\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"2283",leadTitle:null,fullTitle:"Advances in Crystallization Processes",title:"Advances in Crystallization Processes",subtitle:null,reviewType:"peer-reviewed",abstract:"Crystallization is used at some stage in nearly all process industries as a method of production, purification or recovery of solid materials. In recent years, a number of new applications have also come to rely on crystallization processes such as the crystallization of nano and amorphous materials. The articles for this book have been contributed by the most respected researchers in this area and cover the frontier areas of research and developments in crystallization processes. Divided into five parts this book provides the latest research developments in many aspects of crystallization including: chiral crystallization, crystallization of nanomaterials and the crystallization of amorphous and glassy materials. This book is of interest to both fundamental research and also to practicing scientists and will prove invaluable to all chemical engineers and industrial chemists in the process industries as well as crystallization workers and students in industry and academia.",isbn:null,printIsbn:"978-953-51-0581-7",pdfIsbn:"978-953-51-4297-3",doi:"10.5772/2672",price:159,priceEur:175,priceUsd:205,slug:"advances-in-crystallization-processes",numberOfPages:670,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:"fbac03612cea22d52fd05bd8ebace89c",bookSignature:"Yitzhak Mastai",publishedDate:"April 27th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/2283.jpg",numberOfDownloads:118633,numberOfWosCitations:205,numberOfCrossrefCitations:56,numberOfCrossrefCitationsByBook:13,numberOfDimensionsCitations:144,numberOfDimensionsCitationsByBook:20,hasAltmetrics:1,numberOfTotalCitations:405,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 5th 2011",dateEndSecondStepPublish:"June 2nd 2011",dateEndThirdStepPublish:"October 7th 2011",dateEndFourthStepPublish:"November 6th 2011",dateEndFifthStepPublish:"March 5th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"41724",title:"Prof.",name:"Yitzhak",middleName:null,surname:"Mastai",slug:"yitzhak-mastai",fullName:"Yitzhak Mastai",profilePictureURL:"https://mts.intechopen.com/storage/users/41724/images/2712_n.jpg",biography:"Prof. Yitzhak Mastai was born in 1966 in Tel Aviv Israel. He obtained his B.Sc in physical chemistry from Bar-Ilan University in 1989 and received his PhD from the Weizmann Institute of Science with Prof. Gary Hodes on nanomaterials synthesis (1999). He then went to the Max Planck institute of colloids and interfaces for 3 years, as postdoctoral fellow to work with Prof. M. Antonietti and Prof. H Cölfen on biomimetic chemistry and chiral polymers. In 2003 joined the staff of the chemistry department at Bar-Ilan University, where he is currently a Professor at the institute of nanotechnology at Bar-Ilan University leading the nano chirality laboratory. Prof. Mastai’s earlier interests included nanomaterials synthesis and characterization. His current research is focused on the synthesis and analysis of chiral nanosurfaces, chiral self-assembled monolayers and polymeric chiral nanoparticles. 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Urethral strictures and fistulas are common complications following a phalloplasty with urethral lengthening that may be mitigated with a two-stage technique that utilizes a mucosa-only prelaminated neourethra. Sources of the mucosa may include vaginal and oral mucosa and less commonly, uterine, bladder, and colonic mucosa.
Transition of the trans man genitalia is commonly performed in multiple stages including a hysterectomy and oophorectomy primarily and if desired, followed by a vaginectomy with urethral diversion to the perineum or lengthening with a phalloplasty, scrotoplasty, and glansplasty. The ovaries may be preserved at the time of hysterectomy for possible egg preservation. If the decision is made to preserve the ovaries, it is crucial for the patient to be monitored for abnormalities through yearly routine surveillance.
First stage surgery may consist of a hysterectomy and oophorectomy (if not done prior) along with a vaginectomy with urethra lengthening using an anteriorly based vaginal flap with labia minora tissues along with prelamination of the nondominant radial forearm flap using vaginal mucosa, buccal mucosa, and less common skin grafts.
Second stage surgery, which commonly occurs 2–3 months following the first stage, consists of tubularization of the radial forearm tissue with free flap transfer, microvascular anastomosis, neurotization, urethroplasty, scrotoplasty, and glansplasty.
Given the large cutaneous surface of a native male phallus, autologous construction of a neophallus commonly will necessitate a large cutaneous donor site. Flaps, such as the tube-in-tube radial forearm flap, latissimus dorsi flap, scapular flap, deltoid flap, abdominal pedicled flap, and anterolateral thigh (ALT) flaps have all been used for phalloplasty [1]. Though many techniques have been described, the radial forearm free flap (RFFF) remains the most common for phalloplasty due to its long, reliable vascular pedicle, multiple nerve innervations for anastomosis to the recipient site, and pliability of the tissue facilitating eventual implant placement [2]. In addition, the radial forearm flap has a lower urethral and flap loss complication rate compared to the anterolateral thigh flap [3]. Harvest allows for simultaneous operative sites at the pelvis, upper extremity, and oral region if buccal mucosa is needed. This ability allows for decreased operative time, which can last from 5–12 hours. The RFFF technique makes it possible for patients to fulfill their desires of standing micturition, aesthetic acceptability, and erogenous and tactile sensation.
Erectile rigidity is another commonly reported goal of phalloplasty. To achieve an erection, radial bone can be utilized as an osteocutaneous flap at the time of neophallus creation, or a patient can opt to undergo insertion of a semirigid or hydraulic prosthesis at least 1 year after phalloplasty. It should be noted, however, that our practice prefers to no longer perform the osteocutaneous RFFF due to dyspareunia experienced by the patient post-surgery. This is due to the anchoring of the radius bone at the pubic symphysis. Additionally, most centers report a 30%+ extrusion rate necessitating implant removal at 2–3 years, and reoperation rates reach 100% at 5 years (Figure 1) [4]. There is a significant risk of complications following placement of penile prosthesis including mechanical failure, infection, and mal-positioning. It is critical to have a plastic surgeon trained in microvascular surgery present during the placement of the penile implant as the vascular pedicle may be readily injured during the dissection and subsequent dilation process required for placement of the cylinders. It is critical to avoid multiple passing of the dilators so that devascularization of the phallus does not ensue.
Radius bone exposure following radial forearm osteocutaneous flap phalloplasty.
Adding to the complexity of phalloplasty is the creation of a functional penile urethra. The urethra after neophallus construction can be divided into distinct segments, from proximal to distal: native (female) urethra, fixed or lengthened urethra, the anastomotic urethra, penile shaft urethra, and external meatus. The fixed urethra is the portion of the urethra formed after lengthening the native urethra via local vaginal or labial flaps, extragenital flaps, and grafts of skin or mucosa (Figure 2). The phallic urethra can be constructed by prelamination, tube-in-tube techniques, or pedicle flaps [2].
Patient 3 months following urethral lengthening using labia minora and anterior vaginal wall flaps.
The preoperative assessment begins with a physical examination. The patient is assessed for adequate perfusion to the lower extremities. Ideally, the patient should have a palpable pedal pulse bilaterally. If perfusion is in question especially when dealing with patients with peripheral arterial disease, one can obtain noninvasive studies such as arterial duplex or plethysmography to determine which side to use. Preoperative vein mapping can be performed to assess for deep venous thrombosis as well as the caliber and quality of the great saphenous vein. Ideally, the great saphenous vein should be 2.5–3 mm and free of sclerosis.
A branch of the profunda femoris artery is an option for inflow. The perfusion to the thigh is robust thus a branch of the profunda femoris artery can typically be sacrificed without significantly affecting thigh perfusion. To expose the profunda femoris artery, a longitudinal skin incision is made in the thigh overlying the femoral arteries. The femoral bifurcation is identified and the superficial femoral artery is preserved. The main trunk of the profunda femoris artery is identified and preserved. There are tributary branches of the profunda femoris vein that are ligated to facilitate exposure and hemostasis. The branches of the profunda femoris artery are identified and circumferentially dissected. Typically, the ascending branch is of adequate caliber and length to be used for the inflow. If this branch is not long enough or the caliber is too small, the remaining branches of the profunda can be explored.
An alternative source of inflow can be the superficial femoral artery or the common femoral artery. The great saphenous vein can be used as a conduit. An oblique incision is made in the medial groin overlying the femoral artery bifurcation as well as the saphenofemoral junction. The saphenous vein is identified first and preserved. The superficial femoral artery is then exposed that lies medial to the femoral vein. The artery is sequentially dissected and controlled, and the skin incision is extended distally along the course of the saphenous vein. The length of the vein needed to perform the loop transposition varies by patient. The length required can be estimated with a free tie. Ideally, the loop graft needs to be able to reach the pubis when is oriented medially. Once the saphenous vein is exposed, it is circumferentially dissected and its tributary branches are ligated and divided. Careful attention needs to be made when ligating the branches too close to the vein as it may cause stenosis. The saphenous vein is then transected distally, and the distal end is ligated. The vein is then cannulated and distended with heparinized saline solution. Any defects are identified and repaired. When the vein is distended, it is marked for orientation. To perform the loop configuration, the distal end of the vein is swung in a counterclockwise fashion toward the femoral artery. The patient is systemically heparinized. The femoral artery was clamped proximally and distally and an arteriotomy is made using 11 blades and then lengthened with Potts scissors. Alternatively, an aortic punch device can be used to enlarge the arteriotomy to the desired size. The anastomosis should be approximately 4 mm. An end-to-side anastomosis was performed between the femoral artery and the saphenous vein paying careful attention to maintaining the orientation of the vein to avoid twisting and kinking. Just prior to completing the last few sutures of the anastomosis, the femoral artery is forward and back-bled. The lumen of the artery and vein are flushed with heparinized saline solution to flush any thrombus. Once the anastomosis is completed, the clamps are released. The loop graft is assessed for orientation and flow. The patient’s leg and foot also need to be assessed to ensure there are no changes to baseline perfusion. One can expect a weak pulse and a thrill when palpating the graft. A Doppler can also be used to assess the presence of flow. If the loop graft is kinked or twisted, it may thrombose. When the loop graft is ready to be used, it is transected in the middle; the proximal end is the arterial inflow and the distal end is the venous outflow.
Complications of urinary stricture and fistula are prevalent. Variations of urethral lengthening techniques among centers have resulted from attempts to improve upon urologic complication rates, which range from 33 to 77% in large case series [5]. Urethral cutaneous fistulas following surgery may range from 22 to 75% [6]. Fistulas occur most commonly at or just proximal to the anastomosis between the phallic urethra and fixed urethra due to vascular insufficiency of the flap and decreased lumen of the phallic urethra. Rates of urethral strictures in female-to-male phalloplasty recipients range from 11 to 74% [7, 8, 9]. Since the plastic surgeon alone is not trained in the management of urethral strictures or fistulas, we believe it is essential to have a qualified reconstructive urologist involved in the management of these complications to optimize patient care.
The radial forearm flap may allow the patient to have penetrative sexual intercourse, has minimal donor site scarring, results in a cosmetically acceptable phallus, has tactile and erogenous sensitivity, and potentially creates a competent neourethra that allows for standing urination. These ideal characteristics, described by Hage et al, are mostly met by the RFFF (radial forearm free flap) [10].
Recognizing that urethral strictures and fistulas remain the most challenging complication we face, we have been able to decrease their occurrence with a staged technique. We have found that the radial forearm tube-within-a-tube technique not only requires electrolysis of the forearm to avoid hair growth within the urethra—a common cause of stricture—but also requires a larger donor site since flap skin is used to create the urethra. Minimizing the donor site and decreasing stricture rates have encouraged us to continue the two-stage technique with mucosal prelamination, which more closely mimics native urethra mucosa (Figure 3).
Cystoscopy of prelaminated neourethra prior to stage 2 phalloplasty revealing mucosa which mimics that of native urethral mucosa.
Given the potential morbidity associated with the complex phalloplasty procedure, an adequate preoperative evaluation is essential. The need for gender dysphoria evaluation and medical clearance is unique to this patient population. Gender identity disorder or gender incongruence is classified by the International Classification of Disease Manual as ICD-10-CM F64.9. The DSM-5 defines gender dysphoria as an incongruity between the patient’s experienced and expressed gender and their assigned gender, which causes clinically significant distress lasting at least 6 months, however, this has often lasted nearly the individual’s entire life [11]. According to the World Professional Association for Transgender Health (WPATH), a psychological evaluation and two letters recommending gender affirmation surgery from two psychiatrists or licensed mental health therapists, who independently assessed the patient, are required for the removal of reproductive organs and/or phalloplasty [12]. In addition, the patient must have taken hormone replacement therapy and lived as their true gender for at least 1 year. These prerequisites are not only required by most insurance companies for authorization of the procedure but also ensure that patients have a realistic understanding of the procedure and serve to minimize disappointment and patient regret.
The importance of a thorough preoperative psychosocial evaluation cannot be overstated. Adequate social support is encouraged to facilitate a successful recovery. The patient should be informed to expect frequent postoperative visits 1–2 months following surgery and should understand that the operation will impact their ability to work for 4–6 weeks. The surgeon should remain involved in all stages of the preoperative evaluation by corresponding with the patient’s mental health provider and urogynecologist.
A clear and candid discussion regarding the patient’s desired goals from surgery, including the length and circumference of the neophallus, allows the surgeon to determine whether expectations are realistic given the patient’s anatomy. The limitations, functional outcomes, recovery, risk of complications, timing of procedures, and cost of each surgery should be honestly discussed with the patient.
It is critical to accurately document current medications, including antiplatelet agents and hormones, in addition to the patient’s smoking history. Androgens such as testosterone must be discontinued 2 weeks prior to surgery to reduce the risk of thrombosis, and smoking cessation is required 4 weeks prior to surgery and up to 4 weeks after to ensure proper healing. Specific information regarding prior infections helps in selecting postoperative antibiotics, as postsurgical infection will delay healing and increase morbidity.
The microsurgical component of RFFF phalloplasty requires additional preoperative evaluation. Adequate recipient vessels will be needed for the microsurgical construction. If arterial inflow from the thigh will be used then pedal vessels should be assessed for adequate inflow. The abdominal wall should be examined for prior incisions particularly if the inferior epigastric vessels will be used as recipient’s vessels. We have used the inferior epigastric artery, descending branch of the lateral femoral circumflex or on occasion arterio-venous loops for recipient arteries and the inferior epigastric vein or saphenous veins for recipient venous outflow.
Allen’s test of the patient’s nondominant hand confirms that harvest of the RFFF flap will not compromise the blood supply to the hand. If the results of Allen’s test are poor, that is, the hand remains cool and pale after the release of ulnar artery occlusion, using another donor site should be considered or the dominant forearm. In addition, sensitive tattoos of the proposed forearm should be evaluated. Patients who live in cold climates may need reconstitution of their arterial anatomy with vein grafts after flap harvest.
Prior to surgery, it is also vital to assess patient sensation to determine if orgasm can be achieved through clitoral stimulation. The dorsal clitoral nerve (Figure 4), ilioinguinal nerve, and genitofemoral nerve co-apted to the medial and lateral antebrachial cutaneous nerves will provide both erogenous and protective sensation to the neophallus. If a patient has difficulty achieving orgasm prior to surgery, it is unlikely that the patient will be able to after surgery.
Clitoral nerves are exposed as recipient’s nerves at stage 2 RFFF phalloplasty.
It should also be noted that part of the patient population has forearm tattoos that will affect the cosmesis of the neophallus. Patient preference will dictate whether the presence of forearm tattoos on the neophallus is acceptable. Clear expectations should be set with the patient regarding the forearm donor site scar, which may be perceived as a stigma, however, we argue the scar is more acceptable than the anterolateral thigh flap scar (Figure 5).
Patient with urethral and flap-related complications following ALT phalloplasty from an outlying institution.
In our practice, we construct the penile urethra by forearm prelamination with mucosa, which obviates the need for forearm depilation (as would be the case in a tube-within-a-tube technique). The native urethra is a fibromuscular tube lined by urothelium, columnar epithelium, and nonkeratinizing squamous epithelium. Mucosal grafts have greater homology to the native urethra as they are also composed of nonkeratinized epithelium, which has led to less scar contracture and subsequent urethral strictures and fistulas following neourethral construction [1].
Prior to phalloplasty, a patient should have had a hysterectomy and oophorectomy. If he has not yet had these procedures, it is possible to have them performed during the first stage of our approach to staged phalloplasty. We have found that uterine mucosa is readily available if the patient is undergoing hysterectomy in the same operative setting as phalloplasty, and can be used to construct a patent, functional penile urethra [1]. If a patient is interested in egg harvesting prior to oophorectomy, this is performed before definitive and irreversible hysterectomy and oophorectomy.
The current sequence of surgery in our practice is first a subcutaneous mastectomy, followed by a hysterectomy and oophorectomy combined with a vaginectomy, scrotoplasty, and reconstruction of the horizontal part of the urethra, and later the actual phalloplasty.
We have found our two-stage technique allows for a urethral conduit which mimics that of a native urethra with no hair growth while minimizing the donor site on the forearm. Our decreased stricture rate has encouraged us to continue the use of this technique in patients pursuing phalloplasty with urethral lengthening.
The main procedures are as follows:
Vaginectomy with the harvest of vaginal mucosa tissue (combined with hysterectomy and oophorectomy if not already performed)—Procedure performed concurrently by urogynecologist or gynecologic oncologist
Urethral lengthening utilizing labia minora flaps and anteriorly based vaginal mucosa flap harvested at the time of vaginectomy
Occasional harvest of buccal mucosa if required for neo-urethra
Radial forearm flap elevation ulnarly for flap urethra prelamination
IV antibiotics against gram-positive, gram-negative organisms and anaerobes are administered to the patient 1 hour prior to incision.
The first stage entails flap prelamination during which the radial forearm flap is designed and the neourethra is formed using autologous tissue; mucosa is preferentially used in our practice. The markings for the planned flap are determined preoperatively following a normal Allen’s test on the patient’s nondominant upper extremity, ensuring that the patient’s hand can be perfused with the ulnar artery alone. The flap is elevated from the ulnar to radial direction in the supra-fascial plane to allow placement of the neourethra.
Prelamination of the patient’s eventual penile urethra is performed by grafting vaginal, and/or buccal mucosa in a suprafascial plane of the donor volar and ulnar forearm. The vaginal mucosa is harvested during the vaginectomy for the creation of the neourethra. We lengthen the native female urethra using labia minora tissues and an anterior pedicled vaginal flap. If a hysterectomy has not already been performed, it can be performed during this stage to provide additional mucosal tissue for the neourethra. The buccal mucosa is also harvested at this time if necessary (Figures 6 and 7). To allow for irrigation of the entire prelaminated neourethra, holes are cut into a 24-French Foley. After mucosal harvest, the mucosal grafts are cleansed with a betadine and normal saline solution and then sewed around the holed catheter construct, exteriorizing the sub-mucosal surface using a running, locking suture. Placing this construct lengthwise in the subcutaneous forearm (suprafascial plane) allows for the creation of a tubular graft, which will become the penile neourethra of the eventual phalloplasty. The patient is then immobilized in a splint for several days. Irrigation of the prelaminated flap is then performed twice daily beginning 1 week after surgery, a practice continued until flap transfer to prevent infection.
Markings of buccal mucosal graft. Avoid injury to Stenson’s duct.
Vaginal and buccal mucosa with mucosal surface toward the foley catheter in preparation for tubularization around the catheter.
Creating the urethra with mucosal tissue and not using forearm tissue decreases the width of the flap skin paddle compared to the traditional tube-within-a-tube urethra and yields a more aesthetically acceptable donor site scar. With this method, the patient can place his upper extremity across his chest with the flexor aspect against the chest and the scar will not be visible (Figure 8). Furthermore, with this technique, the patient does not need to undergo costly depilation treatments as there will be no hair growth within the urethra. Prelamination can also be completed with a skin graft from the thigh or abdomen when mucosal tissue is inadequate in patients who have undergone metoidioplasty with vaginectomy, however, this may lead to increased stricture rates.
Patient following staged radial forearm flap harvest revealing limited donor site secondary due to prelamination of the urethra.
Approximately 8–12 weeks after the first stage flap prelamination, creation of the neophallus can be performed. Although allowing more time between stages may be favorable, we have found that 8 weeks is long enough to achieve successful wound healing and favorable results and is a time frame that is tolerable for our patients [1].
One hour before incision is made, antibiotics against gram-positive, gram-negative, and anaerobic organisms should be intravenously administered to the patient. A tourniquet is used for flap harvest, in addition to a hand table. Separate surgical set-ups are used for the pelvic area and upper extremity to avoid cross-contamination. Two surgical teams can work simultaneously—one team performs the RFFF harvest and the second team performs the dissection of the recipient’s vessels (inferior epigastric artery and vein and/or descending branch of the lateral circumflex artery and saphenous vein), recipient nerves, preparation of the urethra for anastomosis and scrotoplasty.
The design of the radial forearm flap was defined in the first stage. A marking pen is used to delineate the dimensions of the flap, which will commonly measure 5.5–7.5 inches in length and 5.5–6.5 inches in width. Whereas the flap was elevated in the suprafascial plane for prelamination at Stage I, the flap is now elevated in the subfascial plane to avoid injury to the neourethra. The dissection begins on the ulnar side of the forearm and proceeds to the flexor carpi radialis and brachioradialis tendons for the RFFF harvest. The medial and lateral antebrachial cutaneous nerves are preserved during dissection of the radial forearm flap for coaptation to one dorsal nerve of the clitoris end-to-side for erogenous sensation and the ilioinguinal or genitofemoral nerve for tactile sensation. The radial artery and venae comitantes are ligated distally and proximally dissected for vascular anastomosis. Prior to distal ligation, the artery may be temporarily clamped to ensure blood flow to the hand. The basilic and/or cephalic veins are preserved and dissected with the flap. While the RFFF remains connected to its inherent blood supply, the flap is tubed into a phallus and sutured so that the neourethra is buried within the tubed phallus (Figure 9).
Tubed radial forearm flap at the donor site with the prelaminated urethra.
Using a modification of Monstrey’s scrotoplasty technique, the clitoris is dissected free from the lengthened urethra and denuded of skin [13]. The clitoral hood skin is removed and used for the coronaplasty using a technique described by Gottlieb [14] (Figure 10). The recipient arteries harvested for the vascular anastomoses are either the inferior epigastric artery or the descending branch of the lateral femoral circumflex artery. Of note, once we switched to using the descending branch of the lateral femoral circumflex artery as our recipient artery, we no longer had re-open procedures due to vascular compromise [2]. The thigh incision made for the lateral femoral circumflex is also used for the harvest of the great saphenous vein (Figure 11). Since we use the greater saphenous veins as recipient veins for the radial forearm flap, the proximal incision made to harvest the greater saphenous vein is also used for the gracilis muscle harvest. The distal free end of the muscle, harvested via a separate distal incision, is delivered through the proximal incision. Undermining of the soft tissues is performed from the proximal thigh incision to the level of the midline groin defect where the urethral anastomosis is to be performed.
Trans male patient during the harvest of clitoral (or T-dick) hood skin for coronaplasty using Gottlieb technique.
Descending branch of the lateral femoral circumflex artery as recipient artery and saphenous vein as recipient artery in preparation for free flap phalloplasty.
After vessel preparation with a microscope and confirming adequate outflow from the descending branch of the lateral femoral circumflex artery and inflow from the great saphenous vein, the RFFF is transferred to the pubic area. The forearm donor site can be covered with either an autologous split-thickness skin graft or the surgeon can apply a dermal substitute that can be grafted later. The first maneuver is to place the foley catheter, which is located in the neourethra, directly into the patient’s bladder. Absorbable sutures are used for the urethral anastomosis in two layers, which is the first anastomosis performed (Figure 12).
First of two-layered urethral anastomosis in staged radial forearm flap phalloplasty.
The arterial, venous, and neural anastomoses are performed next in that order and are all hand-sewn using 9-0 nylon suture with the aid of an operative microscope. The radial artery is connected end-to-end to the descending branch of the lateral circumflex artery. The venous anastomosis is performed between the cephalic or basilic vein and the greater saphenous vein. A second venous anastomosis can be performed between a radial venous comitante vein with the contralateral greater saphenous vein. Two to three nerve anastomoses may also be performed. The medial and lateral antebrachial cutaneous nerves are anastomosed end-to-end to the ilioinguinal nerves and to one of the dorsal clitoral nerves end-to-side. The ilioinguinal nerve is commonly found exiting the external inguinal ring. A cadaver nerve graft may be used as an interposition nerve graft when needed.
The gracilis muscle may be harvested in a minimally invasive fashion and wrapped around the urethral anastomosis, avoiding compression of the vascular pedicle, to provide vascularity to a minimally vascular urethral anastomosis (Figure 13). This maneuver also provides bulk to the neo-scrotum often obviating the need for scrotal implants. At our institution, we have been able to minimize urethral fistula rates using a gracliis muscle flap to augment the urethral anastomosis [15].
Gracilis muscle harvest via minimally invasive approach prior to alpha wrap around the urethral anastomosis.
A suprapubic tube is placed and used for urinary diversion if needed during urinary training of the neo-phallus.
Upon closure of all incisions, a Norfolk coronaplasty is performed with either a skin graft or labial graft obtained from the clitoral hood region by denuding the clitoris before transposition (Figure 10) [16].
Following surgery, patients are transferred to the intensive care unit for flap monitoring and will remain on strict bed rest for a minimum of 3 days. An implantable Doppler device has been very helpful in flap monitoring. Prophylaxis for microvascular thrombosis is typically subcutaneous heparin and aspirin. Strict monitoring of the free tissue transfer is performed by the intensive care unit and resident staff [17]. Patients whose forearm donor site was first covered with a dermal substitute are taken back to the operating room for definitive coverage with a skin graft after 2 weeks. Several days later the patient may be discharged home with both a penile catheter and suprapubic catheter (Figure 14). A pericatheter retrograde cystourethrogram can be planned 12 weeks post-surgery. If there is no extravasation of dye, indicating that there is no urinary fistula, the foley catheter can be removed and the suprapubic catheter can be clamped (Figure 15). Patients are encouraged to urinate through their neophallus with the suprapubic catheter clamped. We then check for residual urine in the bladder using a bladder scan if necessary. If the patient is successfully able to urinate from the phallus and adequately empty the bladder for several days the suprapubic tube can be discontinued.
Trans man following Stage II phalloplasty revealing suprapubic tube and penile foley catheter.
Pericatheter retrograde cystourethrogram 8 weeks following second stage phalloplasty operation in trans man. The study reveals no contrast extravasation indicating no fistula and no stricture noted.
If the patient desires, he can tattoo the glans and shaft of the neophallus for aesthetic enhancement, which is ideally performed before full tactile sensation has been achieved (typically 1-year postop). Similarly, the donor site can be tattooed to avoid the stigmata of a skin graft (Figure 16).
RFFF donor site with tattoo concealment.
Since the RFFF phalloplasty lacks bone, it may be too soft to allow for penetrative intercourse. Implantation of an erectile prosthesis is a definitive procedure, that may be performed after 8–12 months when tactile sensation is achieved at least ¾ distally of the penile shaft. A simple Tinel sign is often used to assess postoperative tactile sensation in the neo-phallus postoperatively. Both malleable dual or single cylinder penile prostheses or inflatable prostheses may be used for the erectile device commonly anchored to the ischial tuberosities. We strongly recommend plastic surgery involvement in placement of the prosthesis since knowledge of the location and preservation of the neo-phallus vascular supply is critical to successful placement. More technical details of the neo-phallus implant placement will be discussed in a separate chapter. Prior to implant placement, as the patient is awaiting neural sensation, patients may have successful penetrative intercourse by using an elastic 3M Coban wrap and a condom.
It is important that the patient is aware of the potential complications that may occur following surgery, included in the informed consent. Some complications may include partial or total flap loss, hematoma at the donor or recipient site, an insensate flap, anorgasmia, skin graft loss, chronic pain, numbness, urinary complications, hypertrophic scarring, infection, cold intolerance, vascular compromise, abdominal wall weakness or hernia, implant infection or malfunction, dyspareunia, tendon exposure, limited hand function, and persistent gender dysphoria.
Urethral fistulas and strictures are common untoward events following phalloplasty in the transgender male and may prevent the patient from voiding while standing. A meta-analysis of 665 patients drawn from 11 studies found that an average of 0.51 strictures and/or fistulas can be expected per free forearm flap phalloplasty [17]. The published rate of urologic complications following penile reconstruction ranges from 23 to 75% [18, 19]. The subsequent management of urethral fistulas and strictures can be challenging. Initially, conservative measures such as periodic urethral dilatation or internal urethrotomy can be employed as temporizing measures prior to definitive surgical management.
Most urethral fistulas occur at the anastomosis between the fixed urethra and phallic urethra, and often can occur proximal to a concomitant stricture. The techniques for fistula repair described are the simple fistula repair, the use of local tissue transfer, two-stage procedures with use of mesh graft, bladder, or buccal mucosa [20]. When the fistula is small with substantial overlying tissue, spontaneous resolution is likely. However, when a urethrocutaneous fistula is large and superficial, the abovementioned surgical repair is necessary.
Urethral strictures also primarily occur at the anastomotic urethra. The keystone surgical procedures for urethral stricture include urethroplasty (excision and primary anastomosis) and staged Johanson-type urethroplasty with additional skin grafts, preferentially buccal mucosa [21]. Surgical approaches are customized to the length of the stricture. A patient who has both a urethral fistula and stricture should have both problems addressed at the same time.
There are many variations of urethroplasty available owing to the considerable heterogeneity of phallic and neourethral construction techniques. Well-vascularized local flaps are utilized when available, as well as buccal mucosal grafts. A patient who has undergone several urethral fistula and/or stricture repair attempts will have progressively fewer options for reconstruction. At our institution, we have significantly decreased our fistula rates in transgender male phalloplasty by augmenting the paucity of vascularized tissue at this anastomosis using a pedicled gracilis flap at the time of flap transfer [15]. Prelamination with mucosal grafts may also decrease urethral stenosis and fistula formation [2].
The goals of phalloplasty include a sensate, cosmetically acceptable phallus with an incorporated neourethra, and the ability to place an implantable penile prosthesis to allow rigidity for penetrative intercourse. In the majority of cases, phalloplasty is the final stage of treatment for gender dysphoria.
While other donor sites may be used, the radial forearm free flap is a favorable technique due to its high vascularity, adequate sensation, sufficient tissue pliability, and good cosmetic outcome. We have found that our two-stage technique allows for a neourethra, which mimics a native urethra with no hair growth, while minimizing the donor site on the forearm compared to the previously used skin for a tube-within-a-tube radial forearm flap technique. Using a pre-laminated urethra our patients do not need to undergo electrolysis since the urethra is not created from forearm tissue, so we do not have the risk of hair growth in the urethra and its associated complications. Our decreased stricture rate has encouraged us to continue the use of this technique in patients pursuing phalloplasty with urethral lengthening. Although there have not been any blinded, randomized controlled trials comparing single-stage to two-stage phalloplasty, we believe that prelamination using mucosa for the construction of the trans male phallus urethra is a worthwhile technique that has demonstrated a reduction in the prevalence of complications with this already very challenging procedure.
The authors declare no conflict of interest.
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\\n\\nWhite papers, working papers, technical reports and all other forms of papers which fall within the scope of the ‘Luxembourg definition’ of grey literature do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense.
\\n\\nAlthough such papers are regularly made publicly available via personal websites and institutional repositories, their general purpose is to gather comments and feedback from Authors’ colleagues in order to further improve a manuscript intended for future publication.
\\n\\nWhen submitting their work, Authors are required to disclose the existence of any publicly available earlier drafts in a note to the Academic Editor. In cases where earlier drafts of the submitted version of the manuscript are publicly available, any overlap between the versions will generally not be considered an instance of self-plagiarism.
\\n\\n4. SOCIAL MEDIA, BLOG & MESSAGE BOARD POSTINGS
\\n\\nWe feel that social media, blogs and message boards are generally used with the same intention as grey literature, to formulate ideas for a manuscript and gather early feedback from like-minded researchers in order to improve a particular piece of work before submitting it for publication. Therefore, we do not consider such internet postings to be publication in the scholarly sense.
\\n\\nNevertheless, Authors are encouraged to disclose the existence of any internet postings in which they outline and describe their research or posted passages of their manuscripts in a note to the Academic Editor. Please note that we will not strictly enforce this request in the same way that we would instructions we consider to be part of our conditions of acceptance for publication. We understand that it may be difficult to keep track of all one’s internet postings in which the researcher´s current work might be mentioned.
\\n\\nIn cases where there is any overlap between the Author´s submitted manuscript and related internet postings, we will generally not consider it to be an instance of self-plagiarism. This also holds true for any co-Author as well.
\\n\\nFor more information on this policy please contact permissions@intechopen.com.
\\n\\nPolicy last updated: 2017-03-20
\\n"}]'},components:[{type:"htmlEditorComponent",content:'A significant number of working papers, early drafts, and similar work in progress are openly shared online between members of the scientific community. It has become common to announce one’s own research on a personal website or a blog to gather comments and suggestions from other researchers. Such works and online postings are, indeed, published in the sense that they are made publicly available. However, this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
\n\nThe significance of Peer Review cannot be overstated when it comes to defining, in our terms, what constitutes a published scientific work. Peer Review is widely considered to be the cornerstone of modern publishing processes and the key value-adding contribution to a scholarly manuscript that a publisher can make.
\n\nOther than the issue of originality, research misconduct is another major issue that all publishers have to address. IntechOpen’s Retraction & Correction Policy and various publication ethics guidelines identify both redundant publication and (self)plagiarism to fall within the definition of research misconduct, thus constituting grounds for rejection or the issue of a Retraction if the work has already been published.
\n\nIn order to facilitate the tracking of a manuscript’s publishing history and its development from its earliest draft to the manuscript submitted, we encourage Authors to disclose any instances of a manuscript’s prior publication, whether it be through a conference presentation, a newspaper article, a working paper publicly available in a repository or a blog post.
\n\nA note to the Academic Editor containing detailed information about a submitted manuscript’s previous public availability is the preferred means of reporting prior publication. This helps us determine if there are any earlier versions of a manuscript that should be disclosed to our readers or if any of those earlier versions should be cited and listed in a manuscript’s references.
\n\nSome basic information about the editorial treatment of different varieties of prior publication is laid out below:
\n\n1. CONFERENCE PAPERS & PRESENTATIONS
\n\nGiven that conference papers and presentations generally pass through some sort of peer or editorial review, we consider them to be published in the accepted scholarly sense, particularly if they are published as a part of conference proceedings.
\n\nAll submitted manuscripts originating from a previously published conference paper must contain at least 50% of new original content to be accepted for review and considered for publication.
\n\nAuthors are required to report any links their manuscript might have with their earlier conference papers and presentations in a note to the Academic Editor, as well as in the manuscript itself. Additionally, Authors should obtain any necessary permissions from the publisher of their conference paper if copyright transfer occurred during the publishing process. Failure to do so may prevent Us from publishing an otherwise worthy work.
\n\n2. NEWSPAPER & MAGAZINE ARTICLES
\n\nNewspaper and magazine articles usually do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense. Articles appearing in newspapers and magazines rarely possess the depth and structure characteristic of scholarly articles.
\n\nSubmitted manuscripts stemming from a previous newspaper or magazine article will be accepted for review and considered for publication. However, Authors are strongly advised to report any such publication in an accompanying note to the External Editor.
\n\nAs with the conference papers and presentations, Authors should obtain any necessary permissions from the newspaper or magazine that published the work, and indicate that they have done so in a note to the External Editor.
\n\n3. GREY LITERATURE
\n\nWhite papers, working papers, technical reports and all other forms of papers which fall within the scope of the ‘Luxembourg definition’ of grey literature do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense.
\n\nAlthough such papers are regularly made publicly available via personal websites and institutional repositories, their general purpose is to gather comments and feedback from Authors’ colleagues in order to further improve a manuscript intended for future publication.
\n\nWhen submitting their work, Authors are required to disclose the existence of any publicly available earlier drafts in a note to the Academic Editor. In cases where earlier drafts of the submitted version of the manuscript are publicly available, any overlap between the versions will generally not be considered an instance of self-plagiarism.
\n\n4. SOCIAL MEDIA, BLOG & MESSAGE BOARD POSTINGS
\n\nWe feel that social media, blogs and message boards are generally used with the same intention as grey literature, to formulate ideas for a manuscript and gather early feedback from like-minded researchers in order to improve a particular piece of work before submitting it for publication. Therefore, we do not consider such internet postings to be publication in the scholarly sense.
\n\nNevertheless, Authors are encouraged to disclose the existence of any internet postings in which they outline and describe their research or posted passages of their manuscripts in a note to the Academic Editor. Please note that we will not strictly enforce this request in the same way that we would instructions we consider to be part of our conditions of acceptance for publication. We understand that it may be difficult to keep track of all one’s internet postings in which the researcher´s current work might be mentioned.
\n\nIn cases where there is any overlap between the Author´s submitted manuscript and related internet postings, we will generally not consider it to be an instance of self-plagiarism. This also holds true for any co-Author as well.
\n\nFor more information on this policy please contact permissions@intechopen.com.
\n\nPolicy last updated: 2017-03-20
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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This chapter aims for those who need to teach Kalman filters to others, or for those who do not have a strong background in estimation theory. Following a problem definition of state estimation, filtering algorithms will be presented with supporting examples to help readers easily grasp how the Kalman filters work. Implementations on INS/GNSS navigation, target tracking, and terrain-referenced navigation (TRN) are given. In each example, we discuss how to choose, implement, tune, and modify the algorithms for real world practices. Source codes for implementing the examples are also provided. In conclusion, this chapter will become a prerequisite for other contents in the book.",book:{id:"7466",slug:"introduction-and-implementations-of-the-kalman-filter",title:"Introduction and Implementations of the Kalman Filter",fullTitle:"Introduction and Implementations of the Kalman Filter"},signatures:"Youngjoo Kim and Hyochoong Bang",authors:null},{id:"77284",title:"The Paradigm of Complex Probability and Isaac Newton’s Classical Mechanics: On the Foundation of Statistical Physics",slug:"the-paradigm-of-complex-probability-and-isaac-newton-s-classical-mechanics-on-the-foundation-of-stat",totalDownloads:1794,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The concept of mathematical probability was established in 1933 by Andrey Nikolaevich Kolmogorov by defining a system of five axioms. This system can be enhanced to encompass the imaginary numbers set after the addition of three novel axioms. As a result, any random experiment can be executed in the complex probabilities set C which is the sum of the real probabilities set R and the imaginary probabilities set M. We aim here to incorporate supplementary imaginary dimensions to the random experiment occurring in the “real” laboratory in R and therefore to compute all the probabilities in the sets R, M, and C. Accordingly, the probability in the whole set C = R + M is constantly equivalent to one independently of the distribution of the input random variable in R, and subsequently the output of the stochastic experiment in R can be determined absolutely in C. This is the consequence of the fact that the probability in C is computed after the subtraction of the chaotic factor from the degree of our knowledge of the nondeterministic experiment. We will apply this innovative paradigm to Isaac Newton’s classical mechanics and to prove as well in an original way an important property at the foundation of statistical physics.",book:{id:"11066",slug:"the-monte-carlo-methods-recent-advances-new-perspectives-and-applications",title:"The Monte Carlo Methods",fullTitle:"The Monte Carlo Methods - Recent Advances, New Perspectives and Applications"},signatures:"Abdo Abou Jaoudé",authors:[{id:"248271",title:"Dr.",name:"Abdo",middleName:null,surname:"Abou Jaoudé",slug:"abdo-abou-jaoude",fullName:"Abdo Abou Jaoudé"}]},{id:"46862",title:"Analysis of Balancing of Unbalanced Rotors and Long Shafts using GUI MATLAB",slug:"analysis-of-balancing-of-unbalanced-rotors-and-long-shafts-using-gui-matlab",totalDownloads:8534,totalCrossrefCites:4,totalDimensionsCites:5,abstract:null,book:{id:"3845",slug:"matlab-applications-for-the-practical-engineer",title:"MATLAB",fullTitle:"MATLAB Applications for the Practical Engineer"},signatures:"Viliam Fedák, Pavel Záskalický and Zoltán Gelvanič",authors:[{id:"85462",title:"Associate Prof.",name:"Viliam",middleName:null,surname:"Fedak",slug:"viliam-fedak",fullName:"Viliam Fedak"},{id:"154498",title:"Prof.",name:"Pavel",middleName:null,surname:"Záskalický",slug:"pavel-zaskalicky",fullName:"Pavel Záskalický"},{id:"169849",title:"Dr.",name:"Zoltan",middleName:null,surname:"Gelvanič",slug:"zoltan-gelvanic",fullName:"Zoltan Gelvanič"}]},{id:"65445",title:"Power Flow Analysis",slug:"power-flow-analysis",totalDownloads:5190,totalCrossrefCites:4,totalDimensionsCites:5,abstract:"Power flow, or load flow, is widely used in power system operation and planning. The power flow model of a power system is built using the relevant network, load, and generation data. Outputs of the power flow model include voltages at different buses, line flows in the network, and system losses. These outputs are obtained by solving nodal power balance equations. Since these equations are nonlinear, iterative techniques such as the Newton-Raphson, the Gauss-Seidel, and the fast-decoupled methods are commonly used to solve this problem. The problem is simplified as a linear problem in the DC power flow technique. This chapter will provide an overview of different techniques used to solve the power flow problem.",book:{id:"7678",slug:"computational-models-in-engineering",title:"Computational Models in Engineering",fullTitle:"Computational Models in Engineering"},signatures:"Mohammed Albadi",authors:[{id:"209533",title:"Dr.",name:"Mohammed",middleName:null,surname:"Albadi",slug:"mohammed-albadi",fullName:"Mohammed Albadi"}]},{id:"46614",title:"Modeling of Control Systems",slug:"modeling-of-control-systems",totalDownloads:10557,totalCrossrefCites:0,totalDimensionsCites:1,abstract:null,book:{id:"3845",slug:"matlab-applications-for-the-practical-engineer",title:"MATLAB",fullTitle:"MATLAB Applications for the Practical Engineer"},signatures:"Roger Chiu, Francisco J. 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It is a statistical process that transforms the data containing correlated features into a set of uncorrelated features with the help of orthogonal transformations. Unsupervised machine learning is a concept of self-learning method that involves unlabelled data to identify hidden patterns. PCA converts the data features from a high dimensional space into a low dimensional space. PCA also acts as a feature extraction method since it transforms the ‘n’ number of features into ‘m’ number of principal components (PCs; m < n). Mobile Malware is increasing tremendously in the digital era due to the growth of android mobile users and android applications. Some of the mobile malware are viruses, Trojan horses, worms, adware, spyware, ransomware, riskware, banking malware, SMS malware, keylogger, and many more. To automate the process of detecting mobile malware without human intervention, machine learning methods are applied to discover the malware more precisely. Specifically, unsupervised machine learning helps to uncover the hidden patterns to detect anomalies in the data. In discovering hidden patterns of malware, PCA is an important dimensionality reduction technique that can be applied to transform the features into PCs containing important feature values. So, by implementing PCA, the correlated features are transformed into uncorrelated features automatically to explore the anomalies in the data effectively. This book chapter explains all the variants of the PCA, including all linear and non-linear methods of PCA and their suitability in applying to mobile malware detection. A case study on mobile malware detection with variants of PCA using machine learning techniques in CICMalDroid_2020 dataset has been experimented. Based on the experimental results, for the given dataset, normal PCA is suitable to detect the malware data points and forms an optimal cluster.",book:{id:"11201",title:"Advances in Principal Component Analysis",coverURL:"https://cdn.intechopen.com/books/images_new/11201.jpg"},signatures:"Padmavathi Ganapathi, Shanmugapriya Dhathathri and Roshni Arumugam"},{id:"79345",title:"Application of Jump Diffusion Models in Insurance Claim Estimation",slug:"application-of-jump-diffusion-models-in-insurance-claim-estimation",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.99853",abstract:"We investigated if general insurance claims are normal or rare events through systematic, discontinuous or sporadic jumps of the Brownian motion approach and Poisson processes. Using firm quarterly data from March 2010 to December 2018, we hypothesized that claims with high positive (negative) slopes are more likely to have large positive (negative) jumps in the future. As such, we expected salient properties of volatile jumps on the written products/contracts. We found that insurance claims for general insurance quoted products cease to be normal. There exist at times some jumps, especially during holidays and weekends. Such jumps are not healthy to the capital structures of firms, as such they need attention. However, it should be noted that gaps or jumps (unless of specific forms) cannot be hedged by employing internal dynamic adjustments. This means that, jump risk is non-diversifiable and such jumps should be given more attention.",book:{id:"10820",title:"Data Clustering",coverURL:"https://cdn.intechopen.com/books/images_new/10820.jpg"},signatures:"Leonard Mushunje, Chiedza Elvina Mashiri, Edina Chandiwana and Maxwell Mashasha"},{id:"81645",title:"Determining an Adequate Number of Principal Components",slug:"determining-an-adequate-number-of-principal-components",totalDownloads:11,totalDimensionsCites:0,doi:"10.5772/intechopen.104534",abstract:"The problem of choosing the number of PCs to retain is analyzed in the context of model selection, using so-called model selection criteria (MSCs). For a prespecified set of models, indexed by k=1,2,…,K, these model selection criteria (MSCs) take the form MSCk=nLLk+anmk, where, for model k,LLk is the maximum log likelihood, mk is the number of independent parameters, and the constant an is an=lnn for BIC and an=2 for AIC. The maximum log likelihood LLk is achieved by using the maximum likelihood estimates (MLEs) of the parameters. In Gaussian models, LLk involves the logarithm of the mean squared error (MSE). The main contribution of this chapter is to show how to best use BIC to choose the number of PCs, and to compare these results to ad hoc procedures that have been used. Findings include the following. These are stated as they apply to the eigenvalues of the correlation matrix, which are between 0 and p and have an average of 1. For considering an additional PCk + 1, with AIC, inclusion of the additional PCk + 1 is justified if the corresponding eigenvalue λk+1 is greater than exp−2/n. For BIC, the inclusion of an additional PCk + 1 is justified if λk+1>n1/n, which tends to 1 for large n. Therefore, this is in approximate agreement with the average eigenvalue rule for correlation matrices, stating that one should retain dimensions with eigenvalues larger than 1.",book:{id:"11201",title:"Advances in Principal Component Analysis",coverURL:"https://cdn.intechopen.com/books/images_new/11201.jpg"},signatures:"Stanley L. Sclove"},{id:"81542",title:"On the Use of Modified Winsorization with Graphical Diagnostic for Obtaining a Statistically Optimal Classification Accuracy in Predictive Discriminant Analysis",slug:"on-the-use-of-modified-winsorization-with-graphical-diagnostic-for-obtaining-a-statistically-optimal",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104539",abstract:"In predictive discriminant analysis (PDA), the classification accuracy is only statistically optimal if each group sample is normally distributed with different group means, and each predictor variance is similar between the groups. This can be achieved by accounting for homogeneity of variances between the groups using the modified winsorization with graphical diagnostic (MW-GD) method. The MW-GD method involves the identification and removal of legitimate contaminants in a training sample with the aim of obtaining a true optimal training sample that can be used to build a predictive discriminant function (PDF) that will yield a statistically optimal classification accuracy. However, the use of this method is yet to receive significant attention in PDA. An alternative statistical interpretation of the graphical diagnostic information associated with the method when confronted with the challenge of differentiating between a variable shape in the groups of the 2-D area plot remains a problem to be resolved. Therefore, this paper provides a more comprehensive analysis of the idea and concept of the MW-GD method, as well as proposed an alternative statistical interpretation of the informative graphical diagnostic associated with the method when confronted with the challenge of differentiating between a variable shape in the groups of the 2-D area plot.",book:{id:"11201",title:"Advances in Principal Component Analysis",coverURL:"https://cdn.intechopen.com/books/images_new/11201.jpg"},signatures:"Augustine Iduseri"},{id:"81471",title:"Semantic Map: Bringing Together Groups and Discourses",slug:"semantic-map-bringing-together-groups-and-discourses",totalDownloads:25,totalDimensionsCites:0,doi:"10.5772/intechopen.103818",abstract:"This chapter presents a multivariate analysis method which is developed in two steps using a combination of Hierarchical cluster analysis (HCA) and Factorial Correspondence Analysis (AFC). To explain and describe the steps of the method, we use an application example on a survey dataset from young students in Thessaloniki trying to investigate their behavioral profiles in terms of political characteristics and how these may be affected about their attendance to a civic education course offered by the Political Science department in the Aristotle University of Thessaloniki. The method is explained step by step on this example serving as a manual of its application to the researcher. HCA assigns subjects into cluster membership variables and in the next stage, these new variables are jointly analyzed with AFC. Correspondence analysis manages to extract the dimensions of the phenomenon in the study, explaining the inner antithesis between the categories but also giving the opportunity to visualize the information in a two-dimensional space, a semantic map, making interpretation more comprehensive. HCA is then applied again to the AFC’s coordinates of the categories constructing profiles of subjects, assigning them to the categories of the variables.",book:{id:"10820",title:"Data Clustering",coverURL:"https://cdn.intechopen.com/books/images_new/10820.jpg"},signatures:"Theodore Chadjipadelis and Georgia Panagiotidou"},{id:"81460",title:"Spatial Principal Component Analysis of Head-Related Transfer Functions and Its Domain Dependency",slug:"spatial-principal-component-analysis-of-head-related-transfer-functions-and-its-domain-dependency",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.104449",abstract:"In this chapter, the Principal Component Analysis (PCA) was adopted to spatial variation of Head-Related Transfer Function (HRTF) or its corresponding inverse Fourier Transform, called Head-Related Impulse Response (HRIR), in order to compactly represent their spatial variation. This is called the Spatial PCA (SPCA). The SPCA was carried out for a database of HRTFs in all directions by selecting the domain as one of the HRIRs, the complex HRTFs, the frequency amplitudes of HRTFs, log-amplitudes of HRTFs, and complex logarithm of HRTFs. The minimum phase approximation was incorporated for the frequency amplitudes and log-amplitudes of HRTFs. 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He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. 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Her Ph.D. research work on the soft tissue-implant interface at the University of Sheffield has yielded several important publications in the key implant journals. She was awarded an Excellent Exchange Award by the University of Sheffield which gave her the opportunity to work at the famous Faculty of Dentistry of the University of Gothenburg, Sweden, under the tutelage of Prof. Peter Thomsen. In 2016, she was appointed as a visiting scholar at UCLA, USA, with attachment in Hospital Dentistry, and involvement in research work related to zirconia implant. In 2016, her contribution to dentistry was recognized by the Royal College of Surgeon of Edinburgh with her being awarded a Fellowship in Dental Surgery. She has authored numerous papers published both in local and international journals. She was the Editor of the Malaysian Dental Journal for several years. 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His passion for teaching then led him to join the faculty of dentistry at University Malaya and he has since became a valuable lecturer and clinical specialist in the Department of Restorative Dentistry. He is currently the removable prosthodontic undergraduate year 3 coordinator, head of the undergraduate module on occlusion and a member of the multidisciplinary team for the TMD clinic. He has previous membership in the British Society for Restorative Dentistry, the Malaysian Association of Aesthetic Dentistry and he is currently a lifetime member of the Malaysian Association for Prosthodontics. Currently, he is also the examiner for the Restorative Specialty Membership Examinations, Royal College of Surgeons, England. He has authored and co-authored handful of both local and international journal articles. 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She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. 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Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. 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Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. 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