Major QTLs for seed protein, sucrose and oligosaccharide content reported in soybean.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"8781",leadTitle:null,fullTitle:"Weight Management",title:"Weight Management",subtitle:null,reviewType:"peer-reviewed",abstract:"Weight management is a multi- and cross-disciplinary challenge. This book covers many etiological and diagnostic aspects of weight-related disorders and their treatment. This book explains how body weight influences and is influenced by the brain, hormones and immune system, diet, physical activity, posture and gait, and the social environment. This book also elucidates the health consequences of significantly low or pathologically increased body weight. Furthermore, ideas on how to influence and manage body weight including anti-obesity medical devices, diet counselling, artificial sweeteners, prebiotics and probiotics, proanthocyanidins, bariatric surgery, microbiota transplantation, warming, physical exercise, music and psychological therapy are discussed.",isbn:"978-1-83962-543-5",printIsbn:"978-1-83962-542-8",pdfIsbn:"978-1-83962-544-2",doi:"10.5772/intechopen.80199",price:139,priceEur:155,priceUsd:179,slug:"weight-management",numberOfPages:332,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"865bbf7988bae3fdb09bf58d6e6a6cd5",bookSignature:"Hubertus Himmerich",publishedDate:"September 9th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/8781.jpg",numberOfDownloads:13433,numberOfWosCitations:4,numberOfCrossrefCitations:12,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:15,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:31,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 2nd 2019",dateEndSecondStepPublish:"January 2nd 2020",dateEndThirdStepPublish:"March 2nd 2020",dateEndFourthStepPublish:"May 21st 2020",dateEndFifthStepPublish:"July 20th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"231568",title:"Dr.",name:"Hubertus",middleName:null,surname:"Himmerich",slug:"hubertus-himmerich",fullName:"Hubertus Himmerich",profilePictureURL:"https://mts.intechopen.com/storage/users/231568/images/system/231568.png",biography:"Dr. Hubertus Himmerich is a clinical senior lecturer for eating disorders at King’s College London and a consultant psychiatrist on an inpatient ward for patients with eating disorders at Bethlem Royal Hospital, London, UK. Following medical school, Dr. Himmerich received his scientific and clinical training at the Max Planck Institute of Psychiatry, Germany, and the Universities of Mainz and Marburg, Germany. Afterwards, he worked as a consultant psychiatrist at the RWTH Aachen University Hospital and Professor of Neurobiology of Affective Disorders at the University of Leipzig, Germany. He has led and performed national and international scientific projects with researchers from Europe, Australia, and North America, and he has published more than 160 articles in peer-reviewed scientific journals, books, and book chapters.",institutionString:"King’s College London",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"King's College London",institutionURL:null,country:{name:"United Kingdom"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1061",title:"Psychiatry",slug:"mental-and-behavioural-disorders-and-diseases-of-the-nervous-system-psychiatry"}],chapters:[{id:"70984",title:"Risk and Maintenance Factors for Eating Disorders: An Exploration of Multivariate Models on Clinical and Non-Clinical Populations",doi:"10.5772/intechopen.91063",slug:"risk-and-maintenance-factors-for-eating-disorders-an-exploration-of-multivariate-models-on-clinical-",totalDownloads:765,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The recognition of factors involved in the development and maintenance of eating disorders (EDs) may support the choice of therapeutic strategies and improve the prevention/treatment of eating pathologies and their outcomes. Based on this consideration, the overall purpose of the chapter is to investigate how some psychological characteristics link to EDs. It is organized as follows. First, the epidemiological aspects, risk, and maintaining factors for ED are outlined. Next, we present the findings from our two studies. The purpose of the first study was to identify predictors associated with the severity of eating symptomatology. Then, the objective of the second study was to provide an understanding of the relationship among perceived parental bonding, self-esteem, perfectionism, body shame, body mass index, and ED risk and mainly to test a predictive ED risk model in a non-clinical sample. In conclusion, the major findings and practical implications are discussed.",signatures:"Stefania Cella, Mara Iannaccone, Annarosa Cipriano and Paolo Cotrufo",downloadPdfUrl:"/chapter/pdf-download/70984",previewPdfUrl:"/chapter/pdf-preview/70984",authors:[{id:"87790",title:"Prof.",name:"Paolo",surname:"Cotrufo",slug:"paolo-cotrufo",fullName:"Paolo Cotrufo"},{id:"312881",title:"Ph.D.",name:"Stefania",surname:"Cella",slug:"stefania-cella",fullName:"Stefania Cella"},{id:"313379",title:"Dr.",name:"Mara",surname:"Iannaccone",slug:"mara-iannaccone",fullName:"Mara Iannaccone"},{id:"317168",title:"Dr.",name:"Annarosa",surname:"Cipriano",slug:"annarosa-cipriano",fullName:"Annarosa Cipriano"}],corrections:null},{id:"72057",title:"Weight Management: Inflammation",doi:"10.5772/intechopen.92380",slug:"weight-management-inflammation",totalDownloads:662,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Nowadays, obesity is considered as one of the fastest escalating nutritional disorders that reached pandemic throughout the world. Obesity is a condition in which overaccumulation of energy in the form of fat happens in an individual’s subcutaneous and/or abdominal visceral tissue. It is described as an abnormal growth of adipose tissue due to the enlargement of fat cell size (hypertrophic obesity) or fat cell number (hyperplastic obesity) or a condition of both. Earlier, it was reported that the most common type of obesity that affects the general population is the polygenic form that results from a result of a positive energy balance between energy consumption and its expenditure – or a combination of both. The pandemic of obesity has enforced to analyze the link between the role of inflammation and complications of overweight and obesity. This led to crossroads of the field of nutrition, diet therapy, physiology, immunology, and epidemiology and makes the understanding that they are linked inexplicably. The remodeling of obesity as an inflammatory state has led a wide impression in our conceptualization of obesity-related diseases. In this chapter, we highlight the endocrine aspect of adipose tissue, the effect of dysregulated secretion of adipokines due to inflammation and dietary components that affect obesity related to inflammation.",signatures:"Upasana",downloadPdfUrl:"/chapter/pdf-download/72057",previewPdfUrl:"/chapter/pdf-preview/72057",authors:[{id:"317799",title:"Dr.",name:"Upasana",surname:null,slug:"upasana",fullName:"Upasana null"}],corrections:null},{id:"71777",title:"Orexin and Psychoneurobiology: A Hidden Treasure",doi:"10.5772/intechopen.91852",slug:"orexin-and-psychoneurobiology-a-hidden-treasure",totalDownloads:676,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Orexin is a neuropeptide secreted from the lateral hypothalamus and prefrontal cortex concerned in wakefulness and excitement. This study aimed to review the possible neurobiological effect of orexin. A diversity of search strategies was adopted and assumed which included electronic database searches of Medline and PubMed using MeSH terms, keywords, and title words. Orexin plays a vital role in activation of learning, memory acquisition, and consolidation through activation of the monoaminergic system, which affects cognitive flexibility and cognitive function. Orexin stimulates adrenocorticotrophin (ACTH) and corticosteroid secretions via activation of the central corticotropin-releasing hormone (CRH). Cerebrospinal (CSF) and serum orexin serum levels are reduced in depression, schizophrenia, and narcolepsy. However, high orexin serum levels are revealed in drug addictions. Regarding neurodegenerative brain diseases, CSF and serum orexin levels are reduced in Parkinson’s disease (PD), Alzheimer’s disease (AD), Huntington’s disease (HD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS). Orexin antagonist leads to significant reduction of sympathetic overactivity during withdrawal syndrome. Also, orexin antagonist improves sleep pattern. The orexinergic system is involved in different psychiatric and neurological disorders; therefore targeting of this system could be a possible novel pathway in the management of these disorders. In addition measurement of CSF and serum orexin levels might predict the relapse and withdrawal of addict patients.",signatures:"Hayder M. Alkuraishy, Ali I. Al-Gareeb and Naseer A. Al-Harchan",downloadPdfUrl:"/chapter/pdf-download/71777",previewPdfUrl:"/chapter/pdf-preview/71777",authors:[{id:"306350",title:"Prof.",name:"Hayder M.",surname:"Al-kuraishy",slug:"hayder-m.-al-kuraishy",fullName:"Hayder M. Al-kuraishy"},{id:"320583",title:"Dr.",name:"Ali I.",surname:"Al-Gareeb",slug:"ali-i.-al-gareeb",fullName:"Ali I. Al-Gareeb"},{id:"320584",title:"Dr.",name:"Naseer A.",surname:"Al-Harchan",slug:"naseer-a.-al-harchan",fullName:"Naseer A. Al-Harchan"}],corrections:null},{id:"71377",title:"Anorexia Nervosa",doi:"10.5772/intechopen.91278",slug:"anorexia-nervosa",totalDownloads:626,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Anorexia nervosa is characterized as having a significantly low body weight because of restricting energy intake or compensating to an excessive rate intentionally in order to attain or maintain an unrealistically thin ideal weight. Patients suffer multiple comorbid medical and psychiatric problems; moreover, deficits in treatment motivation are commonly seen, which causes a high rate of dropout from treatment programs. Thus, recent studies have focused on the etiology in order to develop efficient treatment options, as this can become a life-threatening problem. Prevention programs are also gaining attention, since full recovery can take a significant time and resources nevertheless may not be available for all cases. In this chapter, a brief history and basic diagnostic criteria of anorexia nervosa will be summarized. A review of comorbid psychiatric and medical conditions will be addressed. Prominent theories regarding its etiology and treatment options will be discussed in terms of a biopsychosocial approach. Finally, prevention studies will be highlighted.",signatures:"Fatima Elif Ergüney Okumuş",downloadPdfUrl:"/chapter/pdf-download/71377",previewPdfUrl:"/chapter/pdf-preview/71377",authors:[{id:"314051",title:"Ph.D.",name:"Fatima Elif",surname:"Ergüney Okumuş",slug:"fatima-elif-erguney-okumus",fullName:"Fatima Elif Ergüney Okumuş"}],corrections:null},{id:"72628",title:"Diagnostic Methods in Childhood Obesity",doi:"10.5772/intechopen.92880",slug:"diagnostic-methods-in-childhood-obesity",totalDownloads:627,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Childhood obesity, the most frequent pediatric disease, a worldwide public health problem, is considered a global epidemic and the main risk factor for obesity in adulthood. Among its consequences, cardiovascular and metabolic diseases stand out, which can be diagnosed during childhood, potentiate morbidity and mortality throughout life. Anthropometry, which includes the analysis of body mass index and the measurement of waist circumference, has proven efficacy in pediatric clinical evaluation. However, these diagnostic methods do not differentiate between subcutaneous and intra-abdominal or visceral fat. In this sense, diagnostic imaging methods complement the assessment of abdominal fat. In children, ultrasography appears as an innocuous, reproducible, and reliable diagnostic imaging method. The importance of knowing diagnostic methods for better monitoring of childhood obesity is emphasized.",signatures:"Leonardo de Souza Piber, Patrícia Colombo-Souza and Jane de Eston Armond",downloadPdfUrl:"/chapter/pdf-download/72628",previewPdfUrl:"/chapter/pdf-preview/72628",authors:[{id:"319391",title:"Ph.D.",name:"Patrícia",surname:"Colombo-Souza",slug:"patricia-colombo-souza",fullName:"Patrícia Colombo-Souza"},{id:"319394",title:"MSc.",name:"Leonardo",surname:"de Souza Piber",slug:"leonardo-de-souza-piber",fullName:"Leonardo de Souza Piber"},{id:"321614",title:"Dr.",name:"Jane",surname:"de Eston Armond",slug:"jane-de-eston-armond",fullName:"Jane de Eston Armond"}],corrections:null},{id:"71076",title:"Obesity: A Risk Factor for Infection after Surgery",doi:"10.5772/intechopen.91216",slug:"obesity-a-risk-factor-for-infection-after-surgery",totalDownloads:754,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Obesity is a prevalent health problem all over the world. It is associated with several diseases including infections. It impairs the immune system function by plenty of mechanisms. For instance, leptin and adiponectin are cytokines produced by the adipose tissue, both participating in immunity, but their effects are impaired in obese patients. Moreover, immune cells also show defects in their functions. They produce a pro-inflammatory state and contribute to obesity-related diseases. Innate immune system and adaptive immunity are both impaired in obese patients which causes a poor response to infections. In addition, in surgical site infections (SSI), there are local factors that must be considered. The large adipose panicle and visceral adipose tissue increase the surgical technique difficulty and extend the operative time. Besides, the adipose tissue has poor oxygenation and reduces operative field. It has been proven that obesity is associated to surgical site infection irrespective of type of surgery. However, minimal invasive surgery has demonstrated that reducing surgical trauma can diminish the risk for surgical site infection.",signatures:"José Alonso Suclla-Velásquez and Connie Smedts",downloadPdfUrl:"/chapter/pdf-download/71076",previewPdfUrl:"/chapter/pdf-preview/71076",authors:[{id:"314098",title:"M.D.",name:"José Alonso",surname:"Suclla-Velásquez",slug:"jose-alonso-suclla-velasquez",fullName:"José Alonso Suclla-Velásquez"},{id:"314101",title:"Ms.",name:"Connie",surname:"Smedts",slug:"connie-smedts",fullName:"Connie Smedts"}],corrections:null},{id:"71381",title:"Calcium Dyshomeostasis in Neuropathy Diabetes",doi:"10.5772/intechopen.91482",slug:"calcium-dyshomeostasis-in-neuropathy-diabetes",totalDownloads:1325,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Diabetes is a ceaseless ailment that is basic in practically all nations. Neuropathy is the most well-known constant difficulty of diabetes and is the underlying reason for ulceration in the legs of lower appendage removals. The predominance of diabetic polyneuropathy shifts from 23 to 29%. Incessant metabolic pressure incited by hyperglycemia, either low insulin creation in type 1 diabetes or diminished fringe affectability to insulin in type 2 diabetes influences cell homeostasis in practically all phone types. Changes in the sign Ca2+ have been recognized in different seclusion tissues from creatures initiated to diabetes just as patients with diabetes. Ca2+ homeostasis variations from the norm have likewise been found in an assortment of tissues, including bone, heart and smooth muscle, secretory cells, platelets, kidneys and osteoblasts. This variation from the norm by and large shows as an expanded resting centralization of intracellular Ca2+ ([Ca2+]I), diminished Ca2+ transporter movement and diminished boost that produces Ca2+ signals. Ca2+ flagging issue are likewise found in neuron-sensory from trial creatures with diabetes.",signatures:"Shahdevi Kurniawan",downloadPdfUrl:"/chapter/pdf-download/71381",previewPdfUrl:"/chapter/pdf-preview/71381",authors:[{id:"316713",title:"Ph.D.",name:"Shahdevi",surname:"Kurniawan",slug:"shahdevi-kurniawan",fullName:"Shahdevi Kurniawan"}],corrections:null},{id:"69739",title:"Hyponatremia and Psychiatric Diseases",doi:"10.5772/intechopen.90011",slug:"hyponatremia-and-psychiatric-diseases",totalDownloads:836,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Eating disorders, psychotic illnesses, and substance use disorders are some of the more common psychiatric conditions encountered in clinical practice that are associated with hyponatremia. The mechanisms that lead to hyponatremia vary, and at times hyponatremia may be a result of a drug side effect or drug-drug interaction. Additionally, hyponatremia from a non-psychiatric condition may lead to psychiatric symptomatology. Given the potential for hyponatremia to cause significant morbidity and potential mortality, clinicians are urged to consider screening for plasma sodium in patients at risk of hyponatremia, such as patients in the three categories of psychiatric conditions described above. Treatment of hyponatremia consists of various acute interventions, with consideration that treatment of the underlying psychiatric condition may help to diminish or eliminate the frequency of hyponatremic episodes in the long run.",signatures:"Ermal Bojdani, Flavia De Souza, Aishwarya Rajagopalan, Anderson Chen, Alesia A. Cloutier, Troy R. Nold and Dil Tahera",downloadPdfUrl:"/chapter/pdf-download/69739",previewPdfUrl:"/chapter/pdf-preview/69739",authors:[{id:"307163",title:"Dr.",name:"Ermal",surname:"Bojdani",slug:"ermal-bojdani",fullName:"Ermal Bojdani"},{id:"310880",title:"Dr.",name:"Flavia",surname:"De Souza",slug:"flavia-de-souza",fullName:"Flavia De Souza"},{id:"310881",title:"Dr.",name:"Aishwarya",surname:"Rajagopalan",slug:"aishwarya-rajagopalan",fullName:"Aishwarya Rajagopalan"},{id:"310882",title:"Dr.",name:"Troy R.",surname:"Nold",slug:"troy-r.-nold",fullName:"Troy R. Nold"},{id:"310883",title:"Dr.",name:"Anderson",surname:"Chen",slug:"anderson-chen",fullName:"Anderson Chen"},{id:"310884",title:"Dr.",name:"Alesia A.",surname:"Cloutier",slug:"alesia-a.-cloutier",fullName:"Alesia A. Cloutier"},{id:"312892",title:"Dr.",name:"Dil",surname:"Tahera",slug:"dil-tahera",fullName:"Dil Tahera"}],corrections:null},{id:"71787",title:"Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance",doi:"10.5772/intechopen.92149",slug:"effect-of-foot-morphology-and-anthropometry-on-bipedal-postural-balance",totalDownloads:626,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Maintenance of accurate postural balance is imperative to avoid falls and incapacities especially in overweight and older population. Normal postural balance is affected by various factors like age, gender, body characteristics like lean muscle mass, soft tissue mass, stature, foot anthropometry, etc. A cross-sectional study was conducted among 1000 young population of north Karnataka in which human stature, weight, body mass index, foot anthropometric parameters, etc. along with postural sway were measured. The correlation of these parameters with human stature, weight and postural sway was studied. Data obtained were tabulated, graphically represented and statistically analyzed. Correlation coefficient was formulated for each variable. Foot length and width showed positive significant correlation with height, weight and other variables. Study observations were compared with those obtained from previous studies. The study observations will enable us to understand the influence of foot anthropometry on postural balance and help researchers to formulate weight transfer strategies, thereby facilitating management and rehabilitation of patients with postural instability.",signatures:"Charmode Sundip Hemant",downloadPdfUrl:"/chapter/pdf-download/71787",previewPdfUrl:"/chapter/pdf-preview/71787",authors:[{id:"314616",title:"Dr.",name:"Charmode Sundip",surname:"Hemant",slug:"charmode-sundip-hemant",fullName:"Charmode Sundip Hemant"}],corrections:null},{id:"71985",title:"Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis and Treatment of Disordered Eating and Clinical Eating Disorders",doi:"10.5772/intechopen.92152",slug:"discretion-or-disorder-the-impact-of-weight-management-issues-on-the-diagnosis-and-treatment-of-diso",totalDownloads:651,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Eating disorders, the most lethal of all the psychiatric disorders, are frequently misdiagnosed as benign weight management problems, which contribute to their being underdiagnosed and under-reported. Though eating disorders are typically first identified through easily discernible weight change, their unseen origins lie in genetic propensities, neurobiology, environmental and family influences, inborn temperament, and trauma. Non-integrative, behaviorally based weight management solutions that call for dieting and meal plans alone, by ignoring the psychological underpinnings and neurobiological origins of dysfunctions driving these disorders, can potentially lead to loss of life and/or life quality. Conversely, generic psychotherapy protocols typically fail to address and enforce the behavioral prerequisite to re-feed the malnourished eating disordered brain and body, which is required to optimize therapy outcomes. It is for the intuitive and skillful diagnostician to determine whether the patient’s desire for weight change is based on healthful autonomous discretion or on the dictates of compulsions based in life-threatening pathology, thus informing treatment. Eating disorders are disorders of the core Self of self-regulation, self-perception, self-esteem and self-care, affecting life spheres far exceeding eating-lifestyle and weight management. Healing weight management problems requires integrative diagnosis and care, re-establishing one’s healthy relationship with food, weight, and eating, as well as with one’s re-integrated core self.",signatures:"Abigail H. Natenshon",downloadPdfUrl:"/chapter/pdf-download/71985",previewPdfUrl:"/chapter/pdf-preview/71985",authors:[{id:"186482",title:"M.A.",name:"Abigail H.",surname:"Natenshon",slug:"abigail-h.-natenshon",fullName:"Abigail H. Natenshon"}],corrections:null},{id:"70972",title:"Warming in Anorexia Nervosa: A Review",doi:"10.5772/intechopen.90353",slug:"warming-in-anorexia-nervosa-a-review",totalDownloads:741,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Anorexia nervosa (AN) is a severe psychiatric condition primarily affecting young women, and AN has the highest mortality rate among psychiatric disorders. AN continues to be a disorder refractory to psychological or pharmacological treatment. An innovative approach arises from research in rats simultaneously placed on a restricted feeding schedule and given free access to an activity wheel. The detrimental effects of combining diet and exercise in rats can be reversed by a manipulation of ambient temperature (AT). Warming animals exposed to these experimental arrangements reverses running activity, preserves food intake, and enables rats to recover from acute weight loss. This represents a strong preclinical evidence that provides a rationale for a translational approach for the treatment of AN. However, heat application to AN patients was already a recommendation made by William Gull in his seminal paper on AN disorder. A historical perspective of supplying heat to AN patients reviews the circumstances and foundation of this practice. The manipulation of AT in activity-based anorexia (ABA) rats has ended with a period of neglect of AT that parallels the complete neglect of the role of AT in the human AN disorder, either as a risk factor, as a modulating factor in the course of the disorder, or in terms of its utility in the treatment of AN.",signatures:"Emilio Gutiérrez and Olaia Carrera",downloadPdfUrl:"/chapter/pdf-download/70972",previewPdfUrl:"/chapter/pdf-preview/70972",authors:[{id:"312907",title:"Prof.",name:"Emilio",surname:"Gutiérrez",slug:"emilio-gutierrez",fullName:"Emilio Gutiérrez"},{id:"314346",title:"BSc.",name:"Olaia",surname:"Carrera",slug:"olaia-carrera",fullName:"Olaia Carrera"}],corrections:null},{id:"72173",title:"A Software-Assisted Qualitative Study on the Use of Music in People with Anorexia Nervosa",doi:"10.5772/intechopen.92589",slug:"a-software-assisted-qualitative-study-on-the-use-of-music-in-people-with-anorexia-nervosa",totalDownloads:664,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Anorexia nervosa (AN) is an eating disorder associated with a high mortality and an often chronic and disabling course. Thus, novel treatment options should be explored. We performed two focus groups with a total of six people with AN on their use of music and their thoughts about music as an additional therapeutic option. Interviews were transcribed and analyzed in-depth using the NVivo 12 software package. The most prevalent theme throughout the focus groups involved positive expressions, emotions and memories related to music. This theme occurred in ~25% of the data. The importance of music was the second most common theme. Negative feelings and memories associated with music accounted for only ~10% of all references. All six patients expressed that they see benefit in using music therapy as an adjunct to their current treatment. Our analysis shows that people with AN connect music mainly with positive emotions and memories. Therapists might think about applying music more frequently during their sessions with AN patients and consider adding music therapy to their overall treatment concept. However, the results also suggest that music can influence mood not only positively but negatively as well. Quantitative research in bigger patient samples and randomized clinical trials will be necessary to verify these results.",signatures:"Briana Applewhite, Aishwarya Krishna Priya, Valentina Cardi and Hubertus Himmerich",downloadPdfUrl:"/chapter/pdf-download/72173",previewPdfUrl:"/chapter/pdf-preview/72173",authors:[{id:"231568",title:"Dr.",name:"Hubertus",surname:"Himmerich",slug:"hubertus-himmerich",fullName:"Hubertus Himmerich"},{id:"317826",title:"Dr.",name:"Briana",surname:"Applewhite",slug:"briana-applewhite",fullName:"Briana Applewhite"},{id:"317827",title:"Dr.",name:"Aishwarya Krishna",surname:"Priya",slug:"aishwarya-krishna-priya",fullName:"Aishwarya Krishna Priya"},{id:"317828",title:"Dr.",name:"Valentina",surname:"Cardi",slug:"valentina-cardi",fullName:"Valentina Cardi"}],corrections:null},{id:"72328",title:"Evidence-Based and Novel Psychological Therapies for People with Anorexia Nervosa",doi:"10.5772/intechopen.92680",slug:"evidence-based-and-novel-psychological-therapies-for-people-with-anorexia-nervosa",totalDownloads:957,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:1,abstract:"Anorexia nervosa (AN) is a serious and often highly persistent psychiatric disorder, whereby sufferers struggle to maintain a healthy weight. Its complexity creates challenges regarding treatment, however psychological therapy is recommended by the National Institute for Heath and Care Excellence (NICE). There are four major evidence-based psychotherapies recommended for treating adults – enhanced cognitive behavioural therapy (CBT-E), the Maudsley model of anorexia nervosa treatment for adults (MANTRA), specialist supportive clinical management (SSCM) and focal psychodynamic therapy (FPT)—and three main psychotherapies recommended for treating adolescents with anorexia-family therapy for anorexia nervosa (FT-AN), enhanced cognitive behavioural therapy (CBT-E) and adolescent focused therapy for anorexia nervosa (AFP-AN). Additionally, several novel adjunct treatments are under examination, two of which—cognitive remediation therapy (CRT) and cognitive remediation and emotion skills training (CREST)—are also discussed in this chapter. Other relevant areas regarding psychological treatment include: combinations of medication or occupational therapy and psychotherapy, treating individuals with comorbidities, the challenges of studying psychological treatment for anorexia and future directions of psychotherapies for anorexia, and are also discussed.",signatures:"Anna Carr, Kate Tchanturia, Emmanuelle Dufour, Mary Cowan and Hubertus Himmerich",downloadPdfUrl:"/chapter/pdf-download/72328",previewPdfUrl:"/chapter/pdf-preview/72328",authors:[{id:"231568",title:"Dr.",name:"Hubertus",surname:"Himmerich",slug:"hubertus-himmerich",fullName:"Hubertus Himmerich"},{id:"317829",title:"Dr.",name:"Anna",surname:"Carr",slug:"anna-carr",fullName:"Anna Carr"},{id:"317831",title:"Dr.",name:"Mary",surname:"Cowan",slug:"mary-cowan",fullName:"Mary Cowan"},{id:"317832",title:"Dr.",name:"Kate",surname:"Tchanturia",slug:"kate-tchanturia",fullName:"Kate Tchanturia"},{id:"320604",title:"Ms.",name:"Emmanuelle",surname:"Dufour",slug:"emmanuelle-dufour",fullName:"Emmanuelle Dufour"}],corrections:null},{id:"71394",title:"Anti-Obesity Medical Devices",doi:"10.5772/intechopen.91697",slug:"anti-obesity-medical-devices",totalDownloads:712,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Obesity is a major health problem worldwide responsible for increased morbidity/mortality and high cost for the society. Management of obesity requires multidisciplinary approaches including diet, food supplement, exercise, behavior change, drug, medical device, gut microbiome manipulation, and surgery. Anti-obesity medical devices are an option for subjects who have not responded to more conservative medical treatments but want an alternative to surgery. Compared to bariatric surgery, they have the advantage of being less invasive, easier to perform, and reversible. In the United States of America (USA), based on the expected weight loss, the Center for Devices and Radiological Health (CDRH) of the Food and Drug Administration (FDA) categorizes anti-obesity medical devices as weight-loss devices or weight-management devices. The weight-loss devices include gastric band devices, gastric space-occupying devices, and gastric emptying devices. The weight-management devices include oral removable palatal space-occupying devices and ingested transient gastric space-occupying devices. The effectiveness, safety, and cost of anti-obesity medical devices vary considerably by the type of medical device. Their use should always be combined with lifestyle changes. Considering the large market size of obesity treatment, anti-obesity medical devices can play a major role in the management of obesity.",signatures:"Hassan M. Heshmati",downloadPdfUrl:"/chapter/pdf-download/71394",previewPdfUrl:"/chapter/pdf-preview/71394",authors:[{id:"313921",title:"Dr.",name:"Hassan M.",surname:"Heshmati",slug:"hassan-m.-heshmati",fullName:"Hassan M. Heshmati"}],corrections:null},{id:"71736",title:"Gut Microbiome in Obesity Management",doi:"10.5772/intechopen.91974",slug:"gut-microbiome-in-obesity-management",totalDownloads:644,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Obesity is a worldwide pandemic causing increased morbidity/mortality and high cost for the society. Management of obesity requires multidisciplinary approaches including diet, food supplement, exercise, behavior change, drug, medical device, gut microbiome manipulation, and surgery. Over the past two decades, there has been a growing awareness of the importance of gut microbiome in human health and disease. Profound changes affecting the diversity and the abundance of gut microbiome are associated with several disorders including obesity. A decrease in microbiome diversity and an increase in the ratio of Firmicutes-to-Bacteroidetes phyla have been reported in obese subjects. The gut microbiome can be manipulated to change the host metabolism and manage obesity. Potential interventions include diet (e.g., low calories, low fat, and high fiber), prebiotics (e.g., inulin, lactulose, and resistant starch), probiotics (e.g., yogurt, cheese, and milk), synbiotics (combination of prebiotics and probiotics), bariatric surgery (e.g., Roux-en-Y gastric bypass), and fecal microbiota transplantation (through colonoscopy, esophagogastroduodenoscopy, orogastric tube, or oral capsule). A better understanding of the interactions between different diets and gut microbiome should help the development of new guidelines for the prevention and management of obesity.",signatures:"Hassan M. Heshmati",downloadPdfUrl:"/chapter/pdf-download/71736",previewPdfUrl:"/chapter/pdf-preview/71736",authors:[{id:"313921",title:"Dr.",name:"Hassan M.",surname:"Heshmati",slug:"hassan-m.-heshmati",fullName:"Hassan M. Heshmati"}],corrections:null},{id:"71027",title:"Beneficial Effects of Proanthocyanidins on Intestinal Permeability and Its Relationship with Inflammation",doi:"10.5772/intechopen.91212",slug:"beneficial-effects-of-proanthocyanidins-on-intestinal-permeability-and-its-relationship-with-inflamm",totalDownloads:842,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The intestinal barrier is constantly exposed to potentially harmful environmental factors including food components and bacterial endotoxins. When the intestinal barrier function and immune homeostasis are compromised, inflammatory conditions may be developed and impact overall health. Evidence from experimental animal and cell-culture studies suggests that exposure of intestinal mucosa to proanthocyanidin-rich plant products may contribute to maintain the barrier function and to ameliorate the inflammation present in prevalent pathologies such as diet-induced obesity and inflammatory bowel disease. In this review, we aim to update the current knowledge on the bioactivity of PACs in experimental models of altered intestinal permeability and in humans, emphasizing the beneficial effects of grape-seed proanthocyanidin extracts in intestinal health and giving insights into the subjacent biochemical and molecular mechanism.",signatures:"Carlos González-Quilen, Esther Rodríguez-Gallego, Raúl Beltrán-Debón, Montserrat Pinent, Anna Ardévol, Maria Teresa Blay and Ximena Terra",downloadPdfUrl:"/chapter/pdf-download/71027",previewPdfUrl:"/chapter/pdf-preview/71027",authors:[{id:"315872",title:"Dr.",name:"Ximena",surname:"Terra",slug:"ximena-terra",fullName:"Ximena Terra"},{id:"317550",title:"BSc.",name:"Carlos",surname:"González-Quilen",slug:"carlos-gonzalez-quilen",fullName:"Carlos González-Quilen"},{id:"317554",title:"Dr.",name:"Esther",surname:"Rodríguez-Gallego",slug:"esther-rodriguez-gallego",fullName:"Esther Rodríguez-Gallego"},{id:"317555",title:"Dr.",name:"Raúl",surname:"Beltrán-Debón",slug:"raul-beltran-debon",fullName:"Raúl Beltrán-Debón"},{id:"317556",title:"Dr.",name:"Montserrat",surname:"Pinent",slug:"montserrat-pinent",fullName:"Montserrat Pinent"},{id:"317557",title:"Dr.",name:"Anna",surname:"Ardévol",slug:"anna-ardevol",fullName:"Anna Ardévol"},{id:"317558",title:"Dr.",name:"Maria Teresa",surname:"Blay",slug:"maria-teresa-blay",fullName:"Maria Teresa Blay"}],corrections:null},{id:"72790",title:"Artificial Sweeteners",doi:"10.5772/intechopen.93199",slug:"artificial-sweeteners",totalDownloads:586,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Nowadays, sugar*free food is very popular because of its low calorie value. So food industries make use of various artificial sweeteners of low calorie as an alternative to high calorie sugars and they provide low glycemic response. The U.S. Food and Drug Administration has approved artificial sweeteners such as saccharin, acesulfame-K, sucralose, aspartame, etc. as per acceptable daily intake value (ADI) value, but these artificial sweeteners that breakdown products during metabolism in turn are known to have health and metabolic effects. Hence, in this work, we will discuss about artificial sweeteners, types, and their metabolic and health effects.",signatures:"Kanagamani Krishnasamy",downloadPdfUrl:"/chapter/pdf-download/72790",previewPdfUrl:"/chapter/pdf-preview/72790",authors:[{id:"309960",title:"Dr.",name:"Kanagamani",surname:"Krishnasamy",slug:"kanagamani-krishnasamy",fullName:"Kanagamani Krishnasamy"}],corrections:null},{id:"71716",title:"Long-Term Weight Loss Maintenance",doi:"10.5772/intechopen.92103",slug:"long-term-weight-loss-maintenance",totalDownloads:746,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Weight maintenance can be considered a challenge for all patients who are in a reduced obese state. In this chapter, we first provide an overview of the chances for maintaining weight loss, how physiological adaptations and psychological dynamics lead to weight regain in the long-term, and of the factors that have been associated with long-term success. Then we review what is known about the patient perspective on that critical time period following weight loss, focusing on the experience of barriers and facilitators as well as attempted strategies. Finally, we introduce an approach for providing a targeted and individualized support at this stage.",signatures:"Martin Fischer, Nadine Oberänder and Arved Weimann",downloadPdfUrl:"/chapter/pdf-download/71716",previewPdfUrl:"/chapter/pdf-preview/71716",authors:[{id:"313764",title:"Dr.",name:"Martin",surname:"Fischer",slug:"martin-fischer",fullName:"Martin Fischer"},{id:"313765",title:"Prof.",name:"Arved",surname:"Weimann",slug:"arved-weimann",fullName:"Arved Weimann"},{id:"319867",title:"Dr.",name:"Nadine",surname:"Oberänder",slug:"nadine-oberander",fullName:"Nadine Oberänder"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"7885",title:"Anorexia and Bulimia Nervosa",subtitle:null,isOpenForSubmission:!1,hash:"33446a27725d6ca6f66b4bddb2de4b64",slug:"anorexia-and-bulimia-nervosa",bookSignature:"Hubertus Himmerich and Ignacio Jáuregui Lobera",coverURL:"https://cdn.intechopen.com/books/images_new/7885.jpg",editedByType:"Edited by",editors:[{id:"231568",title:"Dr.",name:"Hubertus",surname:"Himmerich",slug:"hubertus-himmerich",fullName:"Hubertus Himmerich"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"510",title:"Anxiety Disorders",subtitle:null,isOpenForSubmission:!1,hash:"183445801a9be3bfbce31fe9752ad3db",slug:"anxiety-disorders",bookSignature:"Vladimir Kalinin",coverURL:"https://cdn.intechopen.com/books/images_new/510.jpg",editedByType:"Edited by",editors:[{id:"31572",title:null,name:"Vladimir V.",surname:"Kalinin",slug:"vladimir-v.-kalinin",fullName:"Vladimir V. 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Fractal Geometry: An Attractive Choice for Miniaturized Planar Microwave Filter Design",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/66069.pdf",downloadPdfUrl:"/chapter/pdf-download/66069",previewPdfUrl:"/chapter/pdf-preview/66069",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/66069",risUrl:"/chapter/ris/66069",chapter:{id:"64430",slug:"fractal-geometry-an-attractive-choice-for-miniaturized-planar-microwave-filter-design",signatures:"Hadi T. Ziboon and Jawad K. Ali",dateSubmitted:"June 5th 2018",dateReviewed:"September 6th 2018",datePrePublished:"December 31st 2018",datePublished:"April 3rd 2019",book:{id:"7293",title:"Fractal Analysis",subtitle:null,fullTitle:"Fractal Analysis",slug:"fractal-analysis",publishedDate:"April 3rd 2019",bookSignature:"Sid-Ali Ouadfeul",coverURL:"https://cdn.intechopen.com/books/images_new/7293.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"103826",title:"Dr.",name:"Sid-Ali",middleName:null,surname:"Ouadfeul",slug:"sid-ali-ouadfeul",fullName:"Sid-Ali Ouadfeul"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"261659",title:"Prof.",name:"Jawad",middleName:null,surname:"Ali",fullName:"Jawad Ali",slug:"jawad-ali",email:"jawadkali@theiet.org",position:null,institution:{name:"Institution of Engineering and Technology",institutionURL:null,country:{name:"United Kingdom"}}},{id:"262048",title:"Dr.",name:"Hadi",middleName:null,surname:"Ziboon",fullName:"Hadi Ziboon",slug:"hadi-ziboon",email:"haditarishziboon@yahoo.co.uk",position:null,institution:null}]}},chapter:{id:"64430",slug:"fractal-geometry-an-attractive-choice-for-miniaturized-planar-microwave-filter-design",signatures:"Hadi T. Ziboon and Jawad K. Ali",dateSubmitted:"June 5th 2018",dateReviewed:"September 6th 2018",datePrePublished:"December 31st 2018",datePublished:"April 3rd 2019",book:{id:"7293",title:"Fractal Analysis",subtitle:null,fullTitle:"Fractal Analysis",slug:"fractal-analysis",publishedDate:"April 3rd 2019",bookSignature:"Sid-Ali Ouadfeul",coverURL:"https://cdn.intechopen.com/books/images_new/7293.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"103826",title:"Dr.",name:"Sid-Ali",middleName:null,surname:"Ouadfeul",slug:"sid-ali-ouadfeul",fullName:"Sid-Ali Ouadfeul"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"261659",title:"Prof.",name:"Jawad",middleName:null,surname:"Ali",fullName:"Jawad Ali",slug:"jawad-ali",email:"jawadkali@theiet.org",position:null,institution:{name:"Institution of Engineering and Technology",institutionURL:null,country:{name:"United Kingdom"}}},{id:"262048",title:"Dr.",name:"Hadi",middleName:null,surname:"Ziboon",fullName:"Hadi Ziboon",slug:"hadi-ziboon",email:"haditarishziboon@yahoo.co.uk",position:null,institution:null}]},book:{id:"7293",title:"Fractal Analysis",subtitle:null,fullTitle:"Fractal Analysis",slug:"fractal-analysis",publishedDate:"April 3rd 2019",bookSignature:"Sid-Ali Ouadfeul",coverURL:"https://cdn.intechopen.com/books/images_new/7293.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"103826",title:"Dr.",name:"Sid-Ali",middleName:null,surname:"Ouadfeul",slug:"sid-ali-ouadfeul",fullName:"Sid-Ali Ouadfeul"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"8843",leadTitle:null,title:"Mucosal Immunology",subtitle:null,reviewType:"peer-reviewed",abstract:"\r\n\tThis book will focus on the wide specter of mucosal inflammation intending to provide the reader with a comprehensive overview of the current knowledge on the topic. More and more studies are focused on finding different aspects of mucosal inflammation since it is involved in the pathogenesis of many diseases - from gut to lungs, urogenital system, etc. To better understand the causes of its occurrence as well as the search for therapeutic strategies, many resources are invested in scientific developments in this field.
\r\n\r\n\tFacts about the role of calprotectin and other biomarkers were accumulated. Participation of neutrophils appears an attractive way to explain the involvement of different subpopulations of immunocompetent cells and cytokines in mucosal inflammation. Over the last five years, scientific developments in the field have discovered more genes involved in the pathogenesis of mucosal inflammation elucidating the interaction of innate immune mechanisms with the microorganisms in the gut and their role in maintaining intestinal homeostasis. Besides, the science aims at identifying and characterizing immune and non-immune cells involved in the emergence and maintenance of chronic inflammation.
\r\n\r\n\tThe book aims to cover the developing diagnostic methods for identifying the mucosal inflammation, towards a better analysis of the inflammation, understanding of the relationship between genetic and proteomic markers and response to therapy; and improving therapeutic options for patients who have mucosal inflammation.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"2e7bde3621cdf64518356b76e3132542",bookSignature:"Dr. Tsvetelina Velikova",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/8843.jpg",keywords:"Inflammation, Neutrophils, Cytokines, Mucosal Biomarkers, Gut Tolerance, Antigen Tolerance, Mayo Score, Lesions, Acute Inflammation, Chronic Inflammation, Gut Permeability, Asthma",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 16th 2020",dateEndSecondStepPublish:"July 7th 2020",dateEndThirdStepPublish:"September 5th 2020",dateEndFourthStepPublish:"November 24th 2020",dateEndFifthStepPublish:"January 23rd 2021",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 years",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Dr. Velikova research focuses on autoimmune disorders, such as celiac disease, IBD, diabetes, asthma, as well as on the delicate autoimmunity mechanisms involving Th17 and Treg cells, cytokines, biomarkers, novel biologic therapies. She has been engaged in fifteen projects in the field of immunology and internal medicine. She is an editorial board member and reviewer for several medical journals and has publications in eminent journals and book chapters in the field of gastrointestinal immunology.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"180979",title:"Dr.",name:"Tsvetelina",middleName:null,surname:"Velikova",slug:"tsvetelina-velikova",fullName:"Tsvetelina Velikova",profilePictureURL:"https://mts.intechopen.com/storage/users/180979/images/system/180979.jpg",biography:"Dr. Tsvetelina Velikova received her MD and Ph.D. degrees, both with honors, from the Medical University of Sofia, Bulgaria. Subsequently, she became involved in active immunology research and teaching. Dr. Velikova also received advanced training in Clinical Immunology at University Hospital St. Ivan Rilski, Sofia, Bulgaria. \r\nShe is currently an assistant professor of Clinical immunology affiliated to the Sofia University and University Hospital Lozenetz, Bulgaria. \r\nHer research focuses on autoimmune disorders, such as celiac disease, IBD, diabetes, asthma, as well as on the delicate autoimmunity mechanisms involving Th17 and Treg cells, cytokines, biomarkers, novel biologic therapies and their implication in clinical practice.\r\nDr. Velikova has been engaged in fifteen projects in the field of immunology and internal medicine. 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Soybeans typically possess protein and oil contents of approximately 40 and 20%, respectively. This composition gives the possibility for a broad variety of applications such as feed, biodiesel, edible oils, and other food products. Commercially, soybean can be categorized as (i) commodity type, mainly used for oil and animal feed, and (ii) food type soybean, mainly used for human consumption. One important application of soybean is its use in animal feed. Approximately 85% of the soybean is crushed into oil and meal. The greatest part of the meal is used as protein source in animal feed, Approximately 6% of the produced soybean is directly used for food purposes [5]. When soybean is exclusively used for consumption by the farm animals, nutritionally, it should have at least 36% protein to meet part of their daily requirement for protein. The food-type soybean, on the other hand, contains protein higher than feed-grade soybean; it usually ranges between 40 and 45%. It helps in making better quality soy-based food products. Usually, food-grade soybeans are used for production of soy milk, tofu or soy paneer, soy sprouts, and other soy-based food items.
\nGlobally soybean meal accounts for 63% of all the protein sources in animal feed. Next to the soybean meal, soybean oil obtained after crushing is refined and used as cooking oils and salad oils, and they can also find their use in mayonnaise and butter substitute. Soybean oil is refined and lecithin is obtained as a main by-product. Lecithins are found in many products such as in chocolate, margarine, and emulsifying agents [6]. Furthermore, the unraveling of the health and nutritional benefits of soybean contributed to increased interest for soybeans destined for food production, the so-called food-grade soybeans. Hence, the breeding of cultivars with enhanced food-grade traits is gaining great importance [7]. Soy foods available in the market can be divided in traditional and non-traditional soy foods. Traditional soy foods includes edamame (green vegetable soybeans), soy milk (a drink produced by soaking and grinding soybeans, boiling the mixture, and filtering out remaining particulates), tofu (soybean curd), tempeh (made of whole cooked soybeans), miso (fermented soup-based paste), soy sauce, okara, natto (fermented whole soybeans), and soy sprouts. They originated from Asia where soybean has been grown for centuries before its introduction to the rest of the world. Non-traditional foods are, for instance, soy yoghurt, soy cheese, pudding, snacks, etc. [6]. Soy food available in the market is classified into two groups based on the soybean seed size. Soy foods made of large seeds (>20 g/100 seeds) include tofu, edamame, miso, and soy milk. Soy foods made of small seeds (<12 g/100 seeds) include natto, soy sauce, tempeh, and bean sprouts.
\nSoybean seed needs to satisfy specific physical and chemical requirements for soy food production. In addition to seed size, visual appearance such as uniformity of seed size and shape with light-colored hilum and yellow seed coat without physical damage such as mottling, splits, shriveling, purple stain, and insect damage are the main consideration of food-grade soybeans [8]. It is reported that the seed size uniformity affected water absorption and the quality of the final soy product [9]. Shrunken or discolored seeds were undesirable due to the consumer requirements [10]. Stone seeds that do not absorb water during soaking cause serious problems for food processing as it affects the texture and consistency of the soy products particularly for fermented soy food such as natto [11]. Seeds with harder texture have higher calcium content and absorb less water [12]. Seed’s hardness could be estimated by the seed swell ratio that was related to seed weight or water volume change before and after soaking [13]. High water absorption was required to obtain soft steamed seeds [14]. Thus, soybean seeds with rapid and high water uptake are preferred by processors in order to provide more products per unit of time [9]. However, seed composition requirements vary according to the type of soy food. Soybean seeds with high protein content (>45%), low oil content, high sucrose content, and low oligosaccharides (raffinose and stachyose) content are suitable for making tofu. For soy food such as natto made through short fermentation process, soybean seed with a high carbohydrate content are preferred for the purpose of getting a quick conversion to simple sugars [10].
\nLike other plants, soybean too synthesizes a range of secondary metabolites for their adaptation and self-protection, called anti-nutritional factor (ANF). From nutritional point of view, the ANF is considered as harmful and toxic, as it interferes with normal growth, reproduction, and health. Therefore, soybean, in general, and food-grade soybeans, in particular, are expected to be free from anti-nutritional factors or allergens that may cause harm to the consumers. Soybean contains several anti-nutritional factors among which trypsin inhibitor (TI) and phytase are the most important ones. Kunitz trypsin inhibitor (KTI), which constitutes more than 80% of the total TI, is primarily responsible for improper digestibility of soybean, if consumed unprocessed. Although KTI is heat labile, yet heat inactivation process is neither fully effective nor economic. Genetic elimination of KTI is the most effective way of making soybean free from KTI [15].
\nSoybean seeds contain phosphorus in the form of inositol hexaphosphate commonly known as phytate [16]. Besides sequestering inorganic phosphate, phytate may also chelate divalent cations such as Fe, thereby decreasing their availability. It also contributes toward water pollution by eutrophication as the phosphate-rich waste discharges into water bodies. So, reduction of seed phytase can enhance mineral and protein bioavailability in soybean. Microarray-based gene expression profiling of phytic acid biosynthesis pathway indicated stepwise regulation of eight genes, viz. myo-inositol-3-phosphatesynthaes (MIPS), inositol phosphate kinase (IPK1–4), etc. Gene silencing constructs were used to silence
Vast areas of agricultural soils are contaminated with Cadmium (Cd) through the use of super phosphate fertilizers, sewage sludge, and inputs from the mining and smelting industries [18]. Cadmium (Cd) is a highly toxic element for human beings because of its extremely long biological half-life. Soybeans grown in cadmium-contaminated soil take up cadmium by roots and translocate into aerial organs, where it affects photosynthesis and consequently root and shoot growth. Many soybean cultivars can accumulate high Cd concentration in seed when grown on Cd-polluted soil [19, 20]. Consumption of food containing excessive Cd leads to a risk of chronic toxicity. In humans, it can damage kidneys, causing a loss of calcium and associated osteoporosis [21]. To reduce the health risk, it is desirable to limit the concentration of Cd in crops used for human consumption. Due to growing concern about safety of foods and human health, the Codex Alimentarius Commission of Food and Agriculture Organization/World Health Organization (FAO/WHO) has proposed an upper limit of 0.2 mg kg−1 for Cd concentration in soybean grain [22]. However, a large-scale survey of agricultural products revealed that the Cd concentration of 16.7% of soybean seeds exceeded the international allowable limit of 0.2 mg kg−1, which is much higher than that of other upland crops [23]. Cultivars with reduced uptake of Cd are needed for human consumption. Cd uptake depends both on the Cd concentration in the soil and on the characteristics of the specific cultivars. Breeding cultivar with reduced Cd is an attractive method for changing the element profile of crops as the benefit will persist in the seed that can reduce the requirement for other management practices [24].
\nSoybean contains about 40% protein and is noteworthy as it is the most complete vegetable protein [25]. Concretely, with exception of sulfur-containing amino acids such as methionine, the amino acid pattern of soybean resembles the pattern derived from high-quality animal protein sources [25]. In fact, soybean protein can even enhance the nutritional quality of other vegetable protein. Protein sources that are deficient in some amino acids can be complemented by soybean. Soybean is rich in lysine, tryptophan, threonine, isoleucine, and valine and therefore complements well with cereal grains that are deficient in those amino acids [26]. By ultracentrifugation studies, four different fractions have been revealed, with approximate Svedberg coefficients of 2S, 7S, 11S, and 15S [6]. The 2S fraction contains from 8 to 22% of the extractable soybean protein. It consists of several enzymes, including the trypsin inhibitors, Bowman-Birk and Kunitz inhibitors [6]. Trypsin inhibitors inhibit the protein-cleavage effect of proteases (such as trypsin) affecting the digestibility and leading to growth depression in animals. Therefore, soybean meal needs first to be heated in order to inactivate the trypsin inhibitors. However, trypsin inhibitors have been found to be powerful anti-carcinogenic agents in humans and therefore they can be considered as functional components of soybeans [27].
\nMore than 70% of the soybean seed storage protein is composed of 7S β-conglycinin and 11S glycinin. The 7S fraction makes up 35% of the extractable soybean protein. The quantity and the quality of the protein in the seed are the major biochemical components influencing the quality of tofu and other soy food products [28]. The mean glycinin to β-conglycinin protein ratio is known to influence the protein quality of soybeans, and greatly affects the functional properties of food products made from soybeans [29, 30]. Glycinin and β-conglycinin also differ in amino acid composition, with glycinin being higher in sulfur (S), containing amino acids that account for 3–4.5% of the total amino acid residues [31]. G1, G2, and G7 glycinin subunits contain a higher amount of methionine (6–7 per subunit) compared to G3, G4, and G5 glycinin subunits, which contain 5, 2, and 4 methionine residues per subunit, respectively [31]. By comparison, β-conglycinin is devoid of methionine [32, 33] and β-conglycinin contains a major allergen in its subunit [34]. Increased glycinin content in soybean protein is an important trait for increasing the concentration of the S-containing amino acids [35]. Because glycinin and β-conglycinin have a great impact on the nutritional value and quality of soybean products, these two storage proteins have been extensively studied and targeted for genetic manipulation in breeding programs. Soybean mutant genotypes differing in seed storage glycinin and β-conglycinin subunit composition were developed and tested for their effects on tofu quality [30]. It was shown that group IIb (A3) glycinin played the major role in contributing to tofu firmness with any coagulant, while the group IIa (A4) subunit could have a negative effect on tofu quality. Yu et al. [36] reported that soybean cultivars with 7S α′ and 11 S a4 nulls always make firm tofu than the check cultivar Harovinton. The hardness of gels from glycinin decreased in the order of group IIa, IIb, and I [37, 38]. Protein subunit composition also affects the quality and stability of soymilk [39].
\nOther soybean seed proteins include lipoxygenase and lectins. The lipoxygenase enzyme constitutes about 1–2% of the soybean protein. The lipoxygenase enzyme generates a grassy-beany flavor when it oxidizes fats and is not preferred by consumers in some countries. It is possible to avoid the oxidation of the fats by heat inactivation of the lipoxygenase enzyme; however, this is cost-ineffective and leads to insolubilization of proteins. Therefore, the genetic elimination of the lipoxygenase is preferred in order to reduce the beany flavor. Genotypic variation and the influence of growing environment on lipoxygenase accumulation in soybean seed are well documented in the literature [2, 26]. Lipoxygenase 1, 2, and 3 null germplasm lines were developed and showed that the grassy-beany flavor was eliminated [40]. Triple-null soybeans can be used for edible soy products, such as soymilk and tofu [40]. Similarly, saponins and isoflavones may also be the cause of undesirable taste in soy products although this is not well documented yet. The breeding of cultivars with low isoflavones and saponins is possible [2]. The 11S fraction comprises 31–52% of the extractable soybean proteins [6]. The 11S fraction is responsible for the gelling character of tofu, and hence, the proportion of this fraction compared to 7S plays an important role in tofu firmness [2]. The 15 S fraction comprises about 5% of the total extractable protein. It is only poorly characterized and is thought to be composed of polymers of the other soybean proteins [6].
\nDry soybeans contain on average 35% of carbohydrates, which can be divided into soluble and insoluble carbohydrates [27]. Soybean seeds possess 15–20 different soluble carbohydrates that makes up approximately 15–25% of dry weight [41]. Sucrose, raffinose, and stachyose are the most relevant soluble carbohydrates for breeding of food-grade soybean. Sucrose in dry soybean seeds is found in contents of typically 5.5% [27]. Sucrose is important for improving taste in soybean-based products. The oligosaccharides raffinose and stachyose typically constitute about 0.9 and 3.5% of dry soybean seeds, respectively [27]. The seed coat of soybeans contains a major part of insoluble carbohydrates such as cellulose, hemicellulose, pectin, and a trace amount of starch [27]. Consumers, especially in countries where fermented and vegetable soybean are not in vogue, may be skeptical toward the use of soy products because of flatulence and poor digestibility. These effects are caused by oligosaccharides, stachyose and raffinose. Humans and monogastric animals do not possess the enzyme called α-galactosidase necessary for hydrolyzing the linkages present in these oligosaccharides, so they cannot be digested when consumed. Intact oligosaccharides reach the lower intestine and undergo anaerobic fermentation by bacteria with gas expulsion (H2, CO2, and traces of CH4), causing the flatus effect and sometimes diarrhea and abdominal pain. Although raffinose and stachyose can be reduced to an extent by soaking or boiling, genetic reduction is one of the prime plant breeding objectives.
\nThe major components of crude soybean oil are triglycerides. After refinement of the oil, soybean oil is composed of 99% of triglycerides. Triglycerides are neutral lipids composed of one glycerol linking three fatty acids [27]. The saturated fatty acids in soybean oil are palmitic acid (16:0) and stearic acid (18:0), with average concentrations of about 11 and 4% (relative to the oil), respectively, and they are useful in making low trans-fat margarines. Soybean oil contains an average of 22% monounsaturated fatty acid, oleic acid (18:1). Monounsaturated fatty acids are healthy and have good oil stability [42]. Soybean oil possesses the two polyunsaturated fatty acids: linoleic acid (18:2), an omega-6 fatty acid, and linolenic acid (18:3), an omega-3 fatty acid [26]. They can be found in average concentrations of 53 and 8% of the oil, for linoleic and linolenic acid, respectively. Low (reduced) linolenic soybeans have half the linolenic acid level of standard soybeans, which reduces the need for hydrogenation, a process used in converting vegetable oils to margarine that results in the production of unhealthy trans fatty acids.
\nSoybean crude oil is also shown to consist of phospholipids, unsaponifiable material, free fatty acids, and metals. Unsaponifiable material consists of tocopherols, phytosterols, and hydrocarbons [27]. Tocopherols and phytosterols are considered as functional components. Soybean oil provides an additional benefit due to presence of enriched amounts of α-tocopherol or natural vitamin E. Oils containing low contents of linolenic acid (18:3) have been shown to contain high amount of α-tocopherol and results in lowered amount of ϒ-tocopherol [5].
\nSoybeans contain water-soluble and oil-soluble vitamins. The water-soluble vitamins such as vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin B5 (pantothenic acid), and vitamin B6 (niacin) and the oil-soluble vitamins vitamin A and vitamin E (tocopherols) are present in soybean. Vitamin A mainly exists in the form of β-carotene in immature and germinated seeds, whereas it is present in negligible amount in mature seeds [27]. Most of the minerals are found in the meal fraction rather than in the soybean oil fraction. Dry soybean seeds contain on an average concentration ranging from 0.2 to 2.1% major minerals such as potassium, which is present in the highest concentration followed by phosphorus, magnesium, sulfur, calcium, chloride, and sodium [27]. Minor minerals found in soybeans include silicon, iron, zinc, manganese, copper, molybdenum, fluorine, chromium, selenium, cobalt, cadmium, lead, arsenic, mercury, and iodine [27].
\nFunctional components of soybeans include isoflavones, saponins, lecithin, trypsin inhibitors, lectins, oligosaccharides, tocopherols, and phytosterols [27]. Presence of such biological ingredient creates interest to consider soybean food products as functional foods, i.e., foods that contain biological components that deliver special health benefits, e.g., anticancer, hypocholesteromic, and antioxidative effects to the consumer [26]. Isoflavones are phytoestrogens and are known to have positive health effects such as the reduction of the risks for coronary heart disease, osteoporosis, certain types of cancer, and the moderation of postmenopausal symptoms in women [43]. Soybean possesses 0.1–0.4% of isoflavones on a dry weight basis; hence, soybean possesses the highest amount of isoflavones compared to all other crops [27]. The isoflavone concentration varies considerably depending upon the genotype and environmental conditions. It is thought that isoflavones are mainly responsible for most of the health benefits from soybean-based foods. Therefore, they gained more and more attention from the scientific world [27], and research on breeding for enhanced isoflavone content is increasing. Refined soybean oil possesses about 1000–2000 mg/kg. Tocopherol exists in four isomers, three of them being α-, ϒ-, and δ-isomers that are present in soybean oil. α-tocopherol (natural vitamin E) in soybean is the leading commercial source of this vitamin. Tocopherols protect the polyunsaturated fatty acids from oxidation; hence, they are antioxidants and used in pharmaceutical applications [42].
\nSoybeans with large seed size and high protein levels are primarily used for soymilk and tofu production. Other traditional food from soybean includes tempeh, miso, soy sauce, okara, soynuts, soy milk, yoghurt, meat, and cheese alternatives. Tofu is perhaps the most widely consumed soy food in the world. Tofu is naturally processed and it retains a good amount of nutrients and phytochemicals such as the isoflavones [5]. Tofu typically contains 7.8% protein and 4.2% lipid on a wet basis [5]. It has a relatively low carbohydrate and fiber content, making it easier to digest. There are two main types of tofu: silken, or soft tofu and hard tofu. They are made by soaking whole soybeans and grinding them into a slurry with water. The slurry is cooked to form soymilk and a coagulant is added. The most commonly used coagulants are magnesium chloride, calcium sulfate, or glucono-D-lactone; the coagulants can be used purely or in combinations to achieve different flavor or textural characteristics. Heating is also usually applied in order to facilitate the coagulation. The result of the coagulation is that after a few minutes, the soymilk begins to curdle and large white clouds of tofu curd are formed. The water in the curds are then removed and placing the tofu curd in cloth-lined forming boxes where pressure is applied from the top results in the formation of hard tofu. Silken tofu in comparison to hard tofu is not pressed and is often coagulated in the container in which it is to be sold. [2].
\nThe popularity of soymilk has expanded from Asia to the U.S. and Europe since the 1980s. Traditionally, it is made from whole beans in the same way as the first few steps of tofu manufacture. This soy milk contains nutrients, saponins, isoflavones, and other soluble components of the soybean from which the soy milk is made. Some manufacturers add isoflavones back into the soy milk in order to make health claims about the product. Additionally, soymilks are also fortified with vitamins and minerals, such as β-carotene and calcium or docosahexaenoic acid (DHA), an omega-3 fatty acid [2]. However, beverage-quality soy milks available in the market are usually prepared from soy protein isolate, to which sugars, fats, and carbohydrates are added to improve flavor and generate a nutritional profile similar to that of cow’s milk [2].
\nVegetable soybean consists of the whole soybean picked at the R6-R7 stage and seeds are bigger and sweeter. At this stage, the soybean has a firm texture, contains a high level of sucrose, chlorophyll, and is at its peak of green maturity. The harvested pod can be left entire or be shucked into individual beans. After being blanched and frozen, the soybean can be sold as “edamame,” referring to the entire pod, or “mukimame,” referring to individual beans [2]. Nutritionally, it is highly rich in protein (11–16%), monounsaturated fatty acid, vitamin C, fiber, iron, zinc, calcium, phosphorous, folate, magnesium, potassium, tocopherol, and anticancer isoflavones [44]. It also has a pleasant flavor and soft texture and is easier to cook. Cooked vegetable soybean has the highest net protein utilization value (NPU: ratio of amino acid converted to protein) among all soy products. Vegetable soybean also has 60% more calcium and twice the phosphorus and potassium levels of green peas, which is India’s most commonly consumed fresh legume (https://www.gov.uk/government/case-studies/dfid\n\n). The vegetable soybean, in general, carries a flavor, called “beany flavor” or “grassy flavor.” Genotypes with high levels of sucrose, aspartic acid, glutamic acid, and alanine are found to have acceptable taste [44]. Biochemical analysis has established that production of “beany flavor” in soybean or soy-based products is primarily due to the lipoxygenase or the oxidative rancidity of unsaturated fatty acids [45]. Plant lipids are sequentially degraded into volatile and nonvolatile compounds by a series of enzymes via the lipoxygenase pathway, which catalyzes the hydroperoxidation of polyunsaturated fatty acids to form the aldehyde and alcohols that are responsible for the grassy-beany flavor [46].
Breeding for food-grade soybeans with unique seed composition has focused on a specific nutritional trait of the soybean seed. Examples of such varieties are given according to the fraction from which the targeted trait origins. Food-grade soybean that targets a specific trait such as varieties high in total protein content, high in β-conglycinin, low in lipoxygenase, high in specific amino acids such as lysine, methionine, and threonine, and low in allergenic proteins [13]. High-protein soybeans (>43%) are used for tofu, soymilk, soy sauce, beverages, baked goods, pudding, cheese, and meat analogs. The breeding of food-grade soybeans can be classified into three major categories: the breeding of large-seeded soybeans, the breeding of small-seeded soybeans, and the breeding of soybean with unique seed composition [13].
\nBy targeting specific traits, soybean breeders try to develop soybeans with good yield and quality [5]. Large-seeded soybeans are bred for tofu, soymilk, miso, edamame, and soynuts [13]. An important factor for the breeding of tofu soybeans is the tofu yield, which is defined as the weight of fresh tofu produced from a unit of harvested soybean. Seed size and seed appearance are also of importance for tofu soybeans. Tofu soybeans are larger than 20 g/100-seeds [13]. It is possible to produce good quality tofu with dark hilum beans but this requires prior dehulling of the beans and careful soymilk filtration [5]. In order to avoid these additional processing steps, soybeans with a yellow cotyledon, yellow seed coat, and clear hilum are preferred. Moreover, a thin but strong seed coat that is free from cracking and discoloration is desirable [13]. Soybean seeds with high protein content exceeding 45% on dry matter basis and improved ratio of 11S/7S is desirable for tofu soybeans as this enhances tofu yield and gelling characteristics, respectively [5]. A high protein/oil ratio provides a higher tofu yield and firmer texture; therefore, low oil content is preferred. Moreover, tofu soybeans should have high water uptake, a low calcium content, and a high germination rate. The carbohydrate content and composition influence the taste of tofu and soymilk [13]. High total sugar content (above 8% on dry matter basis) [5], high sucrose, low raffinose, and low stachyose are highly desirable for tofu and soymilk [13]. Examples of tofu and soymilk varieties: Black Kato, Toyopro, Grande, Proto (from Minnesota), Vinton-81, HP 204, IA1007, IA1008 (from Iowa), and Harovinton [13, 47].
\nVegetable soybean varieties should meet certain requirements such as sweeter seeds with thin seed coat and large seed size (>30 g/100-seeds dry weight) [13]. As the pods are eaten directly, genotypes with sparse gray pubescence with green and thin seed coat are preferred [13]. Moreover, edamame cultivars should possess as less as possible of one-seeded pods as they require greater effort to shell by consumers. Those cultivars with genetically “stay green” and delayed yellowing toward maturity make it possible for growers to have extended harvest period closer to maturity. Vegetable-type soybean should possess important nutritional traits such as high content of sugar (sucrose and maltose) and free amino acids to impart sweet and delicious taste. Sucrose is primarily responsible for the sweetness of vegetable soybeans, where sucrose content is preferably higher than 10% on dry matter basis. Certain free amino acids, such as glutamic acids, are major contributors to the taste of vegetable soybeans [13].
\n\n
It is reported that the Asian small-seeded lines exhibited high diversity indices than the U.S. lines for seed hardness, calcium content, and stone seed rate. In addition, the average genetic diversity of the U.S. small-seeded soybeans (1.48) was lower than that of Asian small-seeded soybeans (1.57), suggesting narrower genetic base in the U.S. lines. Seed uniformity, hardness, protein, and calcium content appeared to be relatively high in diversity index for both the U.S. and the Asian large-seeded lines. The U.S. small-seeded soybeans were desirable for natto production because of their softer texture with higher water absorption capacity and lower stone seed ratio. However, the Asian large-seeded soybeans had a lower stone seed ratio and a higher water absorption capacity. Therefore, using the Asian large-seeded genotypes may potentially improve seed quality for tofu and soymilk [48]. Therefore, the Asian soybean gene pool may serve as valuable genetic source for increasing protein content of the U.S. food-grade soybeans.
\nAvailability of genetic variability for soybean food-grade traits offers scope to improve through breeding. Breeding cultivated soybean varieties with high protein or high oil are an extremely important and promising objective. High protein and low oil content add nutritional value to soy foods. Germplasms that cover a wide range in protein content (33.1–55.9%) and oil content (13.6–23.6%) are available for breeders to modify the seed/oil ratio in the breeding program. The negative correlation between protein and oil facilitates the development of high protein and low oil lines. High protein content is generally associated with low yield, which makes the development of lines that combine high protein and high yield difficult. However, high yield is mostly achieved by selection for moderately high protein content (43–45%) [13]. Seed protein and oil content are two valuable quality traits controlled by multiple genes in soybean. The phenotypic range of protein content of soybean has been reported to be 34.1–56.8% of seed dry mass, and oil content ranged from 8.3 to 27.9% [49], suggesting that there is great potential for genetic improvement of soybean seed protein and oil content. The negative correlation between oil and protein content makes improvement of both traits simultaneously a challenging task using conventional breeding [50]. Therefore, the identification of molecular markers associated with quantitative trait loci (QTLs) controlling protein and oil content is a prerequisite for breaking the negative correlations between both traits [51].
\nIn the SoyBase database, 241 QTLs for protein content and 315 QTLs for oil content were reported and found to be distributed over 20 soybean chromosomes [52]. A majority of these QTLs were mapped by linkage mapping based on bi-parental populations and limited by the relatively small phenotypic variation and by the fact that only two alleles per locus can be studied simultaneously. The broad chromosome regions of QTLs make it difficult to identify putative candidate genes of interest [53]. With the advancement of genetic map construction, the availability of a well-annotated reference genome, resources for association mapping, and whole-genome resequencing (WGRS) data, a large number of QTLs for seed protein content have been identified (Table 1).
\nSeed protein | \n20, 15, 18 | \nAkond et al. [54]; Diers et al. [55]; Nichols et al. [56]; Brummer et al. [57]; Lee et al. [58]; Sebolt et al. [59]; Chung et al. [60]; Fasoula et al. [61]; Panthee et al. [62]; Lu et al. [63]; Pathan et al. [53]; Wang et al. [64]; Phansak et al. [65]; Hwang et al. [50]; Vaughn et al. [66]; Sonah et al. [67]; Bandillo et al. [68]; Valliyodan et al. [69]; Zhou et al. [70]; Tajuddin et al. [71] | \n
5, 6, 8 | \nHyten et al. [72]; Pathan et al. [53], Sonah et al. [67]; Bandillo et al. [68] | \n|
10, 14 | \nWang et al. [64]; Phansak et al. [65] | \n|
13, 03, 17, 12, 11 | \nZhou et al. [70] | \n|
Sucrose and oligosaccharides content | \n5, 7, 8, 11, 13, 18, 16, 19, 20 | \nMaughan et al. [73]; Kim et al. [74]; Kim et al. [75]; Alkond et al. [76], Cicek [77]; Clevinger [78]; Maroof et al. [79]; Feng et al. [80]; Zeng et al. [81]; Wang et al. [82] | \n
Major QTLs for seed protein, sucrose and oligosaccharide content reported in soybean.
Several genome-wide association studies [50, 66, 68] and QTL analysis [53, 56] have shown similar QTL genomic loci (e.g., Chrs20, 15, and 5) for protein and oil indicating negative pleiotropic effect or linkage (larger LD). The QTL on Chr20 was most likely in the genomic region of 29.8–31.6 Mbp that was supported by integrating GWAS, transcriptome, and QTL mapping analysis (Table 1) [68]. It was observed that the gene order was conserved and 18 identified genes were tandemly duplicated on Chr10 and showed similar gene ontology [83]. Three putative candidate genes were identified on Chr20 and suggested that these non-duplicated genes might be related to protein content [68]. Similarly, Chr15 QTL (38.1–39.7 Mbp) showed an inversely duplicated genomic block on Chr8. The QTL on Chr15 comprises 18 putative genes, 13 of which were duplicated with similar gene function. Syntenic analysis provided a basis for divergence of QTL regions that took place during recent genome duplication and suggested the retention or loss of several genes that might be responsible for oil content and protein in soybean. In addition to pleiotropic effects of protein on oil and yield, variation in seed protein concentration significantly affects seed size, crop growth, and development [84]. High-protein genotypes showed lower leaf area and harvest index when compared with high-yielding genotypes. While high-protein small seed showed higher leaf area at the beginning of seed fill, more canopy biomass production, and low levels of assimilate per seed [84]. Therefore, breaking the undesirable genetic linkage between protein, oil, and yield related loci through repetitive recombination and random mating is necessary.
\nConsumers have preference for firmer tofu texture that partly depends upon the protein composition. The genotypic variation in this trait is partly due to the ratio of 11S-to-7S protein fraction in the seed. The 11S fraction generally possesses greater gelling potential than 7S; hence, high 11S-to-7S ratio is desirable as it results into harder than those with low ratio. The 11S-to-7S ratio is reported to range from 0.3 to 4.9. However, genotypes with same 11S-to-7S ratio do not always result in the same firmness because of different 11S subunit composition. In general, a high 11S-to-7S ratio as well as suitable 11S composition is of importance for good tofu firmness.
\nThe selection and manipulation of specific subunit composition will play a major role in the development of improved protein quality. Molecular markers linked to the various subunit of glycinin and β-conglycinin have been reported previously. PCR-based markers were reported for the identification of β-conglycinin genes [85, 86]. An RFLP marker associated with the
Functional markers (FMs) have advantages over the linked markers, because their polymorphic sites have been derived from the genes involved in phenotypic trait variation [92]. Glycinin genes have high degree of conservation within the subgenus
Besides breeding for increased protein content, protein composition is important for its nutritional value. Based on solubility properties, globulins and albumins are two major components of dicot seed storage protein, and soybean primarily belongs to the globulin (~70%) family [96]. The soybean globulins (glycinin and β-conglycinin) are relatively low in sulfur-containing amino acids methionine (Met) and cysteine (Cys) as well as threonine (Thr) and lysine (Lys) [97]. Increasing the soybean storage protein content of seed along with improving the ratio of glycinin to β-conglycinin is of great potential for food grade soybean improvement [98, 99]. Therefore, besides increased protein content, enhancing sulfur containing amino acids (Met, Thr, Cys, and Lys) would improve the nutritional value. More than 70% of the essential amino acid enriched meal is used in the feed industry [97, 100]. Although soybean cultivars with improved protein content have been successfully developed, only a few studies have been conducted to identify genomic regions controlling amino acid composition. The difficulty in breeding for improved amino acids could be due to lack of genetic variability, lack of high throughput, and cost-effective phenotyping platform to screen a large number of samples for amino acids. Panthee et al. [99] identified QTL for essential amino acids in a F6-derived recombinant inbred population. In another study, a major QTL for essential amino acids and crude protein was identified on Chr20 [97]. Moreover, negative correlations of crude protein with Lys and Thr and a positive correlation between Thr with Lys were also observed [97]. Among the essential amino acids, Met, Lys, and Thr are synthesized from a common precursor aspartate; thus, they are strongly correlated. Krishnan et al. [101] introgressed leginsulin (Cys-rich protein) and a high protein trait from an Asian soybean germplasm, PI 427138, into North American experimental line (LD00–3309). While they were successful in introgressing leginsulin and improving protein content, the overall concentration of sulfur-containing amino acids was not changed compared to parental lines.
\nSeed protein content and composition are dependent on the genetic background of an elite parent that plays an important role in the expression of a newly introgressed allele because of complex epistatic interactions [102]. It has been found that most of the QTLs affecting seed protein and yield and yield-related components were detectable only in one of the parental genetic backgrounds (GBs) in introgression lines of reciprocal crosses [103]. The high protein allele within a different genetic background resulted into reduced Thr and Lys content [103]. The high protein allele from Danbaekkong on Chr20 has been demonstrated to increase seed protein content in several maturity groups (III–VIII) in various genetic backgrounds with little drag on seed yield [104]. On the other hand, yield drag was observed for the protein QTL alleles on Chr20 from other sources, including wild
The integration of genomic tools and breeding practices are the core components of genomics-assisted breeding (GAB) for developing improved cultivars for any given trait. Near-isogenic lines (NILs) can be developed for major QTL (e.g., protein QTL on Chr20) by backcross breeding. Using NILs, the effect of a QTL and the phenotype it produces (i.e., protein or amino acid content) can be estimated precisely without the confounding effects of differences in genetic backgrounds. Additionally, developing NILs in a range of maturity groups is desirable to study the effect of environment and maturity on seed protein content. Marker-assisted backcrossing selection approach was utilized to produce a NIL-(cgy-2–NIL)-containing mutant cgy-2 allele, responsible for the absence of allergenic α-subunit of β-conglycinin [110]. It is also possible to incorporate multiple genes/QTL into elite lines in a cyclic forward crossing scheme and employing marker-assisted recurrent selection (MARS) as an effective approach [111, 112]. Recurrent selection was effectively utilized for increased gain yield, protein, oil, and oleic acid content [111, 113, 114]. Furthermore, the next-generation sequencing (NGS) data can be used effectively for genomic selection (GS) to identify desirable parents and progenies. Jarquin et al. [115] assessed the genomic and phenotypic data of over 9000 accessions and developed genomic predication models to evaluate the genetic value for protein, oil, and yield traits. Similarly, genomics-assisted haplotype analysis is a promising approach if the information of a major QTL is available and that can be applied to select desirable haplotype blocks for parental selection and crossing by design [116].
\nIn order to widen the genetic base, it may be necessary to utilize wild species accessions as introgression libraries as well as developing interspecific populations. On the other hand, elite cultivars and landraces can be used to develop mapping populations, and training populations [114]. Wild soybean (
Breeders aim to increase the sucrose content in soybean seeds which contribute to the sweet taste of soy foods, especially for tofu, soy milk, and edamame. The sucrose content in soybeans ranges from 1.5 to 10.2%, and germplasm with even higher content, 13.6%, has been identified [13]. Varieties that target a specific component of the carbohydrate fraction are varieties high in sucrose content and varieties low in oligosaccharides [13]. Compared to conventional soybeans, high-sucrose soybeans contain 40% more sucrose but 90% less stachyose and raffinose. High-sucrose soybeans are used to produce tofu, soymilk, beverages, baked goods, puddings, cheese, and meat analogs [13]. The genotypic correlation between sucrose and 100-seed weight is positive and significant, as well as the genotypic correlation of 1000-seed weight with protein. Moreover, the heritability for 1000-seed weight is high. Hence, the breeding program selection on 100-seed weight would result in a good response on relative protein and sucrose content.
\nStachyose and raffinose are not readily digestible and cause flatulence when soy foods are consumed. Therefore, breeders aim to develop soybean seeds with reduced oligosaccharide content. Stachyose and raffinose content among soybean germplasm range from 1.4 to 6.7%, and 0.1 to 2.1%, respectively. Breeding lines with less than 1% stachyose and raffinose have been developed [13]. Soybean germplasm “V99–5089” was developed with high sucrose, low raffinose, and low stachyose content to use as a parent in food-grade soybean breeding programs [118]. The genetic variability of seed sugars has significant allelic difference in the genes controlling the biosynthetic enzymes. QTL mapping of soluble sugars in soybean seed were reported and of which 28 were for seed sucrose (Table 1). These 28 QTLs were mapped on LGs A1 and E; 3 QTLs on A2, I, and F, and 3 QTLs on L, M, and B1 [73], two QTLs on L, D1b, 7 QTLs on L [74], and B2, D1B, E, H, J [75]. The genomic regions associated with sucrose, raffinose, and stachyose were identified in segregating F2–10 RILs [74].
\nAlkond et al. [76] reported 14 significant QTLs associated with sucrose and oligosaccharides that were mapped on 8 different linkage groups (LGs) and chromosomes (Chr). Seven QTL were identified for raffinose content on LGs D1a (Chr1), N (Chr3), C2 (Chr6), K (Chr9), B2 (Chr14), and J (Chr16). Four QTL for stachyose content were identified on LG D1a (Chr1), C2 (Chr6), H (Chr12), and B2 (Chr14) [76]. Three QTL for seed sucrose content were identified on LGs N (Chr3), K (Chr9), and E (Chr15). The region of Chr15 (LG E) that has been reported to be associated with sucrose was detected by others [73, 75, 77, 78], but the position of the QTL was different [76]. The two of the regions underlying seed sucrose QTLs identified on LG N (Chr3) and K (Chr9) are additions to the loci previously reported on LGs D1b (Chr2), A1 (Chr5), M (Chr7), A2 (Chr8), B1 (Chr11), H (Chr12), F (Chr13), G (Chr18), J (Chr16), L (Chr19), and I (Chr20) [73, 75, 77, 78]. The selection for beneficial alleles of these QTLs could facilitate breeding strategies to develop soybean lines with higher concentrations of sucrose and lower levels of raffinose and stachyose.
\nNormal soybean seeds contain three lipoxygenase isozymes that are responsible for the grassy beany flavor and bitter taste of soy food. Research is being conducted for the genetic elimination of lipoxygenase from soybean seeds to reduce undesirable flavors in soy food products. Soybean seed lipoxygenase exists in three isozymic forms, namely lipoxygenase-1, −2, and −3 controlled by single dominant genes, viz.
Soybean cultivars with good isoflavone content are desirable as it contributes health benefits. High-isoflavone soybeans contain more than 0.4% isoflavones compared to levels of 0.15–0.25% for traditional soybean varieties [13]. Isoflavone content is influenced by genetic factors and environmental factors such as temperature and irrigation during seed maturation [13]. For instance, the total isoflavone content of soybean seeds appears to be negatively related to growth temperature [5]. Understanding the genetic regulation of this pathway may be necessary for obtaining cultivars with good isoflavone levels. Interest has been put in the phenylpropanoid synthetic pathway which is catalyzed in its first step by isoflavone synthase (IFS). Two genes for IFS have been identified in soybean. Furthermore, negative correlation has been found between total isoflavone content and linolenic acid (18:3) concentration. Other data suggest negative correlation between isoflavone content and protein content [5]. QTLs affecting isoflavones were identified using recombinant inbred line population and found five QTLs contributed to the concentration of isoflavones, having single or multiple additive effects on isoflavone component traits [123]. Similarly, six QTLs were identified using the linkage map constructed with specific length amplified fragment sequencing, of which one major QTL (qIF20-2) contributed to a majority of isoflavone components across various environments and explained a high amount of phenotypic variance (8.7–35.3%) [124]. Akond et al. [125] identified QTL controlling isoflavone content in a set of recombinant inbred line (RIL) populations of soybean derived from “MD96–5722” by “Spencer” cultivars. Wide variations were found for seed concentrations of daidzein, glycitein, genistein, and total isoflavones among RIL populations. Three QTLs were identified on three different linkage groups (LG). One QTL that controlled daidzein content was identified on LG A1 (Chr 5) and two QTLs that underlay glycitein content were identified on LG K (Chr 9) and LG B2 (Chr 14). Identified QTLs could be used to develop soybean with preferable isoflavone concentrations in the seeds through MAS.
\nIncreasing the seed oil concentration has been a breeding goal for centuries. The ancestor of the domesticated soybean used to have small, hard, black seeds with low oil content, high protein content, and low yield. It is known that an increase in oil content is positively correlated with yield and negatively correlated with protein content. Selection for yield, agronomic characteristics and seed quality, large yellow seeds with typical averages of 20% oil and 40% protein were obtained. However, soybean is appreciated for its high protein meal and versatile vegetable oils; therefore, breeders mostly prefer to obtain modest gains in oil and yield without substantial loss in protein concentration [42]. Breeding for oil quality such as with reduced saturated fatty acids are prime focus as it is responsible for elevating cholesterol. The saturated fatty acids present in soybean oil are palmitic acid, 16:0, and stearic acid, 18:0. Especially, palmitic acid is a health concern as it is correlated to cardiovascular disease. It has been suggested that saturated fatty acids should be kept below 7–10% on a daily basis [42]. Soybean oil contains the monounsaturated fatty acid, oleic acid, 18:1. The oxidative stability of the soybean oil is enhanced by increasing three times higher the concentration of monounsaturated fatty acid such as oleic (18:1) than the normal content which is about 22%. Therefore, breeders target a concentration of 18:1 of about 65–75% of total lipid in soybean. By the means of genetic engineering, 18:1 levels of about 80% total lipid have been achieved [42]. In general, soybean varieties with unique fatty acid composition such as high oleic acid content, high stearic acid content, low linolenic acid content, or low palmitic acid content are preferred [13].
\nAssessment of agronomic traits has been used to evaluate phenotypic diversity in 20,570 Chinese soybean accessions and it was reported that seed coat color had the highest diversity index among the qualitative traits [126]. Plant’s height had the most variation among quantitative traits, and followed by seed size, protein content, growth period, and oil content. The seed size of those accessions ranged from smaller than 2 to as large as 46 g/100-seeds. The protein content ranged from 30 to 53%; and oil content ranged from 10 to 25%. The variances of seed size, protein content, and oil content of the U.S. cultivars were lower than the Chinese cultivars [127]. The Southern U.S. soybeans were more variable in oil and protein contents and less variable in seed size than the Northern U.S. soybeans. The food-grade soybean breeding aims to increase the nutritional content and quality of protein and oil [128]. Greater genetic diversity of protein content, seed hardness, calcium content, and seed size uniformity than other quality traits in both small and large-seeded genotypes were evaluated [128]. The U.S. soybean genotypes with small seed were more diverse and exhibited higher swell ratio and oil content but lower stone seed ratio and protein content than the Asian accessions [128]. Among the large-seeded accessions, the U.S. genotypes had higher stone seed ratio and oil content but lower swell ratio and protein content, and were less diverse than the Asian genotypes [128]. The characterization of diverse food grade soybeans will facilitate parent selection in specialty soybean breeding [1].
\nSoybean germplasm PI542044, also known as Kunitz soybean, contains the null allele of KTI, i.e., kti that encodes a truncated protein and it was developed in a backcross program involving Williams 82 and PI157440 [129]. Introgression of kti is complicated by a number of factors viz., (i) kti being recessive in inheritance, each conventional backcross generation would be requiring selfing followed by estimation of KTI content in the seeds so as to identify a target plant. However, three recessive null alleles, viz. Kunitz trypsin inhibitor, soybean agglutinin, and P34 allergen null were stacked in the background of “Williams 82” and were termed as “Triple Null” [130]. Three SSR markers, viz. Satt228, Satt409, and Satt429 have been reported to be closely linked (0–10 cM) with the null allele of Kunitz trypsin inhibitor [131]. These SSR markers was also validated in the mapping population generated using Indian soybean genotypes as the recipient parent (
Based on the importance of soybean as a staple food crop, the development of low Cd soybean cultivars should be a priority. The genetic variability for Cd accumulation within a species provides an opportunity to select soybean genotypes with low Cd concentration. In soybean grain, Cd concentration was found to be controlled by a single gene, with low Cd dominant in the crosses studied [134]. Lines with the low Cd trait had restricted root-to-shoot translocation, which limited the Cd accumulation in the grain. Genetic variability in soybean [19, 135] has been reported. An understanding of genetics and heritability of the Cd accumulation is essential in designing the breeding strategy to incorporate gene(s) controlling low Cd accumulation in modern cultivars. However, identifying low Cd phenotypes by analysis of the grain is challenging due to the high cost of analysis [136]. Developing inexpensive methods would assist in transferring the low Cd accumulation traits with other desirable traits.
\nMarker-assisted selection (MAS) could be an alternative to phenotypic selection. In soybean, DNA markers linked to low Cd accumulation were identified using RIL population (
Breeding for soybean seed composition traits is a complicated process; fortunately, ample genomic resources and tools are now available to soybean breeders/researchers for dissection of seed composition traits. The combination of conventional breeding strategy and genomic approaches will help to identify genomic loci, haplotypes, and FMs in breeding for improvement of seed composition traits. For improvement of protein, the major protein QTL, which was repeatedly mapped on Chr20, Chr15, and Chr18, may facilitate breeders to select parental lines and consider them for crossing schemes or introgression into locally adapted superior yielding cultivars through genomics-assisted breeding and MAS. Issues related to protein increase without yield drag, pleiotropic effects, and background/allelic effects could be addressed via screening diverse germplasm, considering wild soybean alleles for introgression, undertaking genomics-assisted breeding, precise high-throughput phenotyping, mutational breeding, and genome editing through Crisp/Cas. Integrating these aspects will extend our current genetic and genomic portfolio far beyond that of traditional breeding. Finally, when a cultivar with improved food-grade characteristics is developed, a further step is the evaluation of the quality of the product obtained from this cultivar. This is important as the success of a food-grade soybean cultivar is determined by the preferences of the consumers.
\nIn recent years, the desire for smaller families and healthy birth spacing has steadily increased in developed and developing countries alike [1, 2]. The United Nations Millennium Development Goals calls for universal access to contraceptive services so that women and couples are able to have the desired number of births at the desired time [3]. Measuring and documenting levels and trends in contraceptive use and the unmet need for family planning services is crucial to informing the decisions of healthcare providers, program planners, and those in charge of resource allocation, particularly in developing nations [4].
Available information regarding unmet needs for contraception in developing countries allows health promoters, professionals, policymakers, and funding bodies to identify the necessary level of investment required in family planning programs [5]. Women are considered to have an unmet need for contraception if they are sexually active and want to avoid becoming pregnant, but are not using any method of contraception to achieve this goal [6]. When women receive health guidance in preventing unintended pregnancies, this helps reduce unwanted births and unsafe abortions, ultimately improving both maternal and child health [7].
The ideal contraceptive method needs to be highly effective in preventing pregnancy with the minimum number of possible side-effects and risks; in addition, it should be affordable, reversible, widely available, and acceptable to people of various cultures and religions [8]. These characteristics are believed to enable better utilization of modern contraception methods by couples and, more specifically, by women, with research showing that women transform their knowledge into behavior—in other words, that knowledge of contraceptives reduces fertility [9].
Investing in family planning is one of the most crucial measures to improve human wellbeing, as population dynamics have a fundamental influence on the pillars of sustainable development. Most importantly, the utilization of modern contraceptives is believed to be highly cost-effective in enhancing the socioeconomic status of nations and thus reducing poverty [3, 9]. This chapter gives the reader an overview of the various methods of modern contraception available, as well as their mechanisms of action, health benefits, and potential side-effects and risks, thereby allowing health care practitioners to better support women in making informed decisions about their fertility.
Combined hormonal contraception (CHC) is a combined formulation of progestin and synthetic estrogen [10]. This type of contraception has been utilized by women worldwide for almost 60 years, with significant changes in dosage and preparation over time [11, 12]. More than a third of women aged 16–44 years in the UK use oral contraception; in addition, oral contraceptive pills are used annually by approximately 10 million U.S. women [11]. Health care practitioners should support women to make informed decisions about choosing specific forms of CHC, ensuring that they are aware of their effectiveness—and how they compare to other contraceptive methods—as well as their potential risks and benefits.
CHC contains estrogen paired with a progestogen in different formulations.
The majority of combined oral contraceptives (COCs)—as well as the combined transdermal patch and combined vaginal ring—contain between 20 and 35 μg of ethinylestradiol (EE), a synthetic form of estrogen. Current ‘low-dose’ COCs were developed to reduce the health risks associated with the high estrogen content of COCs used in the 1960s and 1970s [13]. Low-dose COCs (i.e., formulations containing <50 μg of EE) are a safe and reliable contraceptive option for the vast majority of women [14, 15].
Progestogens are synthetic steroids designed to have some of the properties of progesterone. The synthetic progestogen component of CHC allows for convenient dosing intervals, potent suppression of ovulation, and prevents overproliferation of the endometrium in response to estrogen. Newer progestogens were developed to have fewer androgenic and glucocorticoid effects; some are anti-androgenic and have potentially favorable anti-mineralocorticoid effects [16]. However, different progestogens can modify the effect of EE on hepatic clotting factors in different ways; for example, forms of CHC which contain certain newer progestogens in combination with EE appear to be associated with a greater risk of venous thromboembolism (VTE) compared to COCs containing other progestogens [17, 18, 19, 20, 21].
The different progestogens included in CHC are sometimes grouped by ‘generation’ as below, according to the time they were first marketed as constituents of COCs:
There are currently two types of CHC regimens offered: standard hormonal regimens or tailored/combined regimens.
The majority of COCs are designed to be taken on a 28-day cycle, with 21 consecutive daily active pills followed by a 7-day hormone-free interval prior to starting the next packet of pills. The first 7 pills inhibit ovulation and the remaining 14 pills maintain anovulation.
For combined transdermal patches, 1 patch is applied to the skin and worn for 7 days to suppress ovulation. Thereafter the patch is replaced on a weekly basis for 2 further weeks. The fourth week is patch-free to allow a withdrawal bleed. A new patch is then applied after 7 patch-free days [23].
For combined vaginal rings, 1 ring is inserted into the vagina and left in place continuously for 21 days. After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring is inserted [24].
The majority of COC products are monophasic; that is, all pills in the packet contain the same dose of estrogen and progestogen. Multiphasic (variable dose) COCs are also available in which the dose of either or both steroid hormones varies during the pill cycle. Evidence is inadequate to establish whether multiphasic COCs differ significantly from monophasic COCs in terms of bleeding patterns, side-effects, discontinuation rates, or effectiveness in preventing pregnancy [25, 26, 27]. As existing evidence suggests there is no particular advantage to multiphasic preparations, it is recommended that monophasic COCs should be used as a first-line intervention.
Tailored CHC regimens include:
Continuous use of CHC with no free interval.
Extended use of CHC with a less frequent hormone-free interval in which the timing of the hormone-free interval can be either fixed or flexible.
CHC regimens in which the hormone-free interval is shortened.
In continuous or extended CHC regimens, the contraception is taken for more than 21 consecutive days without a hormone-free interval. Such regimens have the potential advantage of eliminating or reducing the frequency of withdrawal bleeding and associated symptoms; the bleeding pattern is, however, unpredictable. Less frequent hormone-free intervals could also reduce the risk of escape ovulation and, potentially, contraceptive failure [28, 29, 30, 31]. A shortened hormone-free interval, offering more continuous ovarian suppression, could also reduce the risk of escape ovulation, particularly if contraceptive use is imperfect around the hormone-free interval. A shortened hormone-free interval can be taken either after every 21 days of active CHC use or incorporated into an extended regimen.
The main mechanism of action of COCs is the suppression of ovulation through the inhibition of gonadotropin-releasing hormone from the hypothalamus, as well as inhibition of both luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and disruption of the mid-cycle LH surge. These effects are mediated by both the progestogen and estrogen components of the COC working synergistically; however, it is the estrogen’s ability to suppress FSH and thus prevent folliculogenesis that is likely the most important mechanism.
The additional estrogen exposure in continuous-use pills, pills with a shorter pill-free interval, and pills with an additional 10 μg of EE in the placebo week results in more complete suppression of FSH and less folliculogenesis. However, a substantial number of women can still develop follicles while taking low-dose COCs [32, 33]. Additionally, the estrogen component stabilizes sufficient endometrium production to maintain a regular withdrawal bleeding pattern, thereby permitting cycle control.
Additional progestogen-related mechanisms that contribute to the contraceptive effect of COCs include:
Effects on the endometrium, rendering it less suitable for implantation. Long-term cyclic or daily progestogen exposure leads to endometrial decidualization and eventual atrophy.
Thickening of the cervical mucus, which becomes less permeable to penetration by sperm.
Impairment of normal tubal motility and peristalsis.
The efficacy, or failure, of COCs can differ considerably based on the type of user. The perfect user never misses taking a pill, takes the pill at the same time each day, and never vomits or has diarrhea. The failure rate for perfect users is <1 pregnancy per 100 women (or 3 per 1000 women). In turn, the typical user’s behavior results in the failure rates reported for the general population, which is 5–8 pregnancies per 100 women in the first year [34, 35, 36, 37, 38].
It is important to note that the risk of pregnancy is greatest when a woman starts a new pack of pills 3 or more days late or misses 3 or more pills near the beginning or end of a pack.
In addition to their high contraceptive efficacy, COCs have many advantages, including rapid reversibility, regulation of menstrual bleeding, decreased menstrual blood loss, and dysmenorrhea, as well as population-level reductions in the risk of ovarian and endometrial cancers. Furthermore, CHC use does not interfere with intercourse and can be easily discontinued at any time.
COCs are also widely used to treat a variety of other disorders and conditions, including:
There are certain disadvantages to CHC use. The efficacy of this form of hormonal contraception is highly user-dependent as it must be taken every day at the same time; forgetfulness and missing pills increases the likelihood of failure. Similarly, CHC effectiveness may also be lowered with the simultaneous use of certain medications. Moreover, this method requires periodic resupply and offers no protection against gastrointestinal tract infections or sexually-transmitted infections (STIs), like the hepatitis B virus and HIV/AIDS. Though very infrequent, CHC use may sometimes delay return of fertility for 2–3 months. Finally, CHC may cause minor side-effects and risks, as detailed below.
Patients may experience breast tenderness, nausea, and bloating when starting COCs. These symptoms typically resolve quickly. Other concerns can include unscheduled bleeding, which typically resolves within 3 months, and a possible impact on mood and sexual function. There is no evidence to show that COCs cause weight gain.
The risks associated with COC use are influenced by the type and dose of estrogen and progestogen contained in the formulation. These risks are as follows:
VTE—COC use has been associated with an increased risk of VTE. The risk of VTE varies with estrogen dose and patient-specific factors, such as age, obesity, and smoking status. Nevertheless, while the VTE relative risk is increased, the absolute increase in VTE risk is still low for most women and does not outweigh the numerous benefits of this contraceptive method, particularly when compared with the VTE risk during pregnancy and the postpartum period [45].
Cardiovascular health—COC use has been associated with increased risks of hypertension, myocardial infarction, and stroke in certain populations. However, the absolute risk of myocardial infarction and stroke attributable to COCs is low in women of reproductive age. Rarely, COCs can cause a mild elevation in blood pressure in the range of 3–5 mmHg; however, this is unlikely to be clinically significant in healthy women [46].
Cancer—COC use does not appear to increase the overall risk of cancer. The impact of COC use on breast cancer risk is a subject of active debate, with conflicting data reported. At least 1 study has reported a differing risk of breast cancer with COC use based on hormone receptor subtype. Women who have taken COCs also appear to have a slightly increased risk of developing cervical cancer. By contrast, COC use is associated with a reduced risk of developing ovarian and endometrial cancers [47].
STI acquisition—The impact of developing STIs in women using COCs appears to vary by type of infection. Two systematic reviews reported that COC use positively correlated with chlamydia infections, but not with gonorrhea, herpes simplex virus-2, trichomoniasis, syphilis, and human papillomavirus. While COCs may be associated with increased rates of chlamydia, rates of pelvic inflammatory disease (PID) do not appear to be increased. One study reported similarly increased rates of bacterial vaginosis, trichomoniasis, and vaginal candidiasis among women starting either COCs or an LNG-IUS device, which makes sexual exposure the likely risk factor for these infections and not the contraceptive method. Other studies have reported reduced rates of bacterial vaginosis in women using COCs. Data generally do not support any influence of COC use on the acquisition of HIV. There are currently no restrictions on COC use among women with STIs, PID, or HIV [48, 49, 50].
The progestogen-only pill (POP) is a form of hormonal contraception which contains a progestogen. It is often referred to colloquially as the “mini-pill”.
The POP is formulated with a single synthetic hormone, progestin. Unlike CHC, POPs do not contain any estrogen. Moreover, the dose of progestin in POPs is substantially lower than that included in COCs (NET: 0.35–1 mg, DRSP: 3–4 mg).
There are multiple types of progestins available:
NET—Commonly available as individual 0.35-mg tablets, NET is dispensed in packs of 28 active pills, which are taken continuously (i.e., without a 7-day hormone-free interval) [51].
DRSP—DRSP is dispensed in packs of 20 tablets containing 4 mg of DRSP and 4 inert tablets [52]. One tablet is taken daily until the pack is empty and then a new pack is started.
DSG—In numerous countries, DSG POPs are available in a 75-μg formulation [53]. This formulation has significant differences from NET-POPs.
Depending on their formulation, POPs have several independent modes of action that contribute to their contraceptive effect [51, 52, 53]. POPs increase the volume and viscosity of the cervical mucus, preventing sperm penetration into the upper reproductive tract [54]. This change occurs soon after starting a POP, within 2 days of taking the pill. However, the contraceptive effect provided by these mucosal changes is short-lived; it has been estimated that full protection conferred via cervical mucosal changes may last less than 24 h unless maintained by regular pill-taking [53].
In addition, POPs can act to suppress ovulation [54]. However, the extent to which this occurs is variable; for example, up to 60% of cycles in women using LNG pills are anovulatory, whereas ovulation is suppressed in up to 97% of cycles in women using DSG pills [55, 56]. Other modes of action include endometrial changes that hinder implantation and reduction in cilia activity in the fallopian tube that slows the passage of the ovum [54]. The main mechanism of action of DRSP-POPs and DSG-POPs is the suppression of ovulation.
The effectiveness of POPs in preventing pregnancy is as high as that of combined estrogen-progestin contraceptive pills; moreover, intake delay of up to 12 h does not affect contraceptive efficacy [57]. Nevertheless, the effectiveness of this method still depends on the user, as higher failure rates occur with poor compliance. For perfect users, the failure rate is <1 pregnancy per 100 women over the first year (3 per 1000 women). However, for typical users, the failure rate is 1 pregnancy per 100 women in the first year for breastfeeding women and 3–10 pregnancies per 100 women in the first year for non-breastfeeding women [58].
The most important advantage of POPs is their rapid effectiveness (<24 h), if taken within the first 7 days of the menstrual cycle. Unlike COCs, intake delay of up to 12 h does not affect contraceptive efficacy [57]. Moreover, the lack of estrogen eliminates the possibility of estrogen-related side-effects and complications. POPs do not interfere with intercourse or affect breastfeeding. Women taking POPs can easily cease taking the pills with an immediate return of fertility. Anecdotally, some women mention that the POP tablets are easier to take compared to COCs because each tablet is the same color.
Daily use of progestin protects against the development of endometrial cancer [59]. In addition, NET acetate has demonstrated efficacy in treating dysmenorrhea, abnormal uterine bleeding, and endometriosis-related pain, albeit at higher doses (2.5–15 mg per day) [60]. A single-arm trial of continued DRSP use over 13 cycles in adolescent females reported reduced rates of dysmenorrhea, as well as a corresponding decrease in the use of pain medication to treat the aforementioned dysmenorrhea [61].
Although POPs neither protect from nor increase the risk of acquiring STIs, progestin-induced thickening and increased viscosity of the cervical mucus has been hypothesized to inhibit the ascent of bacteria and thus potentially reduce the risk of PID development. Nevertheless, all women at risk of STI acquisition should be advised to use a condom.
As with COCs, there are certain disadvantages to POPs. Although the window of time for contraceptive efficacy when taking POPs is more forgiving compared to COCs, the efficacy of POPs still relies on the user taking the pill every day. Similarly, this method also requires a periodic resupply of pills and offers no protection against STIs. Moreover, POP users may experience certain side-effects and risks, as detailed below.
Bleeding—Altered bleeding patterns are a common reason given by women for stopping POPs [62, 63, 64]. Indeed, almost half of POP users experience prolonged bleeding and up to 70% report breakthrough bleeding or spotting in 1 or more cycles [64]. Bleeding patterns associated with POPs may depend upon the type of progestogen used, the dose at which it is given, circulating endogenous estradiol concentrations, and ovulation.
Decreased libido—Decreased libido is a commonly reported adverse reaction (≥1 per 100 women) in clinical trials [64, 65]. However, establishing causation is difficult, given the subjective nature of sexual interest and the multitude of factors that may influence it. Studies looking specifically at the impact of POPs on libido are lacking.
Weight changes—In women of reproductive age, minor weight fluctuation is common. However, a review of 16 randomized controlled trials (RCTs), one of which examined a POP, reported limited evidence of weight gain (<2 kg over 12 months) among users of progestogen-only contraceptives. Whilst there is a paucity of evidence relating to the POP specifically, the available evidence does not support a causal association between POP use and weight change [66].
Headaches—Although there are limited data on the effects of progestogen on migraine development, the available evidence does not suggest an increased incidence of migraines associated with the use of POPs [67].
Depression and mood changes—As with other forms of hormonal contraception, depression and mood changes are possible undesirable effects of POP use [68, 69, 70]. However, there is as yet no direct evidence from studies to suggest a causal association.
Cardiovascular health—Few studies have been large enough to evaluate VTE risk associated with the use of progestogen-only contraceptives. However, the available evidence does not demonstrate an increased VTE risk with the POP [71, 72, 73]. Hypertension is a condition for which there is no restriction on the use of POPs, as there is no evidence that POPs increase blood pressure [54]. Even for women with vascular disease, the advantages of POPs generally outweigh the theoretical or proven risks [74]. POPs are generally appropriate for women with cardiac disease and are useful as a bridging method while specialist advice is being sought [75].
Breast cancer—The annual risk of breast cancer increases with age, irrespective of hormone use. Due to the small numbers of women using progestogen-only methods in studies that have investigated the association between hormonal contraceptive use and breast cancer, data are limited with regards to determining breast cancer risk associated with POP use [76]. Any attributable risk is likely to be small and, as with COCs, likely to reduce with time after discontinuation of the contraceptive.
Ectopic pregnancy—The risk of ectopic pregnancy associated with any particular contraceptive method is determined, in the first instance, by the ability of the method to prevent pregnancy and, subsequently, by the proportion of ectopic to intrauterine pregnancies that occur. Other factors may also influence this risk, including age, smoking status, and a previous history of ectopic pregnancy. The incidence of ectopic pregnancy associated with POPs is difficult to determine due to the small numbers of ectopic pregnancies that occur and the inability to adequately control for other risk factors. Up to 10% of pregnancies that occur in traditional POP users may be ectopic [54]. Methods that suppress ovulation are likely to be associated with a lower overall rate of ectopic pregnancy than those that do not. Women should be informed of possible signs of ectopic pregnancy (e.g., lower abdominal pain or shoulder tip pain). A previous history of ectopic pregnancy does not place any restrictions on the use of POPs [74].
Progestogen-only injectables (POIs) are one of the most effective contraceptive methods and are reversible, safe, and easy to use [77]. These long-acting contraceptives consist of injections of progestogen which are steadily released into the bloodstream over several weeks. Injections are given every 8–13 weeks, depending on the type of injectable [78, 79].
Much like POPs, POIs contain progestin, a synthetic hormone that mimics progesterone, the natural hormone present in a woman’s body.
There are three types of POIs currently available:
150 mg of depot medroxyprogesterone acetate (DMPA) given intramuscularly every 3 months (DMPA-IM).
104 mg of DMPA given subcutaneously every 3 months (DMPA-SC).
200 mg of NET enanthate given intramuscularly every 2 months [78, 80].
In 1992, the U.S. Food and Drug Administration (FDA) approved the marketing of DMPA as a contraceptive agent [81]. Of the three options outlined above, DMPA-IM is the most commonly used and extensively researched injectable progestin [79]. It should be administered deep into the muscles, as the preparation is released slowly into the blood stream from the site of injection [82]. For DMPA-SC, the BD Uniject™ system (Becton, Dickinson & Co., Franklin Lakes, NJ) is a useful option for community-based programs or home delivery as it can be self-administered using the system’s prefilled, single-dose, disposable hypodermic syringes [83]. The efficacy of DMPA-SC is likely maintained when administered in the upper arm, abdomen, or thigh, which may be preferrable for some women [84].
There are three primary mechanisms of action that contribute to the efficacy of injectable DMPA in preventing pregnancy:
Inhibition of ovulation through suppression of the hypothalamus, the main mechanism of action [85].
Mucosal changes in which the cervical mucus becomes more viscous, thick, and scanty, thereby inhibiting sperm from reaching the oviduct (fallopian tubes) and preventing egg fertilization [81, 82].
Thinning and atrophy of the endometrium through decreased estradiol concentrations [86].
POIs containing DMPA are one of the most effective methods of contraception. Contraceptive efficacy is achieved rapidly (<24 h) and, because there is a grace period of 4 weeks, is non-user-dependent. Nevertheless, it is important that the injections are given consistently and correctly. Pregnancy protection rates reach 99% with perfect use and 96% with typical use, assuming occasional non-use and/or incorrect use for the latter [80, 87]. The risk of pregnancy is higher when a woman misses an injection. The failure rate is up to 6 pregnancies per 100 women in the first year of use [88]. Age, income, desire to prevent or delay pregnancy, and culture affect the consistent and correct usage of any method of contraception [80].
In general, POIs are a good choice for women who want a reliable, long-lasting, reversible method of contraception without the need for daily action on their part, such as pill-taking. This type of contraceptive can be used by women of any age and parity status and is easily discontinued. Client satisfaction is high, as injections are often considered more convenient compared to other forms of contraception and follow-up injections can be easily given by a nurse. There is no need for a pelvic examination prior to the use of POIs. Furthermore, the injections do not affect breastfeeding or interfere with intercourse. Overall, POIs have a good safety profile and few specific health risks. They have minimal drug interactions.
Since its introduction into the market in the 1960s, DMPA has been used for a variety of gynecological conditions, including endometriosis and abnormal menstrual bleeding [81]. Because it decreases menstrual blood loss by 50% at 1 year of use and by 70% after 2 years of use, DMPA improves iron deficiency anemia and amenorrhea [83]. The mechanism of action of progestin with regards to endometrial thinning and atrophy contributes to its use in the treatment of endometriosis, plus its direct effect on endometrial lesions [86]. DMPA can also be used in the treatment of abnormal uterine bleeding associated with uterine fibroids, adenomyosis, or coagulopathies [39]. In addition, it protects against endometrial cancer and symptomatic PID.
DMPA also improves cyclical menstrual symptoms, such as pain, mood changes, headaches, and breast tenderness, and decreases the incidence of benign breast disease, ovarian cysts, and ectopic pregnancy. Furthermore, women with sickle cell disease will have fewer sickle cell crises, while those with epilepsy will have fewer
There are several limitations to the use of DMPA. The main disadvantage of this type of contraception is its ability to engender changes in the bleeding pattern of a woman’s menstrual cycle, potentially limiting its uptake. Indeed, discontinuation of DMPA is reported to be 25–50% in the first year of use [89, 90]. Moreover, POIs do not provide protection against STIs such as chlamydia, gonorrhea, and HIV. The client has to return to the clinic for follow-up injections and, once given, their contraceptive action cannot be stopped until the time of the next injection. Furthermore, there is some delay in return of fertility which takes approximately 7–10 months from the date of the last injection [79, 82].
Counseling is highly recommended to ensure that the possible side-effects and risks of POIs, described below, are explained to clients, particularly the reasons behind any menstrual changes.
Bleeding—Unpredictable, irregular, frequent, or heavy bleeding usually occurs with the first 3 months of POI use; subsequently, by 1 year of use, the majority of women have achieved amenorrhea [82].
Weight changes—There is some evidence to show that the use of progestogen-only contraceptives up to 12 months may cause weight gain (mean of <2 kg/4.4 lb). In addition, progestogen-only contraceptive users showed greater increases in body fat and decreases in lean mass compared to users of non-hormonal contraceptive methods [66]. Another prospective study with a longer follow-up over 36 months found that DMPA users gained an average of 5.1 kg/11.2 lb, whereas women who used COCs did not gain any weight [91, 92]. Weight gain with the first injection may be predictive of weight gain over time and women who are overweight and obese may be at higher risk [81].
Hormonal side-effects—Like other hormonal contraceptives, DMPA has other related side-effects, including breast tenderness, headaches, nausea, acne, abdominal bloating and discomfort, and hypo-estrogenic effects such as hot flashes, reduced libido, and vaginal dryness. While DMPA may cause mood changes, depression is not a contraindication to its use [93].
Bone health—In suppressing gonadotropin production and ovulation, DMPA also suppresses ovarian production of estradiol and hypoestrogenemia causes a decline in BMD in current DMPA users [94]. The rate of loss is greatest during the first 1–2 years of use (by 0.5–3.5% at first and 5.7–7.5% subsequently) [95]. This reduction in BMD normalizes after discontinuation of DMPA use for up to 5 years [96, 97, 98]. There is no reported increase in fracture risk among DMPA users [99].
Allergic reactions—Allergic reactions are a serious side-effect of DMPA [81].
Cardiovascular health—DMPA use is not associated with an increased risk of cardiovascular events in healthy women, including VTE, myocardial infarction, or stroke. Although circulating lipids are affected by DMPA use, it does not increase production of coagulation factors and has no adverse effect on blood pressure. No adverse clinical effects on cardiovascular disease have been observed [83].
Depression—prospective studies do not support a causal relationship between DMPA use and depression.
Implants are small, flexible, impermeable plastic rods about the size of a matchstick that are placed just under the skin of the upper arm [100, 101]. Over the past 35 years, various types of contraceptive implants have been approved in more than 60 countries; today, this method of contraception is used by millions of women worldwide [102]. Implants are a good choice for women of reproductive age who are sexually active and desire continuous, long-term contraception.
Contraceptive implants include a progestin which is released in a low, steady dose into the bloodstream. The most common forms of progestin used in implants are LNG and etonogestrel.
There are several types of contraceptive implants on the market:
Jadelle® (Bayer, Leverkusen, Germany), which consists of 2 rods each containing 75 mg of LNG, labeled for up to 5 years of use [103].
Implanon NXT®/Nexplanon® (Organon, Jersey City, NJ), which consists of 1 rod containing 68 mg of etonogestrel, labeled for up to 3 years of use. The Nexplanon® has replaced the Implanon NXT® which is now discontinued [104].
Levoplant®/Sino-Implant (II) (Shanghai Dahua Pharmaceutical Co. Ltd., China), which consists of 2 rods each containing 75 mg of LNG, labeled for up to 4 years of use. Levoplant® is also sometimes referred to as Sino-Implant (II) [105].
Norplant® (Wyeth Pharmaceuticals, Madison, NJ), which consisted of 6 capsules each containing 36 mg of LNG and was effective for 5–7 years. This device was discontinued in 2008 and is no longer available for insertion.
Of the various types of contraceptive implants available, the Implanon NXT®/Nexplanon® is the most commonly used and is registered in approximately 80 countries worldwide [106]. It is radio-opaque (visible on X-ray) and has an improved insertion device.
Contraceptive implants have two primary mechanisms of action: inhibition of ovulation and restriction of sperm penetration [107]. The anti-estrogenic effect of the progestin causes the cervical mucus to become more viscous and scanty, thereby stopping sperm penetration and egg fertilization [108]. Furthermore, high doses of progestin diminishes gonadotropin secretion, inhibiting follicular maturation and ovulation. While progestin also suppresses endometrial activity by causing the endometrial thinning and atrophy, thereby impeding implantation, these two actions remain the major mechanisms of action in preventing fertilization [109]. There is no evidence of embryonic development among implant users, indicating that progestin implants have no abortifacient properties [81].
The etonogestrel implant (Implanon NXT®/Nexplanon®) is among the most effective and long-lasting contraceptives available and is as good as or better than sterilization procedures, with pregnancy protection rates of >99% for both typical and perfect users [88, 110]. If inserted within the first 5 days of the menstrual cycle, the implant is effective immediately after insertion, with peak serum levels occurring within 4 days [111]. The failure rate is negligible at <1 pregnancy per 100 women in the first year (or 1 per 1000 women). Beyond the first year of use, a small risk of pregnancy remains and continues as long as the client is relying on the implant as the only form of contraception.
The efficacy of implants is based on correct sub-dermal insertion and removal of the device. All healthcare providers should receive instructions and training prior to the insertion or removal of the implant. Women taking efavirenz for HIV should be advised to use condoms along with implants, as this medication may reduce the effectiveness of contraceptive implants.
Contraceptive implants are a highly effective, long-acting form of user-independent, non-coitus-related contraception that provides protection against pregnancy without the need for repeated adherence. Moreover, they have few side-effects and are rapidly reversible [100, 101]. Implants are a good option for adolescents, as they do not require the user to do anything after insertion and there is no need for routine follow-up visits, as well as for adult women who desire highly efficient, easy-to-use, long-term protection. Implants can be inserted without the need for a pelvic examination, breast examination, blood tests, or any other laboratory tests, barring another indication for doing so. Moreover, implants do not interfere with intercourse and clients are ensured of a complete return of fertility after removal.
Implants do not disturb lactation and reduce the risk of ectopic pregnancy and symptomatic PID, probably as a result of the effects of progestin on the cervical mucus; moreover, they may protect against iron-deficiency anemia. Furthermore, implants do not increase the risk of STIs [78, 81]. Implants have been shown to be beneficial in women with dysmenorrhea as they decrease abdominal cramps by up to 80% [112]. Unlike DMPA, etonogestrel implants have not been found to induce bone loss [78, 110].
A woman cannot start or stop using implants on her own as insertion and removal of the device constitutes a minor surgical procedure which must be performed by a well-trained provider. Furthermore, implants are a relatively expensive method of contraception and do not protect against STIs.
Contraceptive implants may cause changes in menstrual bleeding in the first several months to 1 year of use, including lighter bleeding, fewer days of bleeding, prolonged bleeding, irregular bleeding, and even no bleeding. After about 1 year of use, the pattern of bleeding becomes more regular. Changes in bleeding patterns as a result of implants are not harmful but are a common drawback of this contraceptive method. Amenorrhea occurs in approximately 20% of women in the first year of use, although this rates declines with duration of use to 13% by year 3 [113].
Unscheduled bleeding was reported as the reason for discontinuation of this method among 14.8% of users in the U.S. and Europe and 3.7% in Southeast Asia, Chile, and Russia [114]. About 90% of women who discontinued the implant experienced frequent or prolonged bleeding/spotting versus 22% of those who continued using the device [115].
Like other progestogen-only forms of contraception, other possible-side effects of contraceptive implants include headaches, abdominal pain, mood changes, nausea, breast tenderness, dizziness, acne (either improvement or exacerbation), weight change, and possibly enlarged ovarian follicles [78, 110].
Complications are reported in 0.3–1% of implant insertions and 0.2–1.7% of removals [116]. Uncommon insertion/removal complications include infection, hematoma formation, and local irritation and rashes at the insertion site; these occur mostly within the first 2 months of insertion. Clinician training and experience, and the use of a stringent, aseptic technique reduces the incidence of such complications.
In addition, rare complications can occur, including expulsion of the implant (occurring within the first 4 months of insertion) and migration of the implants over time a short distance (<2 cm) from the site of insertion [78, 117]. Nerve injuries have also been reported with implants, including injury to the branches of the medial antebrachial cutaneous nerve during placement and the medial antebrachial cutaneous nerve [118, 119].
Intrauterine contraception devices (IUCDs) are small, flexible devices inserted in the uterine cavity to provide effective, long-acting, reversible contraception. The IUCD is a safe, easy-to-use, and highly cost-effective means of contraception, with significantly low failure rates [120, 121]. It provides a nonsurgical option for pregnancy prevention that is as effective as surgical sterilization. The IUCD is one of the most commonly used methods of long-acting, reversible contraception worldwide, with an average utilization rate of approximately 23% among female contraceptive users, although there is wide variation between countries, ranging from <2% to >40% [122, 123].
There are different types and shapes of IUCD available globally. Most IUCDs have a plastic frame and release either copper or a progestin to prevent pregnancy.
Generally, most frequently used IUCDs are divided into two main categories: hormonal and non-hormonal. Various terms are used to describe IUCDs, including intrauterine device and intrauterine contraception; hormonal IUCDs or progestin-containing devices are also referred to as an IUS.
Copper IUCDs (Cu-IUCDs) are non-hormonal and vary in size and shape. They consist of a piece of plastic and copper, with some types containing silver or other metals. Theoretically, this may increase the longevity of the device; however, no evidence has been identified to confirm any clinical benefit of mixed-metal IUCDs over IUCDs that only contain copper. In addition to their use as long-acting, reversible forms of contraception, Cu-IUCDs can also be used as a method of emergency contraception [124, 125].
In turn, the LNG-IUS is a T-shaped device with an elastomer core containing LNG. There are different LNG-IUSs available which release a varying amount of LNG. In addition to its use for contraception, the LNG-IUS can be used in the management of heavy menstrual bleeding and as endometrial protection during estrogen replacement therapy [126].
The IUCD has multiple mechanisms of action that contributes to its contraceptive properties. The device causes chemical changes that damage the sperm and ova before they can meet, thus preventing fertilization [127]. Moreover, copper ions released by Cu-IUCDs reduce sperm motility and viability and inhibit sperm penetration and migration by affecting the uterotubal fluid, thus decreasing the number of sperm reaching the oviduct and their capacity to fertilize the ova. Copper also induces changes in the endometrium, causing a cytotoxic inflammatory response increasing levels of white blood cells, enzymes, and prostaglandins in the uterine fluid, thereby impairing sperm function and preventing implantation. Additionally, Cu-IUCDs inhibit ova development [114, 128, 129].
The LNG-IUS inhibits fertilization by thickening the cervical mucus which acts as a barrier to the upper genital tract, as well as causing changes in the uterotubal fluid that impair sperm migration. Inhibition of implantation via endometrial changes is the secondary mechanism of action of the LNG-IUS. A foreign body effect may also be a contributing factor, as has been observed with other intrauterine methods [128, 130, 131]. While the LNG-IUS also has a minor effect on the hypothalamic pituitary ovarian axis, serum estradiol concentrations are not reduced, and the majority of women (>75%) continue to ovulate [132, 133, 134, 135].
Progestogenic effects of the LNG-IUS on cervical mucus have been demonstrated, but it is not fully understood how quickly such changes are established [136, 137, 138]. Prevention of implantation occurs via a progestogenic effect on the endometrium [139, 140, 141]. Within 1 month of insertion, high intrauterine concentrations of LNG induce endometrial atrophy [130, 131, 142, 143, 144]. The LNG-IUS also causes changes in the endometrium that may also contribute to its contraceptive effect, particularly by altering the intercellular junctions between the epithelial and stromal cells and increasing the number of phagocytic cells [140, 143, 145].
All of the anti-fertility actions of IUCDs occur prior to implantation [114, 128, 129, 146]. The common belief that the mechanism of action of IUCDs is the destruction of an implanted embryo is not supported by evidence. Studies of IUCD users were unable to find embryos or detect human chorionic gonadotropin, indicating that transient, or chemical, pregnancies had not occurred [128, 147, 148]. In summary, there is no evidence to suggest that IUCDs disrupt an implanted pregnancy [149].
Failure rates within the first year of IUCD insertion are 0.6–0.8% for women with a Cu-IUCD and 0.2–0.9% for women with an LNG-IUS. The cumulative failure rate over 10 years of use of the Cu-IUCD is 2.1–2.8%, while that of the LNG-IUS over 5–7 years of use is 0.7–1.1% [150]. Unlike most other forms of reversible contraception, the IUCD does not rely on patient participation or adherence for correct usage; thus, failure rates for typical and perfect users are similar.
The IUCD is one of the most cost-effective methods of long-acting, reversible contraception available; even though the cost of the device and insertion can be high initially, the overall cost with long-term use decreases with time because no additional expenditure is required [151]. Moreover, this method is highly effective, acts immediately, and is not dependent on user compliance as it does not require regular adherence to maintain its effectiveness. It requires only a monthly self-checking for strings, and yearly follow-up visits. In addition, the IUCD does not interfere with intercourse or breastfeeding and can be inserted 6 weeks after giving birth. Clients are assured of a rapid return of fertility upon removal. Depending on the type of IUCD inserted, women can avoid the use of either exogenous estrogen (both IUCD types) or hormones in general (Cu-IUCDs only).
There are several disadvantages to the utilization of IUCDs. This type of contraceptive device requires the client to undergo a minor procedure for insertion and removal; as such, the client cannot discontinue use of this method on her own. Moreover, the client will need to check strings after each menstrual period. Pelvic examination and genital tract infection screening is mandatory before initiation of use, as per the Centers for Disease Control and Prevention guidelines. In addition, because she may experience heavier monthly bleeding, the device may contribute to anemia if the women has low iron stores prior to insertion [158, 159]. Finally, IUCDs do not protect against STIs.
Pain and menstrual bleeding changes—The IUCD can result in abdominal cramps, pain, and changes in monthly bleeding patterns, especially in the first 3–6 months of use, including prolonged and heavy monthly bleeding, irregular bleeding, and no bleeding [158, 159, 160]. Users of the LNG-IUS are more likely to terminate use due to amenorrhea, while Cu-IUCD users are more likely to terminate the method because of pain and other menstrual events [160].
Hormonal side-effects—Discontinuation because of hormonal side-effects is also more common among LNG-IUS users [158]. These side-effects include acne and weight changes, both of which are rare.
Expulsion of the device—The incidence of expulsion is 3–10% for the Cu-IUCD and 3–6% for the LNG-IUS in the first year of use [146, 147, 161]. A trial reports that the expulsion of the Cu-IUCD occurs less frequently than with the LNG-IUS (8.4 versus 11.7 cases per 100 users). Another study reveals that the expulsion rate is equal between Cu-IUCD and LNG-IUS as well as reported pain.
PID—The IUCD may increase the risk of PID in women who have chlamydia or gonorrhea at the time of insertion, although this is rare [162]. Rates of PID among users of IUCDs are fairly similar regardless of type of device (3.6 cases per 100 women).
Barrier contraception is a safe, effective, and reversible form of contraception acceptable to many couples. These methods can be used either alone as the primary method of contraception, or in combination with other contraceptive methods. In terms of the latter, barrier methods may be used as a short-term combination therapy, for example when CHC is initiated, or in the long term to provide additional protection against pregnancy. Barrier methods are also the only method of contraception which can be used to prevent the transmission of STIs.
Depending on the type of method utilized, barrier devices may be made of rubber, plastic, or organic components such as lambskin [12, 163].
There are several types of barrier methods available, including:
Male condoms (including latex, non-latex, and deproteinized latex varieties).
Female condoms (latex, polyurethane, or nitrile).
Diaphragms (latex or silicone).
Cervical caps (silicone).
Spermicides (foams, gels, and films with sperm-killing or blocking properties) [12, 163].
Male condoms are sheaths or coverings that fit on an erect penis. Female condoms are sheaths, or linings, that fit loosely inside a woman’s vagina, made of a thin, transparent, soft film. Female condoms have flexible rings at both ends; one ring at the closed end helps to insert the condom, while the ring at the open end holds part of the condom outside the vagina [78].
Diaphragms and cervical caps consist of plastic or silicone domes which are inserted inside the vagina to cover the cervix, primarily used in conjunction with a spermicidal agent. A recent survey found that <1% of women reported using diaphragms and caps [12].
Barrier methods provide a physical barrier to prevent the migration of sperm from the vagina to the upper reproductive tract where fertilization occurs, thereby preventing pregnancy. Male and female condoms work by keeping sperm out of the vagina and forming a barrier to ejaculate, pre-ejaculate, and vaginocervical secretions [78]. In turn, diaphragms and caps keep sperm from reaching the cervix. However, as only the cervix is covered by the latter two methods, they do not prevent exposure of the vaginal mucosa to semen or exposure of the penis to vaginocervical secretions.
Data from the U.S. suggest that there is a 5% failure rate with the female condom and a 2% failure rate with the male condom with perfect use (i.e., correct and consistent use). With typical use (which includes incorrect and inconsistent use), failure rates are 21% and 18%, respectively [88]. Nevertheless, many factors other than user error may influence the efficacy of condoms in the prevention of pregnancy, including background fertility, coital frequency, or the use of emergency contraception. A study assessing semen exposure following condom failure suggested that even when condoms break or slip, the risk of pregnancy may be reduced in comparison to when using no method of contraception at all [164]. Although condom studies often report clinical breakage and slippage rates, these are not considered valid surrogate endpoints of pregnancy [165].
Data have suggested that, with perfect use, 4.3–8.4% of women using a diaphragm with a spermicidal cream or jelly experience an unintended pregnancy within the first year of use. With typical use, the percentage increases to 12% [88]. In a comparative study, the only contraceptive cap available in the UK was found to be less effective at preventing pregnancy than the diaphragm to which it was compared. The unadjusted typical-use probability of pregnancy at 6 months of use was 13.5% for contraceptive cap users and 7.9% for diaphragms users, with the adjusted risk of pregnancy being 1.96 times higher in the former group [166, 167].
The advantages of male and female condoms include their rapid effectiveness, low cost, and the fact they are simple to use with no required medical supervision. As a non-hormonal method of contraception, they are free from the side-effects and risks associated with exposure to exogenous estrogen or hormones in general.
Condoms are the only contraceptive method that provides protection against STIs and, by extension, help in the protection against conditions caused by STIs (e.g., PID and cervical cancer). Laboratory studies have shown that both male latex condoms and male and female non-latex condoms protect against many STIs, including hepatitis B and HIV/AIDS [168, 169, 170, 171, 172, 173]. Data from other studies suggest that female condoms may be as effective as male condoms in the prevention of STIs arising due to vaginal intercourse, including
The disadvantages of condoms are that they are entirely user-dependent, requiring continuous user motivation. Moreover, risk of failure is always present due to the possibility of condom slippage or breakage; as such, barrier methods are not suitable for high-risk pregnancy clients. In addition, they should be used at every act of sex, for which re-supply must be readily available. Condoms may interfere with sexual pleasure in some clients. They require appropriate storage and proper disposal. Allergic reactions to latex is the only known side-effect of barrier methods made of latex [78].
Emergency contraception, sometimes referred to as the “morning after” pill or postcoital contraceptives, is designed to prevent or delay ovulation after an act of unprotected sexual intercourse (UPSI).
Current methods of emergency contraception include either the insertion of a Cu-IUCD or the administration of contraceptive pills with hormonal components, including either estrogen and progestin in combination, progestin only, or selective progesterone receptor modulators [175].
There are various types of emergency contraceptive pills (ECPs), including:
Pills containing LNG or ulipristal acetate (UPA) alone.
POPs containing LNG or norgestrel (LNG-ECPs).
COCs containing both estrogen and a progestin (i.e., LNG, norgestrel, or NET).
In Europe, UPA-ECPs have been available since 2009; subsequently, they received approval in the U.S. from the FDA in 2010 for use as an emergency contraceptive. They are now available in more than 50 countries [78].
The risk of pregnancy after an episode of UPSI is difficult to estimate because it depends on a number of factors, including the fertility of both partners, the timing and number of acts of UPSI, cycle length and variability, and whether contraception has been used incorrectly or not at all. Pregnancy is extremely unlikely to occur as a result of UPSI in the first 3 days of a woman’s natural menstrual cycle [141]. However, pregnancy is theoretically possible after UPSI on most days of the cycle. A woman’s fertile period is considered to be the 6 consecutive days ending with, and including, the day of ovulation.
Sperm are viable in the female genital tract for about 5 days after UPSI [141]. If ovulation occurs within those 5 days, fertilization could take place and the woman is at risk of pregnancy. A judicial review concluded that pregnancy begins at implantation [176]. It is therefore currently accepted that any emergency contraception intervention must act either to prevent fertilization or to prevent implantation, rather than to disrupt established implantation. According to available data, the shortest time from ovulation to implantation is 6 days, although over 80% of pregnancies implant 8–10 days after ovulation [177].
LNG-ECPs inhibit ovulation, delaying or preventing follicular rupture and causing luteal dysfunction. If taken prior to the start of the LH surge, LNG inhibits ovulation for the next 5 days, until sperm from the UPSI for which it was taken are no longer viable [178]. In the late follicular phase, however, LNG-ECPs become ineffective [179]. Although post-ovulation effects of LNG-ECP have been suggested, subsequent studies have not shown a significant effect when administered after ovulation [180].
UPA is a selective progesterone receptor modulator that acts by delaying ovulation for at least 5 days, until sperm from the UPSI are no longer viable. Unlike LNG-ECPs, UPA-ECPs delay ovulation even after the start of the LH surge [179]. However, UPA-ECPs cannot inhibit ovulation at or after the LH peak. Moreover, UPA-ECPs have not been demonstrated to be as effective as other ECPs when administered after ovulation. Li et al. found a significant difference between observed and expected pregnancy rates for women who received UPA-ECPs prior to ovulation, but not for women who received UPA-ECPs after ovulation [182].
Despite this, various theoretical mechanisms of action have been suggested for a post-ovulation effect of UPA, including delayed endometrial maturation; however, the clinical relevance of this in terms of its contribution to preventing pregnancy is unclear [183].
The overall effectiveness of ECPs is difficult to ascertain. Most studies report the pregnancy rate after use of various types of ECPs as a percentage of the number of women who used ECPs; however, a significant number of these women would not have become pregnant in any case. Studies assessing the effectiveness of ECPs in preventing pregnancy depend, therefore, on an estimation of the number of pregnancies that would have occurred without the emergency contraception intervention.
UPA-ECPs have been demonstrated to be effective when taken up to 120 h after an episode of UPSI, with no significant reduction in effectiveness observed with increasing time until this point [186, 187]. The overall pregnancy rate after taking UPA-ECPs has been reported to be 1–2% [186, 187].
Studies have reported the overall pregnancy rate among women taking LNG-ECPs within 72 h of an episode of UPSI to be 0.6–2.6% [186, 188]. However, in several of these studies, the LNG-ECPs were taken at any time of the cycle; thus, UPSI may or may not have occurred when the women were at risk of pregnancy. Two large RCTs comparing LNG-ECPs to other ECP regimens estimated the number of pregnancies that would have occurred without the intervention and compared this with the actual number of pregnancies observed [188]. The percentage of pregnancies prevented by LNG-ECPs, when taken within 72 h of a single episode of UPSI, was estimated to be about 85%.
Overall, ECPs can be used by women of any age, including adolescents and women with HIV. They do not cause abortion and do not prevent or affect implantation. In addition, they do not cause birth defects if pregnancy occurs. ECPs are considered safe for women’s health and do not cause infertility. Oral ECPs can be used more than once in a women’s cycle and a woman can take ECPs when needed without first seeing a health care provider. No procedures or tests are needed before taking ECPs, apart from a pregnancy test if indicated [78].
Women may have cultural or religious reasons for avoiding a method of emergency contraception that could have its effect after fertilization [189]. It is therefore important that a client who raises concerns about the mechanism of action of any emergency contraception intervention is given sufficient information about what is known and what is uncertain.
Nausea, abdominal pain, fatigue, headaches, breast tenderness, dizziness, and vomiting are commonly reported side-effects of ECPs. Some users also report changes in bleeding patterns after ECP administration, including slight irregular bleeding for 1–2 days or monthly bleeding that starts earlier or later than expected in the first several days after taking ECPs. However, irregular bleeding due to ECPs will typically stop without additional treatment [78].
The authors declare no conflicts of interest.
CHC | combined hormonal contraception |
COC | combined oral contraceptive |
EE | ethinylestradiol |
VTE | venous thromboembolism |
NET | norethindrone |
LNG | levonorgestrel |
DSG | desogestrel |
DRSP | drospirenone |
LH | luteinizing hormone |
FSH | follicle-stimulating hormone |
IUS | intrauterine system |
WHO | World Health Organization |
PCOS | polycystic ovary syndrome |
BMD | bone mineral density |
STI | sexually-transmitted infection |
PID | pelvic inflammatory disease |
POP | progestogen-only pill |
RCT | randomized controlled trial |
POI | progestogen-only injectable |
DMPA | depot medroxyprogesterone acetate |
DMPA-IM | intramuscular DMPA |
DMPA-SC | subcutaneous DMPA |
FDA | Food and Drug Administration |
IUCD | intrauterine contraception device |
Cu-IUCD | copper-IUCD |
UPSI | unprotected sexual intercourse |
ECP | emergency contraceptive pill |
UPA | ulipristal acetate |
The Internet has irrevocably changed the dynamics of scholarly communication and publishing. Consequently, we find it necessary to indicate, unambiguously, our definition of what we consider to be a published scientific work.
",metaTitle:"Prior Publication Policy",metaDescription:"Prior Publication Policy",metaKeywords:null,canonicalURL:"/page/prior-publication-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"A significant number of working papers, early drafts, and similar work in progress are openly shared online between members of the scientific community. It has become common to announce one’s own research on a personal website or a blog to gather comments and suggestions from other researchers. Such works and online postings are, indeed, published in the sense that they are made publicly available. However, this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
\\n\\nThe significance of Peer Review cannot be overstated when it comes to defining, in our terms, what constitutes a published scientific work. Peer Review is widely considered to be the cornerstone of modern publishing processes and the key value-adding contribution to a scholarly manuscript that a publisher can make.
\\n\\nOther than the issue of originality, research misconduct is another major issue that all publishers have to address. IntechOpen’s Retraction & Correction Policy and various publication ethics guidelines identify both redundant publication and (self)plagiarism to fall within the definition of research misconduct, thus constituting grounds for rejection or the issue of a Retraction if the work has already been published.
\\n\\nIn order to facilitate the tracking of a manuscript’s publishing history and its development from its earliest draft to the manuscript submitted, we encourage Authors to disclose any instances of a manuscript’s prior publication, whether it be through a conference presentation, a newspaper article, a working paper publicly available in a repository or a blog post.
\\n\\nA note to the Academic Editor containing detailed information about a submitted manuscript’s previous public availability is the preferred means of reporting prior publication. This helps us determine if there are any earlier versions of a manuscript that should be disclosed to our readers or if any of those earlier versions should be cited and listed in a manuscript’s references.
\\n\\nSome basic information about the editorial treatment of different varieties of prior publication is laid out below:
\\n\\n1. CONFERENCE PAPERS & PRESENTATIONS
\\n\\nGiven that conference papers and presentations generally pass through some sort of peer or editorial review, we consider them to be published in the accepted scholarly sense, particularly if they are published as a part of conference proceedings.
\\n\\nAll submitted manuscripts originating from a previously published conference paper must contain at least 50% of new original content to be accepted for review and considered for publication.
\\n\\nAuthors are required to report any links their manuscript might have with their earlier conference papers and presentations in a note to the Academic Editor, as well as in the manuscript itself. Additionally, Authors should obtain any necessary permissions from the publisher of their conference paper if copyright transfer occurred during the publishing process. Failure to do so may prevent Us from publishing an otherwise worthy work.
\\n\\n2. NEWSPAPER & MAGAZINE ARTICLES
\\n\\nNewspaper and magazine articles usually do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense. Articles appearing in newspapers and magazines rarely possess the depth and structure characteristic of scholarly articles.
\\n\\nSubmitted manuscripts stemming from a previous newspaper or magazine article will be accepted for review and considered for publication. However, Authors are strongly advised to report any such publication in an accompanying note to the External Editor.
\\n\\nAs with the conference papers and presentations, Authors should obtain any necessary permissions from the newspaper or magazine that published the work, and indicate that they have done so in a note to the External Editor.
\\n\\n3. GREY LITERATURE
\\n\\nWhite papers, working papers, technical reports and all other forms of papers which fall within the scope of the ‘Luxembourg definition’ of grey literature do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense.
\\n\\nAlthough such papers are regularly made publicly available via personal websites and institutional repositories, their general purpose is to gather comments and feedback from Authors’ colleagues in order to further improve a manuscript intended for future publication.
\\n\\nWhen submitting their work, Authors are required to disclose the existence of any publicly available earlier drafts in a note to the Academic Editor. In cases where earlier drafts of the submitted version of the manuscript are publicly available, any overlap between the versions will generally not be considered an instance of self-plagiarism.
\\n\\n4. SOCIAL MEDIA, BLOG & MESSAGE BOARD POSTINGS
\\n\\nWe feel that social media, blogs and message boards are generally used with the same intention as grey literature, to formulate ideas for a manuscript and gather early feedback from like-minded researchers in order to improve a particular piece of work before submitting it for publication. Therefore, we do not consider such internet postings to be publication in the scholarly sense.
\\n\\nNevertheless, Authors are encouraged to disclose the existence of any internet postings in which they outline and describe their research or posted passages of their manuscripts in a note to the Academic Editor. Please note that we will not strictly enforce this request in the same way that we would instructions we consider to be part of our conditions of acceptance for publication. We understand that it may be difficult to keep track of all one’s internet postings in which the researcher´s current work might be mentioned.
\\n\\nIn cases where there is any overlap between the Author´s submitted manuscript and related internet postings, we will generally not consider it to be an instance of self-plagiarism. This also holds true for any co-Author as well.
\\n\\nFor more information on this policy please contact permissions@intechopen.com.
\\n\\nPolicy last updated: 2017-03-20
\\n"}]'},components:[{type:"htmlEditorComponent",content:'A significant number of working papers, early drafts, and similar work in progress are openly shared online between members of the scientific community. It has become common to announce one’s own research on a personal website or a blog to gather comments and suggestions from other researchers. Such works and online postings are, indeed, published in the sense that they are made publicly available. However, this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
\n\nThe significance of Peer Review cannot be overstated when it comes to defining, in our terms, what constitutes a published scientific work. Peer Review is widely considered to be the cornerstone of modern publishing processes and the key value-adding contribution to a scholarly manuscript that a publisher can make.
\n\nOther than the issue of originality, research misconduct is another major issue that all publishers have to address. IntechOpen’s Retraction & Correction Policy and various publication ethics guidelines identify both redundant publication and (self)plagiarism to fall within the definition of research misconduct, thus constituting grounds for rejection or the issue of a Retraction if the work has already been published.
\n\nIn order to facilitate the tracking of a manuscript’s publishing history and its development from its earliest draft to the manuscript submitted, we encourage Authors to disclose any instances of a manuscript’s prior publication, whether it be through a conference presentation, a newspaper article, a working paper publicly available in a repository or a blog post.
\n\nA note to the Academic Editor containing detailed information about a submitted manuscript’s previous public availability is the preferred means of reporting prior publication. This helps us determine if there are any earlier versions of a manuscript that should be disclosed to our readers or if any of those earlier versions should be cited and listed in a manuscript’s references.
\n\nSome basic information about the editorial treatment of different varieties of prior publication is laid out below:
\n\n1. CONFERENCE PAPERS & PRESENTATIONS
\n\nGiven that conference papers and presentations generally pass through some sort of peer or editorial review, we consider them to be published in the accepted scholarly sense, particularly if they are published as a part of conference proceedings.
\n\nAll submitted manuscripts originating from a previously published conference paper must contain at least 50% of new original content to be accepted for review and considered for publication.
\n\nAuthors are required to report any links their manuscript might have with their earlier conference papers and presentations in a note to the Academic Editor, as well as in the manuscript itself. Additionally, Authors should obtain any necessary permissions from the publisher of their conference paper if copyright transfer occurred during the publishing process. Failure to do so may prevent Us from publishing an otherwise worthy work.
\n\n2. NEWSPAPER & MAGAZINE ARTICLES
\n\nNewspaper and magazine articles usually do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense. Articles appearing in newspapers and magazines rarely possess the depth and structure characteristic of scholarly articles.
\n\nSubmitted manuscripts stemming from a previous newspaper or magazine article will be accepted for review and considered for publication. However, Authors are strongly advised to report any such publication in an accompanying note to the External Editor.
\n\nAs with the conference papers and presentations, Authors should obtain any necessary permissions from the newspaper or magazine that published the work, and indicate that they have done so in a note to the External Editor.
\n\n3. GREY LITERATURE
\n\nWhite papers, working papers, technical reports and all other forms of papers which fall within the scope of the ‘Luxembourg definition’ of grey literature do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense.
\n\nAlthough such papers are regularly made publicly available via personal websites and institutional repositories, their general purpose is to gather comments and feedback from Authors’ colleagues in order to further improve a manuscript intended for future publication.
\n\nWhen submitting their work, Authors are required to disclose the existence of any publicly available earlier drafts in a note to the Academic Editor. In cases where earlier drafts of the submitted version of the manuscript are publicly available, any overlap between the versions will generally not be considered an instance of self-plagiarism.
\n\n4. SOCIAL MEDIA, BLOG & MESSAGE BOARD POSTINGS
\n\nWe feel that social media, blogs and message boards are generally used with the same intention as grey literature, to formulate ideas for a manuscript and gather early feedback from like-minded researchers in order to improve a particular piece of work before submitting it for publication. Therefore, we do not consider such internet postings to be publication in the scholarly sense.
\n\nNevertheless, Authors are encouraged to disclose the existence of any internet postings in which they outline and describe their research or posted passages of their manuscripts in a note to the Academic Editor. Please note that we will not strictly enforce this request in the same way that we would instructions we consider to be part of our conditions of acceptance for publication. We understand that it may be difficult to keep track of all one’s internet postings in which the researcher´s current work might be mentioned.
\n\nIn cases where there is any overlap between the Author´s submitted manuscript and related internet postings, we will generally not consider it to be an instance of self-plagiarism. This also holds true for any co-Author as well.
\n\nFor more information on this policy please contact permissions@intechopen.com.
\n\nPolicy last updated: 2017-03-20
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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It is present in different machines we use every day; in fact, technical systems in our homes and all the industries are hard to imagine today without these concepts. Moreover, the same theories can be used for modelling life processes as a collection of inputs, outputs, plants and control loops. Feedback is one of the main concepts behind control; in particular, several examples of physiological control mechanisms for regulating life aspects can be found in the human anatomy, for example, blood pressure, cholesterol levels, body movements, the equilibrium, etc. Those processes can be damaged by the aging effects, diseases, accidents or when the mechanism has been broken and cannot be recovered naturally; consequently, it will be required external assistance. A relative new field in control theory is related with developing technology for helping with physiological and medicals problems. However, in comparison with machines, those physiological processes are highly nonlinear, with delays and slow responses. Another problem is when human becomes the operators using their capacities of decision making to close the control loop, as they are prone to errors and mistakes. For those reasons, the biomedical system needs to be carefully designed and several aspects have to be considered. This chapter gives a small review of some internal and external control processes within the human body and discusses how to interact with them for designing biomedical devices. Under this design scheme, a practical application of a smart electric wheelchair for assisting persons with strong disabilities is presented. These assistive robotic systems are in close contact with the user, and thus, it is determinant to have a user-friendly relation between the human and the interface. Therefore, intuitive interfaces were included in the design and an intelligent navigation assistant to guarantee a collision-free path.",book:{id:"5238",slug:"automation-and-control-trends",title:"Automation and Control Trends",fullTitle:"Automation and Control Trends"},signatures:"David Balderas and Mario Rojas",authors:[{id:"183076",title:"M.Sc.",name:"David",middleName:null,surname:"Balderas Silva",slug:"david-balderas-silva",fullName:"David Balderas Silva"},{id:"184877",title:"MSc.",name:"Mario",middleName:null,surname:"Rojas",slug:"mario-rojas",fullName:"Mario Rojas"}]},{id:"51070",title:"Fuzzy PD Controller in NAO System's Platform",slug:"fuzzy-pd-controller-in-nao-system-s-platform",totalDownloads:1607,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Humanoid robotic platforms rarely achieve the desire trajectory because of the deviation generated during the robot walking. This problem is due to different circumstances such as robot manufacturing, wear and tear of mechanic parts, or variations of floor flatness. Currently, one of the humanoid robots on the market is the robotic platform developed by Aldebaran Robotics called NAO robot, and it is used for different purposes where the robot needs to navigate into controlled spaces. NAO presents the issue of deviation during walking; therefore, a Fuzzy PD Controller is developed and implemented for this platform to reduce the orientation error and to ensure reliability during navigation. Inertial sensors are used to get the orientation reference and for feedback of the closed-loop control. Consequently, a robust control was implemented and tested in different conditions of floor and velocity during the robot’s navigation such as robot races and maze resolution. Experimental results show that fuzzy controller achieves significant improvements in the trajectories of NAO.",book:{id:"5238",slug:"automation-and-control-trends",title:"Automation and Control Trends",fullTitle:"Automation and Control Trends"},signatures:"Edgar Omar López‐Caudana and César Daniel González Gutiérrez",authors:[{id:"26464",title:"Dr.",name:"Edgar",middleName:"Omar",surname:"Lopez-Caudana",slug:"edgar-lopez-caudana",fullName:"Edgar Lopez-Caudana"},{id:"185936",title:"Mr.",name:"César Daniel",middleName:null,surname:"González Gutiérrez",slug:"cesar-daniel-gonzalez-gutierrez",fullName:"César Daniel González Gutiérrez"}]}],onlineFirstChaptersFilter:{topicId:"257",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"3",title:"Dentistry",doi:"10.5772/intechopen.71199",issn:"2631-6218",scope:"\r\n\tThis book series will offer a comprehensive overview of recent research trends as well as clinical applications within different specialties of dentistry. Topics will include overviews of the health of the oral cavity, from prevention and care to different treatments for the rehabilitation of problems that may affect the organs and/or tissues present. 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",coverUrl:"https://cdn.intechopen.com/series/covers/3.jpg",latestPublicationDate:"August 4th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:2,paginationItems:[{id:"1",title:"Oral Health",coverUrl:"https://cdn.intechopen.com/series_topics/covers/1.jpg",isOpenForSubmission:!0,editor:{id:"173955",title:"Prof.",name:"Sandra",middleName:null,surname:"Marinho",slug:"sandra-marinho",fullName:"Sandra Marinho",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGYMQA4/Profile_Picture_2022-06-01T13:22:41.png",biography:"Dr. Sandra A. Marinho is an Associate Professor and Brazilian researcher at the State University of Paraíba (Universidade Estadual da Paraíba- UEPB), Campus VIII, located in Araruna, state of Paraíba since 2011. She holds a degree in Dentistry from the Federal University of Alfenas (UNIFAL), while her specialization and professional improvement in Stomatology took place at Hospital Heliopolis (São Paulo, SP). Her qualifications are: a specialist in Dental Imaging and Radiology, Master in Dentistry (Periodontics) from the University of São Paulo (FORP-USP, Ribeirão Preto, SP), and Doctor (Ph.D.) in Dentistry (Stomatology Clinic) from Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul (HSL-PUCRS, Porto Alegre, RS). She held a postdoctoral internship at the Federal University from Jequitinhonha and Mucuri Valleys (UFVJM, Diamantina, MG). She is currently a member of the Brazilian Society for Dental Research (SBPqO) and the Brazilian Society of Stomatology and Pathology (SOBEP). Dr. Marinho's experience in Dentistry mainly covers the following subjects: oral diagnosis, oral radiology; oral medicine; lesions and oral infections; oral pathology, laser therapy and epidemiological studies.",institutionString:null,institution:{name:"State University of Paraíba",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null},{id:"2",title:"Prosthodontics and Implant Dentistry",coverUrl:"https://cdn.intechopen.com/series_topics/covers/2.jpg",isOpenForSubmission:!0,editor:{id:"179568",title:"Associate Prof.",name:"Wen Lin",middleName:null,surname:"Chai",slug:"wen-lin-chai",fullName:"Wen Lin Chai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRHGAQA4/Profile_Picture_2022-05-23T14:31:12.png",biography:"Professor Dr. Chai Wen Lin is currently a lecturer at the Department of Restorative Dentistry, Faculty of Dentistry of the University of Malaya. She obtained a Master of Dental Science in 2006 and a Ph.D. in 2011. Her Ph.D. research work on the soft tissue-implant interface at the University of Sheffield has yielded several important publications in the key implant journals. She was awarded an Excellent Exchange Award by the University of Sheffield which gave her the opportunity to work at the famous Faculty of Dentistry of the University of Gothenburg, Sweden, under the tutelage of Prof. Peter Thomsen. In 2016, she was appointed as a visiting scholar at UCLA, USA, with attachment in Hospital Dentistry, and involvement in research work related to zirconia implant. In 2016, her contribution to dentistry was recognized by the Royal College of Surgeon of Edinburgh with her being awarded a Fellowship in Dental Surgery. She has authored numerous papers published both in local and international journals. She was the Editor of the Malaysian Dental Journal for several years. Her main research interests are implant-soft tissue interface, zirconia implant, photofunctionalization, 3D-oral mucosal model and pulpal regeneration.",institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},editorTwo:{id:"479686",title:"Dr.",name:"Ghee Seong",middleName:null,surname:"Lim",slug:"ghee-seong-lim",fullName:"Ghee Seong Lim",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003ScjLZQAZ/Profile_Picture_2022-06-08T14:17:06.png",biography:"Assoc. Prof Dr. Lim Ghee Seong graduated with a Bachelor of Dental Surgery from University of Malaya, Kuala Lumpur in 2008. He then pursued his Master in Clinical Dentistry, specializing in Restorative Dentistry at Newcastle University, Newcastle, UK, where he graduated with distinction. He has also been awarded the International Training Fellowship (Restorative Dentistry) from the Royal College of Surgeons. His passion for teaching then led him to join the faculty of dentistry at University Malaya and he has since became a valuable lecturer and clinical specialist in the Department of Restorative Dentistry. He is currently the removable prosthodontic undergraduate year 3 coordinator, head of the undergraduate module on occlusion and a member of the multidisciplinary team for the TMD clinic. He has previous membership in the British Society for Restorative Dentistry, the Malaysian Association of Aesthetic Dentistry and he is currently a lifetime member of the Malaysian Association for Prosthodontics. Currently, he is also the examiner for the Restorative Specialty Membership Examinations, Royal College of Surgeons, England. He has authored and co-authored handful of both local and international journal articles. His main interest is in prosthodontics, dental material, TMD and regenerative dentistry.",institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:47,paginationItems:[{id:"82938",title:"Trauma from Occlusion: Practical Management Guidelines",doi:"10.5772/intechopen.105960",signatures:"Prashanth Shetty, Shweta Hegde, Shubham Chelkar, Rahul Chaturvedi, Shruti Pochhi, Aakanksha Shrivastava, Dudala Lakshmi, Shreya Mukherjee, Pankaj Bajaj and Shahzada Asif Raza",slug:"trauma-from-occlusion-practical-management-guidelines",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}},{id:"82654",title:"Atraumatic Restorative Treatment: More than a Minimally Invasive Approach?",doi:"10.5772/intechopen.105623",signatures:"Manal A. Ablal",slug:"atraumatic-restorative-treatment-more-than-a-minimally-invasive-approach",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Caries - The Selection of Restoration Methods and Restorative Materials",coverURL:"https://cdn.intechopen.com/books/images_new/11565.jpg",subseries:{id:"1",title:"Oral Health"}}},{id:"82608",title:"Early Management of Dental Trauma in the Era of COVID-19",doi:"10.5772/intechopen.105992",signatures:"Khairul Bariah Chi Adam, Haszelini Hassan, Pram Kumar Subramaniam, Izzati Nabilah Ismail, Nor Adilah Harun and Naziyah Shaban Mustafa",slug:"early-management-of-dental-trauma-in-the-era-of-covid-19",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}},{id:"82767",title:"Teeth Avulsion",doi:"10.5772/intechopen.105846",signatures:"Manal Abdalla Eltahir, Randa Fath Elrahman Ibrahim and Hanan Alharbi",slug:"teeth-avulsion",totalDownloads:20,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}}]},overviewPagePublishedBooks:{paginationCount:9,paginationItems:[{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}]},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. 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The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"chapter.detail",path:"/chapters/71760",hash:"",query:{},params:{id:"71760"},fullPath:"/chapters/71760",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()