Criteria type I.
\r\n\t
",isbn:"978-1-80356-951-2",printIsbn:"978-1-80356-950-5",pdfIsbn:"978-1-80356-952-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"bb6fc82b35ad2c63618a9bc15aeb61ce",bookSignature:"Dr. Kim Ho Yeap and Dr. Magdalene Goh Wan Ching",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11948.jpg",keywords:"MOSFET, CMOS, OFET, JFET, FinFET, Integrated Circuit (IC), Oxidation, Metallization, Semiconductor, Silicon (Si), Gallium Arsenide (GaAs), Silicon Carbide (SiC)",numberOfDownloads:5,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 7th 2022",dateEndSecondStepPublish:"June 16th 2022",dateEndThirdStepPublish:"August 15th 2022",dateEndFourthStepPublish:"November 3rd 2022",dateEndFifthStepPublish:"January 2nd 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"18 days",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"A researcher in the fields of microelectronics and electromagnetics. Member of IEEE, IET, IEM.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"24699",title:"Dr.",name:"Kim Ho",middleName:null,surname:"Yeap",slug:"kim-ho-yeap",fullName:"Kim Ho Yeap",profilePictureURL:"https://mts.intechopen.com/storage/users/24699/images/system/24699.jpg",biography:"Kim Ho Yeap is an Associate Professor at Universiti Tunku Abdul Rahman, Malaysia. He is an IEEE senior member, a Professional Engineer registered with the Board of Engineers, Malaysia,a Chartered Engineer registered with the UK Engineering Council, and an ASEAN Chartered Professional Engineer (ACPE). He received his BEng (Hons) Electrical and Electronics Engineering from Universiti Teknologi Petronas in 2004, his MSc in microelectronics from Universiti Kebangsaan Malaysia in 2005, and his PhD from Universiti Tunku Abdul Rahman in 2011. In 2008 and 2015, respectively, Dr. Yeap underwent research attachment at the University of Oxford (UK) and Nippon Institute of Technology (Japan). Dr. Yeap is the external examiner and external course assessor of Wawasan Open University. He is also the Editor in Chief of the i-manager’s Journal on Digital Signal Processing. He has also been a guest editor for the Journal of Applied Environmental and Biological Sciences and Journal of Fundamental and Applied Sciences. Dr. Yeap has been given the university teaching excellence award, and 22 research grants. He has published more than 100 research articles (including refereed journal papers, conference proceedings, books, and book chapters). Prior to joining the academic industry, Dr. Yeap worked in Intel corporation in the pre-silicon validation group. He was awarded 4 Kudos awards by Intel for his contributions in the design and verification of the microchip’s design for testability (DFT) features.",institutionString:"Universiti Tunku Abdul Rahman",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Universiti Tunku Abdul Rahman",institutionURL:null,country:{name:"Malaysia"}}}],coeditorOne:{id:"454196",title:"Dr.",name:"Magdalene",middleName:null,surname:"Goh Wan Ching",slug:"magdalene-goh-wan-ching",fullName:"Magdalene Goh Wan Ching",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Dr Magdalene Goh Wan Ching\r\nDesignation: Senior lecturer\r\nQualifications: Diploma in Electrical & Electronics Engineering (Inti College), BEng in Electrical\r\nEngineering & Electronics (University of Liverpool, UK), PhD in Solid State\r\nDevice Physics & RF Transistors Design (University of Liverpool, UK)\r\n\r\nProfessional Body\r\nMemberships:\r\n\r\nInaugural Senior Member, International Engineering & Technology Institute\r\n(IETI), Hong Kong\r\n\r\nBiodata: Dr. Magdalene Goh obtained her Diploma in Electrical & Electronics Engineering\r\nfrom Inti College before leaving for the UK to pursue her BEng in Electrical\r\nEngineering & Electronics and later on, her PhD. Prior to joining the academia,\r\nshe has worked for a few years in the industry in the areas of semiconductor\r\nprocess technology, silicon wafer characterizations, mask layout design,\r\nanalogue circuits design and design for testability (DFT). While in the academic,\r\nshe had served as a judge for Innovate Malaysia undergraduate final year\r\nprojects competition from 2012 - 2015. She had served as an external examiner\r\nfor a PhD candidate from VIT University, India in 2013, and an external examiner\r\nfor SEGi College Penang from 2014 – 2018. She has been actively involved with\r\nthe Penang Science Cluster in their radio telescope team since 2014, where she\r\nworks with a team of volunteers (from both academia and the industry in\r\nPenang) to create curricula in radio astronomy, for the purpose of introducing the\r\nconcepts of radio astronomy and radio telescopes to both school pupils and\r\ncollege students. She has been a member of the Astronomical Society of\r\nPenang since 2016.\r\n\r\nCourse Development\r\nExperience:\r\n\r\nSince joining WOU, Dr. Goh has developed eight courses, namely Control\r\nSystems, Microprocessors, Digital Communications, Microelectronics, VLSI\r\nDesign, Process Control & Instrumentation, Power Electronics & Drives and\r\nElectrical Power & Drives.\r\n\r\nResearch Interest: Dr. Goh’s research interests are in the areas of semiconductor physics and\r\nelectromagnetics. She also has strong interest in the field of astronomy and is\r\nworking with a group of volunteers to promote astronomy education in the\r\nsecondary schools in Penang. She had also worked with some interns on the\r\nradio telescope project at the Penang Science Cluster.\r\n\r\nResearch Projects and\r\nConsultancy Work:\r\nSelected Publications: Design of Radio Frequency Metal-Insulator-Metal (MIM) Capacitors. \r\n\r\nExperimental Investigation on Thermoelectric Generator for Battery - Charger\r\nBased Oven.\r\nAnalyzing the Physics of Radio Telescopes and Radio Astronomy (book\r\nchapters).\r\n\r\nConferences,\r\nSeminars and\r\nWorkshops:\r\n\r\nDr. Goh was appointed as one of the Technical Committee Member for the\r\nVirtual Conference on Electronics and Communication: Loading Intelligence on\r\nFuture Electronics (October 2020).\r\n\r\nHonorary\r\nAppointments and\r\nAwards:\r\n\r\nDr. Goh is a reviewer of the following journals:-\r\n1. Microwave and Optical Technology Letters.\r\n2. Journal of Electrical Engineering.\r\n3. Journal on Digital Signal Processing.\r\n\r\nOfficial\r\n\r\nDr. Magdalene Goh Wan Ching\r\nSenior Lecturer & Programme Coordinator of Bachelor of Technology in\r\n\r\nCorrespondence\r\nAddress:\r\n\r\nElectronics,\r\nSchool of Science & Technology\r\nWawasan Open University\r\n54, Jalan Sultan Ahmad Shah,\r\n10050 Penang\r\n\r\nEmail Address: magdalenegoh@wou.edu.my\r\nPersonal Homepage\r\n(optional):\r\n\r\nBTEL facebook page:\r\nhttps://www.facebook.com/groups/238200129533176/",institutionString:"Technology Wawasan Open University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:[{id:"82415",title:"Power Consumption in CMOS Circuits",slug:"power-consumption-in-cmos-circuits",totalDownloads:5,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"444312",firstName:"Sara",lastName:"Tikel",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/444312/images/20015_n.jpg",email:"sara.t@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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Then, in our study, we have conducted experiments over a decade so that we can clarify human information processing, aiming to improve their interaction of AI doctor or support robot with human being by predicting their behavior from finding out their individual cognitive traits [1].
Specifically, we have predicted that their traits concerning with information processing would become clearer by comparing response time to short sentences between presenting with sound voice and letters. Those short sentences which are 120 questionnaires of psychological testing (YGPI) ask subjects whether they are the same or not, comparing with their daily ordinary behavior [2]. In other words, those questionnaires are concerning autobiographical memory [3], which are not effects of their knowledge or academic ability, but personality of 12 factors which divided into two factors, emotional and non-emotional [4, 5, 6].
From the results of our previous study, correlation coefficient between individual response time and the criteria of measurement (duration of each reading questions or the number of words in one question) in the experiment by sound voice (listening) was higher than those of by letters (silent reading). And more, there was greater dispersion of response time among subjects in presenting letters experiment than former ones. From these reasons, we predicted that there would be differentiation of individual traits of information processing for letters than those of sound voice [6, 7].
We have therefore examined response time by silent reading individually and found out that there were persons of Visual type (
Moreover, we have inspected reaction time of silent reading, especially among Intermediate type (N = 55), and found out there were another pattern of information processing between Emotional and non-Emotional questionnaires [6, 7].
In this paper, we have categorized two types, Eidetic type and Adjusting type, whose correlation coefficients and response time patters were different with each other. From these viewpoints, we had formulated a hypothesis (dual loop theory) and verified them by the experiments of practical collaborative learning in nursing class. One loop might be concerning positive feedback control (PFC) and other one might be negative feedback control (NFC) [8, 9]. Epidemic type persons might have tendency of PFC while they are solving problems. On the other hand, Adjustive type might tend coordinating two cycles (PFC and NFC) [10, 11]. We had revealed differentiations between the two types of behaviors.
Consequently, we would like to propose that the results of this study might help AI computer to learn machinery, thereby analyzing Big Data of various students’ results and predicting their individual pattern of behavior so that it can support for personalized education, for instance, optimizing combination for collaborative learning.
Our purpose of this study is to clarify human information processing in order to optimize machine learning for AI computer, which is intended to communicate interactively with human being.
At first, there were problems in collaborative learning of practical nursing class at university and we needed to find the solution. After investigating them in 2014, we have found that there was the main cause of those problems which were failing at a relationship among team members. Then, we have developed the Personalized Education and Learning Support System (PELS) in 2015 [1], which helps instructors and learners to work interactively with each other by optimizing combinations of team members from the viewpoint of personality (Figure 1).
Local search for solution of combinatorial optimization.
The main system of PELS is Big Data processing system (1) (Figure 2), [11], which gathers students’ various data, for instance. measuring their traits (2), recording their behavior, results of their performance, questionnaires, and so on, and analyzes them (3), then inform them to instructors (4) so that they can make plans for instructions included teaming members for collaborative learning interactively.
Local search for solution of combinatorial optimization.
The result of students’ performances at the first semester (Figure 3, upper) has been improving after introducing PELS to nursing classes, comparing the average scores with the conventional form in 2014; on the other hand, it has been dealing from 2015 to 2017 at second semester (Figure 3, right). We have supposed that the reason of those phenomena might be influenced by not only their personality but also their cognitive traits [12], especially concerning with language information processing, because our lifestyle has been changed dramatically in digital society even in educational field [6, 7].
Changing scores over the years.
From these reasons, we have been examining PELS from the viewpoints of optimizing combination for teaming members, through comparing performances and individual differences between successful and unsuccessful teams. Combinatorial optimization, however, is considered that it is difficult to find out precise solution because of discrete and non-contiguous data structure; therefore, we have decided to find solution of interactive problems by introducing the method of scaling up [13, 14, 15], which needs to be revised in the field of education. As this scaling up method should not change the current education system at their university, we have asked instructors and students to participate in experimental practical nursing class and agree to investigate their problems and solutions continuously [16].
Before starting those practical experiments, we had been developing the measuring system for individual traits [12], regarding human information processing. This system is simulated interactive communication between an instructor (A) and a learner (B) with using ICT (a) → (b) → (c) → (d) (Figure 4). In the field of educational technology studies, they call this interaction as learning process. When the learner responses to the instructor (A) after the information or instruction for assignments from the instructor (A) conveyed to her or him, the one session of activity has been considered as coming into effect of learning (Figure 5).
Learning processing.
Human information processing.
From this theory of learning processing, we predicted that language information processing might be the same as each other (Figure 5, ①). Then, instead of the instruction or assignment, we decided to use questionnaires of YGPI (Yatabe-Guilford Personality Inventory), which is consisted of 120 short sentences and 12 factors (10 of 120 each), and more, they are composed of two main factors, emotional and non-emotional factors. Subjects are required to choose responses to questionnaires among “yes,” “no,” or “either,” comparing with their daily activities or behavior. The system also measures their response time from the start of presenting the questionnaire to subjects’ replies (Figure 5, ② and ③). Card has introduced the theory that the perceptional system (
As questionnaires would be the same between those presented by sound voice and letters, differences of their response time should be the same, except the duration of comprehension for problem solving (τ
The results of our exploratory experiments (over 100 subjects aged from 13 to 64) have been shown, however, that the system of encoding might not be the same among subjects. Especially, encoding system [19] for letters might be different individually, and the results of preliminary experiments which have been conducted in the same conditions (age, sex, history of education, and environment of experiments) have imprecated the individual differentiation of cognitive system, included encoding.
From these perspectives, we had introduced the model of human information processing (Figure 5) into our research. Specifically, it was predicted that there might be individual differences of information processing, depending on contents of questionnaires, between emotional and non-emotional factors [4] because of the encoding system or image schema system (Figure 5; A2, V2) [20], which is concerning with conceptualization. Those might have effects on their comprehension (Figure 5; A3, V3) or decision making (Figure 5; A4, V4) strongly.
Consequently, the model of information processing had been reviled to Figure 6 which shows two types of cycle: (4) and (5). Along with previous examinations, the criteria would be decided for discriminating each other by analyzing correlation coefficient between response time and duration of reading (listening) or the number of words, depending on contents; emotional and non-emotional factors. In this chapter, we will examine hypotheses of “dual loop theory” as below.
Model of language information processing system.
There might have existed two loops for human information processing: one might be a positive feedback control (PFC) and the other might be a negative feedback control (NFC). Depending on students, which they might choose one during the problem solving would be different and it might be clarified by analyzing the response time, regarding the context of questionnaires.
In the case of PFC, Loop of (1)(2)(4)(5), (Figure 6), encoded words into symbols might be feedback directly to perceptive organs in order to comprehend the next word along with the context of given each questionnaire. Therefore, this type might have a tendency toward eidetic with short-term memory (STM) to make their decisions in a short time without phonologically silent reading.
In the case of NFC, Loop of (1)(2)(4)(6)(7)(3)(4)(8), (Figure 6), encoded words into symbols might be feedback control after phonologization with image schema and matching meanings of the words with sound voice by long-term memory (LTM). If there are conflicts between them, s/he might need to modify either one of them; then, the results would be conveyed to the cycle of feedforward control (Figure 6; (3)). In this case, they need time to make decision.
Most of the students might use both loops to solve problems and make decisions for replies. How they might choose one, depending on questionnaires, would be effects on their performances.
And more over, this tendency might have effects on their personality.
The purpose of prototype experiments is to calibrate the measurement system.
Twenty-eight university students participated in this experiment.
The experiment took place from January to March in 2015.
The participants were divided into two groups for a counterbalance depending on orders of the way of presentation by sound voice or letters. Prototype experiments are implemented twice to the same participants in the same way and conditions in January and March, for example, the arrangement of laptop displays on the desks and seats in the same room.
Each comparative experiment plans to obtain 240 responses and response time per person. Total amount of data should be 6720 for each element.
Under the condition of optimized combinations of team members at this time by considering inter personality which is predicted by the result of YGPI and instructors’ experiences, the aim is to find out problems remaining in collaborative learning class in order to improve students’ performance from another factor.
Ninety-eight new students at university participated in this experiment.
The experiment took place from April in 2015 to March in 2016.
Beforehand, the instructors had been introduced how to optimize combination of team members in teacher training by using personality types and their experiences. At first, students were explained about the practical experiment and collaborative learning. After obtaining their agreements, they had participated in activities of this experiment, for instance, taking personality testing before starting class, answering questionnaires, collaborative learning in practical nursing class with optimized team members, and so on. Students were required to wear the saddlecloth so that observers and instructors can survey their behavior individually in class.
The results of performance in class; both low and high stakes assignment;
YGPI (response, response time, and evaluation (profile));
questionnaires and interviews to instructors and students;
interaction among students while they are using LMS (learning management system);
record of video in class; and
participatory fieldwork.
The calibration is done by comparing the average of response time to questionnaires by presenting sound voice or letters obtained in prototype experiments in the first and the second time, divided by the number of words.
The calibration is done by comparing the average of response time to questionnaires by presenting sound voice or letters obtained in practical experiments in Visual and Auditory types (Table 1), divided by the number of words.
Criteria type I.
The calibration is done by comparing scatter diagrams of response time to questionnaires by presenting letters and standard reading time (sound voice) obtained in practical experiments in Eidetic and Adjusting types (Table 2), dividing into emotional and non-emotion context (Table 3).
Criteria type II.
Comparison of elements between emotion and non-emotion.
After processing parallel distributions of individual records of performance, low and high stakes assessments, and traits of information processing (Tables 1 and 2), a table will be made in order to analyze and evaluate by comparing performances of teams between success and ill-successes team (Team B and Team C).
After processing parallel distributions of individual traits of information processing (Tables 1 and 2), descriptions of answering questionnaires about psychological testing will be compared between two types of presentation and interpersonal communication in class or practical training (Team B and Team C).
Then, their differences will be discussed in order to clarify the effectiveness of collaborative learning.
Twenty-eight participants were the same members as the first and the second implementation on the same seat and the same display for each person. The experiments were conducted by representing counter-balanced by order. The results were obtained by analyzing the average of reaction time divided by number of words in a short sentence (Figure 7); both sound voice and letters were not significantly different between the first and the second experiments. The total average (first, second) of sound voice was (=2.69, =2.58) and letters (=2.32, =2.20). The correlation coefficients between response time and the number of words were not significantly different between the first and the second experiments, both representing questionnaires by sound voice and letters (Table 4).
Comparison of response time between the first and the second experiments (left: presented by sound voice; right: presented by letters).
Examination of comparison between the first and the second response time.
From these results, it has been proved with reliability that the level of calibration was high enough to reproduce scientifically, regarding our measuring system. Concerning standard deviation, however, letters (
As we have mentioned in Section 3.1, from the results of prototype experiments, we have proved the reliability and the reproducibility of our measurement system. Then, in a practical experiment, we have used them and gathered data, with the similar way of procedures and conditions applied in the prototype experiments. As the standard deviation of response time presented by letters was larger than those of sound voice, we have checked individual differences of the correlation coefficients between response time and the number of words. Along with the categorization of those correlation coefficients, we have divided students’ types as traits of information processing I, Visual type and Auditory type. And then, comparing the average of reaction time between Visual and Auditory type (Figure 8), in the case of letters, Visual type (=2.01,
Comparison of reaction time between Visual and Auditory types (left: presented by sound voice; right presented by letters).
Results of tests, the significant differences of reaction time between visual and auditory types.
Figure 9 shows the different patterns of distributed response time (intermediate type of information processing I) between eidetic (
Comparison of reaction time between emotion and non-emotion (upper: Eidetic type; lower: Adjusting type).
Figure 10 shows the quantitative interaction between two types of students, comparing their scores between the first and the second semesters (
Comparison of scores first and second semester.
This phenomenon should be examined in detail, checking whether the statistical results are right or not by seeing individual performances practically. Therefore, we have chosen team members whose team was success or ill-success in low- and high-stakes’ assessments. In the case of low-stakes assessments, Team B members’ records were shown the best improvement among teams, comparing pre-post test scores. On the other hand, in the case of Team C, their records were the worst in class. Those tests conducted in the first semester, and the average of Team C (=77.5) was lower than Team B (=87.3). In the second semester, traits of the whole tendency of teams were the same; however, looking into individual performances, their tendencies were also the same as Figure 10. For instance, both scores of eidetic type; SubB-2 and SubC-2 in the second semester were lower than in the first semester, on the other hand, in the case of Adjusting type, SubB-1 and SubC-3, their scores in the second semester, became much better than those of the first semester.
In order to check them from another viewpoint practically, their descriptions of answering questionnaires were compared among types of information processing (Appendix 1 and 2).
Appendix 1 shows descriptive answers to the questionnaire about the comparison between auditory and visual presentation of testing. Two of four students, who are visual type, said that it was easier for them to decide responses or image by sound voice than by letters. On the other hand, all three students of Adjusting type have described their responses through self-evaluation by testing.
In Appendix 2, regarding interpersonal communication, which students are required to obtain in practical field for nursing, all three Adjusting type students have described that they think it is important. The others have described about the interactive communication a little more subjectively.
All four members of Team B were interviewed on September 9th in 2018. SubB-2, however, did not appear at the appointment time. After getting appointment again, she appeared for the interview. She said that similar cases have repeatedly happened because it was nothing unusual to make misread message (which caused missing appointment). Concerning interpersonal communication, it has been difficult for her in collaborative working in the practical field and it was the best condition in 2015 with Team B members.
In the case of SubB-1 and SubB-4, they both have talked about their strategies to communicate interactively in collaborative working, even at the specialized treatment department. It seemed that they were able to cope with any persons and cases.
There are a significant number of studies, which have been conducted about human information processing in the world [17, 18]. Every study is very important for us; on the other hand, most of them are still vague and unclear, because we need to observe real time while it is working, from outside. It should be difficult, however, to see inside of our mind directly. Therefore, we have developed the measurement of individual traits from cognitive aspects so that we can clarify human information processing and predict their behaviors. I would like to make it a meaningful measurement; however, it is still exploratory research and data analysis.
Although there might be a lot of methods to find out the mechanism of human information processing [21, 22], there should be different approaches from each other to achieve a goal, depending on their own purposes. The end of this study is to improve personalized education, however, both the environments in society and educational field have been changing, which must be a lot of elements and always impact on our cognitive system, in other words, on the way of human information processing. This means that we always need to find out the problems which might be courses of ill-success in education.
For instance, in our study case, we have supported collaborative learning in nursing class, which has been introduced for cutting age electronic equipment. It must help students when they start to work at hospital, coping with electronic equipment. On the other hand, they are required to obtain the skill of interactive communication with patients and coworkers. For this reason, the instructors have introduced the method of collaborative learning, which needs to divide students into teams with four members in each. It seems cumbersome to decide the members of teams, if instructors seek for effective learning, because they would be required to predict students’ behaviors by analyzing their data, for instance, individual traits and their needs. Hence, we have begun to support optimizing combination; however, there is no exact solution for it [23]. For those reasons, we have developed the support system or personalized education and learning. This has the measuring system to provide students’ data to instructors before starting classes.
As I have mentioned above, however, it has been becoming complicated to combine members of teams. Therefore, if AI doctor or machine would solve this problem by optimizing combination, personalized education and learning would be improved. To achieve this meaningful goal, we need to clarify information processing for interactive communication. This must have synergic effect on AI doctor, care assisting robots and so on, because they need to obtain the ability of interactive communication with people by machine learning.
From these viewpoints, this study and the measuring system for clarifying human information processing must be meaningful to achieve our goal.
We have planned to examine dual loop theory, which I have proposed as hypotheses and implemented experiments, gathered data, and analyzed them. Those ideas were hinted by Card’s Model Processor [18], which is a “cognitive model of the user to be employed by the designer in thinking about the human interaction with computer at the interface” and “the Recognize-Act Cycle of the Cognitive Processor,” from the view of LTM and STM as a simple reaction time. Although they have introduced this model, they have tried to propose another one (GOES: Goals, Operations, Methods, and Selections) for tasks which can be taken from the half-second level to the two-second level. Approximately, dual loop theory model (Figure 6) might be a combination of those two models and we can predict subjects’ behavior. Many of such models have been introduced; however, there might be a few to find out individual differences in human information processing.
The idea of this dual loop theory might be similar to the others, however, we seek for finding out individual differences which patters would indicate some types of trait concerning with cognitive behavior.
Although having said that, when the model is examined, we need to use previous studies as references. For instance, by comparing processing between sound voice and letters [24] and cycle reaction time which is proposed by Card [18], we have examined calibration of measuring instrument. From the results of analysis for response time by presenting sound voice have been shown the high level of the calibration from the viewpoints of reliability and the reproducibility (Figure 7, left), considering the high correlation coefficient with the number of words which means cycle of response time. On the other hand, in the letter presentation case, it was recognized reproducibility; however, its correlation coefficient with the number of words was not shown high.
From this result, it was predicted that individual differences clearly among students concerning the way of silent reading. Then, categorized types of trait (visual or auditory type) by strengthening of the correlation coefficient between response time and the number of words or duration of reading aloud. There are no differences between the two types of reaction time represented questionnaires by sound voice, but recognized significantly differences by letters (Figure 8 under Table 5). Students of Auditory type have needed time longer than those of Visual type from starting to silent reading to making decision (Figure 5). This means that the auditory type might tend to process a word and a sentence with phonologization, using LTM or NFC loop; conversely, the visual type tends to process directly encoding symbol using STM or PFC loop.
From these results of analyses, the hypotheses [a] and [b] have been proved, and next hypothesis [c] should be examined. It was predicted that depending on the context of sentences, we might process them with different ways, PFC or NFC Loop. One hundred twenty psychological questionnaires were used as a task for one session, but they consisted of mainly two types of contexts, emotion and non-emotion. From the previous studies, when the emotional context is processed, it is considered that we tend to use STM because the effect of emotion on hippocampal-dependent memory consolidation [25, 26]. Then, the categorization of types concerning contexts is performed, Eidetic [27] and Adjusting type, depending on the differentiation of correlation coefficients between emotional or non-emotional contexts (Table 2). In the case of adjusting type, the differentiation of response time was clear, and the average of response time to emotional contexts is significantly faster than non-emotional ones. This means that students of Adjusting type might change their strategies to read silently and make decision depending on contexts. In the case of emotional contexts, they might use STM or PFC; on the other hand, in non-emotional contexts, their correlation coefficient is higher and much longer time spent from starting silent reading to making decision [28, 29]. This means that they might read silently with phonologization of words, referring concepts of words meaning by sound voice with image schema. This information processing might help them to reflect on their comprehension is right or not, which is considered negative feedback control (NFC).
From these results, we have proved hypothesis (c); however, we would like to examine more details for this hypothesis.
Two teams were selected from the aspect of low stakes assessments (highest and lowest teams, assessing for ability of conceptual metaphor and collaboration), in order to examine more in detail from the aspect of individual differences (Table 7). It is easy to compare the improvement performances among students’ traits and records or between teams by parallel processing and analyses. The result of the comparison of the average scores between Eidetic and Adjusting types and between first and second semesters has been examined this parallel processing and analyses, which have shown matching with each other.
Moreover, the comparison of those examinations between results of scores and descriptions of students (Appendix 1 and 2) by parallel processing has shown their matching. From this viewpoint, whether those results are matching with the evaluation of personality, regarding the factors of lack of objectivity (O Factor) and lack of cooperativeness (Co Factor) among 12 factors (Appendix 3). Students of Adjusting type (SubB-1, SabB-4, and SubC-3) have taken low scores for both factors; in other words, they are evaluated as objectivity and cooperativeness are strong. On the other hand, students of eidetic type (SubB-3 and SubC2) have taken high score in both factors, comparing with the former students, which means they are subjective and a little bit uncooperative.
Consequently, we might be also able to predict their behavior from traits of information processing. Though the results of our experiments have been proven useful, they are complicated for us. In addition to it, instructors must be busy to prepare other instructions for students. From these reasons, AI machine or doctor which might be able to obtain machine learning is expected and prospected for matching members of team by optimizing combinations.
In this chapter, dual loop theory, which consisted of two kinds of feedback control, concerning with human information processing, was proposed (Figure 6) and examined by analyzing the results of experiments. The data were gathered students’ response time, using psychological questionnaires (Figures 4 and 5) and their records of performances in collaborative learning class and analyzed by the way of parallel distributed processing. The results were as follows:
The prototype experiments were conducted by representing counter-balanced by order. The results of analyzing the average of reaction time divided by number of words in a short sentence (Figure 7) in both sound voice and letters were not significantly different between the first and the second experiments. Therefore, it has been proved with reliability that the level of calibration was high enough to reproduce scientifically, regarding our measuring system.
The response time to questionnaires of sound voice presentation was strongly correlated to the number of words which consist of a short sentence of questionnaires. In presenting letters case, the average of correlation coefficients was weaker and dispersed than those of sound voice (Figure 7). From these results, it was supposed that there were individual differences during information processing while students were reading silently. Then, their response time was categorized by the strength of correlation coefficients with the number of words (Tables 1 and 2).
It was found out that the average of response time depending on types was different between each other. In the case of Auditory type, the average of response time was significantly longer than those of Visual type (Table 5 and Figure 8).
Next, when the sentences were divided into two categories, emotion and non-emotion, there were found different phenomena among students, regarding traits of information processing type (Figure 9). In the case of Adjusting type, the average of response time for emotional contexts was significantly faster than that of non-emotional contexts (Table 6).
Therefore, the average scores of students’ records were compared between Eidetic and Adjusting types. The result has shown the quantitative interaction between them (Figure 10).
Moreover, we have examined whether those individual differences are connected to other students’ performances (Table 7, Appendix 1 and 2), and then, checking the verification of the criteria which classified traits both of personality and cognitive features (Appendix 3).
Finally, we have discussed on hypotheses (2.3), from three aspects: meaning of clarifying human information processing, the examination of dual loop theory, and the relevance between individual differences and personality. In conclusion, the feature of Adjusting type has been shown their way of information processing by both positive and negative feedback controls, comparing the other type of students, depending on the context. In addition to this result, we have checked their performances, descriptions, and interviews practically.
Results of tests, the significant differentiation of reaction time between emotion and non-emotion context for Adjusting type.
Comparison scores between teams.
We need to examine this theory furthermore and optimize the combination of members in order to communicate interactively among students and instructors. Eventually, those results would help the modern style machine learning of artificial intelligent to predict human behavior depending on types and consequently improve their interactive communication with human beings.
In conclusion, dual loop theory would be expected to help us to understand the system of human information processing and predict our behavior according to its patterns. It would be also applicable widely to the machine learning system, for instance, AI doctor and assistive robots which requires the interactive communication with human.
The author is grateful to Dr. Kiyoko Tokunaga and participants for collaboration in our practical research.
Medical tourism is an individual or organized journey outside of place of residence due to the use of medical service in another country. However, according to WHO, currently there is no internationally accepted official definition of medical tourism [1]. This could be seen as an obstacle while not having the uniform approach to the subject is often the reason why services differ all over the world. In addition, non-uniform approach to the given subject could slow or enable, depending on country, the process of establishing criteria for services that could or should be welcomed under the health and public health systems.
However, knowing that accessibility to healthcare in patients’ places of residence can be limited for a number of reasons, including cost, distance to the closest health facility and waiting times, medical tourism represents a sector that could significantly improve healthcare access. Unmet care needs may result in poorer health for people forgoing care and may increase health inequalities especially if such unmet needs are concentrated among poor people. Traveling for health is a realistic option to overcome this issue.
The use of some kind of healthcare outside of place of residence is not a new phenomenon. Ancient Greeks, from the area around the Mediterranean, traveled to Epidaurus, to get the medical advice of Aesculapius. In the 18th century, patients from England visited various spas abroad, while they believed their immune system and overall health would be boosted by the different climate and water [2]. In the late 19th and at the beginning of 20th century Austro-Hungarian nobility discovered healing effects of water and air of the Croatian north coast, especially cities like Crikvenica and Opatija. However, finding balneal and climate therapy only, soon became insufficient. During the 20th century, wealthier people from less developed areas traveled to more developed regions to access better health facilities, highly trained medics, and new or more available procedures. Through the time, another group of medical travelers becomes more interested in finding good but less expensive institutions where they can get the same standard of specific medical care but for less money. This led to the new paradigm of medical tourism – patients that travel seeking for health service but also willing to combine they stay with the experiences that other country could give them. They became tourists with the plan [3].
Nevertheless, the shifts that are currently visible in the medical tourism show the main differences in services provided. Some countries develop specific “supply” of services based on specific “demands”. In Europe Union (EU), there are countries that are much wealthier than the other European countries and thus some medical treatments are very expensive. For example, dental and dermatological services are often sought in eastern or southern European countries where the prices are much lower than in the northern and western countries [4]. The highest rate of hip replacement, which is most sought method when it comes to hip arthritis and related pain, are in Switzerland and Germany, among the countries members of Organization for Economic Co-operation and Development (OECD countries) [5]. This procedure has long waiting list if the healthcare access is organized through public clinics. Therefore, many patients opt to travel abroad to be operated sooner and at more affordable rate. In the past ten years, there is a visible in the number of outpatient hip replacements in United States of America (USA).
Not only the price is the cut-off value for the decision to go out of own country and seek the medical service. Sometimes the inability to get a specific medical help in one’s own country is the main reason to travel for health (procedure or technology). In Europe, there are mutual agreements that cover such situations by existing national health insurances [6, 7], but the costs for rare diseases remain high. Sometimes, in certain countries, the procedures themselves or for certain group of people are not allowed due to cultural factors, as abortion, IVF or surrogacy, and thus some people reach for this kind of treatments available through medical tourism. Moreover, there is a controversy related to the transplantations of the organs and the completely new market developed for these procedures. Besides that, in poor countries, there is a risk of organ trafficking.
Different types of demands in medical tourism market and different laws applied in different countries create an environment of too many information, fear and uncertainty especially in relation to the aftermath, which is reasonable to expect to happen in some of the situations. Thus, the reasons why patients make the decision to use medical tourism is very important, especially for studying the possible implications related to [7].
Today, the market of medical tourism is valued at hundreds of billions of USD and is constantly rising, thus presenting multi-way matter of subject. In some countries the health systems are losing patients because of high prices which make the patients to go to other, nearby countries, and in some cases insurance system do not allow patients to use any non-conventional approach in their therapies and healing process [8]. In this case, patients often use all the procedures covered by their insurance and at the same time, they pay for different approach as well. Here we can say – the system (the government system) is losing again.
Medical tourism brings many advantages to patients, countries and governments, but also many negative consequences that affect the individual and public system. Obviously, the lack of internationally accepted official definition of medical tourism, of agreed definitions, of databases that record the total number of patients traveling abroad, of the procedures they undergo and of their outcome, is causing more problems as the time pass.
Without systematic monitoring and collecting data, it will be impossible to do the comparison of the quality of implemented services of medical tourism between countries and institutions. We believe that organized approach to this hot topic of medical tourism and implemented standards and measures through the health systems and services will not provide benefits only for the end-consumers, but also for the countries, governments and their economics as well.
Medical services used by traveling patients are often elective interventions, complex surgery, procedures in the field of plastic surgery, dental medicine, as well as all other forms of medical care. Recently, there is a huge increase in search of second opinion outside of the country of residence and many internationally recognized clinics and hospitals see it as a lucrative side service.
However, the reasons that are behind the patients’ engagement in medical tourism are complex. They include unmet care, the nature of services they are trying to find (including dental care), the manner by which the treatment is accessed (mainly dependable on resident’s country healthcare system), available properly educated staff and waiting time related to the service to be done in the resident country.
Inadequate healthcare access and unmet care in their native countries has led to a significant increase in the number of people using medical services outside the borders of their country. For example, in all European countries, most of the population in 2018 reported that they had no unmet care needs for financial reasons, geographic reasons or waiting times (Figure 1).
Unmet need for medical examination due to financial, geographic or waiting time reasons, 2018. Source: This chart is made by authors by using data from Eurostat Database [
However, in Estonia and Greece for example, at least 8% of the population reported some unmet needs for healthcare, with the burden falling mostly on people from low-income households, particularly in Greece. Nearly one in five Greek people in the lowest income quintile reported going without some medical care when they needed it and these unmet needs were mainly for financial reasons. In Estonia, long waiting times are the main reason for people to report unmet care needs, which are partly explained by the limited volume of some services (such as specialist consultations) fully reimbursed by public health insurance [9].
The gap in unmet medical and dental care needs between poor people and rich people remains large: on average across EU countries, people in the lowest income quintile are still four times more likely to report unmet medical care needs than those in the highest quintile, and six times more likely to report unmet dental care needs [9].
The characteristics of national healthcare system will certainly define the overall demand for medical tourism in each country. In addition, the impact of medical tourism on national care system will depend on those characteristics as well. This double relation between medical tourism and healthcare system will finally affect the policy in this area.
Moreover, it is important to mention staff shortages especially in certain medical specializations or geographic areas [10]. In the coming decades, aged population is expected to be one of the major challenges for the health sector [11, 12]. The demand for healthcare will probably increase substantially in elderly population, particularly in the US and EU, and at the same time the proportion of the people in work will probably decline. In 2018, just over two fifths of all doctors in the EU were aged 55 years and over. According to the European Commission’s Directorate-General for Health and Food Safety, more than 60 000 doctors (or 3.2% of the workforce) were expected to leave the profession each year during the period 2018–2020. There are countries more affected - in 2018, more than half of all physicians in Italy and Bulgaria were aged 55 years and over [13].
Proper healthcare access requires a sufficient number of doctors, with a proper mix of general practitioners and specialists and a proper geographic distribution to serve the population in the whole country. There were many concerns in the late 2000s about projected shortages of doctors arising from population aging and the aging of the medical workforce [9]. These concerns prompted many EU countries to take actions to anticipate the retirement of a large number of doctors, notably by increasing the number of medical students, to replace those retiring [9]. Several countries also took actions to postpone the retirement of current doctors and recruited more doctors from abroad [9].
In many countries, the main concern has been about growing shortages of general practitioners, particularly in rural and remote regions. Whereas the overall number of doctors per capita has increased in nearly all countries (Figure 2), the share of general practitioners (GPs) has come down in most countries.
Practising doctors per 1 000 population, 2008 and 2018 (or nearest year). Source: This chart is made by authors by using data from Eurostat Database [
In many countries, it remains a challenge to attract a sufficient number of medical students to fill the available training places for general practitioners. The uneven geographic distribution of doctors and difficulties in recruiting and retaining doctors in remote and sparsely populated areas is another persisting challenge in many European countries. In all countries, the density of physicians is generally greater in urban regions, reflecting the concentration of specialized services such as surgery in urban centers as well as physicians’ preferences to live and practice in cities [9].
Some services in the international medical tourism are in more demand than others are. Services with long waiting lists are particularly influencing this demand. Moreover, long waiting lists for elective (non-urgent) surgery have been a longstanding issue in many European countries as they generate dissatisfaction in patients because the expected benefits of treatments are postponed. The COVID-19 pandemic will likely increase waiting lists for many elective surgeries, at least temporarily, as non-urgent interventions have often been postponed during the peak of the epidemic.
The median waiting time for people who received a cataract surgery in 2019 (or 2018) varied from about 30 days in Italy, Hungary and Denmark, to about 150 days in Estonia and 250 days in Poland. For hip replacement [5], the median waiting time ranged from 35 to 50 days in Denmark, Hungary and Italy, to 180 days in Poland and 250 days in Estonia. The pattern is generally the same for knee replacement, although in most countries the waiting time is slightly longer than for hip replacement [9].
Oral health is an important, although often neglected public health issue. The global burden of dental diseases is mostly seen in caries and periodontal diseases being major public health problems in industrialized countries among children and adults [14].
The economic burden of oral diseases is substantial. With dental costs on the rise, a vast number of people across Europe and the USA are finding it difficult to afford proper dental care, especially when it comes to procedures that are more complex. This is the main reason people are deciding to spend their holidays in destinations that offer them the same quality of dental services at lower price rates. This cost-effectiveness principle is often the main principle in managing the choice of medical service and country of destination. There are different reasons why the prices in some countries are lower than in the other, but in most of the popular dental tourism destinations, it is due to lower labor and real estate costs. Dentists in these countries can afford themselves to have lower prices than their colleagues in big centers of Europe and USA, while providing the same quality of dental work. Oral diseases account for more than 5% of total health spending on average across EU countries, and productivity losses due to oral diseases have been estimated at around EUR 57 billion a year [15]. The extent of public coverage for dental care costs can also partly explain some of the cross-country variations in the number of dentist consultations. In Romania for example, only 6% of dental care spending is publicly funded. By contrast, in Germany, more than 60% of dental spending is publicly covered [9].
The cost for non-medical dental treatment, esthetic ones, are much higher. This is specially related to the fact that there is no country with the public health coverage for esthetic dental treatments – those are covered mainly in children and for the visible teeth, if they are at all.
Healthcare access mirroring the state organization and social sensitivity. Still, it is usually related to money and availability of services. Nevertheless, there are concerns that low- and middle-income countries will suffer the inequity and worse accessibility to healthcare if the medical tourism prevail [16]. The reasons, as elaborated in earlier paragraphs, are numerous: staff shortage or drain to the private sector [10], long waiting time, higher prices. However, healthcare access does not show only the shortcomings in countries where medical tourism applies [2]. There are benefits related to the growing medical tourism in such countries: money obtained from medical tourism services often spills to the secondary and tertiary sectors thus producing economic expansion. Even though, we need to be conscious on different aspects of medical tourism’ impact on healthcare access [2].
The equity could be the main factor for reasonable approach to healthcare access and should be seen from two different angles. Firstly, equity in healthcare access for domestic population, which is not compromised by growing medical tourism while the systems are separate (national vs. private). Secondly, equity, which is compromised by staff or money drain into medical tourism’ services which leaves healthcare access for residents inadequate.
The way of access to healthcare in relation to medical tourism is important parameter as well. Healthcare system in many countries allows access to some of these services but all-around world approaches differ. In addition, it differs widely according to healthcare diversity. The countries in which access to healthcare is guaranteed by the national policies will suffer less (or not at all, maybe even benefit) by growing presence of medical tourism. Those countries could experience more well-educated staff, new technologies and treatments present at their market, with no restrictions to use them. Competition could make this healthcare markets even better and more accessible. In countries where no national health insurance policies are present, the growing demand will allow medical tourism to expand, but the outcome could involve equation: more money – more services. Thus, the healthcare access will be as equal insofar as the differences between rich and poor are smaller. This does not necessarily mean that the presence of medical tourism will make more difference between rich and poorer. Maybe will be the reason for more output patients seeking the healthcare outside their country of residence.
Is the presence of medical tourism on healthcare market the reason to look the shortcomings or the benefits of it? Or we just should see the whole picture which shows the fact that medical tourism will not vanish, and the countries should only act in a sense of protecting patients, both incoming and domestic. We believe that healthcare access could greatly benefit by opening this kind of services to wider population while at the same time not endangering patient’ safety. Good health insurance policies, certificates and well-defined services could best do this.
Directive No. 2011/24/EU of March 9, 2011 [6] on patients’ rights in cross-border healthcare aims to guarantee patient mobility and the free provision of healthcare services. The Directive contains provisions concerning the reimbursement of costs, the responsibilities of the Member States and their cooperation in healthcare. It has been applicable in the European member States since October 25, 2013, and in the European Economic Area* (Iceland, Liechtenstein, and Norway) since August 1st, 2015. However, it does not apply to Switzerland.
The main goal of this Directive is to facilitate access to “safe, high-quality cross-border healthcare and to promote healthcare-related cooperation between EU and EEA (Iceland, Liechtenstein, and Norway) member States, while maintaining each State’s independent authority to organize and provide healthcare services”.
According to the Directive, the patient is free to choose a healthcare provider or facility in either the public or the private sector, which correspond with the healthcare access, which does not make the difference between them. The patient will be reimbursed by the member State national health insurance, but the amount of money could differ – will be at least the price of the same service in resident county, or sometimes the full amount of the treatment received. If the patients receive the cross-border prescription for medication or medical device, the resident country must provide the follow-up care of same quality. State member is obliged to create National Contact Point responsible to inform patients of all of their rights. Directive also urged creation of updated “e-health” network in each country, which will enable continuity of care and access to high quality healthcare. Network among countries will also promote cooperation between competent centers and authorities, which was visible during COVID-19 pandemic, when EU states worked together and gave money for new treatment solutions (vaccines). Although we have witnessed intensive work on the vaccine in the last year, in previous years member States have also dealt with rare diseases, as one of the common concepts of access to health at European level. We can say Europe is already working on providing patients with “healthcare provider reference networks” and is promoting patient’ mobility for expertise.
Directive 2011/24 EU covers all European Union citizens, nationals of the States of the European Economic Area (Iceland, Liechtenstein and Norway), refugees and stateless persons residing in a Member State of the European Union or the European Economic Area, who are or have been subject to the legislation of one or more Member States, as well as their family members and their survivors.
The Directive does not apply to long-term care (home care services), organ donations and public vaccination programs.
There are some good concepts in European’ healthcare access policies that should be incorporate in medical tourism worldwide. However, we pointed out this Directive as a new medical tourism booster knowing that it will be difficult to copy-paste it in other continents lacking “Bismarck-like” health insurance model.
Medical tourism affects each country, but the challenges and advantages will differ based on specific health insurance. Likewise, state, non-state, individual, institutional levels of care and medical tourism market will engage healthcare system in different ways including profit, autonomy, and ethical aspects. All these relations will then ask for good funding and delivery models, incorporated in good insurance scheme.
Public healthcare systems are even more under the pressure to withstand the new era of globalized medicine [17]. Having in mind, that many countries do, and many do not have public healthcare coverage, the possible model for uniform approach to medical tourism insurances become questionable. In countries without public healthcare insurances, the use of external medical services could become more often but the system will not be burden – while the patients will pay for any consequence, visible after return, related to medical tourism treatment.
But those countries with public healthcare insurances will face another level of problems associated with medical tourism – the cost of all the consequences related to safety and efficacy that will emerge after the patient’ return if he/she decided to use the treatment outside the country of residence. Notably, the patients from countries without national healthcare coverage will seek different treatments based on the price and availability [8]. This is something what Europe is prevented by its multilateral agreements on using national healthcare coverage across the border [6].
Health insurance is a data-driven business, and the more the data are organized and available, the more the insurance will be specific for the treatment. Traditional health insurance product design and pricing rely on gather and analyze the past data (e.g., past claims) of a healthcare access of certain population. The main question they answer is how many times? So, how many times a year the patient will use access to general practitioner, specialist, and hospital? The second question is how much? How much will each healthcare access cost? So, if there are not enough and/or reliable information on cross-border healthcare access than the health insurance policy could not be very precise. Then the next question is raised: How much such health insurance cost? Today’ insurance companies offer coverage for expenses made due to medical tourism, making efforts to reduce costs, but mainly they do so by their own – no policies or laws almost nowhere are implemented in a way to protect nor the individual nor the system.
While there is difference between countries, the calculation is even more difficult. Today, the cross-border health insurance is typically a more rewarding product than a purely domestic product line. Thus, it is important to understand the local context of the country where the medical treatment is taking place, and to know how the healthcare access in this particular country is organized.
Most health insurance products cover treatment received solely in the customers’ main country of residence. Some offer cross-border coverage, like those offered to the expatriate employees of multinational corporations, which give them healthcare access to the nearest centers of medical excellence in their region.
In time, the patients will increasingly be looking abroad for medical care, as they realize that the quality of treatment (physicians, drugs, devices, etc.) or the lower price, or the quicker access they are looking for is often not available locally (or the waiting list is too long). This also presents opportunities for hospitals, accreditation bodies and funders (e.g., insurance companies).
Safety and efficacy may not be the first parameter for choosing the treatment. Being used to get the appropriate care through the national healthcare system may make the patients to risk more. Therefore, the risks related to the medical tourism should be anticipated. For example, the entire documentation patient should carry with, the type of insurance, additional costs, post-operative care and complications. This is separate from medical malpractice insurance, which the doctors cover by own insurance - it only covers the consequences of “no fault” complications, not negligence. This will help the overall medical tourism industry to standardize all the elements related to the trip of their patients: travelers’ choices, booking, treatments payment, insurance, language, etc.
A special section represents travel medical insurance. It pays for emergency medical expenses during a trip. If you are traveling and have an unexpected illness, injury or medical condition that is covered by your travel medical insurance, the plan will reimburse you, up to the plan limits. Travel medical insurance pays “reasonable and customary” charges for bills such as: ambulance service, doctor bills, hospital and operating room charges, X-rays, examinations, treatments, lab tests and anesthetics, drugs and medicines. However, this kind of travel insurance does not count as medical tourism as the main trigger for the trip taken was not a medical procedure of any kind.
Healthcare access enhanced and improved by assigned international accreditations and certificates could make a great impact on in- and specially out-patients service satisfaction.
Obviously, the global medical tourism will not affect all national healthcare systems and institutions in the same way, but a possibility of affecting the national healthcare access must be anticipated. Thus, the accreditations and certificates are needed.
There are world organizations referred as examples that publish accreditation. The oldest international accreditation organization is in Canada, accreditations Canada. They made the first accreditation in 1968 for a hospital in Bermuda. In USA operates accreditation body Joint Commission International (JCI), and this organization provides inspections and accreditation to institutions outside the USA since 1999. In United Kingdom (UK) operates Quality Healthcare Advice Trent Accreditation. The Australian Council on Healthcare Standards (ACHS) is a well-known authorized accreditation organization with the Australian Commission on Safety and Quality in Healthcare. The number of internationally accredited medical centres worldwide has witnessed substantial growth, for example, JCI accredits 100 new centres annually and covers 66 countries.
Unfortunately, there is no organization officially and universally recognized and responsible for such accreditation. Therefore, it is common to see health institutions that are interested in double/multiple accreditations, for US, UK and EU market, to reach patients from different parts of the world. Likewise, there are no necessary demands to obtain accreditation for service of medical tourism providers. This situation affects the consumers to choose the destination and the service without quantitative and/or qualitative information about clinical quality and related outcomes [3].
When a national healthcare system as a whole or an individual health institution is deciding on type of accreditation or certificate, they mostly ask for these main conditions and procedures to be covered by accreditation / certification process is standard of care and patients’ safety including:
ensure safe surgery
reducing risk of healthcare-associated infections
reducing the risk of patient harm resulting from falls
improving the safety of high-alert medications
improving effective communication.
However, what most present accreditation and certification organizations do not cover, as there is also no demand from healthcare systems or institutions at this time, is:
hospital insurance coverage for all of its parts included in medical tourism services provided
telemedicine, if incorporated in hospital work, should be seen as an advantage that reduce the cost of insurance, especially for post-treatment complications, while will allow doctors to follow-up their patients without additional cost of e.g., prolonged stay
the number and severity of post-treatment complications tracked
routine follow-up related to post-treatment care and complications arising from medical procedures performed abroad should be emphasized, identified and addressed
secured funds that will assure medical tourist that any complication will be promptly covered, no matter insurance reimbursement protocol
surveillance of contracts with agencies providing medical tourism services (buyers).
International accreditation also could be seen as a great marketing tool for incoming patients. However, problems related to accreditation process involve difference between countries (developed/non-developed), institutions in charge for accreditation (public/private or national/international), and the choice of criteria for accreditation. Good criteria for accreditation in medical tourism will incorporate the healthcare globalization processes preventing at the same time the unwanted consequences of medical tourism.
Today the term global health is mostly perceived as a part of public health where all the efforts are made to preserve overall health of the population due to socio-environmental impacts. However, the term reflects the efforts made by the national healthcare systems to protect the health of their citizens especially related to the global burden of disease (GBD). Thus, to understand the difference, it is important to see the medical tourism as a part of globalized medicine. It encompasses individual effort made by the single patient to improve his health. This makes medical tourism an important issue for national healthcare system in relation to in- and out-patients. In addition, it affects global health as well, while global health is easily imbalanced by supply/demand of medical services.
Numerous ethical questions on inequity of healthcare access for local residents could arise: drain of the professionals into private sector, fewer services in national sector, better technologies in private, etc. In vice versa situation, where patients are using medical treatments abroad, the system could easily be burden by costs arising from treating post complications due to medical tourism once they are back home.
However, these processes/challenges can help to facilitate creation of policies. Namely, knowing that different types of healthcare systems will be under the different types of demands for medical tourism could affect health insurance policies specifically.
Missing unified standards for, both, patients and organizations involved in medical tourism could bring enormous medical, legal and ethical risks in the future. Further on, having no unified terminology, or safety, legal and ethical standards is the reason why related problems remains unsolved. The accelerating growth in medical tourism industry, enhance urgent need for supporting measures that will ensure patient’ safety at any level.
To create safe environment for this new, fast-growing industry, globally unified accreditation for all included services/facilities are needed. In order to preserve public safety, availability of healthcare and to give excellent service, global standardization and accreditation is expected to be most urgent processes that should be done in any country positioning itself as a medical tourism destination. Harmonized propositions for medical tourism industry access covered by both, private and public health insurances, would contribute to service transparency, physician’ and management’ liability, and patient safety while taking care of moral aspects of such services. Medical tourism without any doubt impacts access to healthcare. Therefore, if consciously incorporated, medical tourism as a part of global healthcare could easily become an efficient and effective additional access to healthcare.
Authors would like to thank Energy Clinic, luxury wellness spa chain in Croatia, for their donation for publishing this chapter.
The authors declare no conflict of interest.
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Kommu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6423",title:"Prostate Cancer",subtitle:null,isOpenForSubmission:!1,hash:"d072a079624084c12169a118fdbbfa87",slug:"prostate-cancer",bookSignature:"Cem Onal",coverURL:"https://cdn.intechopen.com/books/images_new/6423.jpg",editedByType:"Edited by",editors:[{id:"43940",title:"Dr.",name:"Cem",middleName:null,surname:"Onal",slug:"cem-onal",fullName:"Cem Onal"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5516",title:"Bladder Cancer",subtitle:"Management of NMI and Muscle-Invasive Cancer",isOpenForSubmission:!1,hash:"fa255c022acc85f2bd2c12ce4cd9a67b",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",bookSignature:"M. Hammad Ather",coverURL:"https://cdn.intechopen.com/books/images_new/5516.jpg",editedByType:"Edited by",editors:[{id:"88868",title:"Prof.",name:"M Hammad",middleName:null,surname:"Ather",slug:"m-hammad-ather",fullName:"M Hammad Ather"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:4,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"54132",doi:"10.5772/67473",title:"Cross-Polarization OCT for In Vivo Diagnostics and Prediction of Bladder Cancer",slug:"cross-polarization-oct-for-in-vivo-diagnostics-and-prediction-of-bladder-cancer",totalDownloads:1104,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"This chapter contains three parts covering recent efforts to increase the accuracy of optical coherence tomography (OCT) differential diagnostics of bladder pathologies. The first part compares the diagnostic efficacy of traditional OCT and cross-polarization OCT (CP OCT); CP OCT and fluorescence cystoscopy (FC) for detecting flat lesions in the bladder at the early stages of cancer. The second part contains a report on achievements in application of CP OCT for detection of recurrent carcinoma in the scar area that is a hardly distinguishable form of bladder cancer using an optimized CP OCT image analysis. The third part of the chapter reviews the results on CP OCT usage for in vivo diagnosis of the bladder cancer after radiation therapy of cervical cancer.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Elena Kiseleva, Gladkova Natalia, Streltzova Olga, Kirillin Mikhail,\nMaslennikova Anna, Dudenkova Varvara, Yunusova Katerina and\nSergeeva Ekaterina",authors:[{id:"68196",title:"Prof.",name:"Natalia",middleName:null,surname:"Gladkova",slug:"natalia-gladkova",fullName:"Natalia Gladkova"},{id:"191970",title:"Dr.",name:"Elena",middleName:null,surname:"Kiseleva",slug:"elena-kiseleva",fullName:"Elena Kiseleva"},{id:"191990",title:"Dr.",name:"Olga",middleName:null,surname:"Streltzova",slug:"olga-streltzova",fullName:"Olga Streltzova"},{id:"191992",title:"Mrs.",name:"Varvara",middleName:null,surname:"Dudenkova",slug:"varvara-dudenkova",fullName:"Varvara Dudenkova"},{id:"191993",title:"Prof.",name:"Anna",middleName:null,surname:"Maslennikova",slug:"anna-maslennikova",fullName:"Anna Maslennikova"},{id:"191994",title:"Dr.",name:"Katerina",middleName:null,surname:"Yunusova",slug:"katerina-yunusova",fullName:"Katerina Yunusova"},{id:"191995",title:"Dr.",name:"Mikhail",middleName:null,surname:"Kirillin",slug:"mikhail-kirillin",fullName:"Mikhail Kirillin"},{id:"193422",title:"Dr.",name:"Ekaterina",middleName:null,surname:"Sergeeva",slug:"ekaterina-sergeeva",fullName:"Ekaterina Sergeeva"}]},{id:"54019",doi:"10.5772/67309",title:"Bladder Cancer Markers and Recent Innovations",slug:"bladder-cancer-markers-and-recent-innovations",totalDownloads:1687,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Bladder cancer (urothelial carcinoma) is the most common tumor of the urinary tract. It occurs more frequently among men about 65 years old on average. Two forms of the tumor are known: a non–muscle-invasive one and a muscle-invasive one. The latter turns out to be very aggressive with a survival of 5 years average. The non–muscle-invasive form frequently recurs (60–70%) and in 15% of cases, it progresses into the invasive form. The diagnosis is made mainly by cystoscopy and urine cytology. A high number of researches were dedicated in order to find a simple test using voided urine to frequently monitor possible tumor recurrence. During the last 10 years, many tests were proposed concerning either special proteins of which the most common are the bladder tumor antigen (BTA) and the nuclear matrix protein 22 (NMP22) or the presence of genetic mutations [most frequently, fibroblasts growth factor receptor 3 (FGFR3) and TP53], alteration of DNA methylation, chromatin structure and, more recently, the presence of specific micro-RNA. Recently the analysis of lipids present in voided urine showed a difference in fatty acids between healthy individuals and those affected by non-invasive forms. These markers appear to have a high specificity and sensitivity: a deepening of these results could lead to the development of a test that avoids invasive treatment and the cost of cystoscopy.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Mariapia Viola-Magni, Samuela Cataldi and Daniela Marocco",authors:[{id:"192375",title:"Prof.",name:"Mariapia",middleName:null,surname:"Viola-Magni",slug:"mariapia-viola-magni",fullName:"Mariapia Viola-Magni"},{id:"197851",title:"BSc.",name:"Samuela",middleName:null,surname:"Cataldi",slug:"samuela-cataldi",fullName:"Samuela Cataldi"},{id:"197852",title:"Dr.",name:"Daniela",middleName:null,surname:"Marocco",slug:"daniela-marocco",fullName:"Daniela Marocco"}]},{id:"54063",doi:"10.5772/67280",title:"Intravesical Chemohyperthermia for NMIBC: Rationale and Results of This Developing Treatment",slug:"intravesical-chemohyperthermia-for-nmibc-rationale-and-results-of-this-developing-treatment",totalDownloads:1383,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Bladder cancer is the fourth most common cancer in men, and the lifetime risk of getting bladder cancer is 2.4%. Approximately 75% of newly diagnosed cases of bladder cancer are non-muscle-invasive bladder cancer (NMIBC), and half of them will show recurrence and/or progression after transurethral resection. Therefore, after transurethral resection, in high-risk patients, intravesical therapy is mandatory. However, bacillus Calmette-Guérin (BCG) is associated with important side effects such as systemic tuberculosis and bladder retraction. Chemohyperthermia (CHT) has shown a 60% lower recurrence rate than standard mitomycin C (MMC). However, its effectiveness in high-risk patients, especially CIS and BCG refractory patients, is even more important. CHT will probably be an option for patients unsuitable for radical cystectomy or those on whom BCG can’t be used. Two main technologies are currently available for intravesical CHT: microwaves and recirculating heated fluids. Both of them have pros and cons that should be known and evaluated by a urologist. In this chapter, we will speak about rationale, technical options, clinical results, ongoing studies, and future perspective for this interesting treatment option for intermediate and high-risk patients with NMIBC.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Sousa-Escandón Manuel Alejandro, Flores Carbajal Javier, Sousa-\nGonzález Daniel and Rodriguez Gómez Silvia",authors:[{id:"191356",title:"Dr.",name:"Alejandro",middleName:null,surname:"Sousa-Escandón",slug:"alejandro-sousa-escandon",fullName:"Alejandro Sousa-Escandón"}]},{id:"54147",doi:"10.5772/67443",title:"Lymphadenectomy in Muscle Invasive Bladder Cancer",slug:"lymphadenectomy-in-muscle-invasive-bladder-cancer",totalDownloads:1255,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Bladder cancer is the second most common genitourinary malignancy with urothelial cancer comprising nearly 90% of primary bladder tumors. Urothelial carcinoma of the urinary bladder is the fifth most common malignancy in the United States, with an estimated 76,960 new cases and 163,900 deaths in 2016. Radical cystectomy with lymph node dissection remains the standard treatment for patients with muscle-invasive urothelial carcinoma of the bladder, and also for nonmuscle-invasive disease, refractory to intravesical therapy. The current approaches to pelvic lymph node dissections are based on the removal of lymph nodes most commonly harboring metastatic disease, notably the external iliac, obturator, and hypogastric lymph nodes. The boundaries for a standard pelvic lymph node dissection generally include the bifurcation of the common iliac vessels superiorly and the genitofemoral nerve laterally. Extended pelvic lymph node includes the removal of lymph nodes between the bifurcation of the common iliac vessels and the level of the aortic bifurcation, sometimes including distal aortic and caval nodes up to the level of the inferior mesenteric artery, as well as presacral nodes. Extended and superextended dissection has been reported to be associated with superior survival outcome.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Mustafa Ozan Horsanali and Kutan Ozer",authors:[{id:"59702",title:"Dr.",name:"Mustafa Ozan",middleName:null,surname:"Horsanali",slug:"mustafa-ozan-horsanali",fullName:"Mustafa Ozan Horsanali"},{id:"192699",title:"Dr.",name:"Kutan",middleName:null,surname:"Ozer",slug:"kutan-ozer",fullName:"Kutan Ozer"}]},{id:"59222",doi:"10.5772/intechopen.73515",title:"Development of Oncolytic Adenoviruses for the Management of Prostate Cancer",slug:"development-of-oncolytic-adenoviruses-for-the-management-of-prostate-cancer",totalDownloads:1102,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Prostate cancer (PCa) is the fifth most common cause of cancer-related deaths in men globally. Androgen receptor (AR) signalling plays a vital role in initiation and progression and antiandrogens are standard of care first-line therapeutics. However, resistance frequently develops resulting in metastatic castration-resistant prostate cancer (mCRPC). Management of CRPC is currently chemotherapy and/or radiotherapy but is mostly palliative due to rapid development of resistance. The need for novel approaches to eliminate mCRPC is compelling; a promising option is replication-selective (oncolytic) adenoviruses with demonstrated efficacy in preclinical models of multidrug-resistant PCa. The safety of various viral mutants has been confirmed in numerous clinical trials with minimal toxicity in patients. Importantly, oncolytic adenoviruses synergise with the current standard of care for mCRPC even in treatment-resistant cells. In early phase I–II clinical trials, promising efficacy in patients with localised PCa was reported after intratumoural administration, and phase III trials are underway. To enable systemic delivery, for targeting of mCRPC, further developments are necessary because of the short half-life of the adenoviral mutants in human blood. Current progress in preventing the high-affinity binding of adenovirus to erythrocytes, hepatocyte uptake, and elimination by hepatic Kupffer cells will be described.",book:{id:"6423",slug:"prostate-cancer",title:"Prostate Cancer",fullTitle:"Prostate Cancer"},signatures:"Ahmed A. Ali and Gunnel Halldén",authors:[{id:"80427",title:"Dr.",name:"Gunnel",middleName:null,surname:"Hallden",slug:"gunnel-hallden",fullName:"Gunnel Hallden"},{id:"232386",title:"MSc.",name:"Ahmed",middleName:null,surname:"Ali",slug:"ahmed-ali",fullName:"Ahmed Ali"}]}],mostDownloadedChaptersLast30Days:[{id:"70881",title:"Robot-Assisted Partial Nephrectomy: Evolving Techniques",slug:"robot-assisted-partial-nephrectomy-evolving-techniques",totalDownloads:481,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Robotic-assisted partial nephrectomy is now embraced in urology as a recommended treatment option for small localised renal tumours. There is an increasing trend towards setting up robotic-assisted services in urological centres across the world. Our aim is to review the available published common robotic-assisted partial nephrectomy techniques. We present our institutions’ established step-by-step technique for performing robotic-assisted partial nephrectomy, in order to guide aspiring urologists interested in performing robotic-assisted partial nephrectomies. The importance of pre-operative review of imaging in a multi-disciplinary approach is critical. 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The issue of oncological safety of a urethra and anterior vaginal wall‐sparing cystectomy in selected patients has been addressed by several authors. The chapter will discuss the following items: (I) Technique of genital‐sparing radical cystectomy in female patients with muscle invasive transitional cell carcinoma of the bladder. (II) Definition and rationale of genital‐sparing radical cystectomy in female patients. (III) Rational and value of urethral preservation in genital‐sparing cystectomy in female patients with urothelial carcinoma. (IV) Previous reports about genital‐sparing cystectomy in patients with urothelial carcinoma. 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She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. 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She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. 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He is also Member of the Laboratory of genetic, animal and feed resource and member of Animal science Department of INAT. He graduated from Higher School of Agriculture of Mateur, University of Carthage, in 2002 and completed his masters in 2006. Dr. M’HAMDI completed his PhD thesis in Genetic welfare indicators of dairy cattle at Higher Institute of Agronomy of Chott-Meriem, University of Sousse, in 2011. 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I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. Voyich",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Montana State University",country:{name:"United States of America"}}},{id:"330412",title:"Dr.",name:"Muhammad",middleName:null,surname:"Farhab",slug:"muhammad-farhab",fullName:"Muhammad Farhab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"349495",title:"Dr.",name:"Muhammad",middleName:null,surname:"Ijaz",slug:"muhammad-ijaz",fullName:"Muhammad Ijaz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}}]}},subseries:{item:{id:"41",type:"subseries",title:"Water Science",keywords:"Water, Water resources, Freshwater, Hydrological processes, Utilization, Protection",scope:"