure2 has regions in the carboxy-terminal domain affecting the capacity of the amino-terminal domain to become prion-like [76]. The available data for FUS allow us to conclude that the presence of both a prion-like domain and a C-terminal region corresponding to the RGG2 region (see Figure 2) is important for pathologic aggregation. It is most likely that the RNA-binding domain also contributes to the pathologic aggregation. The RNA-binding motif (RRM) in proteins RUS and TAF15 is highly identical and is retained from species to species. On the contrary, the RNA-binding motif (RRM) in protein EWS differs remarkably from other members of the family and does not preserve 100% identity in different species. For example, for FET proteins, the following amyloidogenic regions, revealed using program FoldAmyloid [77], can be indicated in the RNA-binding domain (RRM): AIYVQ/ADFFK/MIHIYL/VEWFD for EWS; TIFVQ/INLYT/IDWFD for TAF15; and TIFVQ/INLYT/IDWFD for FUS.
\nThe prediction of unstructured regions in proteins of the FET/TET family using program IsUnstruct allowed us to isolate two unstructured domains at the N and C termini and one structured region, corresponding to the RNA-binding domain. Figure 4 shows probability profiles for amino acid residues of the FET/TET proteins, which make it possible to determine whether they are structured or unstructured. Motifs in the amino acid sequence are shown by different colors. These proteins are characterized by the presence of a large number of homorepeats when one amino acid is recurrent many times. Generally, the longer are the repeats, the higher is the probability that the aggregated protein containing and it is associated with the development of a disease. For example, protein FUS is characterized by five unstructured patterns from the pattern library obtained by us from the Protein Data Bank: GSHM, GGGGSGG, GGGGG, GGSGGGGSGGG, and RGGGGSG. The occurrence of these patterns in the given protein in different organisms (human, monkey, pig, mouse, quicken and fish) can be found in our HRaP database, containing data on the occurrence of unstructured patterns and homorepeats in 122 proteomes [14]. For protein TAF15, the glycine-rich recurrent motif is well isolated at the C-terminus: DRGGGYGG/DRSSGGGYSG/DRGSRGGYGG, which is characteristic of many animals and fish [78]. We isolated 22 repeats, and the Uniprot program finds 21 repeats at the C terminus: GRGGRGG/DRGGYGG (Figure 4). As concerns EWS, we can observe 14 repeats as SYSQAPS in the prion-like domain (the N-terminal part) and 6 repeats (DRGRGGPGG) in the C-terminal part (Figure 4). It should be noted that 15 imperfect repeated motifs (QPGQGYSQQSS) are positioned in a prion-like region (the N-terminal part) and four repeats (DDRRGGRGGY) in the C-terminal one for FUS (Figure 4).
\nAs known, protein regions enriched in glycine residues cannot have a rigid spatial structure; therefore, the main function characterizing this protein region is determined by a number of adjacent amino acid residues. It should be noted that in the mentioned proteins with high toxic aggregation, the glycine repeats adjoin arginine, serine, and tyrosine. Domains rich in glycine and arginine (RGG) are known to be responsible for the interaction of proteins with each other and with RNA. As a rule, these interactions are controlled by methylation of arginine [79], whereas phosphorylation of serine residues affects the direct mutual interaction of prion-like domains [45, 80]. Of interest is the fact that deletion of serine (S57), the mutation associated with sporadic form of ALS [81], induced paralysis in transgenic
Probability profiles of amino acid residues in proteins of the FET/TET family (A for FUS, B for TAF15, and C for EWS) according to which it is possible to predict possible formation of the structure or its absence by the IsUnstruct program [
All proteins of the FET/TET family are characterized by the presence of a zinc-finger motif. The exclusion is the EWS protein in chickens, because here the zinc-finger motif has not been determined [78]. As known, a classic zinc-finger motif forms a loop, where two cysteine residues and two histidine residues bind zinc ions. The main function of a classic zinc-finger motif is the binding of DNA, which corresponds to its structure consisting of two to three beta-sheets in the N-terminal region of the protein and one alpha-helix in its C-terminal region. As for the FET/TET family of proteins, the amino acid sequence of the zinc-finger motif in them differs significantly from the classic consensus motif (Cys-X2–4-Cys-X3-Phe-X5-Leu-X2-His-X3-His) [83]. It should be noticed here that the amino acid sequence of this motif in proteins FUS and EWS is highly similar, which is preserved in all organisms studied by us. Our plots on the prediction of the structure demonstrated quite well the correspondence of this motif and the predicted structure (Figure 4: proteins FUS and EWS, second peak from the bottom, blue). On the contrary, in TAF15, this motif differs somewhat not only from FUS and EWS but also in the organisms studied by us; according to our prediction, it forms no structure (Figure 4). It is important that in proteins of the FET/TET family the zinc-finger motif occurs only once, contrary to the classic variant when it occurs as tandem repeats. As a rule, if the zinc-finger motif occurs once and its sequence differs considerably from the canonical one, the functions of this motif can differ remarkably from the classic motif. For example, it can both be bound to RNA and have no relation to the binding of nucleic acids [83]. The removal of this motif together with the terminal part of the FUS molecule did not affect the protein ability to aggregate and have toxicity either in yeasts or in the cell culture of the SH-SY5Y neuroblastoma [67]. Additional studies should be conducted to reveal the functions of the zinc-finger motif in proteins of the FET/TET family.
\nIn this study, we have analyzed RNA-binding proteins with prion-like domains, such as TAF15, FUS, and EWS. Using the FoldAmyloid program [77], we revealed the existence of amyloidogenic regions in the RRM domain in all three proteins of the FET family. This allows us to suggest that when the binding to RNA is violated, the proteins can aggregate spontaneously forming amyloid fibrils. In this case, protein FUS can aggregate both upon the removal of RRM and at point mutations in this domain [65, 66]. Further studies should be conducted to clarify whether aggregation of protein FUS in the presence of RRM does not lead to the formation of irreversible pathologic aggregations and functions only by the mechanism of assembly and possible disassembly under favorable conditions analogous to the functioning of SGs. We have also found that in all members of the FET/TET family the zinc-finger motif does not correspond to the classical one because it concerns both the location of tandem repeats and the amino acid sequence. Moreover, according to our prediction, in the FUS and TAF15 proteins, it does not even form any structure. Based on this, we can propose that in proteins of the FET/TET family the zinc-finger motif is not responsible for the DNA binding, but performs other functions determination of which requires further investigations.
\nWe have also predicted unstructured regions corresponding both to prion-like domains and to additional regions, where we have revealed several recurrent amino acid motifs—tandem repeats. In addition, these proteins are characterized by the occurrence of homorepeats when one amino acid is multiply recurrent. The length of homorepeats can affect not only the capacity to aggregate but also the toxicity in an aggregated state. Correspondingly, the larger is the number of repeats, the higher is the probability that the aggregated protein containing them is associated with the development of the disease. We have established that protein FUS contains five disordered patterns from the pattern library obtained from the protein data bank: GSHM, GGGGSGG, GGGGG, GGSGGGGSGGG, and RGGGGSG, which are not located in the prion-like domain predicted for FUS. For other members of this family, these patterns are not characteristic and, as known, are less toxic when compared to FUS. When a larger part of the prion-like domain in protein FUS was removed (100 residues of the 165), it retained its capacity to aggregate [65], but lost completely the ability to form gel and display toxicity. These results allow us to suggest that the presence of short repeats in the unstructured prion-like domain of RNA-binding proteins is required for fast formation of a dynamic cross-beta structure of SGs [84].
\nI thank T.B. Kuvshinkina, E.I. Leonova, I.V. Sokolovsky, and N.V. Dovidchenko for assistance in the chapter preparation. This study was supported by the Russian Science Foundation No. 14-14-00536.
\nHealth literacy (HL) is an issue of increasing importance in the health sector due to its ability to use existing health services effectively and efficiently. It allows the acquisition of better outcomes from the services provided thus, reducing health expenditure. Study findings indicate that a significant number of successful results from health services are closely associated with the health literacy of individuals [1, 2, 3]. Its importance was better understood during the COVID-19 pandemic, because of the dependent relationship between individuals and the health care organizations.
The health literacy concept, which has been initially used to mean individuals’ ability to read drug prospectuses, health-related brochures, and understand health-related information, has changed and expanded over time. Today, health literacy is defined as “people’s knowledge, motivation, and competencies to access, understand, appraise, and apply health information to make judgments and take decisions in everyday life concerning healthcare, disease prevention, and health promotion to maintain or improve quality of life during the life course.” [4], in essence, a lifelong learning activity that needs continuous improvement for individuals.
Over time, it has been understood that health literacy issue is not solely an individual burden, the health system and health organizations have an important role as well, so the “Organizational Health Literacy” (OHL) concept has been launched. OHL is defined as the ability of health organizations to provide information and services that are easy to find, understand and use, to assist people in decision making, and to remove existing barriers to all individuals who are seeking services. Health literate health care organizations are organizations that provide the needed information and services to the people in an easier way of access, understanding, and use [5].
Literacy is not a genetic or an ordinary characteristic of the people. It is a phenomenon that emerges and develops under the influence of several variables. It is the product of a kind of interaction and that means there is a mutual and reciprocal action. For such action there must be at least two sides, a receiver and a sender or influencer. Additionally, it always occurs in an environment that has physical, social, and psychological characteristics. So, all of these variables regarding receiver, sender, and environment should be considered to understand the concept. That means health literacy is a product of an interaction between health-seeking individuals and the health care providers within the environment of health care organizations [6, 7].
Because measurement and evaluation methods of a feature is closely linked to its conceptualization, the concepts of HL and OHL should be clarified before discussing the measurement methods.
The first use of the term health literacy was in the 1970s, during the times when health education was seen as a component of social policy, [8] and evolved in recent years. HL is expressed as the knowledge of individuals throughout their life course, which will guide behaviors and decisions related to themselves and public health, their knowledge of basic health information and services, their access to this information, their understanding of the information accessed, and then their use of this information for the development of health for the maintenance or improvement of quality of life. It is the degree to which individuals have the capacity to access, understand and interpret the basic health information, and services they need to make appropriate decisions associated with their health [4, 6].
Studies have reported that there is an association between low health literacy and various negative health behaviors as well as poor health-related outcomes, such as difficulties to interpret health messages and labels, poor medication adherence, high rates of hospitalization [9], frequent emergency room use, less frequent mammography rates [10], lower participation in preventive activities [11], inappropriate drug use, poor self-management of chronic conditions [12], high mortality rates [13], and increased health care costs [1, 14, 15].
Several definitions of health literacy [4, 16], as well as health literacy measures, were reported in different studies [15]. It is seen that more than 150 health literacy instruments were developed and used in the first decade of the 21st century according to various publications [17, 18].
Presence of different health literacy definitions and use of different measurement tools may be considered normal since they focus on different aspects of the concept and are complementary to each other. Here, the important thing to remember is that methods needed to measure health literacy are usually developed according to our understanding and definition of health literacy. In their study, Urstad et al. [15] have concluded that there will be a risk of missing information when the used measurement tools of health literacy are not consistent with the definition and concept of health literacy.
On the other hand, current health care systems have a complex nature and they are in rapid change and evolution. They usually are not designed according to the abilities of at least some of their service users and this characteristic makes it difficult for some patients to access and use the correct health information they needed. So, such systems should also be literate to help and increase the low literacy level of all patients.
The term OHL is relatively a new concept that emerged a few decades ago to address the challenges faced by individuals with predominantly limited HL. Because the service relationship in healthcare institutions and organizations is a mutual interaction, the literacy of institutions has become an important issue in recent years.
Features of the health organizations, such as a respectful approach to patients, easy access to services, easy information to understand, helpful navigation and signage systems, and correct answers given to every kind of question are important factors. These features are helpful to individuals for the correct use of the services, and they are as effective as the literacy of the individuals [5, 19, 20].
There are numerous studies showing that the development of OHL leads to positive effects on the health of patients and increases patient satisfaction [21, 22, 23, 24]. Although there are various studies and ways on how an institution can become a health literate organization, agreed-upon methods to measure, and evaluate the level of OHL are still lacking. The existing methods are generally highly scoped, but their reliability and criterion validity are generally unknown since they are not used in interventional research.
OHL standards and measurement methods have become an increasingly important topic in the last decade. Although there is a strong interest in OHL, majority of the studies are theoretical, and methodological studies are limited. Presence of measurement methods with different characteristics causes confusion over OHL.
A recent review showed that at least 17 different measures were used to assess OHL. According to the findings of this scoping review, six major categories of OHL have been defined and the most prevalent topic is referred to as “communication with service users.”
The following categories were, “easy access and navigation,” “integration and prioritization of OHL,” “assessments and organizational development,” “engagement support of service users,” and “information and qualification of staff” [25]. However, it was stated that no consensus has been reached on criteria that can describe a health care organization as a health literate organization.
Some criteria are focused on specific health facilities [26] or different aspects of OHL [26, 27] and/or interventions [26, 28], their evaluation [29] and implementation [30].
Another scoping review regarding OHL implementation has found that important factors that can be helpful for creating health literate organizations are ordered as, supportive leadership, a culture of change and innovation, awareness and participation of the staff, and engagement of service users [31]. However, different studies have also commented that still there is not a sufficient amount of evidence to assess the effects of OHL interventions on improved health outcomes or cost-effectiveness, and further studies are needed [26, 28].
As it was stated by Kaper et al. [31], interventional studies regarding the improvement of OHL have several weaknesses and the main limitations of the studies were lack of an experimental design and lack of instruments measuring OHL outcomes with known reliability and validity. Studies were usually conducted on small sample groups and without a control group or based on baseline cross-sectional measurements. Nevertheless, it is concluded that the instruments used in these studies may be useful to observe and monitor the change over time and make comparisons between the organizations [31].
Following are the most frequently referred studies regarding the conceptualization, implementation, and measures of the OHL.
The idea of a
The comprehensive study, prepared by Brach et al. in 2012 [5], is a milestone in OHL. In this study, detailed recommendations on what health literate organizations should and should not be are clearly stated and Ten Attributes of Health Literate Health Care Organizations are defined.
Ten attributes of Health Literate Health Care Organizations are as follows [5]:
Has leadership that makes health literacy integral to its mission, structure, and operations.
Health literacy is an organizational value for a health literate organization, and strategies of health literacy are internalized at every management level. They are perceived as part of the business and integral to its mission, structure, and operations. Leadership is the key to the success and sustainability of such an implementation.
Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement.
Health literacy is integrated into the strategic and operational plans of a health literate organization. It is seen as an inseparable part of patient safety and quality improvement activities and is evaluated regularly.
Prepares the workforce to be health literate and monitors progress.
Every professional in the organization must be health literate and understand the meaning of being a health literate organization. So, they must be trained and educated by appropriate adult education methods for the establishment of a health literate organizational culture. Training and education activities must be continuous and monitored regularly. They must be organized under the responsibility of a training team and include every staff member.
Includes populations served in the design, implementation, and evaluation of health information and services.
Community participation and decision sharing are essential for the success of all health care activities including health literacy. Health literate organizations include representatives of the local people in the design, implementation, and evaluation of services. Especially hearing the voices of individuals with low health literacy is important for designing user-friendly services.
Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
Health literate organizations use communication methods that are as simple as possible. Written, visual or digital communication is not sufficient since some individuals may have difficulties. So, alternatives such as oral communication and escort guiding are useful methods. These methods must be available for and offered to every service user to reduce the low literacy-related stigma. This is particularly important for individuals who have limited health literacy.
Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
Health literate organizations create an environment that has linguistic and cultural competency to support health literacy strategies. Such an environment aims to provide clear communication during all interactions and for every kind of service including clinical, administrative, and financial services.
Provides easy access to health information and services and navigation assistance.
Health literate organizations design their facilities to help people to access information and services easily. They use a simple and easy-to-understand style of symbols, language, and signage.
Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
Health literate organizations design all printed materials, such as education documents, diagnosis and treatment guides, laboratory test results, insurance policies, bills, and various written directives in an understandable style and with easy-to-understand language. The same approach is true for the design and distribution of audiovisual and social media content.
Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
“First, do no harm” is the number one principle of medicine since Hippocrates. However, due to the nature of the health services, there are several high-risk situations that cannot be eradicated in health facilities. Complications following surgical operations, adverse drug reactions, and absence of radical therapies are some examples of these situations. Health literate health care organizations identify such situations and inform patients appropriately.
Communicates clearly what health plans cover and what individuals will have to pay for services.
Health literate organizations communicate openly, clearly, and on time regarding financial issues such as coverage of the patient’s health plans, and how much they will have to pay for which services. They answer all relevant questions of the service users in an understandable language.
The ten attributes are related to health organizations, health care professionals, and various types of healthcare facilities that have direct responsibility for the provision of health services. All kinds of hospitals, clinics, group practices, private physician offices, community health centers, pharmacies, health insurance companies, accreditation agencies, information technology and health education professionals, and administrative staff needed to have these attributes to become health literate. In other words, almost all components of the supply side of a health system must have these ten attributes.
“Ten attributes of health literate healthcare organization” has been used by many researchers in the following years.
In a study conducted by Kowalski et al. [33] a ten items survey tool “Health Literate Health Care Organization Ten Item Questionnaire” (HLHO-10) to represent the ten attributes was developed. It was applied as part of a larger study and cross-sectional data was collected from a key informant survey in 51 German hospitals, and found to be reliable and valid [33]. It was concluded to be a useful tool to assess the level of OHL that is which organizations are helpful to their users to access, find, understand, and use the correct information they needed as well as the services.
Later HLHO-10 has been used during a survey to assess the OHL of a group of hospitals in Turkey and investigate the relationships between OHL, patient satisfaction, and individual health literacy by Hayran and Ozer [21].
Bonaccorsi et al., have used the Italian version of the HLHO-10 scale in healthcare organizations in Tuscany. They have found that accredited hospitals have higher HLHO-10 scores and perceived quality increases with the increase in HLHO-10 scores, which is interpreted as OHL an integral element for the quality of care [34].
HLHO-10 scale was also adapted to measure and use the OHL level of the facilities established for individuals with various disabilities [35].
Ten attributes provided intellectual foundation to other action frameworks. At least two other concepts and tools were based on the principles of the ten attributes. These are, “Vienna Concept of Health Literate Hospitals and Healthcare Organizations” (V-HLO) [36] and “the Organizational Health Literacy Responsiveness self-assessment tool” (Org-HLR) [37].
V-HLO is designed as a self-assessment questionnaire that includes 9 standards, 22 sub-standards, and 160 items [36]. It was tested by Pelikan and Dietscher in Austria and found to be successful [38].
This tool builds upon the “Ten Attributes of Health Literate Health Care Organizations.” However, the V-HLO expands the concept by introducing specific aspects tested in Health Promoting Hospitals (HPH) that were created by an international working group within the ‘International Network of Health Promoting Hospitals. It includes five standards published by WHO-EURO [39], 18 strategies of the HPH [40], and with reference to quality management concepts.
V-HLO considers the significance of organizational support for health literacy as a necessary precondition for sustainable implementation. This support is necessary for the implementation of interventions in relation to four action areas of the concept. These action areas are health literacy that is needed to gain adequate
These action areas are applied to three stakeholder groups, namely, patients, staff, and population.
Nine standards of V-HLO are as follows [38]:
Establishment of management policy and organizational structures for health literacy (includes 2 sub-standards)
Development of materials and services in participation with stakeholders (includes 2 sub-standards)
Qualification of staff for health-literate communication with service users (includes 2 sub-standards)
Provision of a supportive environment with health-literate navigation and access (includes 5 sub-standards)
Application of health literacy principles in routine communication with patients (includes 4 sub-standards)
Improvement of the health literacy of patients and their entourage (includes 2 sub-standards)
Improvement of the health literacy of the staff (includes 2 sub-standards)
Contribution to the health literacy in the region (includes 2 sub-standards)
Sharing experiences and being a role model (includes 1 sub-standard)
In the following years, the French version of V-HLO has been prepared and tested in three hospitals in Belgium. It was concluded to be an appropriate tool for hospitals that have the intention to raise their level of health literacy, create awareness and formulate strategies and actions [41].
The rationale underlying this Project was the need for a specific tool to assess and enhance OHL in primary health care settings. As the authors have stated, most approaches to OHL have usually focused on inpatient care, and outpatient and/or primary health care services have rarely been included. However, especially the level of OHL in primary care settings is of great importance, because they are the first contact points of the well-designed health systems.
The tool has been developed and evaluated with the participation of various practice partners including general practitioners and community health care organizations as well as expert opinions. The aim of this tool is to make the needs assessment, identify the improvement areas, and implement the actions necessary for OHL.
The tool consists of three modules and six dimensions:
A user manual containing instructions
A checklist for self-assessment of the community health services
A handbook to measure the improvement of the check-list items
Six dimensions of the tool were based on the ten attributes of a health literate health care organization [5], the nine standards of the V-HLO [38], and six dimensions of a health literate organization as used in the Tasmanian toolkit [HelloTAS] [43] and finalized after discussions with the representatives of primary care professionals the community health care organizations.
Six dimensions of the tool included the main content of the checklist. Then it was divided into 15 sub-dimensions including a total of 43 criteria (Table 1).
Dimensions | Sub-dimensions (number of criteria) |
---|---|
1. Provision of easy access to primary care services and facilitated navigation | 1.1 Contact (5) 1.2 Navigation within the primary care service (2) |
2. Communication in plain and easy to understand language | 2.1 Oral communication (8) 2.2 Written communication (5) |
3. Promotion of health literacy for service users | 3.1 Empowering service users to use health information (1) 3.2 Promotion of an active role and self-management of service users (2) |
4. Promotion of health literacy of staff members | 4.1 Know-how and professional competence (1) 4.2 Personnel development (3) 4.3 Staff members’ health (1) |
5. Incorporation of health literacy into management and organizational structure | 5.1 Health literacy as an organizational responsibility (2) 5.2 Health literacy as a development goal (2) 5.3 Organizational culture (2) 5.4 User involvement – feedback (2) |
6. Promotion of health literacy at care interfaces, networks, and further activities of the organization | 6.1 Care interfaces (4) 6.2 Networking and further activities (3) |
“Organizational Health Literacy Self-Assessment Tool for Primary Care” (OHL self-AsseT).
Adapted from De Ganni et al. [42].
Authors have concluded that this tool may be helpful for a successful implementation of OHL in primary care settings because it was developed with the participation of various practice partners and shaped by expert opinions.
In their study, Trezona et al. [37] developed the Organizational Health Literacy Responsiveness self-assessment tool (Org-HLR) and conducted an assessment process for supporting the health organizations with the application of the tool.
OHL responsiveness is the synonym term for OHL. It means the provision of health information and services in an equitable manner in terms of access and participation, taking into consideration the literacy needs and preferences of all service users, and supporting community participation during decision-making processes for health and well-being [37].
The self-rating Org-HLR tool and process were derived through co-design processes with a wide range of professionals working in the health and social services sectors, It has seven dimensions for assessment and they are divided into 24 sub-dimensions with 135 performance indicators.
Seven assessment dimensions are:
External policy and funding environment
Leadership and culture
Systems, processes, and policies
Access to services and programs
Community engagement and partnerships
Communication practices and standards
Workforce
A scale to assess the OHL status of different types of secondary and tertiary care hospitals has been developed by Dundar Ege and Hayran [44]. Forty-three 7-point Likert-type scale items were prepared by a comprehensive literature review and shaped by expert opinions. It was tested by the management staff of a sample group of 47 hospitals in İstanbul, including State hospitals, Private Hospitals, University Hospitals, Non-Profit Foundation Hospitals, and Accredited and Non-accredited Hospitals.
Five dimensions of OHL-Hosp were identified following the exploratory and confirmatory factor analyses. Internal consistency of the items of each dimension has been found significantly high and statistically significant (Table 2).
Dimensions (number of items) | Eigenvalues | Variance (%) | Cronbach’s alpha |
---|---|---|---|
1. Leadership and Regulations (16) | 20.996 | 48.828 | 0.987 |
2. Communication (14) | 5.014 | 11.661 | 0.946 |
3. Operational Access (6) | 3.320 | 7.722 | 0.954 |
4. Indoor Access (4) | 2.973 | 6.914 | 0.948 |
5. Outdoor Access (3) | 1.638 | 3.810 | 0.841 |
Dimensions and factor analysis findings of the OHL-Hosp scale.
The scale consisting of 43 items and five dimensions is concluded to be a valid and reliable instrument to determine OHL levels of secondary and tertiary care institutions.
This tool is the updated version of the “Health Literacy Environment of Hospitals and Health Centers” by Rudd and Andersen [45]. It was developed by Harvard University and published in 2019 [7]. Its original form has been widely used in the USA. It was also adapted to use in different countries including Australia, New Zealand and European countries.
It is helpful to identify and rate the factors that are related to the literacy of health organizations for improving health literacy and monitoring change over time.
The HLE2 tool is organized into five sections, 10 parts, and 135 criteria as it is presented in Table 3. Content of all sections is addressed through the lens of health literacy. Each section has a rating scale. Following data collection, a total score and a percentage score is computed for each section. An overall score tally of the HLE2 has not been recommended. Instead, actions to consider for the % score of each section are described.
Sections | Parts (number of criteria) |
---|---|
1. Organizational Policies |
|
2. Organizational Practices |
|
3. Navigation |
|
4. Culture and Language | (10) |
5. Communication |
|
The study is based on visitor observations and standards to be applied by officials and it is organized as a list of things to do for OHL. The list can be applied in the form of brainstorming sessions with active members of healthcare institutions.
In a scoping review [25] which was held in 2021, sixty studies on OHL are examined in-depth and common six main categories, 25 subcategories of attributes, and 494 criteria of OHL were identified.
The main categories were ordered as:
Communication with service users
Easy access and navigation
Integration and prioritization
Assessments and organizational development
Engagement and support of service users
Information and qualification of staff
Among the reviewed articles published between 2006 and 2020, the majority were related to toolkits. This was followed by discussions, case studies, feasibility studies, surveys, workshop summaries, or evaluation studies.
“Ten Attributes of Health Literate Health Care Organizations” by Brach et al. [5] was the most frequently referred publication for the concepts used.
Reviewed studies have used 17 different assessment tools and instruments for the assessment of OHL. The HLHO-10 [33] and the HLE2 [7, 45] were the most frequently referenced tools among them.
The tools were usually designed as questionnaires and used during surveys. Some studies have used them in their original form while others have used a subset of items. Some studies have used the translated tools in a different language while others have adopted the measures for a different type of method.
Design of the assessment methods has also varied. Some studies have used standardized questionnaires and semi-structured interviews while others have collected the data by observations, checklists, and material assessments.
However, the authors have stated that the majority of the tools and instruments were not tested for validity and feasibility.
The goal of the study was to develop a valuable set of measures to inform OHL-related quality improvement activities. The study [46] was based on patient feedback and presented the standards that increase quality in healthcare organizations.
These are organizational structure, policy and leadership, communication, navigation, and patient participation. The results are similar to other studies.
Communication has been deeply examined as the main standard of OHL in this study in 2021 [47]. A sensitive communication approach was assessed from the perspective of the patients’ health in complex care structures.
As an important finding of the study, better processing of the organization is perceived by patients that was related to significantly higher health literacy scores. On the other hand, better health literacy scores were related to more patient-reported social support provided by physicians and nurses as well as fewer unmet information needs.
It was concluded that investing in good processing of the organization can improve the communication that is sensitive to health literacy. This has the potential to encourage service user–provider relationships and it might reduce the unmet information needs of the service users.
In this meta-narrative review, Farmanova et al. have identified 20 health literacy guides with various contexts and scopes [27]. Most guides have been prepared for general healthcare organizations. Six of them were specific for primary care besides hospitals and pharmacies. One was specific to health literacy of nursing practices.
Most included dimensions of OHL in guides were verbal and written communication, and access and navigation. All guides have included these dimensions. Access and navigation referred to the physical environment as well as the provided services by the organization.
Thirteen key barriers under 3 broad themes were identified during the use of health literacy guides: barriers related to the leadership and cultural environment of the organization; barriers related to the design and planning of interventions needed for the improvement; and barriers referred to the health workforce.
Especially recent guides provided best practices and recommendations that are evidence-based to support OHL actions. However, it was found that most of the guides have not been tested and their applicability was unknown in organizational practices, and this finding raises questions regarding their effectiveness [27].
Authors have concluded that OHL seems to be a heterogeneous phenomenon and it can be theorized from many different perspectives and implemented in different ways.
There is a similarity among the criteria identified in the conceptualization of the OHL in various studies. However, despite the conceptual similarities and presence of many different techniques and scales to assess OHL, there is still confusion about conceptualization and operationalization [25].
“Ten Attributes of Health Literate Organizations” by Brach et al. [5], is the most detailed and broad-ranged study in terms of conceptualization of OHL and has been an intellectual foundation for several other studies. Many of the assessment tools and instruments were based on the principles described as ten attributes. Most frequently used examples are, HLHO-10 [33], V-HLO [36], and the Org-HLR [37].
HLHO-10 is designed as a questionnaire that rates each of the ten attributes on a Likert scale.
The V-HLO aims at the sustainability of OHL and expands the concept by introducing specific aspects tested in Health Promoting Hospitals (HPH) [39, 40]. It approaches OHL from the stakeholders’ view considering their impact zone.
The Org-HLR uses health literacy responsiveness as a system-level action. It aims to coordinate and integrate all health care services, and system navigation by intersectoral collaboration [37].
Another important instrument HLE2 Assessment Tool [7] has a long history and wider use and includes palpable criteria mostly based on observations regarding implementation details. It offers ‘to-do lists’, observation forms, and process management details that can also be used during brainstorming meetings in organizations.
Among the several criteria to describe OHL, “communication” seems to be the major and most common component in all studies. Possible benefit effects of HL-sensitive communication were examined in several studies [47] including specific groups such as cancer patients [48], culturally diverse patient groups [49], and concluded to be an important dimension of OHL.
“Ease of access and navigation” is another significant criterion to describe OHL that has been investigated in many studies. Zanobi et al. [26] and Bremer et al. [25] have identified many different interventions for easy access and navigation in their scoping reviews. Use of pathways with different color codes, directions prepared with a plain and standardized language, support from volunteer escorts, directions posted in commonly used languages, and navigation apps are some examples. However, no studies have been found to evaluate their effects.
In some studies, quality is considered the main aspect [46] and OHL is examined as an instrument to raise the quality of healthcare.
It is known that patient satisfaction and responsiveness are high in organizations with high OHL [21]; however, it is not possible to say the opposite and it is important not to confuse OHL with patient satisfaction or health care responsiveness.
According to a study conducted during the COVID-19 pandemic, OHL principles and guidelines may be helpful to promote human-centered health care and services even in times of crisis [50].
OHL has been examined in various countries, in different settings, and from different aspects by many researchers. Among the limited number of scales that have been presented in some studies, none of them was tested for validity and reliability [51].
Additionally, many patient health outcomes have been investigated, but it is seen that almost all of them were related to supportive interventions for patients. No study was found reporting the patient health outcomes that are related to staff.
The effects of environmental support on health care staff have been rarely studied. Only a few studies have reported outcomes related to the satisfaction and helpfulness perception of the staff [26].
Comprehensive work done by Brach et al. on the conceptualization of the OHL is a milestone as we have mentioned above [5]. It serves as an intellectual base for other studies. In studies, regarding the implementation and assessment of OHL, checklists based on on-site observation and interview forms based on general questions for qualitative evaluation purposes are used. Furthermore, in some studies, it is observed that checklists for self-evaluation and guidelines to assess the healthcare organizations including primary healthcare institutions are also used.
In a comprehensive systematic review, it was found that the practices, measurement, and evaluation criteria in the field of OHL are very diverse and differ from each other [52]. According to the results of the screening, there were 8 main measurement-evaluation tools used for OHL measurement-evaluation, among which HLHO-10 (Health Literate Health Organization-10) [33] and V-HLO (Vienna Health Literate Organization) [36, 38] were used more frequently.
No definitive list of actions for implementation was found as well as assessment and measurement of the OHL. As a matter of fact, the rapid change in health care systems, institutions, types of services, technologies, and even professions naturally will affect and change the ways of our understanding of OHL.
So, aims for the implementation, operationalization, and improvement of the OHL must be addressed in a systematic and flexible manner. This issue is particularly significant for the communication of health care organizations with service users.
As the last word, some recommended steps to facilitate organizational change when promoting OHL practices can be summarized as encouragement of leadership, presence of clear and effectively communicated change vision, and provision of staff training and education to promote OHL practices [53]. These are the most important steps during the journey to facilitate organizational change toward OHL.
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Extreme weather conditions and changes in humidity rates significantly affect the concrete compressive strength development. Concrete as one of the substantial material used in residential buildings and infrastructures is subjected to a massive strength change under extreme weather conditions. For understanding, the different concrete’s behavioral aspects, various commercial cement types under different temperatures, and humidity rates are investigated in this chapter. The experiments are aimed to investigate the concrete strength development over time when the material is cast at lower to mild temperatures and different humidity index rates. Results show that reducing the curing temperature more than 15° could result in 20% reduction in total compressive strength, while decreasing humidity rates by 50% leads to less than 10% drop in ultimate strength. To understand the strength developing process, maturity tests are conducted. 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In addition to ordinary Portland cement, the essential components of the base of concrete are aggregates and water. For practical requirements, additives and admixtures can be added to these raw materials to improve some desirable characteristics. The following requirements should be considered in producing high performance concrete (HPC): (i) low water/cement (w/c) ratio; (ii) fine aggregate; (iii) large quantity of mineral additives, silica fume, and fly ash; (iv) high dosage of superplasticizer; and (v) high-pressure steam curing. The microstructure of high performance concrete (HPC) is more homogenous than that of normal concrete (NC) due to the physical and chemical contribution of the additives (silica fume and fly ash) as well as it is less porous due to reduced w/c ratio with the addition of a superplasticizer. Inclusion of additives (individually or in combination) helped in improving the strength and durability of concrete mixes due to the additional reduction in porosity of cement paste and an improved interface between it and the aggregate.",book:{id:"5214",slug:"high-performance-concrete-technology-and-applications",title:"High Performance Concrete Technology and Applications",fullTitle:"High Performance Concrete Technology and Applications"},signatures:"Ameer A. Hilal",authors:[{id:"180518",title:"Dr.",name:"Ameer",middleName:null,surname:"Hilal",slug:"ameer-hilal",fullName:"Ameer Hilal"}]},{id:"51861",doi:"10.5772/64779",title:"Concretes with Photocatalytic Activity",slug:"concretes-with-photocatalytic-activity",totalDownloads:2836,totalCrossrefCites:8,totalDimensionsCites:15,abstract:"This chapter is a short review about the modified concretes with photocatalytic activity. In the beginning, the photocatalysis process is explained; the authors are focused on the mechanism of organic contamination and nitrogen oxide decomposition. Next the three main methods for concretes modification are presented: the first group is when the concrete is covered by thin layer of TiO2 materials, e.g., paints or TiO2 suspensions. The second group is the concretes with thick layer of photoactive concrete on the top. The third group constitutes concretes modified in mass with TiO2. The two main methods for photocatalytic activity of the modified concrete determination were shown: an air purification by a nitrogen oxide decomposition and the self-cleaning properties by dyes decomposition. Also in this chapter the mechanical properties of the modified concrete are presented. In the end, the examples of the buildings made of photocatalytic concretes are shown.",book:{id:"5214",slug:"high-performance-concrete-technology-and-applications",title:"High Performance Concrete Technology and Applications",fullTitle:"High Performance Concrete Technology and Applications"},signatures:"Magdalena Janus and Kamila Zając",authors:[{id:"180824",title:"Associate Prof.",name:"Magdalena",middleName:null,surname:"Janus",slug:"magdalena-janus",fullName:"Magdalena Janus"}]},{id:"64801",doi:"10.5772/intechopen.82489",title:"Bitumen and Its Modifier for Use in Pavement Engineering",slug:"bitumen-and-its-modifier-for-use-in-pavement-engineering",totalDownloads:1550,totalCrossrefCites:5,totalDimensionsCites:12,abstract:"This chapter focuses on bitumen specifically. This chapter consists of several parts that can be mentioned, including the history of the appearance of bitumen and the types of constituent elements, as well as its mechanical properties and chemical structure and its thermal sensitivity. In all parts, the effects of bitumen on asphalt are discussed. In the following sections, the bitumen modification mechanism, polymer modifiers, and their behavior on the bitumen resistance to asphalt failures are also discussed. This chapter is very suitable for students and researchers interested in improving polymerization asphalt and bitumen and will help them to carry out research and concepts.",book:{id:"8412",slug:"sustainable-construction-and-building-materials",title:"Sustainable Construction and Building Materials",fullTitle:"Sustainable Construction and Building Materials"},signatures:"Mehrdad Honarmand, Javad Tanzadeh and Mohamad Beiranvand",authors:[{id:"268734",title:"M.Sc.",name:"Mehrdad",middleName:null,surname:"Honarmand",slug:"mehrdad-honarmand",fullName:"Mehrdad Honarmand"},{id:"271251",title:"Prof.",name:"Javad",middleName:null,surname:"Tanzadeh",slug:"javad-tanzadeh",fullName:"Javad Tanzadeh"}]},{id:"64787",doi:"10.5772/intechopen.82525",title:"A Decade of Research on Self-Healing Concrete",slug:"a-decade-of-research-on-self-healing-concrete",totalDownloads:1459,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"The main findings of a decade of research on the design and development of the first self-healing concrete are summarized in this chapter. The autonomous healing concept is introduced, and plethora of design campaigns is enlisted. Healing agent encapsulation and agent tubes vascular networks are reported as the most efficient healing configurations for laboratory-scale and real-size applications, respectively. Crack formation, closure after healing and further damage are phenomena tracked by using advanced experimental monitoring methods and their performance is critically revised. The effect of self-healing technology on concrete mechanical response, durability and long-term response to damage are critically discussed. The study contributes to the open discussion in the scientific research community regarding self-healing concrete upscaling feasibility and finally it aims to contribute as a base for the future studies dealing with concrete design optimization.",book:{id:"8412",slug:"sustainable-construction-and-building-materials",title:"Sustainable Construction and Building Materials",fullTitle:"Sustainable Construction and Building Materials"},signatures:"Eleni Tsangouri",authors:[{id:"263163",title:"Ph.D.",name:"Eleni",middleName:null,surname:"Tsangouri",slug:"eleni-tsangouri",fullName:"Eleni Tsangouri"}]}],mostDownloadedChaptersLast30Days:[{id:"70605",title:"Designing a Tunnel",slug:"designing-a-tunnel",totalDownloads:2725,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Designing a tunnel is always a challenge. 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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. 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He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. 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Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:20,paginationItems:[{id:"82526",title:"Deep Multiagent Reinforcement Learning Methods Addressing the Scalability Challenge",doi:"10.5772/intechopen.105627",signatures:"Theocharis Kravaris and George A. 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He has been honored by different authorities for his outstanding performance in various fields like research and education, and he has received the World Academy of Science Young Scientist Award (2014) and the University Grants Commission (UGC) Award 2018. He is a fellow of the Bangladesh Academy of Sciences (BAS) and the Royal Society of Biology.",institutionString:"Sher-e-Bangla Agricultural University",institution:{name:"Sher-e-Bangla Agricultural University",country:{name:"Bangladesh"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",biography:"Kusal K. Das is a Distinguished Chair Professor of Physiology, Shri B. M. Patil Medical College and Director, Centre for Advanced Medical Research (CAMR), BLDE (Deemed to be University), Vijayapur, Karnataka, India. Dr. Das did his M.S. and Ph.D. in Human Physiology from the University of Calcutta, Kolkata. His area of research is focused on understanding of molecular mechanisms of heavy metal activated low oxygen sensing pathways in vascular pathophysiology. He has invented a new method of estimation of serum vitamin E. His expertise in critical experimental protocols on vascular functions in experimental animals was well documented by his quality of publications. He was a Visiting Professor of Medicine at University of Leeds, United Kingdom (2014-2016) and Tulane University, New Orleans, USA (2017). For his immense contribution in medical research Ministry of Science and Technology, Government of India conferred him 'G.P. Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. in Chemistry in July 2000, and his Ph.D. in Physical Chemistry in 2007 from the University of Khartoum, Sudan. In 2009 he joined the Dr. Ron Clarke research group at the School of Chemistry, Faculty of Science, University of Sydney, Australia as a postdoctoral fellow where he worked on the Interaction of ATP with the phosphoenzyme of the Na+, K+-ATPase, and Dual mechanisms of allosteric acceleration of the Na+, K+-ATPase by ATP. He then worked as Assistant Professor at the Department of Chemistry, University of Khartoum, and in 2014 was promoted to Associate Professor ranking. In 2011 he joined the staff of the Chemistry Department at Taif University, Saudi Arabia, where he is currently active as an Assistant Professor. His research interests include:\r\n(1) P-type ATPase Enzyme Kinetics and Mechanisms; (2) Kinetics and Mechanism of Redox Reactions; (3) Autocatalytic reactions; (4) Computational enzyme kinetics; (5) Allosteric acceleration of P-type ATPases by ATP; (6) Exploring of allosteric sites of ATPases and interaction of ATP with ATPases located in the cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from the Area.\n\nInternationally, Dr Mesraoua is an active and elected member of the Commission on Eastern Mediterranean Region (EMR ) , a regional branch of the International League Against Epilepsy (ILAE), where he represents the Middle East and North Africa(MENA ) and where he holds the position of chief of the Epilepsy Epidemiology Section; Dr Mesraoua is a member of the American Academy of Neurology, the Europeen Academy of Neurology and the American Epilepsy Society.\n\nDr Mesraoua's main objectives are to encourage frequent gathering of the epileptologists/neurologists from the MENA region and the rest of the world, promote Epilepsy Teaching in the MENA Region, and encourage multicenter studies involving neurologists and epileptologists in the MENA region, particularly epilepsy epidemiological studies. \n\nDr. Mesraoua is the recipient of two research Grants, as the Lead Principal Investigator (750.000 USD and 250.000 USD) from the Qatar National Research Fund (QNRF) and the Hamad Hospital Internal Research Grant (IRGC), on the following topics : “Continuous EEG Monitoring in the ICU “ and on “Alpha-lactoalbumin , proof of concept in the treatment of epilepsy” .Dr Mesraoua is a reviewer for the journal \"seizures\" (Europeen Epilepsy Journal ) as well as dove journals ; Dr Mesraoua is the author and co-author of many peer reviewed publications and four book chapters in the field of Epilepsy and Clinical Neurology",institutionString:"Weill Cornell Medical College in Qatar",institution:{name:"Weill Cornell Medical College in Qatar",country:{name:"Qatar"}}},{id:"282429",title:"Prof.",name:"Covanis",middleName:null,surname:"Athanasios",slug:"covanis-athanasios",fullName:"Covanis Athanasios",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/282429/images/system/282429.jpg",biography:null,institutionString:"Neurology-Neurophysiology Department of the Children Hospital Agia Sophia",institution:null},{id:"190980",title:"Prof.",name:"Marwa",middleName:null,surname:"Mahmoud Saleh",slug:"marwa-mahmoud-saleh",fullName:"Marwa Mahmoud Saleh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/190980/images/system/190980.jpg",biography:"Professor Marwa Mahmoud Saleh is a doctor of medicine and currently works in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. She got her doctoral degree in 1991 and her doctoral thesis was accomplished in the University of Iowa, United States. Her publications covered a multitude of topics as videokymography, cochlear implants, stuttering, and dysphagia. She has lectured Egyptian phonology for many years. Her recent research interest is joint attention in autism.",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259190/images/system/259190.png",biography:"Dr. Naqvi is a radioanalytical chemist and is working as an associate professor of analytical chemistry in the Department of Chemistry, Government College University, Faisalabad, Pakistan. Advance separation techniques, nuclear analytical techniques and radiopharmaceutical analysis are the main courses that he is teaching to graduate and post-graduate students. In the research area, he is focusing on the development of organic- and biomolecule-based radiopharmaceuticals for diagnosis and therapy of infectious and cancerous diseases. Under the supervision of Dr. Naqvi, three students have completed their Ph.D. degrees and 41 students have completed their MS degrees. He has completed three research projects and is currently working on 2 projects entitled “Radiolabeling of fluoroquinolone derivatives for the diagnosis of deep-seated bacterial infections” and “Radiolabeled minigastrin peptides for diagnosis and therapy of NETs”. He has published about 100 research articles in international reputed journals and 7 book chapters. Pakistan Institute of Nuclear Science & Technology (PINSTECH) Islamabad, Punjab Institute of Nuclear Medicine (PINM), Faisalabad and Institute of Nuclear Medicine and Radiology (INOR) Abbottabad are the main collaborating institutes.",institutionString:"Government College University",institution:{name:"Government College University, Faisalabad",country:{name:"Pakistan"}}},{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",country:{name:"Hungary"}}},{id:"277367",title:"M.Sc.",name:"Daniel",middleName:"Martin",surname:"Márquez López",slug:"daniel-marquez-lopez",fullName:"Daniel Márquez López",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/277367/images/7909_n.jpg",biography:"Msc Daniel Martin Márquez López has a bachelor degree in Industrial Chemical Engineering, a Master of science degree in the same área and he is a PhD candidate for the Instituto Politécnico Nacional. His Works are realted to the Green chemistry field, biolubricants, biodiesel, transesterification reactions for biodiesel production and the manipulation of oils for therapeutic purposes.",institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",country:{name:"Argentina"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",biography:"Francisco Javier Martín-Romero (Javier) is a Professor of Biochemistry and Molecular Biology at the University of Extremadura, Spain. He is also a group leader at the Biomarkers Institute of Molecular Pathology. Javier received his Ph.D. in 1998 in Biochemistry and Biophysics. At the National Cancer Institute (National Institute of Health, Bethesda, MD) he worked as a research associate on the molecular biology of selenium and its role in health and disease. After postdoctoral collaborations with Carlos Gutierrez-Merino (University of Extremadura, Spain) and Dario Alessi (University of Dundee, UK), he established his own laboratory in 2008. The interest of Javier's lab is the study of cell signaling with a special focus on Ca2+ signaling, and how Ca2+ transport modulates the cytoskeleton, migration, differentiation, cell death, etc. He is especially interested in the study of Ca2+ channels, and the role of STIM1 in the initiation of pathological events.",institutionString:null,institution:{name:"University of Extremadura",country:{name:"Spain"}}},{id:"198499",title:"Dr.",name:"Daniel",middleName:null,surname:"Glossman-Mitnik",slug:"daniel-glossman-mitnik",fullName:"Daniel Glossman-Mitnik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/198499/images/system/198499.jpeg",biography:"Dr. Daniel Glossman-Mitnik is currently a Titular Researcher at the Centro de Investigación en Materiales Avanzados (CIMAV), Chihuahua, Mexico, as well as a National Researcher of Level III at the Consejo Nacional de Ciencia y Tecnología, México. His research interest focuses on computational chemistry and molecular modeling of diverse systems of pharmacological, food, and alternative energy interests by resorting to DFT and Conceptual DFT. He has authored a coauthored more than 270 peer-reviewed papers, 32 book chapters, and 4 edited books. He has delivered speeches at many international and domestic conferences. He serves as a reviewer for more than eighty international journals, books, and research proposals as well as an editor for special issues of renowned scientific journals.",institutionString:null,institution:null},{id:"217323",title:"Prof.",name:"Guang-Jer",middleName:null,surname:"Wu",slug:"guang-jer-wu",fullName:"Guang-Jer Wu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217323/images/8027_n.jpg",biography:null,institutionString:null,institution:null},{id:"148546",title:"Dr.",name:"Norma Francenia",middleName:null,surname:"Santos-Sánchez",slug:"norma-francenia-santos-sanchez",fullName:"Norma Francenia Santos-Sánchez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/148546/images/4640_n.jpg",biography:null,institutionString:null,institution:null},{id:"272889",title:"Dr.",name:"Narendra",middleName:null,surname:"Maddu",slug:"narendra-maddu",fullName:"Narendra Maddu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272889/images/10758_n.jpg",biography:null,institutionString:null,institution:null},{id:"242491",title:"Prof.",name:"Angelica",middleName:null,surname:"Rueda",slug:"angelica-rueda",fullName:"Angelica Rueda",position:"Investigador Cinvestav 3B",profilePictureURL:"https://mts.intechopen.com/storage/users/242491/images/6765_n.jpg",biography:null,institutionString:null,institution:null},{id:"88631",title:"Dr.",name:"Ivan",middleName:null,surname:"Petyaev",slug:"ivan-petyaev",fullName:"Ivan Petyaev",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Lycotec (United Kingdom)",country:{name:"United Kingdom"}}},{id:"428313",title:"Dr.",name:"Sambangi",middleName:null,surname:"Pratyusha",slug:"sambangi-pratyusha",fullName:"Sambangi Pratyusha",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"CGIAR",country:{name:"France"}}},{id:"423869",title:"Ms.",name:"Smita",middleName:null,surname:"Rai",slug:"smita-rai",fullName:"Smita Rai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"424024",title:"Prof.",name:"Swati",middleName:null,surname:"Sharma",slug:"swati-sharma",fullName:"Swati Sharma",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"439112",title:"MSc.",name:"Touseef",middleName:null,surname:"Fatima",slug:"touseef-fatima",fullName:"Touseef Fatima",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}}]}},subseries:{item:{id:"15",type:"subseries",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11411,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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