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.
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We 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!
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.
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Throughout 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\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\n
We 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
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WSNs have found application in a vast range of different domains, scenarios and disciplines. These have included healthcare, defence and security, environmental monitoring and building/structural health monitoring. However, as a result of the broad array of pertinent applications, WSN researchers have also realised the application specificity of the domain; it is incredibly difficult, if not impossible, to find an application-independent solution to most WSN problems. Hence, research into WSNs dictates the adoption of an application-centric design process. This book is not intended to be a comprehensive review of all WSN applications and deployments to date. Instead, it is a collection of state-of-the-art research papers discussing current applications and deployment experiences, but also the communication and data processing technologies that are fundamental in further developing solutions to applications. Whilst a common foundation is retained through all chapters, this book contains a broad array of often differing interpretations, configurations and limitations of WSNs, and this highlights the diversity of this ever-changing research area. The chapters have been categorised into three distinct sections: applications and case studies, communication and networking, and information and data processing. 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\r\n\tCommunicable diseases that are common to humans and animals, zoonoses, are determined by biological, epidemiological, social, and economic factors that make them a serious and complex public health problem, difficult to tackle, especially in countries with low income. They can contribute to the deepening of the nations’ development problems, so it is necessary to know the relevant aspects of zoonotic diseases concerning their life cycle, transmission mechanisms, pathogenesis, epidemiological behavior, treatment, diagnosis, and health control programs.
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He is a full professor at the Faculty of Health Sciences, Department of Public Health, University of Carabobo, Valencia, Venezuela. 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1. Introduction
Corticosteroid replacement therapy in adrenal insufficiency namely glucocorticoids such as hydrocortisone serve as life sustaining therapy therefore its appropriate administration when stable or unwell is of vital importance. In this chapter we explore the indications and guidance for corticosteroid replacement therapies including management during special circumstances such as emergencies, pregnancy and breastfeeding. We also look at current novel therapies and look towards future perspectives on treatment therapies under research.
2. Overview
Adrenal insufficiency was first postulated by the physician Thomas Addison of Guy’s Hospital London in 1855. He characterized the condition of progressive anemia, bronze skin pigmentation and low blood pressure in disease of the ‘supra-renal capsules’ – now known as Addison’s disease [1]. This is a condition epitomized by insufficient production of steroid hormones from the adrenal cortex: primarily glucocorticoids from the zona fasiculata but can also affect mineralocorticoid and adrenal androgen production (from the zona glomerulosa and zona reticularis respectively).
It has historically carried a high mortality rate until the advent of therapeutic corticosteroid preparations in the mid-20th century. Life expectancy is generally considered normal with the application of appropriate replacement therapy but there is a growing body of evidence of highlighting increased morbidity and reduced life expectancy likely related to increased cardiovascular risk with hormonal over replacement and adrenal crises. Glucocorticoid administration is essentially life sustaining therapy; some patients will also require the co-administration of mineralocorticoids drugs and the adrenal androgen dehydroepiandrosterone (DHEA). The importance of replacement therapy is not only to starve off symptoms of hormone deficiency (including fatigue, muscle weakness, dizziness, weight loss, low mood, low libido) but also is imperative in maintaining key physiological processes (including gluconeogenesis, immune modulation, electrolyte balance, metabolism and haemodynamic modulation).
3. Conditions necessitating hormone replacement
Adrenal insufficiency requiring corticosteroid hormone replacement therapy is triggered by conditions or factors interrupting the normal function of the hypothalamic–pituitary–adrenal axis (HPA axis). Most causes are acquired in nature rather than congenital and can be divided into primary adrenal insufficiency (direct adrenal hormone synthesis dysfunction) and secondary adrenal insufficiency (inadequate ACTH production).
Hormone deficiency is a deficit deemed unable to meet the physiological demands of the body, most notably in response to stress. In deficiency states glucocorticoid replacement therapy is always required. However because mineralocorticoid and adrenal androgen production is only partially mediated by ACTH; replacement therapy of these hormones is not usually required in secondary adrenal insufficiency.
The most common cause of primary adrenal insufficiency in the developed world is autoimmune in nature – approximately 70% of cases [2] with antibodies present against the 21-hydroxylase enzyme.
Other notable causes of primary adrenal insufficiency include:
Notable causes of secondary adrenal insufficiency include:
Pituitary tumors
Hypothalamic/pituitary infections or inflammation (e.g. tuberculosis, lymphocytic hypophysititis)
Iatrogenic (e.g. post transpenoidal surgery, radiotherapy)
Isolated ACTH deficiency
Long term exogenous glucocorticoid therapy (causing suppression of HPA axis).
Corticosteroid replacement therapy is often required lifelong but, depending on the cause, therapy may be able to be safely withdrawn in future if adrenal function recovers.
4. Historical perspective
Early animal studies in 1930 proved bovine adrenal extracts could transiently treat symptoms of adrenal insufficiency. The later production of synthetic desoxycorticosterone acetate in 1938 was the major step in providing a therapeutic agent to successfully treat adrenal insufficiency. In 1950 commercial therapeutic use of hydrocortisone was established after recognition of cortisol as the key end product of adrenal cortex hormone synthesis [3]. To current day hydrocortisone therapy still remains the mainstay replacement therapeutic drug.
5. Assessing for glucocorticoid deficiency
Suspicion of glucocorticoid deficiency can be initially indicated by typical symptomology, hypotension and skin hyperpigmentation (in cases of primary adrenal insufficiency associated with excess ACTH production). Baseline biochemistry can often reveal a combination of hyponatraemia, hyperkalaemia or hypoglycaemia. Morning cortisol and ACTH levels are useful markers in preliminary testing with cortisol levels <140 nmol/L being indicative of deficiency. Elevated or low ACTH levels assist in defining primary vs. secondary adrenal insufficiency respectively (an ACTH level two-fold the upper reference range is consistent with primary adrenal insufficiency). There is no evidence to support the role of random cortisol levels to diagnose adrenal insufficiency [4].
A corticotropin (ACTH) stimulation test is considered the gold standard confirmatory test in primary adrenal insufficiency. Typically baseline cortisol and ACTH levels are taken followed by the administration of a 250 μg IV corticotropin bolus and further monitoring of cortisol levels at 30 minutes and/or 60 minutes. Acceptable cortisol levels indicating sufficient adrenal response remain controversial. Newer monoclonal antibody cortisol immunoassays (including Roche II Elecsys) display increased sensitivities and specificity, allowing for a diagnostic peak cortisol threshold of >400 nmol/L [5].
In cases of secondary adrenal insufficiency an insulin tolerance test – ITT (or insulin stress test) has proved to be more successful in detecting cortisol deficiency in comparison to corticotropin stimulation testing in studies [6]. In testing the aim is to induce extreme hypoglycaemia (<2.2 mmol/L) with the administration of (0.15 units/kg soluble insulin). In normal circumstances hypoglycaemia leads to hypersecretion of the insulin antagonizing hormones ACTH and growth hormone (GH) from the anterior pituitary gland; with a subsequent cortisol rise of <500 nmol/L is considered an inadequate response. It is a potentially harmful test and therefore should be undertaken with care. It is contraindicated in ischaemic heart disease, epilepsy and severe panhypopituitarism; in these circumstances glucagon is often used instead of insulin as the stress provocation agent. Notable scenarios for effective ITT utility include following borderline corticotropin stimulation testing and following recent pituitary surgery [7].
6. Glucocorticoid replacement
Human endogenous glucocorticoid release follows a circadian rhythm i.e. an internal process following a 24 hour cycle. There are also 60–90 minute ultradian oscillations during the day to consider. These processes are ultimately under the control of the hypothalamic suprachiasmatic nuclei (SCN) and subsequent corticotropin-releasing hormone (CRH) secretion that stimulates pituitary ACTH synthesis variably [8]. The circadian rhythm may be altered by changes to activity, aging, sleep and mood.
Typically in a 24 hour profile we see an early morning ACTH/cortisol peak with declining levels during the daytime until quiescence at midnight. There is then a brisk elevation during late sleep leading on to the early morning peak we see at the beginning of the cycle. It is this pattern that administered glucocorticoid therapy ideally attempts to recreate.
Hydrocortisone is the most commonly administered glucocorticoid therapeutic agent for adrenal insufficiency. Clinic data from the UK revealed 72% of patients were managed with hydrocortisone, 26% with prednisolone and 2% with modified release hydrocortisone [9]. Data from the European Adrenal Insufficiency Registry.
(EU-AIR) study additionally showed that over 80% of patients were on conventional hydrocortisone replacement therapy on enrolment [10].
In clinical practice the use of hydrocortisone or prednisolone are often preferable due to their more predictable pharmacokinetics compared to their precursor hormones cortisone and prednisone [9]. The normal functioning adrenal glands are thought to produce 5-10 mg cortisol per m2 body surface area/per day; this equates to an oral hydrocortisone dose of 15-25 mg/per day for an adult [11]. Due to its short half-life hydrocortisone is usually given in 2–3 divided doses with the largest dose in the morning and the last dose at least 4–6 hours prior to bedtime to avoid sleep disturbances. Prednisolone is a glucocorticoid analogue with a greater avidity for the glucocorticoid (GC) receptor. Studies have shown once daily prednisolone administration to be superior to thrice-daily hydrocortisone in imitating the physiological cortisol profile and reducing over replacement at a recommended dose of 3-5 mg daily [12]. Other potential benefits of prednisolone include cost-effectiveness and increased medication compliance although the comparative long-term metabolic side effect risk between hydrocortisone and once daily prednisolone remain controversial [13, 14, 15].
6.1 Novel glucocorticoid replacement therapies
Plenadren® is a novel modified-release form of hydrocortisone given European marketing authorization in November 2011. This once daily preparation contains both immediate-release and extended-release components with an aim to more closely mimic the body’s physiological circadian rhythm. It can be considered an alternative for patients who continue to feel unwell on conventional therapy, given typically at a dose of 15-25 mg daily. Evidence from 2 randomized-controlled trials (RCTs) has shown a reduction in CV disease risk parameters with modified release hydrocortisone compared to conventional therapy [9]. Though Plenadren® carries a significantly higher cost basis to the other traditional therapeutic glucocorticoid medications and carries a higher vulnerability to malabsorption during intercurrent gastrointestinal illness [16].
Chronocort® is another novel modified-release form of hydrocortisone with delayed absorption, taken at night with an aim to replicate the physiological early morning cortisol rise and circadian rhythm more closely. It has completed phase III trials for the use in adrenal insufficiency and congenital adrenal hyperplasia; currently awaiting licensing authorization in Europe.
Continuous subcutaneous hydrocortisone infusions (CSHI) were first used from 2007. These offer variable hydrocortisone delivery often through traditional ‘insulin pumps’ helping to replicate the circadian rhythm most accurately compared to oral therapies. This requires a high degree of patient education and autonomy. Those that can benefit include those patients poorly tolerant or responsive to tablets especially in light of gastric absorption issues. Studies using continuous infusions have shown better normalization of morning ACTH levels [3]. From minimal comparative studies there has been no consistent evidence of improvement in subjective health outcomes. One RCT showed a mild increase in weight and fasting glucose levels in patients on hydrocortisone infusions but it was felt likely attributable to supra-physiological hydrocortisone dosing (based on elevated urinary and salivary cortisol levels in comparison to the oral hydrocortisone group recipients).
The therapy remains uncommon in healthcare systems, potentially cumbersome and is best commenced by experienced endocrine units. The Endocrine Society 2016 guidance on management of primary adrenal insufficiency suggests reserving such treatment for patients encountering major difficulties on conventional therapy [4].
6.2 Mineralocorticoid replacement
Most patients with primary adrenal insufficiency will exhibit mineralocorticoid deficiency. As release is also under the control of the renin-angiotensin system (RAS) deficiencies can also be caused by reduced renin levels (hyporeninemic hypoaldosteronism) due to conditions including diabetic nephropathy, sickle cell anemia, myeloma and medications (e.g. NSAID, beta blockers, Ciclosporin).
Mineralocorticoids are important in circulatory homeostasis and salt balance. Deficiencies can lead to salt craving, postural hypotension, dizziness, hyponatraemia, hyperkalaemia and reduced cognition. To alleviate symptoms replacement therapy is typically met through the use of fludrocortisone and as well advice to increase dietary salt. The Endocrine Society 2016 guidance on management of primary adrenal insufficiency suggests a starting dose of fludrocortisone 50-100mcg in those with confirmed deficiency (assessed by way of plasma renin and aldosterone levels) [4]. Typically higher doses of replacement therapy are required for the more physically active and less sedentary patient cohorts [11].
6.3 Androgen replacement
Primary adrenal insufficiency can also affect adrenal androgen reserve. In women adrenal androgen precursors DHEA and androstenedione are major contributors to the physiological production of potent androgens and oestogen in the zona reticularis. Clinically deficiencies can lead to notable axillary and pubic hair loss.
The benefits of replacement therapy are not very clear. There is some evidence to suggest that health related quality of life markers can be improved with synthetic DHEA in patients with primary adrenal insufficiency [3]. The Endocrine Society notes that there is insufficient evidence to advocate routine androgen replacement therapy but suggests a 6 month trial of DHEA for women with ongoing symptoms of low libido, low mood and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement. A single DHEA dose of 25-50 mg in the morning can be considered in the first instance [4].
7. Glucocorticoids (dose titration and monitoring)
Signs of glucocorticoid under replacement may include development of lethargy, nausea, headaches, muscle aches, weight loss, increased skin pigmentation and hypotension. Biochemistry may reveal elevated potassium levels and reduced sodium levels. On the contrary signs of over replacement may include weight gain, facial puffiness, insomnia, and glucose intolerance. Longer term over replacement can lead to established hypertension, type 2 diabetes mellitus, osteoporosis and increased overall CV risk. Stability of replacement therapy is therefore of importance to achieve and optimal dosing will vary between individuals with differences including body composition, absorption, metabolism and protein binding.
The Endocrine Society recommends measuring the adequacy of replacement primarily with clinical assessment including weight, postural blood pressure, energy levels and signs of frank glucocorticoid excess. It is advised against routine hormonal monitoring, instead for titration of treatment based on clinical response. In cases where malabsorption is suspected further analysis with serum or salivary cortisol day curves are recommended as a guide for dosing [4] but there is a lack of reliable biomarkers for treatment monitoring and notably measured concentrations of ACTH are not a useful parameter [11, 17].
7.1 Mineralocorticoids (dose titration and monitoring)
Fludrocortisone under replacement is common and can be often seen compensated by supra-physiological glucocorticoid doses which puts patients at high risk for developing the subsequent metabolic sequelae associated with hypercortisolaemia. Signs of over replacement with fludrocortisone include hypertension and oedema. The Endocrine Society recommends reviewing replacement dosing clinically by assessing for salt craving, postural hypotension, oedema and blood electrolytes (aiming for normokalaemia). It is also advised the hypertension is initially managed by dose reduction following the addition of antihypertensive agents if necessary [4].
It is common to use plasma renin activity as a guide for appropriate Fludrocortisone replacement although the data to support its usefulness is limited. The ideal renin target levels lie in the upper reference range. Caution must be taken with interpretation as levels can be affected by variables such as body position, time of day and medications. Additionally liquorice and grapefruit potentiate the mineralocorticoid effects of hydrocortisone and should thus be avoided [4, 11].
7.2 Androgens (dose titration and monitoring)
Adequate replacement with DHEA may be noted by improved libido, mood and energy levels on assessment. The Endocrine Society recommends taking morning (pre-dose) DHEAS levels to guide treatment, aiming for levels in the mid-normal range [4]. Levels may be taken by saliva, serum or urine. There are however potential side effects of DHEA therapy related to androgen excess including hirsutism, acne, deepened voice and hair loss. Studies have shown some benefits to bone density, lean mass and psychological wellbeing scores [18].
8. Sick day rules, emergency advice and adrenal crises management
During periods of acute illness and physiological stress there are increased demands of cortisol production placed on the body. Glucocorticoid doses must be increased accordingly to match demands and prevent the onset of an adrenal crisis (commonly evidenced by hypotension, nausea, abdominal pain, reduced consciousness and electrolytes disturbances). Therefore in the presence of illness such as infection with fever, diarrhea/vomiting, significant trauma or significant psychological stress/bereavement; there is general consensus that glucocorticoid doses should be doubled for the duration of illness/antibiotic course (patients taking Plenadren® are best placed switching to hydrocortisone during these periods for better physiological cortisol profiling). Management of therapy is also of important consideration in the perioperative setting with general advice of giving hydrocortisone 100 mg IV or IM just prior to surgery or at anesthetic induction and weaning doses back to baseline during the recovery period as applicable. Fludrocortisone doses do not need to be routinely increased as hydrocortisone/prednisolone also convey mineralocorticoid receptor activity which is potentiated at higher doses due to saturation of 11β-hydroxysteroid dehydrogenase enzyme (this is not the case for dexamethasone which does not exert mineralocorticoid activity).
At diagnosis patients should be well educated in the sick day management of steroid therapy often provided through endocrine specialist nurses and reinforced through patient specific literature and leaflets. Patients should be provided with a supply of IM 100 mg hydrocortisone with counseling provided to patients and carers on its emergency use. In the event of severe illness and/or inability to tolerate oral glucocorticoids; stat IM 100 mg hydrocortisone should be given alongside contact to emergency medical services as these patients may require admission for parenteral hydrocortisone, fluids and stabilization. Further advice and support can be provided by specialist endocrine team and national support organizations such as The Pituitary Foundation and Addison’s Self-Help Group in the UK. Steroids emergency cards (Figure 1), bracelets and necklaces are increasingly commonplace in Europe. The Endocrine Society suggests that all patients with adrenal insufficiency carry medical alert identification so that medical personnel can be prompted to increase steroids doses to avert adrenal crises and to administer parenteral hydrocortisone immediately in emergency circumstances [4].
Figure 1.
Example of a European (UK) steroid emergency card (https://www.endocrinology.org/media/3873/steroid-card.pdf).
An adrenal crisis if a life threating scenario that requires prompt intervention. Data from the European Adrenal Insufficiency Registry has shown an incidence rate 7.94 adrenal crises per 100 patient years [19] which is consistent with rates seen in other studies [20]. There are no systematic dose–response studies for the appropriate dosing of hydrocortisone during a crisis therefore management is mostly undertaken on an empirical basis. Underdoing of therapy can be harmful therefore general guidance is to give 100 mg of parenteral hydrocortisone followed by a 200 mg/day infusion or 6 hourly 50 mg boluses alongside appropriate intravenous fluid resuscitation and treatment of the intercurrent illness. To prevent future crises it is important the preceding medical and behavioral factors are explored including medicine concordance and knowledge of sick day rules. It is also recommended that patients with adrenal insufficiency receive an annual influenza vaccine and pneumococcal vaccination above the age of 60, as well as continuing to alert healthcare staff of their steroid dependent status prior to procedures or in light of acute illness [4, 11].
9. Pregnancy and breast feeding
The diagnosis of primary adrenal insufficiency in pregnancy is a rare entity and is a challenge to diagnose due to a degree in overlap in symptomology. The corticotropin stimulation test remains the most appropriate and safe diagnostic tool. A higher minimum post stimulation cortisol is expected during pregnancy and from a small cohort study of healthy pregnant woman levels of 700 nmol/L, 800 nmol/L and 900 nmol/L have been suggested as diagnostic thresholds for the first, second and third trimesters respectively [4]. Timely diagnosis and management of this condition are imperative for reducing maternal/foetal morbidity and mortality.
There is a gradual increase of free cortisol levels during pregnancy with a significant influence of CRH secretion from the placenta peaking in the third trimester (up to 2–3 fold). There is also a notable increase in estrogen driven cortisol binding globulin levels. Therefore an increase in glucocorticoid dosing is expected during pregnancy; with a 20–40% dose increase often necessitated after the 24th week of gestation reflecting the physiological increased cortisol demand in pregnancy [21].
During pregnancy hydrocortisone is the preferable glucocorticoid replacement agent and dexamethasone is best avoided due to its lack of inactivation by 11β-hydroxysteroid dehydrogenase type 2 when traversing the placenta. Reviewing hormone replacement challenging but is best placed by assessing for signs/symptoms of over or under replacement including weight gain/distribution, fatigue, blood pressure and glycaemic control; with recommendation of at least one endocrine clinical review per trimester from The Endocrine Society [4]. Patient education and glucocorticoid self-adjustment in relation to sick days rules remain important in the gestational period and advice should be readily available from endocrine specialist teams.
Plasma renin activity is not a reliable measure in judging suitability of Fludrocortisone dosing due to physiological increments in plasma levels during pregnancy. Therefore assessment should include review for signs/symptoms of over or under replacement including weight gain, salt craving, blood pressure and excessive fluid retention. Progesterone has anti-mineralocorticoid effects therefore fludrocortisone doses often need to be increased in the third trimester [11]. However as hydrocortisone exhibits mineralocorticoid activity, an increased dose of hydrocortisone in the second/third trimesters may negate the need to increase the fludrocortisone dose [21].
A delivery care plan should be made in advance from the endocrinologists for the obstetricians. This should involve the administration of a 100 mg parenteral hydrocortisone bolus prior to the active stage of labour followed by 6 hourly 50 mg boluses or a continuous infusion. Cortisol requirements rapidly reduce post-delivery. Patients can be given doubled dosing of gestational hydrocortisone doses in the initial 24-48 hours post-delivery; with prompt down titration back to pre-pregnancy doses if clinically stable [11, 21].
Studies exploring medicines excretion into breastmilk and subsequent effects on infants are rare. Glucocorticoids are expressed in breast milk in minimal amounts and are unlikely to pose any significant harm to breast feeding infants. Therefore in most cases the benefits of replacement therapy will outweigh any potential risk. Greater caution should be employed in those taking high dose steroid therapy i.e. >160 mg daily hydrocortisone or > 40 mg daily prednisolone. In such cases infants should be monitored more closely for potential signs of adrenal suppression and consideration of delaying breast feeding until a few hours post dose administration to minimize exposure.
10. Dosing in special circumstances
There has been minimal clinical research into the effect of exercise or prolonged traveling on patients with adrenal insufficiency. A small randomized-control cross over trial with pre-exercise hydrocortisone revealed no discernable benefits (in metabolic, hormonal or QoL parameters) in short strenuous exercise compared to placebo [22]. Generally dose increments of hydrocortisone or fludrocortisone is not required in exercise regimens and patients should keep to the principles of warming-up, staying well hydrated and warming-down. However with very intense or prolonged exercise (e.g. marathons) or challenging environmental conditions (e.g. hot weather) increased doses may be warranted at 1.5 to 2 times usual dosing during duration of exercise [23, 24]. Patients are encouraged to take extra hydrocortisone with them (or their alternative glucocorticoid medications) when traveling abroad. On long haul flights greater than 12 hours a doubled dose of hydrocortisone is recommended on the day of the flight. Patients should also carry a letter from their endocrinologist with them to enable them to bring their emergency kit along with them. Severe psychological shock such as bereavement or a road traffic accident may also warrant short term doubling of hydrocortisone dosing.
Studies have confirmed changes in the diurnal cortisol pattern in shift workers [25]. Therefore with night shift workers medications should be taken in line with their current sleep–wake cycle with the first dose taken upon waking irrespective if this is in the evening time.
11. Drug interactions
Drugs such as carbamazepine, phenytoin, topiramate and rifampicin induce the hepatic CYP3A4 enzyme which increases cortisol metabolism; grapefruit juice also has a similar effect. Drugs such as ketoconazole, etomidate, abiraterone acetate and tyrosine kinase inhibitors are known to reduce steroidogenesis and lower cortisol levels. Liquorice ingestion can inhibit the 11β-hydroxysteroid dehydrogenase type 2 enzyme leading to cortisol led over-activation of renal mineralocorticoid receptors causing fluid retention, hypertension, hypokalaemia and metabolic alkalosis [11].
On the contrary antiretroviral drugs such as ritonavir are potent enzyme inhibitors and can commonly cause cushingoid features and adrenal suppression. Patients on any interfering medications may need titration of hormone replacement therapy and closer monitoring under endocrinologist review. Additionally it is important to note that those with combined adrenal insufficiency and hypothyroidism should receive glucocorticoid replacement therapy first as proceeding with thyroxine initially can increase cortisol metabolism and precipitate an adrenal crisis.
12. Future perspectives
Although hydrocortisone generally remains the cornerstone of adrenal insufficiency hormone replacement. There have been advancements in delivery modalities including modified released preparations (Plenadren®, Chronocort®) and continuous subcutaneous hydrocortisone infusions (CSHI) for which further comparative RCTs would be beneficial to further explore any benefits in metabolic and QoL parameters. Subcutaneous 100 mg hydrocortisone has also been shown to have similar pharmacokinetics and increased satisfaction rates in comparison to intramuscular delivery in a randomized crossover study [26] and therefore could be considered for increased adoption in emergencies circumstances.
Previously it was common place to manage Cushing’s disease with bilateral adrenalectomy with occasional deployment of adrenocortical tissue autotransplantation. This has shown variability in long term graft survival and degree of cortisol production [27, 28]. This is now no longer common practice with advancements in techniques in localizing and resecting autonomous corticotroph pituitary lesions. Successful allotransplantation has also been described to the level of individual case reports including simultaneous kidney-adrenal and kidney-adrenal-pancreas transplantation [29, 30] and a young girl with a successfully functioning intramuscular adrenal allograft at 3 years follow up [31]. Xenotransplantation has been explored in more recent research with good results in pre-clinical studies with transplanted adrenocortical cells displaying the ability to survive, become vascularized and to supersede the hosts’ organ in secreting sufficient cortisol levels [32].
There has been growing interest and understanding in the realms of the extraction and reprogramming of pluripotent stem cells (from human embryonic or somatic origins) towards obtaining adrenocortical resembling cells with steroidogenic properties as observed in several pre-clinical studies. Reprogramming can be achieved through the forced expression of steroidogenic factor 1 (SF1) allowing cells the maintained ability to secrete steroid hormones in response to physiological and pharmacological stimuli once transplanted into murine specimens [3]. Encapsulation devices with biocompatible semi-permeable membranes have shown efficacy in type 1 diabetic undergoing islet cell transplantation in sparing the need for immunosuppression [33] which should pave the way for preventing rejection (without need for immunosuppression) from transplantation of adrenocortical tissue regardless of original source. Further research and collaboration is required to translate these therapies into relevant clinical studies.
There are reports that 15–30% of patients can retain some corticosteroid production even years after diagnosis [11]. Individual studies have reviewed the ability to regenerate adrenal function with B-cell depleting therapy and tetracosactide therapy both in isolation and combined. There is some evidence of partial or full response and is an area which may warrant further research [34, 35, 36].
Gene therapy is another area of interest in regards to management of 21-hydroxylase deficiency. With the intravenous injection of an adenoviral-Cyp21a1 vector in murine studies have displayed a return to functioning enzyme production and steroidogenesis but the effects appear to be transient [37, 38, 39, 40]. It is yet to be seen whether these pre-clinical findings will translate into sustained and effective treatments in humans but is another area with potential for future considerations.
Acknowledgments
I would like to thank the endocrinology department at King’s College Hospital NHS Foundation Trust for all their hard work and ongoing support.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"Corticosteroids, Glucocorticoids, Hormone Replacement, Adrenal Crisis, Sick Day Rules, Novel Therapies",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/77380.pdf",chapterXML:"https://mts.intechopen.com/source/xml/77380.xml",downloadPdfUrl:"/chapter/pdf-download/77380",previewPdfUrl:"/chapter/pdf-preview/77380",totalDownloads:145,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,impactScore:0,impactScorePercentile:33,impactScoreQuartile:2,hasAltmetrics:0,dateSubmitted:"June 3rd 2021",dateReviewed:"June 9th 2021",datePrePublished:"July 1st 2021",datePublished:"November 24th 2021",dateFinished:"July 1st 2021",readingETA:"0",abstract:"The advent of synthetic corticosteroids in the 20th century provided a vital breakthrough in the management of adrenal insufficiency. In this chapter we review the main indications and guidance for appropriate hormone replacement and also look into the management of therapy during special circumstances. For decades hydrocortisone has remained the cornerstone for glucocorticoid replacement but we explore the alternatives including recently introduced modified-release drug preparations and the future treatment considerations currently undergoing research and pre-clinical trials.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/77380",risUrl:"/chapter/ris/77380",book:{id:"10716",slug:"corticosteroids-a-paradigmatic-drug-class"},signatures:"Michael C. Onyema",authors:[{id:"349089",title:"Dr.",name:"Michael",middleName:null,surname:"Onyema",fullName:"Michael Onyema",slug:"michael-onyema",email:"michael.onyema@nhs.net",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Overview",level:"1"},{id:"sec_3",title:"3. Conditions necessitating hormone replacement",level:"1"},{id:"sec_4",title:"4. Historical perspective",level:"1"},{id:"sec_5",title:"5. Assessing for glucocorticoid deficiency",level:"1"},{id:"sec_6",title:"6. Glucocorticoid replacement",level:"1"},{id:"sec_6_2",title:"6.1 Novel glucocorticoid replacement therapies",level:"2"},{id:"sec_7_2",title:"6.2 Mineralocorticoid replacement",level:"2"},{id:"sec_8_2",title:"6.3 Androgen replacement",level:"2"},{id:"sec_10",title:"7. Glucocorticoids (dose titration and monitoring)",level:"1"},{id:"sec_10_2",title:"7.1 Mineralocorticoids (dose titration and monitoring)",level:"2"},{id:"sec_11_2",title:"7.2 Androgens (dose titration and monitoring)",level:"2"},{id:"sec_13",title:"8. Sick day rules, emergency advice and adrenal crises management",level:"1"},{id:"sec_14",title:"9. Pregnancy and breast feeding",level:"1"},{id:"sec_15",title:"10. Dosing in special circumstances",level:"1"},{id:"sec_16",title:"11. Drug interactions",level:"1"},{id:"sec_17",title:"12. Future perspectives",level:"1"},{id:"sec_18",title:"Acknowledgments",level:"1"},{id:"sec_21",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Thomas-Addison [Internet]. 2018. Available from: https://www.encyclopedia.com/people/medicine/medicine-biographies/thomas-addison [Accessed: 2021-05-01]'},{id:"B2",body:'Wass J, et al. Oxford Handbook of Endocrinology and Diabetes. 2nd ed. Oxford University Press; 2014'},{id:"B3",body:'Liew S, Akker Sam Guasti L, Pittawy JFH. Glucocorticoid replacement therapies: past, present and future. Current Opinion in Endocrine and Metabolic Research. 2019;8:152-159'},{id:"B4",body:'Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, Husebye ES, Merke DP, Murad MH, Stratakis CA, Torpy DJ. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. 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Impact of shift work on the diurnal cortisol rhythm: a one-year longitudinal study in junior physicians. Journal of occupational medicine and toxicology. 2018;13,23'},{id:"B26",body:'Hahner S, Burger-Stritt S, Allolio B. Subcutaneous hydrocortisone administration for emergency use in adrenal insufficiency. European Journal of Endocrinology. 2013;169(2):147-154'},{id:"B27",body:'Hardy JD, Moore DO, Langford HG. Cushing\'s disease today. Late follow-up of 17 adrenalectomy patients with emphasis on eight with adrenal autotransplants. Annals of surgery. 1985;201(5):595-603'},{id:"B28",body:'Hardy JD. Surgical management of Cushing\'s syndrome with emphasis on adrenal autotransplantation. Annals of surgery. 1978;188(3):290-307'},{id:"B29",body:'Dubernard JM, Cloix P, Tajra LC, Alduglihan W, Borson F, Lefrançois N, Martin X. Simultaneous adrenal gland and kidney allotransplantation after synchronous bilateral renal cell carcinoma: a case report. Transplant Proc. 1995;27(1):1320-1321'},{id:"B30",body:'Vouillarmet J, Buron F, Houzard C, Carlier MC, Chauvet C, Brunet M, Thivolet C, Morelon E, Badet L. The first simultaneous kidney-adrenal gland-pancreas transplantation: outcome at 1 year. American Journal of Transplantation. 2013;13(7):1905-1909'},{id:"B31",body:'Grodstein E, Hardy MA, Goldstein MJ. A case of human intramuscular adrenal gland transplantation as a cure for chronic adrenal insufficiency. American Journal of Transplantation. 2010;10(2):431-433'},{id:"B32",body:'Ruiz-Babot G, Hadjidemetriou I, King PJ, Guasti L. New directions for the treatment of adrenal insufficiency. Frontiers in endocrinology. 2015;6,70'},{id:"B33",body:'Ludwig B, Reichel A, Steffen A, Zimerman B, Schally AV, Block NL, Colton CK, Ludwig S, Kersting S, Bonifacio E, Solimena M, Gendler Z, Rotem A, Barkai U, Bornstein SR. Transplantation of human islets without immunosuppression. Proc Natl Acad Sci USA. 2013;110(47):19054-19058'},{id:"B34",body:'Simon SHS, Mitchell AL, Bennett S, King P, Chandran S, Nag S, Chen S, Smith BR, Isaacs JD, Vaidya B: Adrenal Steroidogenesis after B Lymphocyte Depletion Therapy in New-Onset Addison\'s Disease. The Journal of Clinical Endocrinology & Metabolism. 2012;97(10):E1927–E1932'},{id:"B35",body:'Napier C, Gan EH, Mitchell AL, Gilligan LC, Rees DA, Moran C, Chatterjee K, Vaidya B, James RA, Mamoojee Y, Ashwell S, Arlt W, Pearce SHS. Residual Adrenal Function in Autoimmune Addison’s Disease—Effect of Dual Therapy With Rituximab and Depot Tetracosactide. The Journal of Clinical Endocrinology & Metabolism. 2020;105(4):e1250–e1259'},{id:"B36",body:'Gan EH, MacArthur K, Mitchell AL, Hughes BA, Perros P, Ball SG, James RA, Quinton R, Chen S, Furmaniak J, Arlt W, Pearce SH. Residual adrenal function in autoimmune Addison\'s disease: improvement after tetracosactide (ACTH1-24) treatment. The Journal of Clinical Endocrinology & Metabolism. 2014;99(1):111-118'},{id:"B37",body:'Tajima T, Okada T, Ma XM, Ramsey W, Bornstein S, Aguilera G. Restoration of adrenal steroidogenesis by adenovirus-mediated transfer of human cytochromeP450 21-hydroxylase into the adrenal gland of21-hydroxylase-deficient mice. Gene Therapy. 1999 Nov;6(11):1898-1903'},{id:"B38",body:'Perdomini M, Dos Santos C, Goumeaux C, Blouin V, Bougnères P. An AAVrh10-CAG-CYP21-HA vector allows persistent correction of 21-hydroxylase deficiency in a Cyp21-/- mouse model. Gene Therapy. 2017;24(5):275-281'},{id:"B39",body:'Markmann S, De BP, Reid J, Jose CL, Rosenberg JB, Leopold PL, Kaminsky SM, Sondhi D, Pagovich O, Crystal RG. Biology of the Adrenal Gland Cortex Obviates Effective Use of Adeno-Associated Virus Vectors to Treat Hereditary Adrenal Disorders. Human Gene Therapy. 2018;29(4):403-412'},{id:"B40",body:'Naiki Y, Miyado M, Horikawa R, Katsumata N, Onodera M, Pang S, Ogata T, Fukami M. Extra-adrenal induction of Cyp21a1 ameliorates systemic steroid metabolism in a mouse model of congenital adrenal hyperplasia. Endocrine Journal. 2016;63(10):897-904'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Michael C. Onyema",address:"michael.onyema@nhs.net",affiliation:'
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1. Introduction
Food is the most basic need for survival, growth, and good health of human beings. Freedom from hunger is the most fundamental human right that can be attained if an individual is food secure [1]. However, a significant proportion of the world’s population still lives under the situation of food insecurity. As it is clear from the FAO et al. [2] report on the state of food and nutrition in the world, even the prospect itself is not sufficiently bright to the extent expected. Five years after the world committed to ending hunger, it has been learned that, the world is still off track to achieve this objective by 2030. Given the current pace, the world is making headway neither towards Sustainable Development Goal target 2.1, of ensuring access to safe, nutritious and sufficient food for all people all year round, nor towards target 2.2, of ending all forms of malnutrition [2].
Looking at the trends and projections of the state of global food insecurity may help to understand this claim. According to the same report, the number of undernourished people was 690 million in 2019 (60 million more than in 2014), and is expected to exceed 840 million in 2030. When it comes to Africa, the continent’s share of undernourishment prevalence for 2019 exceeds one-third of global undernourishment with about 250 million undernourished people. This figure represents about 19% of its overall population and is projected to be about26% in 2030 [2].
Various reports show that Ethiopia hosts a handful proportion of food insecure people. For instance, WFP and CSA [3] report the persistence of poverty and food insecurity despite the country’s efforts to counteract the situation. MOFED [4] reported a level of food poverty prevalence of 33.6% in 2014 versus 31.8% in 2012/13. However, Ethiopia is moving in a good direction to improve the situation. A joint report of WFP and CSA [5], showed that the country has made tremendous socio-economic progress that resulted in the reduction of the prevalence of hunger and undernourishment to 25.5%. Nevertheless, the country still embraces a noticeable level of food-insecure people.
Response mechanisms to food insecurity shocks varies based on the objectives of the agents responding to it as well as the level at which they are targeted. As active actors/agents/of their own, households employ various coping strategies (response mechanisms) in the event of shocks that challenge their food security. According to Maxwell and Caldwell [6], USAID [7], and Degefa [8], such strategies are not uniform and may also not be equally sustainable, as in some cases they may erode household’s capacity to withstand future food insecurity shocks. Although, effects of households’ coping mechanisms and resilience to future shocks have been widely discussed, mainly at the conceptual level, empirical statistical evidences on the nexus are quite limited.
For instance, though Carter et al. [9] provide elegant theoretical explanation on the linkage between shock-initiated coping mechanisms and a household’s resilience, the unavailability of data on coping strategies constrains them from including this variable in their estimation model. The study of Tran [10] fails to make the distinction between positive and negative coping at the empirical level and focuses only on the immediate positive effects to recover from shocks. However, a particular coping strategy, though resilience erosive, can contribute to smooth current consumption and/or recovery from shocks. Moreover, capturing resilience only through the recovery speed proxy is also too simplistic. Thus, there is an increasing understanding of resilience as an ex ante capacity of households to withstand the effect of shocks [11, 12, 13, 14, 15, 16]. This way of conceptualizing enables to better capture the essence of resilience as absorptive (buffering), adaptive, as well as transformative capacity in addition to recognizing a futuristic nature. Considering this scenario, this chapter brings forward the linkage between resilience and coping mechanisms, focusing on Boricha woreda as a case study. For that, the following interrelated questions are discussed: (1) how do the study area’s households respond to food insecurity shocks? (2) does the resilience level of households vary based on the nature of previously employed coping mechanisms?
2. Linkage between household’s resilience to food insecurity and coping mechanisms
Maxwell and Caldwell [6] identify four coping strategies that households employ when they face food shortages or do not have the resources to purchase food. They include taking action on the quality of food to eat, looking for options that help increase food supply, reducing the number of household members that they have to feed through such mechanisms like sending some of them to neighbors’ houses, and managing the deficit through mechanisms such as food rationing. Conceptually, these strategies are consumption-based ones having a lesser impact on the households’ capacity to cope with future food insecurity shocks.
Carter et al. [9] put the households’ actions to cope with shock-induced food security challenges in a certain rational decision-based logical order. As per this source, initially households choose to depend on the markets and other institutions that they have access to. To maintain their consumption standard without further asset depletion, households with financial market access or access to informal finance might borrow against future earnings. Resorting to insurance arrangements, seeking for and receiving disaster aid as well as working for long hours are also coping options that they can exercise before taking action against their productive assets. Households without access to such options may opt to sustain their consumption by drawing down on their assets: the decision which they argue can further increase the sensitivity of assets and weaken the future. Finally, households may cope by reducing consumption. This coping strategy can be the last option for those lacking other assets or options and may also be pursued by households who are reluctant to increase their future vulnerability due to depletion of the stock of assets. However, coping by reducing consumption is regarded unfavorably as it does have multiple costs, i.e., immediate hunger as well as the long-term effect on children’s growth and development [17].
To the linkage between coping mechanisms and shocks, it is postulated that adverse events (shocks) may cause a decline in assets and incomes in the short-run and might have negative effects on household livelihoods in the longer-run [10]. However, the extent of the effects, depends on the nature of the shocks, the asset dynamics, as well as on the coping strategies employed. Carter et al. [9] opine that when a given shock happens, it will have both direct and indirect impact on households’ resilience to future shocks. Firstly, the shock itself brings direct harm to the quality of households’ asset. As households’ respond to shocks using their assets and resources, the indirect impact comes via such responses to a particular shock. The whole idea here is that the coping mechanisms used in response to food insecurity-related shocks at a given point can cause a decline in the household’s ability to cope with future shocks depending on the strategies employed in between two time periods.
The origin of the concept of resilience is linked to the field of ecology. According to Holling [18], in ecology, the term resilience is used as a measure of systems persistence and capacity to absorb changes and disturbances and still retain the same relationship with state variables. To a household’s food security, resilience has been conceptualized as the ability of the household to maintain its food security withstanding shocks and stresses, depending on the options available and its ability to handle risks [11]. Accordingly, resilience is a multifaceted capacity: absorptive, adaptive, and transformative. While explaining the linkage between the nature of coping strategies and resilience, Frankenberger et al. [19] sustain those certain strategies may have negative and permanent consequences to resilience. Positive coping strategies are those based on available skills and resources, to face, manage and recover from shocks and that do not compromise resilience. On the other hand, negative coping strategies, if employed, undermine future options making it more difficult to cope with the next shock or stress [20]. Hence, it can be argued that the resilience status of a household at a particular time point (resilience to future food insecurity shocks) is partly a reflection of the type of coping strategies previously employed. Figure 1 represents this conceptualization.
Figure 1.
Conceptual representation of food insecurity shocks-coping strategies-resilience nexus.
3. Illustrative case
3.1 Description of the study area
The illustrative case is based on the data collected from one of the food-stressed woredas from the Sidama National Regional State called Boricha woreda. As per the CSA [21] report, Boricha woreda has a total population of 250,260 inhabitants, of whom 125,524 are men and 124,736 women. Yirba is the administrative capital. The area has two rain periods a year: the short rainy months (the belg rain-from March to May) and the long rainy months (the kiremnt rain from June to October). The remaining months constitute the dry season when both humans and animals face water shortages. Besides that, Boricha woreda is known for unreliable rainfall patterns (both in amount and periodicity) for a couple of years and associated food stresses. Mixed subsistence agriculture supports the livelihood of the population. Enset and maize are the two dominant food crops grown at the household level. Khat, coffee, and livestock are also part of the household’s economy in the area through their concentration is not uniform across all kebeles. Complete dependence on rain-fed farming for subsistence together with rainfall variability exposes people to high risks of harvest loss that easily translates into food insecurity [22]. There are 39 kebeles (the lowest administrative unit) in Boricha woreda. Of these, three are urban and 36 are rural. According to SNNPR [23] livelihood profile report, these Kebeles are classified into three livelihood zones: Sidama Coffee Livelihood, Sidama Maiz Belt Livelihood, and Agro-pastoralist Livelihood.
3.2 Methodological briefing
Based on insights from literature and the resulting framework presented in Figure 1, it was assumed that the coping strategies employed by households in response to food insecurity shocks that happened at time (T0), can have an influence on the resilience level at a time (T1) in a way that households with negative coping strategies at T0scoreless on resilience at T1. As the households’ coping mechanisms are the response actions to shocks, data can be captured usually ex post (or retroactively). Accordingly, the linkage between the level of resilience and household coping mechanisms was examined based on surveys before time T1 in response to various stressors/shocks challenging their food security situation. Conceptually, the study examined the relationship between the nature of coping mechanisms employed at time (T0) and the resilience status of households at the time (T1), the proxy of households’ capacity to effectively respond to future food insecurity shocks.
The selection of the illustrative study was based on a cross-sectional survey conducted by using structured questionnaires and key informants’ interviews. It involved 420 randomly selected households from three randomly selected kebeles (one kebele from each livelihood zone). As resilience is a multi-dimensional concept that is not directly observable, it has to be measured through a proxy. To this end, the study adopted the FAO’s Resilience Index Measurement Analysis Model (RIMA) originally proposed and used by [11, 12]. The model quantitatively assesses household resilience through latent variable modeling. Accordingly, in the study, resilience was treated as a latent variable to be estimated by using seven indicators (dimensions): agricultural assets, agricultural technology adoption, access to basic services, social capital, social safety nets, adaptive capacity, income and food access. Each of these seven indicators of resilience is a latent variable to be estimated using observable household-level variables. Using the Principal Component Analysis (PCA), the estimation of resilience score (index) was done hierarchically. First, an index for each of the above dimensions of resilience was done separately using observable variables. Then, the resilience score for each household was estimated with PCA based on the indices of those resilience dimensions (indicators) (see Figure 2). All the seven indicator variables were strongly loaded on the first component and the component scores were used as resilience index for each household. The following path diagram (Figure 2) has been adapted from [12], in order to visually depict this estimation procedure.
Figure 2.
Household’s resilience estimation procedure.
At the household level, the resilience index was estimated using the Eq. (1) below, which was further transformed using the weighting mechanisms and applying the Bartlett method of component scoring. The Bartlett method was selected as it generally produces latent variable scores that are unbiased and univocal [24].
Ri = resilience of household i, AAi = agricultural assets, ATAi = agricultural technology adoption, ABSi =access to basic services, SCi = social capital, SSi = social safety nets, ACi = adaptive capacity, IFAi = income and food access, w= Weight for each indicator of resilience.
The surveys to analyze the coping mechanisms measurements included two sets of questions: consumption-based (strategies employed in the last 7 days before the date of the survey) and non-consumption based (strategies used in the last 2 years preceding the survey date). The analysis of data on coping strategies was done descriptively using percentages. The linkage between households’ resilience and the previously employed coping mechanisms was examined using contingency table and chi-square tests as well as using the odds ratio. In the analysis, households were categorized into two groups: those who previously employed negative (resilience erosive) coping mechanisms and those who did not employ such coping strategies over the past 2 years. In the current study, such categorization was done based on insights from conceptual literature such as [7, 19]. Hence, based on these conceptual works, coping strategies such as selling of reproductive animals, oxen used for farming, and land, land rental, withdrawal of children from school, borrowing money at the high interest rate, and diversion of loans from MFIs were treated as resilience erosive or negative strategies. Accordingly, households who did use any of these coping strategies over the past 2 years were classified under the negative coping category. Based on Guyu and Muluneh [15] and considering the relative location of the surveyed households on the latent variables (resilience scores,) the study households were categorized into resilient and none- resilient groups.
4. Findings and discussion
4.1 Coping strategies adapted
Literature indicates that the response of households to food insecurity challenges include different coping strategies. These may involve the modification of consumption habits (consumption-based coping strategies) and/or use of the available resources (non-consumption-based strategies). For instance, Christiaensen and Boisvert [25] contend that when they anticipate food shortage people start to consider changing their consumption habits rather than waiting until food is completely exhausted. Though such change in the consumption habits is generally believed to be a short-term adjustments, it could go long as a normal habit even in the situation where non-consumption-based strategies too are activated. This is mainly true in the situation where a given community lives under long standing food stress in terms of availability and/or access. The point here is that though non-consumption-based strategies such as selling key productive assets are used, foods obtained through such actions could still be subject to consumption-based coping such as rationing. This can lead us to safely argue that the two sets of coping strategies, consumption and non-consumption based, should not be seen as completely isolated and mutually exclusive as they appear in the literature. Notwithstanding the complexity here, the analysis of the household’s coping strategies was done in light of the general assumption that households are rational decision-makers and thus, the first options are those with the least impact on livelihood or future food security.
Consumption-based coping strategies constitute short-term alteration of consumption patterns. Writers like Watts [26], Corbett [27], and Devereux [28] consider them as easily reversible strategies that do not jeopardize long-term prospects as they mostly do not require a commitment of domestic resources. The households’ responses summary (Table 1) indicates that 60.2% (253) of the households rely on less preferred foods at least once in a week. 45.5% (191) reported that the consumption of adults was restricted in favor of children. According to one of the elderly key informants “during food shortage, usually mothers take the burden of not having to eat giving priority to children and father”. Similarly, a total of 181 (43%) and 141 (33.6%) households limited portion sizes and reduced the number of meals. The proportion of households who reported that they borrowed food or relied on the help from a friend/relative and purchased food on credit was 39.5% (166) and 32.4% (136), respectively. All the remaining coping strategies summarized in Table 1 were utilized by a small proportion of the households. Only 7.6% (32) of the surveyed households indicated that they relied on wild foods and/or immature crops. Probably, this could be due to the timing of the survey, as it was conducted just after the harvesting period (dry season). Similarly, only a small number of households, 17.9% (75), gave priority to working members at the expense of non-working members, and only 1.7% (7) fastens the entire day. Again, a relatively small proportion of total households, 13.6% (57), consumed seed stocks held for the next season at least once a week. The proportion of households who engaged in the coping behavior of sending family members to eat elsewhere and begging was12.1% (51) and 2.6% (11), respectively. Such findings could be because the experienced level of food insecurity might not be of the extent that forces households to engage in such behaviors or due to the strong local culture that discourages such practices.
Coping strategy
Number/proportion of households employed
Count
Percentage (%)
Relied on less preferred foods
253
60.2
Borrowed food or relied on help from a friend/relative
166
39.5
Purchased food on credit
136
32.4
Relied on wild foods, hunt, or immature crops
32
7.6
Consume seed stock held for next season
57
13.6
Household members sent to eat else where
51
12.1
Household members sent to beg
11
2.6
Portion size at mealtimes limited
181
43
Consumption by adults restricted in order for small children
191
45.5
Priority given for working members of household at the expense of non-working members
75
17.9
Meals eaten in a day reduced
141
33.6
Entire days skipped without eating
7
1.7
Table 1.
Consumption based coping strategies.
Complementary and non-consumption-based coping strategies (Table 2) included, selling reproductive animals at least once within the last 2 years period (42.6%), and renting (10%) or selling (2.1%) their lands (10%). About 20.7% (87) and 21% (88) of the households had removed their children from school and borrowed money at high-interest rates respectively. A total of 37.6% (158) households reported that they coped by selling small animals and about 19% (80) migrated to nearer areas in search of wage labor. Almost none, 1.9% (8), of the households had engaged in the coping behavior of diverting loans from Monetary Financial Institutions (MFIs) to consumption and only 4.8% (20) households had drawn on financial savings to respond to the food insecurity problem. This could be due to a lack of cash savings to draw from and/or limited access to MFIs both of which are common in the rural context. Nearly half, 51.7% (217), reported that they have appealed for food aid to overcome food insecurity within the last 2 years. One-third of the households, 33.3% (140), reported that they used selling firewood as a coping mechanism (see Figure 3).
Coping strategies
Number of households adopted
Count
Percentage (%)
Sold reproductive animals
179
42.6
Sold oxen used for farming
98
23.3
Sold land
9
2.1
Rented out land
42
10
Removed children from school
87
20.7
Borrowed money at high interest rate
88
21
Sold small animals
158
37.6
Migrated to nearer areas to wage labor
80
19
Drawing on savings
20
4.8
Selling fire wood
140
33.3
Diverting loans from MFIs to consumption
8
1.9
Appealed for aid
217
51.7
Table 2.
Non-consumption based coping strategies used by households.
Figure 3
Household members taking fire woods collected form forests to market centers.
According to the key informants, they collect fire wood from the forest around Bilate River towards the border of Loka Abaya woreda and supply to Dila Anole and Balela towns. From our discussions, we further learned that due to persistent food stress, poor people have made collecting and selling fire wood as a regular source of income for food purchase. However, the issue of concern exists. That is, if left unchecked, such a heavily reliance on forests could wipe out the only left over of the ancient forests in the area. Almost all elderly key informants stressed that in the past most of the woreda had been covered by dense forests that hosted many wild animals until the downfall of the emperor regime. But, the increasingly growing demand for farm land since then has resulted in the clearance of forests to its demise.
4.2 Relationship between previously employed coping mechanisms and resilience status (level) of the households
As referred above, several authors such as Frankenberger et al. [19], Carter et al. [9], Tran [10], and USAID [7], pinpoint that the types of coping mechanisms employed by households in response to previously happened shocks can affect their resilience to future shocks.
Based on these conceptual backdrops, we have endeavored to understand how the previously used coping strategies of households relate to their resilience status. To this end, households were asked if they experienced one or more shocks challenging their food security situation in the last 2 years preceding the survey and the responses are summarized in Table 3. Most of the surveyed households, 79.3% (333), experienced one or more types of shocks that they believe affected their food security situation. Households have also identified a set of coping strategies employed in the past 2 years to cope with food insecurity problems/shocks (Table 2).
Variables
Response
Count
Percentage (%)
If shocks affecting ability to feed HHs occurred within the last 2 years
List of shocks include crop failure, household member death, livestock death, and illness.
When it comes to identifying negative coping strategies (erosive resilience), it seems that literatures lack perfect unanimity. With the argument that they undermine future options making it more difficult to cope with next shocks, Pasteur [20] considers strategies such as delaying medical treatment, exploiting natural resources, taking children out of school, eating less, eating less nutritious food, and eroding productive assets as resilience erosive coping strategies. However, some of the strategies considered as negative coping here are consumption-based (temporary adjustments on eating) that are considered by others as easily reversible. Specially, stage 2 and stage 3 coping strategies from the list identified by Watts [26] and Frankenberger [29] are generally treated as erosive coping mechanisms. Based on the literature and on study area’s context, selling reproductive animals, oxen, and land, or renting land, taking children from school, borrowing money at high-interest rates, and diversion of loans from MFIs to consumption were considered as negative (resilience erosive) coping in this illustrative case. Accordingly, households were classified into two coping categories (Table 4): those who used negative coping in the past 2 years and those who did not. As indicated in the table, 59.5% (250) of the households employed one or more negative (erosive) coping strategies in the last 2 years preceding the date of the survey.
Frequency
Percent
Valid percent
Cumulative percent
Valid
Non resilience erosive (positive) coping
170
40.5%
40.5%
40.5%
Resilience erosive (negative) coping
250
59.5%
59.5%
100.0
Total
420
100.0
100.0
Table 4.
Households by coping type.
The households’ resilience position (status) was determined based on their relative resilience scores and using the criteria of [15]. Based on relative resilience score (index) achieved by households, Guyu and Muluneh [15] classify four resilience categories: Vulnerable (resilience index (RI) < 0.100). Moderately Resilient (0.100 ≤ RI < 0.250), Resilient (0.250 ≤ RI < 0.500) and Highly Resilient (RI ≥ 0.500). Using the resilience scores estimated through the Bartlett method in PCA and applying these cutoff schemes, households are categorized into four categories (Table 5). A very significant proportion of the surveyed households (61%) was not resilient (or vulnerable to food insecurity shocks) and only 39% was resilient at different levels. With these pieces of information on the nature of previously employed coping and resilience status, now the discussion turns to examine the relationship between the nature of coping mechanisms and the relative resilience position (status) of the households. Our analysis proceeds with the proposition that the nature of previously used coping strategies can affect the predictive resilience of households (estimated at time T1) in the form that those with prior negative coping strategies scoreless on resilience. Contingency Table and chi-square test statistic, and the odds ratio were employed to analyze and test this proposed relationship of the two variables. Table 6 presents cross-tabulation of previously employed coping types and households’ resilience levels. About 59.5% (250) of the households used one or more types of erosive resilience (negative) coping strategies within the last 2 years. From this group, only 19.6% (49) was found to be resilient (scoring relatively high on resilience index) at time T1 (time of the survey). Most households, 80.4% (201), that adapted one or more negative coping strategies were found to be non-resilient. On the other hand, out of the total households who did not previously use negative coping strategies, 67.6% (115) was found to be resilient at time T1 (scoring relatively high on resilience index) against 32.4% (55) scoring relatively low on resilience (non-resilient).
Measurement
Households by resilience category
Total
Non resilient
Moderately resilient
Resilient
Highly resilient
Count
256
22
18
124
420
Percent
61%
5.2%
4.3%
29.5%
100
Table 5.
Distribution of household resilience status.
Coping type
Total
Non-resilience erosive (positive coping)
Resilience erosive (negative coping)
Resilience level
Resilient
Count
115
49
164
% within resilience level
70.1%
29.9%
100.0%
% within coping type
67.6%
19.6%
39.0%
% of Total
27.4%
11.7%
39.0%
Non-resilient
Count
55
201
256
% within resilience level
21.5%
78.5%
100.0%
% within coping type
32.4%
80.4%
61.0%
% of Total
13.1%
47.9%
61.0%
Total
Count
170
250
420
% within resilience level
40.5%
59.5%
100.0%
% within coping type
100.0%
100.0%
100.0%
% of Total
40.5%
59.5%
100.0%
Table 6.
Cross-tabulation of households’ resilience level and previously used coping strategy.
The Chi-Square test was run as a way of checking if the observed frequency (or percentage) differences in the contingency table (Table 6) were statistically significant. In statistical terms, it tests the implicit null hypothesis that there is no relationship between types/nature of previously employed coping strategies and the resilience status of the households. That is, it tests the hypothesis that the household’s resilience score (status) at time T1 is independent of types of coping methods employed by a household in response to shocks that occurred before time T1. The result of the Chi-Square test (Table 7) revealed high significance for χ2 (1) = 98.149, P < 0.001 indicating an association between household’s resilience status and types of previously employed coping strategies. Besides the association between these two variables, it does not show the strength of the relationship that has been detected. Therefore, the Phi test for 2 by 2 contingency table, was also performed [30] giving a noticeable level of association between the household’s resilience level and types of coping strategies previously employed (Table 8). The sign of the relationship is also as expected as the two variables were coded similarly.
Tests of association between resilience status and coping type.
0 cells (0.0%) have expected count less than 5. The minimum expected count is 66.38.
Computed only for a 2 × 2 table.
Value
Approx. sig.
Exact sig.
Nominal by Nominal
Phi
0.483
0.000
0.000
N of valid cases
420
Table 8.
Test of the strength of association (resilience level and coping type).
Not assuming the null hypothesis.
Using the asymptotic standard error assuming the null hypothesis.
Both association (Chi-Square) and strength of association (Phi test) tests highlighted the existence of meaningful relationships between the two variables under consideration. To further check the strength of association between the two variables the odds ratio was used as a supplement to the Phi test. The odds ratio here refers to the ratio of the odds that a household will be resilient to future shocks with no prior use of negative coping strategies to the odds that a household will be resilient through it previously used some kind of negative coping strategies. Based on frequencies in Table 6, the odds ratio was computed as:
Oddsratio=Odds of being resilient withnoprioruseof negative coping÷Odds of being resilient with prioruseof negative copingE2
Odds of being resilient withnoprioruseof negative coping=Number of resilient householdswhodidn’tusenegative coping÷Number of nonresilient householdswhodidnotusenegative coping=115÷55=2.0909E3
This ratio shows that the number of households who are resilient with no prior use of negative coping is as twice as those who are non-resilient though they did not employ negative (erosive) coping before. It is also possible to be resilient or non-resilient to future shocks without prior negative (erosive) coping. However, it is more likely to be resilient than non-resilient given the initial state (previous experience in terms of coping type) is that of no negative (erosive) coping strategy.
Odds of being resilient with prior use of negative coping=Number of resilient households who did use negative coping÷Number of nonresilient households who did use negative coping=49/201=0.24378E4
The ratio here shows that the number of resilient households experiencing previous negative coping is about four times less than the number of non-resilient households.
Given the two pieces of information (odds ratios presented above) and referring to the first equation, the odds ratio of interest here (the odds that a household will be resilient to future shocks with no prior use of negative coping strategies to the odds that a household will be resilient through it previously used some kind of negative coping strategies) can be computed as follows:
Oddsratio=2.09090÷0.24378=8.57E5
The odds ratio indicates that households who did not previously use negative coping strategies were 8.57 times more likely to be resilient to future shocks. So, the clear implication of this finding is that the type of coping mechanisms used in response to given food insecurity-related shocks at a particular point in time can have an impact on households’ ability to respond to the upcoming shocks. This finding is in line with the Chi-Square test result above and the extant theoretical literature discussed in the chapter.
5. Conclusion
Depending on the initial state of the households, some of the coping strategies can lead to the poverty trap and erode the ability to cope with similar problems in the future. If left uncontrolled, even the coping mechanisms with no immediate individual impact, like selling firewood, may not be environmentally sustainable. This is especially true in the case of the study area as the source of firewood collection is, mostly, the single leftover of the ancient forest, which is confined to marginal areas around the Billate River. Additionally, the coping mechanisms utilized currently by the households can have important implications on their capacity to cope with future shocks, depending on their resource base. Hence, well-targeted interventions that go beyond saving lives (humanitarian emergency) and focusing on livelihood assets protection and capacity building to future shocks is the recommended policy option.
\n',keywords:"households, coping strategy, resilience",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/80749.pdf",chapterXML:"https://mts.intechopen.com/source/xml/80749.xml",downloadPdfUrl:"/chapter/pdf-download/80749",previewPdfUrl:"/chapter/pdf-preview/80749",totalDownloads:47,totalViews:0,totalCrossrefCites:0,dateSubmitted:"August 9th 2021",dateReviewed:"January 11th 2022",datePrePublished:"March 6th 2022",datePublished:null,dateFinished:"March 6th 2022",readingETA:"0",abstract:"This chapter reports on the coping strategies employed by households in the event of food insecurity shocks and the nexus between the types of coping strategies and resilience to food insecurity in one of the food-stressed woreda from Sidama National Regional State, Ethiopia. The households use various consumption-based coping strategies that run from compromising the quality of food-to-food rationing. Repeatedly occurring food shortage has also forced some households to employ resilience erosive coping mechanisms such as selling reproductive assets. Such coping strategies have an important implication on the household’s capacity to cope with the future food insecurity-related shocks, with a statistically significant relationship between the nature of coping strategies utilized in response to previous food insecurity-related shocks and the household’s resilience to upcoming shocks. Coordinating crises management based on humanitarian intervention with households’ livelihood assets protection and resilience strengthening is the major policy implication of this study.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/80749",risUrl:"/chapter/ris/80749",signatures:"Adane Atara Debessa, Degefa Tolossa and Berhanu Denu",book:{id:"10897",type:"book",title:"Food Systems Resilience",subtitle:null,fullTitle:"Food Systems Resilience",slug:null,publishedDate:null,bookSignature:"Dr. Ana I. Ribeiro-Barros, Prof. Daniel Tevera, Dr. Luis F. Goulao and Dr. Lucas Daniel Tivana",coverURL:"https://cdn.intechopen.com/books/images_new/10897.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-004-6",printIsbn:"978-1-80355-003-9",pdfIsbn:"978-1-80355-005-3",isAvailableForWebshopOrdering:!0,editors:[{id:"171036",title:"Dr.",name:"Ana I.",middleName:null,surname:"Ribeiro-Barros",slug:"ana-i.-ribeiro-barros",fullName:"Ana I. Ribeiro-Barros"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Linkage between household’s resilience to food insecurity and coping mechanisms",level:"1"},{id:"sec_3",title:"3. Illustrative case",level:"1"},{id:"sec_3_2",title:"3.1 Description of the study area",level:"2"},{id:"sec_4_2",title:"3.2 Methodological briefing",level:"2"},{id:"sec_6",title:"4. Findings and discussion",level:"1"},{id:"sec_6_2",title:"4.1 Coping strategies adapted",level:"2"},{id:"sec_7_2",title:"4.2 Relationship between previously employed coping mechanisms and resilience status (level) of the households",level:"2"},{id:"sec_9",title:"5. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Ngongi AM. Food Insecurity and Coping Strategies of Farm Households in Kahama District. Tanzania; 2013. Available from: http://suaire.suanet.ac.tz/bitstream/handle/123456789/581/ANNA%20MARCO%20NGONGI.pdf?sequence=1&isAllowed=y'},{id:"B2",body:'FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in the World 2020. Transforming Food Systems for Affordable Healthy Diets. Rome: FAO; 2020. DOI: 10.4060/ca9692en'},{id:"B3",body:'WFP and CSA. Comprehensive Food Security and Vulnerability Analysis (CFSVA): A Joint Publication between the Ethiopia Central Statistical Agency (CSA) and the World Food Program (WFP). 2014'},{id:"B4",body:'MOFED. 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Goats before ploughs: Dilemmas of household response sequencing during food shortages. IDS Bulletin. 1993;24(2):52-59'},{id:"B29",body:'Frankenberger T. Household food security: A conceptual review. In: Maxwell S, Frankenberger T, editors. Household Food Security: Concepts, Indicators, Measurements: A Technical Review. New York and Rome: UNICEF and IFAD; 1992'},{id:"B30",body:'Field A. Discovering Statistics Using SPSS. 2nd ed. SAGE Publications; 2005 Available from: https://www.researchgate.net/publication/247826587'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Adane Atara Debessa",address:"adaneatara@gmail.com",affiliation:'
Addis Ababa University College of Business and Economics, Ethiopia
Addis Ababa University College of Business and Economics, Ethiopia
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Previous studies showed that its administration decreases hepatic steatosis in male Apoe-knockout mice, but these changes might be complex. Transcriptomics, using DNA microarrays, and proteomics from mitochondrial and microsomal fractions, analyzed by 2D-DIGE and mass spectrometry, were used in these mice that received 1 g/kg/day squalene for 10 weeks. Squalene administration significantly modified the expression of genes such as lipin 1 (Lpin1) and thyroid hormone responsive (Thrsp). Changes in methionine adenosyltransferase 1 alpha (Mat1α), short-chain specific acyl-CoA dehydrogenase (Acads), and thioredoxin domain–containing protein 5 (Txndc5) expressions were consistent with their protein levels. Their mRNA levels were associated with hepatic fat content. These results suggest that squalene action involves changes in hepatic gene expression associated with its anti-steatotic properties. This approach shows new connections between nutrition and gene expression since Txndc5, a gene with unknown biological function, was upregulated by squalene administration. Overall, this nutrigenomic approach illustrates the effects of squalene and provides further support to the idea that not all monounsaturated fatty acid–containing oils behave similarly. Therefore, selection of cultivars producing olive oils enriched in this compound will be a plus.",signatures:"Adela Ramírez-Torres, Clara Gabás-Rivera and Jesús Osada",authors:[{id:"182842",title:"Prof.",name:"Jesus",surname:"Osada",fullName:"Jesus Osada",slug:"jesus-osada",email:"josada@unizar.es"}],book:{id:"5286",title:"Products from Olive Tree",slug:"products-from-olive-tree",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"83442",title:"Dr.",name:"Alegria",surname:"Carrasco-Pancorbo",slug:"alegria-carrasco-pancorbo",fullName:"Alegria Carrasco-Pancorbo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Granada",institutionURL:null,country:{name:"Spain"}}},{id:"182130",title:"Dr.",name:"Valentina",surname:"Domenici",slug:"valentina-domenici",fullName:"Valentina Domenici",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/182130/images/4395_n.jpg",biography:null,institutionString:null,institution:{name:"University of Pisa",institutionURL:null,country:{name:"Italy"}}},{id:"182471",title:"Dr.",name:"Gianluca",surname:"Bleve",slug:"gianluca-bleve",fullName:"Gianluca Bleve",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"182960",title:"Dr.",name:"Sara",surname:"Cicerale",slug:"sara-cicerale",fullName:"Sara Cicerale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"183171",title:"Prof.",name:"Alessandro",surname:"Parenti",slug:"alessandro-parenti",fullName:"Alessandro Parenti",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Florence",institutionURL:null,country:{name:"Italy"}}},{id:"183238",title:"Dr.",name:"Sabria",surname:"Aued-Pimentel",slug:"sabria-aued-pimentel",fullName:"Sabria Aued-Pimentel",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Adolfo Lutz",institutionURL:null,country:{name:"Brazil"}}},{id:"186812",title:"Prof.",name:"Aadil",surname:"Bajoub",slug:"aadil-bajoub",fullName:"Aadil Bajoub",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"186912",title:"Dr.",name:"Lorenzo",surname:"Guerrini",slug:"lorenzo-guerrini",fullName:"Lorenzo Guerrini",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"187809",title:"Dr.",name:"Mario",surname:"Cifelli",slug:"mario-cifelli",fullName:"Mario Cifelli",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"187810",title:"Ms.",name:"Cristina",surname:"Lazzerini",slug:"cristina-lazzerini",fullName:"Cristina Lazzerini",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"OA-publishing-fees",title:"Open Access Publishing Fees",intro:"
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It has many different shapes as well as many various effects, both on the economy and the society at large. Among the most common causes of corruption are the political and economic environment, professional ethics and morality and, of course, habits, customs, tradition and demography. Its effects on the economy (and also on the wider society) are well researched, yet still not completely. Corruption thus inhibits economic growth and affects business operations, employment and investments. It also reduces tax revenue and the effectiveness of various financial assistance programs. The wider society is influenced by a high degree of corruption in terms of lowering of trust in the law and the rule of law, education and consequently the quality of life (access to infrastructure, health care). There also does not exist an unambiguous answer as to how to deal with corruption. Something that works in one country or in one region will not necessarily be successful in another. This chapter tries to answer at least a few questions about corruption and the causes for it, its consequences and how to deal with it successfully.",book:{id:"6487",slug:"trade-and-global-market",title:"Trade and Global Market",fullTitle:"Trade and Global Market"},signatures:"Štefan Šumah",authors:[{id:"228073",title:"Mr.",name:"Stefan",middleName:null,surname:"Sumah",slug:"stefan-sumah",fullName:"Stefan Sumah"}]},{id:"55499",title:"Human Resources Management in Nonprofit Organizations: A Case Study of Istanbul Foundation for Culture and Arts",slug:"human-resources-management-in-nonprofit-organizations-a-case-study-of-istanbul-foundation-for-cultur",totalDownloads:2198,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The aim of this study is to investigate the efficiency and importance of human resources management in nonprofit organizations. The understanding was included to the literature as personnel management at the beginning of the twentieth century and it turned into an approach as human resources management in the 1980s. It could be observed that many organizations, which deem the human as the most critical stakeholder, adopt a traditional way of personnel management in operating human resources. The employees play a key role in the success of an organization. For this reason, subjects such as recruitment, training, development, career management, performance appraisal, occupational health, and safety are the fundamental functions of human resources management. The study examines to what extent these roles are evaluated through a case study. The subject matter of the study is the most powerful culture and art foundation in Turkey. Compared to many other nonprofit organizations, the foundation actively performs a variety of services within a year worldwide. 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Social marketing strategies can also be used to promote behavioral change and help individuals transform their lives, achieve well-being, and adopt prosocial behaviors. In this chapter, we seek to analyze with a netnographic study, how SNS are being employed by nonprofits and nongovernment organizations (NGOs) to enable citizens and consumers to participate in different programs and activities that promote social transformation and well-being. A particular interest is to identify how organizations are using behavioral economic tactics to nudge individuals and motivate them to engage in prosocial actions. 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Statistical analysis included several generalised additive models, with additive, smoothing, and tensor effects, such as geographic position and chemical parameters. Findings showed most farms belonged to small producers, 86.5% of cattle farms being family owned. Rotational grazing is the predominant system in 93% of farms; 58% of dairy farms and 94% of beef cattle farms do not fertilise their pastures. Results show high variability of soil chemical parameters. There are high levels of iron and low levels of sodium. Macronutrients, such as phosphorus and potassium show high levels in some dairy subregions and medium to low levels in others. Calcium (Ca) and magnesium levels are low for all subregions, excluding “Urabá” and “Occidente.” Most subregions have organic matter (OM) levels below 13%. The distribution of some chemical parameters is related to geographical location, such as pH and Ca, which change according to latitude and longitude. Different correlations were found amongst OM, total nitrogen, Ca, and exchangeable aluminium. Due to the high variability of soil fertility parameters, management programmes should be implemented for each distinctive production system.",book:{id:"11253",title:"Sustainable Rural Development",coverURL:"https://cdn.intechopen.com/books/images_new/11253.jpg"},signatures:"Marisol Medina-Sierra, Mario Cerón-Muñoz and Luis Galeano-Vasco"},{id:"81831",title:"Deep Network Model and Regression Analysis using OLS Method for Predicting Lung Vital Capacity",slug:"deep-network-model-and-regression-analysis-using-ols-method-for-predicting-lung-vital-capacity",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.104737",abstract:"With the advancement of technology, many new devices and methods with machine learning and artificial intelligence (ML-AI) have been developed and these methods have begun to play an important role in human life. 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The simulation results showed that the VC parameter was predicted with higher than 90% accuracy using the proposed deep network model with real data.",book:{id:"11604",title:"Decision Science - Recent Advances and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11604.jpg"},signatures:"Harun Sümbül"},{id:"81770",title:"Role of Microcredit in Sustainable Rural Development",slug:"role-of-microcredit-in-sustainable-rural-development",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.102588",abstract:"Around 1.7 billion adults have no access to transaction accounts in the world. The majority of those are poor and women in rural areas of two developing regions of the world (South Asia and Sub-Saharan Africa). Rural areas of these regions are home to the poor and poverty, hunger, unemployment/underemployment is widespread phenomenon. Access to financial services is crucial for economic development. However, poor and smallholder have been neglected by traditional banks for a long time. Microcredit a development model to provide loans to the poor who have no, or little collateral emerged in Bangladesh and has been adopted in many countries of the world. In this chapter, microcredit as a solution to much of the problems of the rural areas has been discussed. Over time there has been a shift in objectives of rural development. Rural development nowadays is about an overall improvement of the human quality of life in terms of economic, social, political, and environmental, issues. Access to microcredit has a positive impact on three dimensions of sustainable rural development; social, economic, and environmental. Microcredit helps in the alleviation of poverty, employment, entrepreneurship, higher productivity from agriculture, women empowerment, gender equality, reduced rural outmigration, better health and education, green entrepreneurship, and adoption of modern technology/inputs in agriculture.",book:{id:"11253",title:"Sustainable Rural Development",coverURL:"https://cdn.intechopen.com/books/images_new/11253.jpg"},signatures:"Muhammad Imran, Shamsheer Ul Haq and Orhan Ozcatalbas"},{id:"80714",title:"Balancing Hedging and Flexing for Inclusive Project Management",slug:"balancing-hedging-and-flexing-for-inclusive-project-management",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.102972",abstract:"Current project management often emphasizes hedging through a strictly phased and funneled development of the project scope. However, an increasingly engaged project environment and rise in the complexity of societal challenges cause an emerging demand for more open and interactive ways of managing projects. This requires projects to adopt an integrated management approach that focuses on flexing, which emphasizes the ability of a project to adapt to and co-create with the environment. Overemphasizing flexing, however, may undermine the controlled nature of project management. Therefore, it is necessary to find a form of project management that is both open and interactive without losing control. On the basis of specific project contexts and characteristics, this chapter presents criteria and tools for balancing hedging and flexing for inclusive project management.",book:{id:"11260",title:"Project Management - New Trends and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11260.jpg"},signatures:"Wim Leendertse, Bert de Groot and Tim Busscher"},{id:"81686",title:"Living the Brand",slug:"living-the-brand",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104174",abstract:"The way employees embody brand purpose and values build or erode the brand’s equity. It is people who bring the brand to life as they interact with brand stakeholders across brand contact points over time. Traditionally, brand management is concerned with the corporate and customer-facing brands. Inside organizations, the functional ownership of the employer and internal brand often resides with human resources management, with brand management having varying levels of involvement. Yet it is the employer and internal brand that defines the brand’s culture organization wide, straddling the theoretical domains of business, brand, marketing, corporate communication, human resources, talent management and more. In this chapter, we’ll explore the nature and purpose of the employer and internal brand, discuss approaches to the alignment thereof, and propose ways in which a strategically aligned leadership team can ensure brand alignment, co-creation, loyalty and advocacy through people living the brand.",book:{id:"11094",title:"Brand Management",coverURL:"https://cdn.intechopen.com/books/images_new/11094.jpg"},signatures:"Michelle Wolfswinkel and Carla Enslin"},{id:"81664",title:"A Systematic Review and Research Agenda on Standardization versus Adaptation of Brand Elements in International Markets",slug:"a-systematic-review-and-research-agenda-on-standardization-versus-adaptation-of-brand-elements-in-in",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.103866",abstract:"This paper aims to systematically review and critically examine marketing research on the standardization/adaptation of brand elements and explain its importance, given its increasing influence internationally. 46 journal articles indexed in Scopus and Web of Science databases examine with focus on research theme with broad scope approach, one of the types of literature review. The findings show that there is a live stream about the standardization/adaptation of brand elements in the marketing discipline, and contextual, methodological, and thematic diversity. Moreover, the findings of the review also highlight various literature trends and gaps. Results of the current review offer deep insights and create an ambitious research agenda that raises exciting new research questions for researchers. Besides results help to encourage the development of future theories on international branding.",book:{id:"11094",title:"Brand Management",coverURL:"https://cdn.intechopen.com/books/images_new/11094.jpg"},signatures:"Tamer Baran"}],onlineFirstChaptersTotal:64},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:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:287,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,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:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,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:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"May 18th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. 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He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. 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He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. 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Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}},{id:"351158",title:"Prof.",name:"David W.",middleName:null,surname:"Anderson",slug:"david-w.-anderson",fullName:"David W. Anderson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Calgary",country:{name:"Canada"}}}]}},subseries:{item:{id:"11",type:"subseries",title:"Cell Physiology",keywords:"Neurodevelopment and Neurodevelopmental Disease, Free Radicals, Tumor Metastasis, Antioxidants, Essential Fatty Acids, Melatonin, Lipid Peroxidation Products and Aging Physiology",scope:"
\r\n\tThe integration of tissues and organs throughout the mammalian body, as well as the expression, structure, and function of molecular and cellular components, is essential for modern physiology. The following concerns will be addressed in this Cell Physiology subject, which will consider all organ systems (e.g., brain, heart, lung, liver; gut, kidney, eye) and their interactions: (1) Neurodevelopment and Neurodevelopmental Disease (2) Free Radicals (3) Tumor Metastasis (4) Antioxidants (5) Essential Fatty Acids (6) Melatonin and (7) Lipid Peroxidation Products and Aging Physiology.
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He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"186048",title:"Prof.",name:"Ines",middleName:null,surname:"Drenjančević",slug:"ines-drenjancevic",fullName:"Ines Drenjančević",profilePictureURL:"https://mts.intechopen.com/storage/users/186048/images/5818_n.jpg",institutionString:null,institution:{name:"University of 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