Nameplate and available capacities of IEK power generation in 2018 [16].
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\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:"8662",leadTitle:null,fullTitle:"Data Service Outsourcing and Privacy Protection in Mobile Internet",title:"Data Service Outsourcing and Privacy Protection in Mobile Internet",subtitle:null,reviewType:"peer-reviewed",abstract:"Mobile internet data has the characteristics of large scale, variety of patterns, and complex association. 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\r\n\tIn this book, the technological and functional properties of barley will be highlighted comprehensively. Moreover, Nutritional and bioactive profiles and barley utilization in different baking products will also be in the limelight of this book. This depiction will be valuable for all consumers from health points of view.
\r\n\r\n\tFood security is an alarming issue in developing countries as the population is increasing day by day. So, researchers have to think about alternative sources of staple diet(wheat) that should have the same nutritional composition as compared to wheat. Among cereals, barley is an alternative source because of its nutritional and functional properties, despite all the functional ingredients it is rarely used in the food industry. From different researches, it is revealed that it contains 24 % dietary fiber, so it is beneficial for CVDs and other health-related disorders. Now a day, barley consumption is very rare. There are many barley products in the food market such as malt flour, grits, flakes, pot, and pearled barley. Bread formulations also involve the usage of barley flour and cracked barley. The possibility of high fiber barley utilization in breakfast cereals production through blending with other grains, flaking, puffing, and extrusion is becoming common. So, there is a dire need to do value addition of barley into various products. Furthermore, the most important reason for wheat replacement with barley is its allergy-causing nature in some cases. Keeping in view all of the above facts, the present book has been designed.
",isbn:"978-1-80356-924-6",printIsbn:"978-1-80356-923-9",pdfIsbn:"978-1-80356-925-3",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"996125d4599193b3b6b749f5d8aa3cb2",bookSignature:"Dr. Farhan Saeed and Dr. Muhammad Afzaal",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11793.jpg",keywords:"Cereal, Barley, Dietary Fibers, Nutritional Composition, Grains, Technology, Processing, Milling, Flour, Rheology, Bioactive Profile, Utilization",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 6th 2022",dateEndSecondStepPublish:"June 14th 2022",dateEndThirdStepPublish:"August 13th 2022",dateEndFourthStepPublish:"November 1st 2022",dateEndFifthStepPublish:"December 31st 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Farhan is an Assistant Professor at Government College University Faisalabad-Pakistan where he finished his Ph.D. at the age of 28 years. He has an h index of 16 and has published more than 70 papers in reputed journals with an impact factor of more than 140. His research focus is on finding innovative and effective practices to improve food production, quality, and safety, keeping in view the betterment of human health.",coeditorOneBiosketch:"Dr. Muhammad Afzaal is working as an Assistant professor in the Department of Food Science. Government College University Faisalabad. He has 10 years of teaching and research experience. He has more than 40 publications in well-reputed journals and 5 book chapters published. His research interests are food science and technology, food microbiology and biotechnology, microencapsulation, probiotics, prebiotics & synbiotics, biopreservation, and waste value addition.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"192244",title:"Dr.",name:"Farhan",middleName:null,surname:"Saeed",slug:"farhan-saeed",fullName:"Farhan Saeed",profilePictureURL:"https://mts.intechopen.com/storage/users/192244/images/system/192244.jpg",biography:"PERSONAL STATEMENT\r\nMy name is Farhan Saeed. During Master study, I received an Indigenous Fellowship from Higher Education Commission (HEC) Pakistan. The selection process was a rigorous process starting from a GRE-based test. After being short listed by HEC, part of the Fellowship was the opportunity to complete doctorate degree mainly within Food Science and Technology field. I did my Doctorate thesis entitled 'Biochemical characterization of non-starch polysaccharides in relation to end-use quality of spring wheats” under the supervision of Dr. Imran Pasha. The doctorate research was focused on value addition of bioactive components extracted from spring wheats. The addition of extracted non-starch polysaccharides enhances the quality of baked products as well as important in nutraceutical point of view. The products under proposed study were thoroughly investigated for assessment of nutritional and end use quality of bread. The output of the proposed research work was highly beneficial to the consumers as well as Government of Pakistan for their intended purposes. The awareness about nutritional significance of non-starch polysaccharides enriched bread was really set the new horizons in product development in Pakistan. In 2012, I joined Institute of Home & Food Sciences, Government College University Faisalabad as Assistant Professor. In 2014, I became HEC Approved Supervisor. During 2015, I have visited Massachusetts, Amherst, USA under Pakistan Program for Collaborative Research (PPCR), HEC Pakistan for two months training program for the development of innovative project. After that, I have been selected to receive a 2016 'Endeavour Research Fellowship” to undertake proposed program in Australia. I did work in Centre for Nutrition & Food Science, The University of Queensland, Brisbane, Australia under the supervision of Professor Mike Gidley. The commencing date of current program is May 17, 2016 and the expiry is on November 15, 2016. In October, 2018. I was promoted to Tenured Associate Professor. I have published more than 70 papers in reputed journals with impact factor more than 140. I have 20 book chapters in international books. I presented research works in international level at Huazhong University Wuhan, China and Conference on Food Properties in Sharjah. I also got two research projects funds from Higher Education Commission Islamabad, Pakistan. I would like to be granted the KGSP because it will offer me with the opportunity to partake in Post-Doctoral program of Food Science and Biotechnology at Kyungpook National University (KNU) among the best universities in Korea. In my home country, vital issues stressed in this particular degree program are quite overlooked, and this scholarship program will bring me a great chance to come within reach of them. By taking this course, I am optimistic for finding innovative and effective practices to improve food production, quality and safety, keeping in view the betterment of human health; and moreover, to improve the end-product quality for maintenance of customer’s health. To sum up, winning the KGSP will enable me not only to broaden my knowledge, but also to gain experience from people and culture of both countries Korea and Pakistan. In the longer term, I sturdily desire to contribute to the cause of assuring food security and safety initially in my country and laterally worldwide. The main objective of applying here to get international exposure while working with world class food experts especially those working in the area of functional foods and nutraceuticals. The knowledge and expertise together with the international interaction developed through this project will finally be utilized for the development of laboratory of functional foods and nutraceuticals at my home institute.",institutionString:"Government College University, Faisalabad",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}}],coeditorOne:{id:"245894",title:"Dr.",name:"Muhammad",middleName:null,surname:"Afzaal",slug:"muhammad-afzaal",fullName:"Muhammad Afzaal",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSF1qQAG/Profile_Picture_1618812051691",biography:"Dr. Muhammad Afzaal, Ph.D., is an Assistant Professor in the Department of Food Science, Government College University Faisalabad, Pakistan. He is involved in various additional assignments as a Business Manager-BIC (Food & Services), and Lab Incharge (Food Safety and Biotechnology). He has about 10 years of teaching and research experience. Dr. Afzaal has been a part of many national and international research projects. His research interests are Food Science & Technology, Food microbiology & Biotechnology, Hydrogels, Encapsulation, Probiotics, and Biopolymer. Dr. Muhammad Afzaal completed his Ph.D. in Food Science and Technology from GC University Faisalabad. His doctorate research focus was on the development of functional foods containing encapsulated probiotics with improved viability. Dr. Afzaal is also working on various carbohydrates, protein, and lipid-based encapsulation wall materials to elucidate their key role in the viability and stability of probiotics under stressed conditions. He is HEC approved supervisor since 2019. He has executed many research projects as a team member and Coordinator. Dr. Afzaal is a life member of the Pakistan Society of Food Scientists & Technologists (PSFST) and General Secretary of Faisalabad- PSFST chapter.",institutionString:"Government College University, Faisalabad",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"5",title:"Agricultural and Biological Sciences",slug:"agricultural-and-biological-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"252211",firstName:"Sara",lastName:"Debeuc",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/252211/images/7239_n.png",email:"sara.d@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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The drop in oil exports comes in response to an agreement between worldwide oil producers to cut production and revive the oil market in response to the coronavirus global lockdowns and a collapsing demand for oil [3]. Iraq also has the world’s 11th largest reserves of natural gas [4]. However, following four decades of war and international sanctions, the electricity supply system is now in a poor condition and unable to supply the rapidly increasing demand for electricity of a growing population [5].
The electricity infrastructure of Iraq was severely damaged during the First Gulf War in 1991. The sanctions imposed by the United Nations during the early 1990s further reduced electricity supply [6]. In 2003, following the Second Gulf War, the power generated fell from a pre-war value of 5300 MW to 3500 MW whereas the peak demand at that time was estimated to be 6000 MW [7]. Despite the rehabilitation of old power plants and construction of new ones, an annual rate of increase of electrical demand of more than 10% means there is now an estimated deficit of generating capacity of more than 10,000 MW [5].
After the Second Gulf War, the shortage of power led the Iraqi government to encourage the use of neighbourhood diesel generators and novel local distribution networks. Exact details of the numbers of these generators are not available. Reference [8] estimates there are 55,000–80,000 neighbourhood generators while reference [9] reports that the actual number of these generators is between 90,000 – 150,000. These medium sized (100–500 kVA) diesel generators supply 90–95% of households with about 20–30% of their electricity [5, 8]. This unusual community response to electricity shortages by using medium-size diesel generators serving neighbourhoods through a novel distribution network and tariff system is in contrast to some other oil-rich countries with poor public electrical infrastructure where small generators serve only individual consumers.
Over the last three years, encouraged by the falling costs of photovoltaic (PV) modules in international markets, the public have shown growing interest in installing rooftop solar PV systems. These small-sized (1–10 kW) systems are deployed to help residents supplement the public electricity supply and reduce their electricity bills by minimising their dependence upon expensive and polluting neighbourhood generators [10, 11, 12]. On the other hand, the Iraqi government has invited independent power producers (IPPs) to develop seven utility-scale PV solar power sites in the range between 30 and 300 MWp with a total power generation capacity of 755 MWp [13]. However, taking into consideration the recent dramatic drop in oil prices, a large deficit in the federal budget and the outbreak of the COVID-19 virus, it is thought to be unlikely that those utility-scale projects will become operational (as planned) by end of 2021 [12, 14].
The Iraq public electricity system is divided into two networks, which have very limited interconnection. The smaller network of around 7000 MW of power generation capacity (in 2019) is owned and operated by the Ministry of Electricity in the Kurdistan Region of Iraq [15]. The larger network of around 27,300 MW of generation capacity, which is the focus of this study, covers Iraq Excluding Kurdistan (IEK) and is owned and operated by the Federal Ministry of Electricity.
The capacity of power generation installed in Iraq (IEK) in 2018 is shown in Table 1. It can be seen that the mean generation is considerably less than the installed capacity in spite of the high demand for electricity, indicating power plant is often unavailable. Generation is from gas and steam turbines with some hydro-power. The large diesels listed in Table 1 have capacities of up to 23 MW and are operated by the Federal Ministry of Electricity using heavy fuel oil.
Power generation technology | All units | Operating units | |
---|---|---|---|
Nameplate capacity (MW) | Mean generation (MW) | Generation capacity factor | |
Steam turbines | 7305 | 3270 | ~ 0.448 |
Gas turbines | 15,857 | 5521 | ~ 0.348 |
Large diesels | 2327 | 376 | ~ 0.162 |
Hydroelectric turbines | 1864 | 208 | ~ 0.112 |
IPPs and Imports | — | 3627 | — |
Nameplate and available capacities of IEK power generation in 2018 [16].
Table 2 lists the types of fuel used in central power plants in 2018. The steam turbines are fuelled mainly by crude oil while most gas turbines are supplied by natural gas. Some gas turbines have been modified to burn crude oil, but these are then de-rated from a nameplate capacity of 2878 MW to a mean generation of 1178 MW.
Power generation technology | % of total fuel burnt in generation plants | ||||
---|---|---|---|---|---|
Crude oil | Heavy fuel oil | Light diesel | Natural gas | ||
Steam turbines | 75% | 12.8% | ~ 0% | ~ 0% | 12.2% |
Gas turbines | 20.3% | 11.4% | 2.2% | 3.8% | 62.3% |
Large Diesels | 0% | 96.6% | 0% | 3.4% | 0% |
Type of fuel burnt in IEK central power plants in 2018 [16].
The Iraqi transmission networks (400 kV in IEK only and 132 kV throughout Iraq) connect the central power plants with load centres [17]. Distribution networks use 33 kV and 11 kV to distribute the power supplied by the transmission network between primary and secondary substations and 0.4/0.23 kV to supply end-users with electricity. Distribution networks in Iraq are unreliable due to unplanned network growth, shortage of spare parts and lack of maintenance. The absence of effective metering and billing leads to widespread under-collection of revenues [8]. According to the International Energy Agency (IEA) [5], the aggregate technical and non-technical losses in transmission and distribution networks in IEK are between 50 and 60% of the total electrical energy generated and imported, and are among the highest in the world.
The Federal Ministry of Electricity estimated the mean power demand in 2018 to be 22,530 MW but the mean power dispatched to supply this demand was 12,109 MW [16]. For the same year, the IEA estimated the summer peak demand was about 27,000 MW and the unmet demand to be 10,500 MW [5]. The lack of electricity leads to severe hardship in a country where daytime temperatures in summer regularly exceed 45°C and has prompted most households and small businesses to rely on electricity from neighbourhood diesel generators. The source and hours of electricity supplied to residential customers in 2011 are shown in Figure 1. This shows that, even at that time, most households supplemented their electricity supply from the public network with a connection to the neighbourhood diesel generators or by using small individual household gasoline generators (or both). This practice of supplementing the public supply remains common. In summer 2020, electricity consumers in IEK received an average of 14–16 hours of electricity per day, with only 6–8 hours provided by the public network [19, 20].
Source and hours of electricity supplied to residential customers in Iraq, 2011 (Source: [
In response to this power deficit, private entrepreneurs and the Local Provincial Councils (LPCs) have been encouraged by the government to install medium-sized diesel generators at a neighbourhood level to supplement grid supply and alleviate some power shortages particularly in the peak summer months. These generators are owned and operated either by independent entrepreneurs or by the LPCs. In Baghdad, around 18% of more than 13,000 neighbourhood generators are owned and operated by the LPCs [21]. The generating sets are usually assembled locally from reused truck diesel engines coupled to imported generators, as shown in Figure 2. An assembly line of a local assembler of generating sets is shown in Figure 3. The control panels are manufactured locally using imported components. The price of a locally assembled 250 kVA generating set is between $8500–10,000 compared to the cost of a UK made imported 220 kVA unit of $18,000 – 19,000. Larger generating sets with capacities up to 2500 kVA are imported as complete units and operated by the LPCs.
Locally assembled neighbourhood generator (Source: Author).
Assembly line of a local manufacturer of neighbourhood diesel generators (Source: Local assembler).
The Federal Ministry of Electricity and the LPCs regulate the installation and connection of neighbourhood diesel generators. The ‘Regulations of Power Supply to End Customers’ of the Federal Ministry of Electricity [22] requires that neighbourhood diesels are electrically isolated from the public network. Electrical protection must be installed to ensure no current can flow from a generator into the public network. The Federal Ministry of Electricity records the numbers and sites of neighbourhood diesels and they cannot be relocated without obtaining permission from the Ministry and the LPCs. Apart from the technical details given in the ‘Regulations of Power Supply to End Customers’ and health and safety regulations, all other communications provided by the LPCs and Ministry of Electricity are guidelines only.
The LPCs provide the sites for the neighbourhood diesels, which are typically located on roadside and mid-road pavements, in public parks and near local markets [23]. Figure 4 shows an example of a neighbourhood generator installation in urban Baghdad. Also, the LPCs define the tariffs used to charge customers and the number of hours that the neighbourhood diesels operate, but these vary between different provinces. Several campaigns by non-governmental organisations and the general public have called for clarification and enforcement of the policies and regulations for operating neighbourhood diesels.
Neighbourhood diesel generator installed on a mid-road pavement in Baghdad (Source: Author).
The Ministry of Oil provides the fuel necessary to operate the neighbourhood diesels. The Ministry of Oil defines the amounts of fuel to be supplied, according to the power available from central power plants and anticipated customer electricity demand (Table 2). Between 2003 and 2017, fuel was provided initially free-of-charge and later at subsidised rates. After 2017, the diesel fuel was sold to entrepreneurs and LPCs at the regular retail price of 34 US cents per litre (Table 3).
Months | Amount of fuel (litre/kVA) |
---|---|
20–35 | |
10–15 | |
10–15 | |
5–10 |
Amount of fuel per month supplied by the Ministry of Oil to neighbourhood diesels [24].
Most residential premises in Iraq pay two monthly electricity bills, the first to the Federal Ministry of Electricity and the second to the operator of their local neighbourhood diesel. Electricity from the public network is charged by energy ($/kWh) while the neighbourhood diesels sell electricity based on the maximum current the customer has chosen ($/Amp).
Table 4 shows the domestic tariffs charged by the Federal Ministry of Electricity for different levels of energy consumption. It has been recognised by the World Bank and the International Energy Agency that these very low tariffs do not promote efficient and rational use of electricity and combined with poor billing and collection, they result in very low cost recovery ratios (approximately 10%) and the electricity sector operating at a loss [5, 25].
Customer type | Energy consumed (kWh) per month | Tariff (US ȼ/kWh) |
---|---|---|
1–1500 | 0.83 | |
1501–3000 | 2.92 | |
3001–4000 | 6.67 | |
over 4001 | 10.00 |
Electrical energy tariffs charged by the Federal Ministry of Electricity in September 2020 [26].
All costs in this chapter have been converted from Iraqi dinars to US dollars at a rate of 1200:1.
The monthly tariffs charged by the neighbourhood diesels are divided into two types (Table 5). The standard tariffs of restricted hours are defined by the LPCs and apply to all generators while the premium service that provide 24-hour electricity is offered only by the private entrepreneurs. For the premium service, the entrepreneurs buy additional fuel from the Ministry of Oil at approximately 59 US cents per litre [27].
Summer | Spring & autumn | Winter | (US ȼ/litre) | ||
---|---|---|---|---|---|
10 | 7.5 | 5 | 34 | ||
10 | 3–10 | ||||
21 | 12.5 | 59 | |||
24 |
Approximate monthly tariffs of the private neighbourhood diesel generators.
There is a considerable difference in the price paid for electricity from the public network and the neighbourhood generators. Table 6 shows the approximate monthly energy consumption and bills for electricity of a typical residential customer in IEK. The calculation assumes a 24/7 supply of electricity from the public grid with an assumed set of appliances in a typical dwelling. The electrical load is that assumed by the Federal Ministry of Electricity to estimate the consumption of households that are without a functioning meter [22]. An on-line calculator using these assumptions has recently been published by the Ministry of Electricity to help customers estimate their consumption and calculate their bills [28]. Table 6 contrasts this cost with the charge for a neighbourhood diesel to supply only the essential loads of lighting, fans, evaporative air coolers, white goods and home entertainment systems. It can be seen that the neighbourhood diesels provide a much more expensive service to fewer appliances for reduced hours.
1740 | 19.5 | 7 | 70 | 147 | |
780 | 6.5 | 5 | 37.5 | 62.5 | |
1245 | 10.4 | 25 | |||
154.7 | 575 | 1172.5 |
Approximate monthly energy consumption and bills of a typical residential customer.
The circuits used for connecting the neighbourhood diesels are unusual and Figure 5 shows how the neighbourhood diesel generators are connected using radial private wire distribution circuits of single 2.5 mm2 or 6 mm2 copper conductors. Single conductors connect a live phase of the neighbourhood diesels to individual customer premises. The neutral of the generator is permanently connected to the neutral conductor of the public network. A changeover switch, either automatic or manual, is installed at the customer premises for transfer of the live phase from the public network to the neighbourhood generator when a power outage occurs. There are no clear, enforced regulations for neutral earthing (grounding) but a common practice is not to earth the generator neutral but rely on the earth of the neutral of the 11/0.4 kV distribution transformer.
Simplified diagram of neighbourhood generator connections.
This unusual neutral connection practice would contravene safety regulations in many countries. There is no means of detecting if the connection between the generator and transformer neutral is lost and, in this condition, ill-defined “floating voltages” will appear at consumers premises. If the single-phase wire to a dwelling is broken, then again there is no means of detecting this and a hazardous voltage may result. There is considerable anecdotal evidence of fires being caused by faults on these circuits and electrocution of members of the public [29, 30, 31].
Miniature circuit breakers (MCBs) in a distribution board at the generator limit the electrical current drawn by each customer. The current ratings of the MCBs are used to determine the monthly charge and also provide overcurrent protection. Most customers buy less than 10 amperes to supply only their essential loads. Figure 6 shows an MCB distribution board supplying around 100 dwellings installed at a neighbourhood diesel generator in Baghdad.
A miniature circuit breaker board of a neighbourhood diesel generator (Source: Author).
Figure 7 shows informal distribution circuits supplying power from a neighbourhood diesel in Baghdad. In IEK, it is common for individual final circuits to radiate directly from the generator distribution board to each consumer. Problems of the distribution circuits include loose or disconnected wiring, short circuits, mal-operating changeover switches and sustained high voltages caused by poor neutral earthing.
Informal distribution circuits using redundant utility support insulators (Source: Author).
Neither the generators nor private wire distribution networks are regulated by the Federal Ministry of Electricity and the agreements between the generator operators and customers are verbal [32]. Customers sometimes experience poor power quality with voltage and frequency falling below their rated values of 230 volts and 50 Hz when the operators reduce the running speed of their engines to save fuel. It is also known for operators to overcharge their customers [5]. The disposal of engine lubricants in public sewage systems has been reported [33] while poor handling procedures of fuel and non-compliance with electrical safety regulations have been identified as causes of fires [23, 34, 35].
It is widely recognised that neighbourhood diesel generators can create a significant noise nuisance [8, 23, 36] especially when their enclosures and canopies are removed to increase cooling (Figure 8).
Neighbourhood diesel generator with enclosures removed showing exposed fan (Source: Author).
According to the Iraq ‘Law of Noise Control’ of 2015 [37], the noise limits in residential areas are Sound Pressure Levels (SPLs) between 55 and 60 dBA during the day and 45–50 dBA at night, depending on the source of the noise (e.g. local crafts and industrial workshops). There are no specific limits for the noise produced by neighbourhood diesel generators. In November 2019, the LPC in Erbil (Kurdistan Region of Iraq) issued new regulations requiring that, from May 2020, all neighbourhood diesels should be fitted with soundproofing systems. Non-compliant owners of the neighbourhood diesels face fines of approximately US $ 1670 and their licences being suspended [23, 38].
The results of national studies of noise from neighbourhood diesels are shown in Table 7.
[39] | 63.1 dBA at 10 m with enclosure | 89.2 dBA at 10 m without enclosure | Size of the generator sets not provided |
[40] | 74.86 dBA at 50 m | 98.91 dBA at 5 m | State of the enclosure not available |
[41] | 69 dBA at 15 m | 103 dBA at 1 m | Neither the number, rating nor the state of the enclosure available |
[42] | 63–65 dBA at 50 m | 105–109 dBA at the generator site | The number of 250 kVA generator sets is not available. All units are without enclosures |
Measurements of noise from neighbourhood diesels.
In [39], the SPLs of diesel generators with and without enclosures were measured at 1.1–1.2 metre from the ground. In [40] and [41], the SPLs of neighbourhood diesels installed in the cities of Duhok and Erbil were measured at various distances from the diesel generator. In [42], the SPLs produced by 250 kVA neighbourhood diesels were measured to investigate the impacts of noise pollution in the city of Mosul using geographic information systems (GIS).
Using the data from the references in Table 7 and a simple hemi-spherical propagation model [43], Sound Power Levels for the generating sets were estimated of between 103 and 121 dBA without enclosures and about 91 dBA with an enclosure.
The location of the neighbourhood diesel generators in residential areas leads to particular concerns over local air pollution. A ‘Draft Iraqi Standard’ [44] defines limits on the exhaust emissions from diesel generators but the common practice of mixing the diesel or gas oil fuel with heavy oil, and poor maintenance of the engines increase the level of emissions [23, 45, 46].
Table 8 shows emissions measured in local studies. The allowable emissions from small diesel generators are shown on the top line of Table 8 with measured values shown on the lower 3 lines. Reference [39] records the concentrations of air pollutants from diesel generators measured between August and November 2012. Higher wind speeds in autumn spread the pollutants and reduces their concentration. Alrawi and Hazim [47] show the maximum concentrations of CO, SO2 and H2S pollutants emitted from new and old 150, 250 and 500 kVA generators located in Baghdad. Najib [48] measured the emissions from diesel generators installed at Al-Qadisiya University. In all cases the measured emissions exceeded those specified in the draft standard.
[44, 47, 48] | |||||||
[39] | 4.25 | 5.98 | 3.40 | Not measured | 0.48 | ||
3.50 | 4.60 | 3.15 | 0.42 | ||||
2.95 | 3.90 | 2.44 | 0.32 | ||||
2.66 | 2.85 | 2.75 | 0.23 | ||||
[47] | 1.62–2.23 | 0.70 | 0.80–1.30 | 0.60–1.10 | Not measured | ||
2.10–2.60 | 0.60–0.80 | 0.90–1.30 | 0.50–1.00 | ||||
2.10 | 0.50 | 1.20 | 0.60 | ||||
3.00 | 0.70 | 1.50 | 1.00 | ||||
2.90–3.40 | 0.80–0.90 | 1.80–2.40 | 1.60–2.50 | ||||
3.10 | 0.90 | 2.10 | 2.10 | ||||
[48] | 2.80 | Not measured | 0.65 | 0.009 | Not measured |
Concentrations of pollutants emitted from different neighbourhood diesels in ppm.
In the Kurdistan Region of Iraq (KRI) in June 2020 consumers received an average of 16 hours per day of electricity from the public grid [49]. Neighbourhood diesels, however, remain common with at least 5500 generators registered and operating in the region [50, 51, 52]. Connection practice differs from elsewhere in Iraq with local distribution boards mounted on utility distribution poles from which the final connections radiate to customer premises. The boards are supplied using single conductor mains of 50–95 mm2 copper conductor. The neutral wire connection practice (employing the neutral wire of the public grid) is similar to the practice seen in other Iraqi cities. The tariffs of the neighbourhood diesels in KRI are defined in ($/Amp) for neighbourhoods that have a connection to the public distribution grid. However, the tariffs are defined in ($/kWh) for the diesel generators supplying newly built residential housing complexes which are not connected to the public distribution grid [53, 54].
In Lebanon, neighbourhood diesels (known as ishtirak or ‘subscription’ [55]) have been common since the early days of the civil war of 1975–1990. In 2018, these generators, described by the World Bank Group as ‘illegal and informal’, were used to supplement customers with 8.1 TWh of power amounting to about 37% of the total power demand in Lebanon [56]. In Beirut, which has a daily supply of about 21 hours of electricity from the public distribution grid, neighbourhood diesels make up the 24-hour supply. In other cities of Lebanon which receive less than 12 hours of public grid electricity each day, the neighbourhood diesels supply customers with electricity for up to 6–8 hours per day [57, 58, 59, 60].
The World Bank Group and the American University of Beirut [61] report that ratings of neighbourhood diesels in Lebanon are typically below 500 kVA, similar to Iraq. The connection practice of the neighbourhood diesels employing the neutral wire of the public distribution grid is the same [58]. Also, the contracts between the private entrepreneurs and the customers are verbal. Connection practice of the neighbourhood diesels in Lebanon is to use fuse boxes (or local distribution boards) mounted on subscribing buildings rather than on poles of the public distribution grid [57, 58]. Prior to October 2018 some customers only had MCBs while others had both MCBs and energy meters. Nowadays, all Lebanese customers (old and new) are required to have MCBs (to limit the maximum current) and energy meters (for tariff charging). There is also a standing charge defined by the current rating of a customer’s MCB [62].
In Syria, neighbourhood diesels (locally called ‘ampere or subscription’ generators [63]) supply customers with electricity due to the damage sustained by the public grid during the civil war [64]. These generators were initially employed in regions controlled by the Syrian rebels to supply customers with no more than 10 hours of electricity per day [63]. The practice was later adopted in regions controlled by the Syrian Government [65, 66]. The topology of the private wire networks of the neighbourhood diesels in Syria is similar to KRI and Lebanon with thick single live conductors supplying local distribution boards mounted on public distribution poles or subscribing buildings. The use of the public network neutral wires is similar in Iraq, KRI and Lebanon [67]. The customers in Syria are not equipped with energy meters. The tariffs of the neighbourhood diesels, regulated by the LPCs in Syrian cities, are defined in ($/Amp).
Iraq, located between latitude 29°.98′ and 37°.15′, has a high potential of solar energy with a mean global PV potential of approximately 4.7 kWh/kWp, global horizontal irradiation (GHI) of 5.5 kWh/m2 and an average of 3250 of hours of sunshine per year in Baghdad [68, 69] (Figures 9 and 10).
PV power potential (PVOUT) in Iraq [
Global horizontal irradiation (GHI) in Iraq [
However, the utilisation of solar energy for electric power generation did not receive attention until 2019 when the Iraqi government (with the aid of international organisations) became more active in formulating a solar policy for the country [12]. Licences have been awarded for private companies to install residential solar power systems [71], technical specifications for these solar systems have been defined [72], and investors (local, international and IPPs) have been invited to construct grid scale solar plants [13] and pilot rooftop residential solar systems [73].
The technical specifications of rooftop solar PV systems issued by the Federal Ministry of Electricity imply that when the systems are financed by soft loans, they must be hybrid systems. Hybrid solar systems (Figure 11) combine the functions of solar panels, inverter, maximum power point tracker (MPPT), battery charger and battery pack to ensure that power supplied to the load is uninterrupted. A hybrid solar system can be operated as an on-grid system with battery storage or as an off-grid system with backup power from the grid. Power is never exported to the grid deliberately.
Hybrid solar PV system.
Taking into consideration the nature of loads and the power generation capacity (1–10 kW) of hybrid solar PV systems (recommended by the Federal Ministry of Electricity and commonly deployed in Iraq), the operation modes of these systems are summarised in Figures 12–17. It is assumed that the priority of a hybrid solar inverter/charger is to feed the essential load first and to charge the battery bank only if sufficient power is generated by the PV panels.
Off-grid mode: PV power is not available. The essential load is fully supplied by the batteries.
Off-grid mode: PV power is not sufficient to supply the essential load which will therefore be supplied by both PV panels and batteries.
Off-grid mode: PV power is sufficient to supply the essential load and charge the batteries.
On-grid mode: PV power is not sufficient to fully supply the essential load and the batteries are not connected (e.g. removed for maintenance or replacement). The essential load is supplied by both PV panels and LV grid.
On-grid mode: PV power is neither sufficient to supply essential load nor charge the batteries. LV grid supplies power to the essential load and charges the battery bank.
On-grid mode: PV power is not sufficient to fully supply the essential load but is sufficient to charge the batteries. The essential load is supplied by both PV panels and LV grid.
Besides hybrid solar PV systems, entirely on– or off–grid rooftop solar systems have been deployed in limited numbers in Iraq. On–grid systems, which are similar to hybrid systems except that they do not have battery banks, have been installed at a number of governmental buildings including the Federal Ministry of Electricity (an aggregate of 350 kW at two different sites), University of Babylon (with a 130 kW capacity) [74] and University of Technology [75].
In contrast, off–grid systems include battery banks, but are not connected to the LV distribution grid. Off–grid systems are used for rural agricultural (irrigation and drainage) applications and have also been employed for experimental studies. Figure 18 shows an experimental off–grid system rooftop solar system installed at a residential premise in Baghdad.
A rooftop array of solar panels in Baghdad (Source: Dr. Jaafar Ali Kadhum Al-Anbari).
A detailed illustration of the system is shown in Figure 19. Block (1) is the infeed cable collecting the outputs of the solar panels shown in Figure 18. Block (2) is a 10 kW inverter that converts 48 volts DC to 220 volts AC to supply the essential load of the residential premise. Block (3) is an MPPT charge controller while block (4) shows the cooling system installed to cool the inverter (block (2)). Finally, block (5) is a 48 volts battery bank comprising 54 lead acid batteries (of different capacities) connected to produce an aggregated capacity of 1500 Ah.
Detailed illustration of a 10 kW experimental rooftop off-grid solar system in Baghdad (Source: Dr. Jaafar Ali Kadhum Al-Anbari).
Solar energy, if actively exploited, has an important role in improving Iraq’s energy security and could help fill the gap between the available electrical power supply and demand without using traditional power generation technologies or neighbourhood diesel generators. Oil and gas consumed for power generation can be saved which in turn allows more oil exports that will add to the government revenues [12].
A pilot project comprising six rooftop solar PV systems (each having a capacity of 5 kW) in Najaf [76] was able, over four years, to save a total of 58 tonnes of CO2 (equivalent of consuming more than 7000 gallons of diesel) from being emitted into the atmosphere [77]. Reference [78] reports that the potential savings in CO2 emissions would amount to approximately 804 gCO2/kWh should a 315 kW solar power plant be constructed at Sulaymaniyah airport to replace fossil fuel based electric energy supplying the airport.
A comparison between the present levelized cost of electricity (LCOE) from open-cycle gas turbines (OCGT), combined cycle gas turbine (CCGT), neighbourhood diesel generators and solar panels (Table 9) shows that rooftop solar PV systems offer a competitive alternative to neighbourhood diesel generators. In Table 9, residential rooftop solar systems have a maximum power generation capacity of 15 kW, commercial rooftop systems can generate up to 500 kW whereas utility-scale systems are multi-megawatt solar farms [79].
0.04–0.06 | [5, 12] | ||
0.07–0.11 | |||
0.64–1.30 | |||
0.018–0.085 | [5, 11, 12, 79] | ||
0.062–0.064 | [79] | ||
0.063–0.265 |
Comparison between LCOE of solar PV and fossil fuel based power generation technologies.
In Iraq, the installation cost of rooftop solar systems can either be paid as a one-off payment or over 36–60 months with a long-term loan. A 5 kW hybrid solar system costs between US $ 3800–4800 with a one-off payment whereas the cost of the same system increases to about US $ 6450 (over 36 instalments) – 6860 (over 60 instalments) on a long-term loan [80]. The variation in costs depends upon both the number of solar panels and batteries connected. A replacement lead acid battery is usually required every two years, at a cost of US $ 210–280 per 200 Ah battery.
Comparing the installation and battery replacement costs with the approximate electricity bill of a residential customer (Table 6), it can be concluded that a hybrid rooftop solar system is expensive and may not deliver the financial savings anticipated over its lifetime of 20–25 years. Similar findings were reported in [51] recommending the installation of rooftop off-grid solar systems only when an annual discount rate of below 9.4% was assumed for the battery bank. Analysis of different scenarios showed that investment in rooftop solar systems would not be cost effective at high battery discount rates. Alternatively, reference [12] recommends exploring community solar microgrids rather than installations on each house.
In summary, it can be seen that numbers of rooftop solar system installations in Iraq are increasing; however, these will probably not reach a tipping point to replace neighbourhood diesel generators for some time. The public are often reluctant to install rooftop solar systems because of their high upfront and maintenance costs especially with the current unstable economic conditions in the aftermath of the coronavirus outbreak and worldwide drop in oil prices. The lack of government support for soft loan mechanisms as well as high commercial interest rates (more than 40%) for loans to fund domestic solar systems are other factors that discourage widespread installations of solar systems. Also, the customers are reluctant to invest in solar PV systems because present Iraqi legislations do not support net-metering or feed-in tariffs [12].
There is some evidence that the reducing cost of photovoltaic panels may offer a partial solution to this problem of deficit of generation. Iraq has an extremely attractive solar resource but so far implementation of photovoltaic generation has been limited. For widespread adoption of rooftop systems, a more attractive commercial climate is required, through low interest loans, net metering or feed-in tariffs.
The electricity systems of Iraq, and parts of Lebanon and Syria, experience frequent power cuts caused by shortage of generation, damaged transmission and distribution networks as well as rapidly increasing demand. In response to the limited hours that electricity is available from the public supply systems, local organisations have established innovative arrangements using diesel generators and simple distribution networks. These systems operate independently and are managed separately from the public electricity supply.
The generators are typically in the range of 100–500 kVA and are often locally manufactured from reused truck engines and imported generators. The generators provide each subscribing consumer with a supplementary supply of up to several kW of electrical power through informal networks that extend over a small area of a town or city. The final connection to the consumer premises is made through a radial single wire and the neutral of the public LV network. There is no connection of the live conductors from the generators with the public network and each customer has a changeover switch to select either the public mains when supply is available or the neighbourhood diesel. Monthly tariffs are based on $/amp with miniature circuit breakers limiting the current drawn by each consumer.
Neighbourhood diesels create significant local air pollution and noise, and can only supply small amounts of power at considerable cost. However, for those areas that have only limited public electricity supply they provide some power when the public service is unavailable. In Iraq, electricity from the public network is sold to domestic customers at a price that is below the cost of supply so limiting revenue that could be used to increase the capacity of the public supply system. There is no immediate prospect of the public electricity supply in Iraq improving dramatically and of these neighbourhood generators becoming redundant. Until the public electricity supply system can fully meet the load demand, the use of neighbourhood diesels is likely to continue.
Suitable Iraqi standards exist, some in draft form, to regulate the noise and gaseous emissions from neighbourhood diesels but local studies indicate these standards are not being met. No standards to regulate the novel connection practice of using a common neutral connection from the public network were identified. There appears to be scope both to enforce existing standards and develop a new electrical standard to regulate the connection and operation of the diesel generators and the innovative networks.
The author gratefully acknowledges the support of the FLEXIS project in the School of Engineering, Cardiff University. FLEXIS is part-funded by the European Regional Development Fund (ERDF), through the Welsh Government. Ariennir yn rhannol gan Gronfa Datblygu Rhanbarthol Ewrop drwy Lywodraeth Cymru. The author also acknowledges the assistance of Dr. Jaafar Ali Kadhum Al-Anbari providing the details and photos of an experimental 10 kW off-grid residential solar power system.
Reorganization of the U.S healthcare system began in the early 1980s as hospital ownership and affiliation began to move toward health care network conglomerates. Prior to this, there were a large number of freestanding hospitals, both nonprofit and for-profit, which existed independently from other hospitals in the area. The system was such that each hospital functioned without any reliance on – or interactions with – neighboring hospitals. However, by the early 1990’s, many of these hospitals had entered into agreements to merge with each other. Additionally, many of these hospitals began to acquire autonomous physician groups to form a health care network conglomerate. This restructuring of the U.S. health care system continued throughout the begin of the 21st century. Much of this was driven by the introduction of new payment models in the Patient Protection and Affordable Care Act in 2010, which only served to further initiate mergers and acquisitions as a way to contend with ongoing payment reform.
These mergers were advantageous for a variety of reasons, but financially they were favorable based on the amount of market overlap between separate institutions. Based on previous research by Brooks and Jones [1], two major factors in increasing the likelihood of a merger were identified: the opportunity to increase efficiency and the opportunity to enhance market power.
The expected outcome of enhancing the market power was to increase profitability. By decreasing the amount of competing facilities, there was an opportunity for each healthcare network or set of hospitals to dictate certain prices for healthcare goods and services. The merger of hospitals tended to make the market power of the combination much greater than that of either hospital independently. This substantive alteration of power also served to change the market structure itself. Subsequently, this remodeling of the structure would then place pressures on other competing firms to engage in merger agreements as well.
Gains in efficiency would be made by incorporating the relative strengths of each independent hospital or physician group into a larger structure. Most often, one member of the merger benefits immediately from management expertise of the other merged affiliate. These increases in efficiency can only be seen when facilities combine their collective operations. The amount of market overlap is somewhat predictive of the amount of increase in efficiency seen with mergers. In those facilities with overlap between served markets, consolidating to decrease duplication of services will likely not only be easy, but also rewarding.
Hospital system mergers are well-established in the available literature. Of those that are reported, three significant mergers in major metropolitan cities are the most well-known and time tested [2]. In Philadelphia, in 1995, the University of Pennsylvania Health System acquired the Presbyterian Hospital, followed shortly thereafter by the Pennsylvania Hospital in 1997. This was part of an overarching goal to form an integrated city-wide academic healthcare system. In Boston, in 1994, Massachusetts General Hospital and the Brigham and Women’s Hospital merged to form a new healthcare system: Partners Healthcare. Both institutions were affiliated with Harvard University; the goal was to preserve each distinguished institute’s identity and renown while also forming a more inclusive healthcare system. Finally, in New York, in 1998, New York Hospital merged with Presbyterian Hospital to form New York-Presbyterian Hospital. Each institution was affiliated with a separate medical school (Cornell and Columbia, respectively); despite the merger, they have maintained a clinical independence from one another.
With an increasing number of hospital system mergers, a known sequela is the merging of the healthcare educational system. There is a considerable amount of literature reporting the trends in health care market concentration [3], in addition to the impact those trends have on healthcare costs and quality of care (arguably two of the most important factors in the health care system). However, there is a paucity of literature in regard to the outcomes of residency programs when their associated institutions have a merger or acquisition event.
The economics of residencies have been increasingly difficult during recent changes in the healthcare system. Historically, postgraduate medical education has been subsidized through a combination of public (Medicare and Medicaid) and private insurance payments. Teaching hospitals have, however, faced issues with decreasing reimbursements for a variety of reasons. A major difficulty that teaching hospitals encounter is the large amount of patients who are uninsured; some of their unpaid medical bills are financed by the hospital, while some is simply a debt that will never be repaid [4]. Another complex issue is the shifts in what type of reimbursement model is utilized by insurance companies. These issues overall result in a lower amount of total reimbursements, which trickles down to graduate medical education. These overall cost deficiencies put a tremendous amount of pressure on residency programs for collaboration to resolve these financial burdens.
With the ever-changing paradigm of healthcare delivery in the United States, the education of future physicians and surgeons remains a dynamic process. Residency mergers have become more common and will continue to occur more frequently. Establishing best practice to successfully merge residencies is important for seamlessness in training. In this chapter, we will review the available literature regarding reported residency mergers, with a focus on models and guidelines proposed to make an effective residency merger, including strategies to overcome the difficulties that present themselves during the process.
We began our literature review in August 2020 by conducting a search for “residency program merger” on PubMed and Google Scholar from all years available (1968–2020). There were a total of 33 results for this search query. We then narrowed down these results to those only describing mergers of graduate medical education. Additionally, we incorporated several papers that did not appear in our original search, but were listed as references in one or more publications that appeared in our search. Our aim was to include as many examples of residency mergers to develop a comprehensive view of graduate medical education mergers and the successes and challenges that have been identified.
The first reported residency merger was between two psychiatry residencies, one from The Institute of Living, and the other from the University of Connecticut [5]. In 1989, leaders from each program came together to discuss what the combined program would look like and how they would implement the changes; in July 1990, the combined program began. Both programs had their own set of strengths. The Institute of Living, which is located in downtown Hartford, Connecticut, is one of the oldest private psychiatric hospitals in the US; its reputation and location provide a diverse patient base and the opportunity for long term follow up. On the other hand, the University of Connecticut Health Center, which is located in a Hartford suburb, is an academic institution with a strong commitment to the education of both medical students and residents.
Based on these complementary characteristics, the respective institution leaders were hopeful that the merger would be successful. A task force to construct the new residency program was assembled and was comprised of both faculty and residents from both institutions. Salaries of the residents had differed between residency programs, so once merged, all salaries were standardized. Similarly, call requirements differed, so those too were standardized. Overall the merger was successful; both institutions used the merger to improve their educational experience as one cohesive unit.
There is limited literature available regarding residency mergers, but the most widely referenced specialties include pediatrics [6], psychiatry [5], family medicine [7], and surgery [8]. For the most part, the publications generally present the process behind the merged programs, the challenges they faced throughout the process, and the advice they offer for future mergers. Success of the merger is very subjective and is not typically measured objectively, with the exception of some literature which follow residents’ perspective of the process through surveys evaluating how positively or negatively they felt about the merger.
Unfortunately, the limited amount of information available about residency programs that have merged or are undergoing a merging process is compounded by the fact that there is no official record or list which is published by the Accreditation Council for Graduate Medical Education (ACGME). Not only does the ACGME not keep records of this, but previous personal communication with ACGME administrators have revealed that no data on residency mergers is maintained [9].
Although not specifically a merger, a well-publicized closure of a large academic institution made national news in the United States in 2019. Hahnemann University Hospital, a 500-bed teaching hospital in Philadelphia, Pennsylvania, announced its closure abruptly in June 2019, soon after it had recently welcomed 140 new residents to its varied residency programs. This chaotic sudden closure suddenly displaced more than 550 residents and fellows, who then had to quickly find residency positions elsewhere. Fortuitously, all trainees were able to find educational opportunities within 43 days [10]. This is a worst-case scenario result of financial pressures placed upon teaching hospitals. The goal of raising this discussion about residency mergers and collaboration is to avoid a similar unfortunate event.
Rider and Longmaid, both of Harvard Medical School, have had personal experience with mergers as well as conflict resolution and therefore published an article in 2003 detailing their advice for merging residency programs [9]. They identified 10 specific guidelines to keep in mind while going forward with the merging process, which we will discuss briefly.
The success of any merger is dictated by having a definitive plan that is effectively carried out. This can only be achieved with establishment of a leader who is capable of not only creating this plan but also putting it into action. Whether that is one of the previous residency program directors (PDs), a combination of individuals, or even another individual entirely, the leader should be clearly identified and communicated to all involved parties.
A plan should be established which addresses a few particular issues for the new program: goals of education and training, educational philosophy, governance of combined program, institutional cultures, and the impact of merger on faculty and trainees. The vision of the leader should be used to formulate a plan for these issues as well as a timetable for that plan to be fully operational. A more rapid timetable for the enactment of the plan is preferable, as the goal is of course to minimize the amount of disruptions during the process of combining programs.
The importance of a dynamic leader is not to be neglected, either. Although the leader may have his or her own vision, it should be combined with the input of faculty and residents from both institutions. Differing opinions will allow for the creation of an ideal program, to which all faculty will then be motivated to contribute. A suggestion based on previous successes in other health care mergers would be to create a committee of involved individuals who are dedicated to shaping the goals and vision for the future residency program. This would be a concrete way to incorporate the influence of all departments interested, as well as those of the residents. Flexibility is a necessary characteristic of a leader to establish a plan that not only fits the original vision but combines with the constructive input of others.
Communication is key! While the vision and plan are put into action by the leader, obstacles that challenge the success of that plan will always be encountered. Having clear channels of communication already established can be helpful when trying to address some of these obstacles. Frequent updates via multiple modes of communication will ensure that a communication link is available should any issues arise. Email would be the easiest, but not always the preferred method for everyone. An in-person meeting that is scheduled either weekly or bi-weekly could be helpful in making sure that all parties remain involved in planning and enacting change.
Generally, most people do not feel like change is a positive construct. Whenever change is initiated, it is sometimes felt as if it is a negative comment on how programs were already operating. This can be detrimental to staff and program morale, which can lead to a host of negative results including staff attrition/resignation or feelings of inadequacy/anxiety. Leadership for the merger should be responsible for helping faculty and residents cope with the change by “giving them time to react, validating and respecting their feelings, keeping them up to date and creating a safe environment in which they can talk about the change” [9].
While it initially may not seem like a good idea to allow involved parties to express their displeasure in the merging process, it does allow those individuals to feel as if they have been heard and their opinions matter. Even acknowledgement itself can sometimes satiate a person’s displeasure in the process. This can lead to acceptance, begrudging as it may be, rather than tension or conflict with many involved parties.
During a residency merger, it is not just the institutional structure of the overall program that has to and will change, but also the personal structure of how individuals carry out their daily activities and tasks. This may not necessarily be accepted, but rather “physicians may react to the changes brought about by a merger in a predictable pattern, usually reflecting a combination of denial, anger and frustration as their professional lives become progressively more disrupted by a process they may not support” [9].
Personal commitment to the success of the merger will be essential in overcoming the disruptions presented by the operational and structural changes, which is why it is so important to make sure that all individuals’ concerns are heard. The more the merger feels like it is a cooperative effort, the more individuals are willing to push through and own the discomforts of the process.
No institutional culture will be the same. Even if one larger program is enveloping a smaller program, it will be crucial to incorporate the cultures of both programs. The residents and faculty in each program chose their particular program for a unique set of reasons. Often, a major reason why a medical student would choose a program is that the culture fits with their particular value system and needs. Being able to assimilate the strengths of both programs, while abandoning the weaknesses, will allow for both sets of residents to succeed in the new environment. Without endorsement by each program’s residents and faculty, the program will flounder in the setting of resentment and tensions between the two separate groups. In a merger between Howard University Hospital (HUH) and Children’s National Medical Center (CNMC), the institutional leaders address a specific example of cultural differences experienced in the merger of their pediatric residencies that we will discuss in detail later in the chapter [11].
While this may seem like a simple concept, mutual respect is not always a given. Parties from either residency program may come into the merging process with pre-conceived notions and hostilities. One program may feel as if it is being “taken over” by the other, or one may feel as if it is being “invaded” by outsiders. When two groups merge, the natural instinct is for people to stay within their own group and be loyal to themselves, rather than incorporating with the second group. With time, this chasm between groups should begin to close, as they begin to interact with each other on a more frequent basis. Making sure that these interactions are positive is essential, and starts with making sure all residents and faculty have a mutual respect for one another.
The more an individual feels as if they are a part of the process to create a new and improved residency, the more dedicated they are to enduring the process. Regular meetings and an inclusive committee will be essential in making staff feel as if they are able to provide input and help shape the process. The goal is to reduce uncertainty and make individuals feel more comfortable with the changes throughout the merger.
Residents, not just faculty, are an important source of constructive input during this process. While a residency merger does impact faculty and other hospital staff, the most changes will be felt by the residents. Disruptions in everyday life and operations will be most noticeable to them. It is critical that they are able to give input just as much as the input provided by leaders in the department. They may, however, not be able to dedicate the same amount of time to the process, such as attending frequent meetings, given how much time they are dedicating to their education. There should be some type of forum or meeting specifically dedicated to residents, so they feel as if their input is received while also still protecting their time to focus on their professional training.
Each residency program will come with its own strengths and weaknesses. One may have a stronger academic program, while the other may have a stronger clinical program. Through the acceptance and assimilation of these separate resources, the combined program can be more successful than either program was individually. Identifying these strengths and weaknesses and discussing them among the leadership of the merger will be essential in deciding which components of each program to include in the combined program to create the most successful program possible.
Salaries, benefits, and stipends must be made equal for residents and faculty to allow for mutual respect between these groups. Without this, there will be resentment and hostilities among individuals, which will be a hindrance to the programs coming together as one. This idea of fairness and equality must also apply to call assignments and workloads for the same reason.
It will be helpful to identify individuals who are dedicated to improving the program merger process. This could be a pre-appointed committee, as originally discussed, which is comprised of individuals from both programs as well as those from a variety of departments including the resident groups themselves. Personal ownership and responsibility will then be felt by this team which is, together in cooperation, motivated to create the best residency program possible. This does have to occur in the background of all normal clinical activities, which means that the team or teams will need to be efficient and focused. Setting particular tasks and identifying sets of individuals to complete those tasks can be helpful in having them accomplished in reasonable time periods (Table 1).
Key Aspect | Suggested Actions |
---|---|
Establish program director(s) Equal representation from each program Create committee of involved faculty and residents | |
Outline objectives by each PGY level Design a comprehensive curriculum Protected time for all residents Systematic evaluations of faculty and residents | |
Develop combined vision for the future of the residency program | |
Acknowledge differences in institutional culture | |
Provide opportunities early on in the process for residents to work together Frequent social functions | |
Regularly scheduled meetings to provide updates Multiple modes of communication Acknowledge opinions (both negative and positive) | |
Equal call responsibilities Access to hospital-provided tablet or computer for clinical responsibilities | |
Provide equal salaries and benefits between residents of same PGY level Equity in resident book funds |
Key aspects and suggested actions for GME mergers.
In the small pool of literature available regarding residency mergers, one of the major difficulties described with the process is institutional cultural differences. Different facilities will have their own backgrounds and their own ways of doing things. Recognizing these cultural differences and finding a way to incorporate them together is crucial to setting a program merger up for success. This allows for the residents and faculty from each program to feel as if they are a part of the new residency program without feeling a sense of identity loss. We know that successful physicians are created in a variety of training environments; a merger that integrates the strengths of each culture to create shared values will be more successful in the long run, as it engages faculty and residents from both programs in a common goal. Cooperation is a major factor in determining program merge success.
A prime example of a residency merger which united programs with vastly different cultural backgrounds was the merger between two pediatrics programs at Howard University Hospital (HUH) and Children’s National Medical Center (CNMC) as described in a case study by Cora-Bramble et al. [11]. Howard University and its associated medical programs are historically black institutions, while Children’s National is predominantly white with relatively low representation of minorities. Respectively, the compositions of the two different residency programs differed in terms of the residents’ race and ethnicity in addition to inclusion or exclusion of international medical graduates (IMGs). Sizes of the residency programs also differed substantially, as the HUH program was comprised of 30 residents, while the CNMC program was comprised of 72 residents. Perhaps even most notably, the levels of care at each institution differed in that CNMC was a tertiary care center with a high level of specialization including PICU/NICU capabilities, while HUH was more of a community hospital without advanced capabilities or intensive care units.
The merger occurred in 2003 and was prompted by the closure of one of the largest hospitals associated with HUH, which was responsible for the majority of their pediatric patient volume. This triggered citations of the program by the ACGME based on the low volume and lack of available subspecialty exposure. HUH recognized its own weaknesses and began to seek out an opportunity to form a collaborative partnership with another institution. CNMC, which had originally been a rival rather than a partner, stepped in to fill this need. This partnership would serve both institutions as well as the community. Goals of this partnership were identified by the CNMC leadership as “1) to increase the size of the residency program without additional cost, 2) to increase the racial and ethnic diversity of residents, 3) to provide needed support to the historic HUH pediatric residency program, and 4) to establish a community health track.” [11].
Difficulties encountered during the merging process included clinical challenges, operational challenges, and interpersonal challenges. For the most part these impediments are the same that present themselves during any merger, as we have already discussed, but the most complex of these in this particular case was identified as the interpersonal. Apart from the typical difficulties such as unfamiliarity with the organizational structure of their new home hospital, the HUH residents also struggled against inherent biases. The CNMC residents were accustomed to the faster work pace that accompanied their more clinically advanced institution, while the HUH residents were particularly challenged by the higher demand. This lack of clinical acumen was concerning to both CNMC and nursing staff, and immediately put the HUH residents at a disadvantage. This disadvantage was further compounded by encounters of racism and elitism which they encountered during day-to-day operations.
A dramatic observation made in this study was the dichotomy between experiences of the two programs’ residents. Only 13% of CNMC residents felt like the merger was positive for the institution as a whole, as opposed to 63% of HUH residents. The disjunction between opinions was even more distinct when residents were asked if the merger was positive for the residency program in particular – 63% of HUH residents identified it as positive, versus 10% of CNMC residents. Although these striking differences were initially alarming, as time went by after the initial merging process, the dichotomy between the separate programs’ residents did begin to disappear. This was attributed to both the influx of new residents with each year, in addition to a gradual acceptance of the daily reality by pre-existing residents.
The authors of this study did identify some salient points from their merger which have implications to other residency programs undergoing mergers, particularly those with cross-cultural conflicts. Out of concern for the ethnic and racial biases expressed toward HUH residents, a zero-tolerance policy was adopted by the CNMC leadership. This did benefit the HUH residents and their interactions with other staff, but it also had the undesired effect of making the CNMC residents feel uncomfortable expressing any legitimate negative opinions, even those that were associated with patient safety issues. The suggestion made to combat this difficulty would be to engage in more frequent feedback with all residents (in this case the CNMC residents) to ensure that all residents are able to express concerns and have those addressed by faculty or other leadership.
Another recommendation in this study was to use social events in a constructive manner. Gatherings set up between the HUH and CNMC residents were not always successful due to the different cultural norms. It is important, then, when trying to merge two independent, culturally-divided groups, that a common social ground must be established. Allowing constructive interpersonal relationships between resident groups to blossom in the setting of a shared social ground would alleviate some of the conflicts felt by both factions.
The most critical lesson identified by the Howard University Hospital-Children’s National Medical Center merger was that of creating a “safe space” for the residents of both programs. This was presented as an opportunity for residents to discuss and resolve issues, especially those concerning racism, elitism, or other cultural challenges, in an atmosphere of open respect and tolerance. By creating this environment, many concerns were able to be addressed, with the goal to improve the merging process as it happened.
Developing a strong core of cultural competence is vital to a successful residency program merger. By instituting a positive set of attitudes, behaviors, and policies, a health care system can protect its residents as they undergo the difficult transition of a merger. This will not only benefit the residents themselves in terms of the level of satisfaction with their experience, but should also improve the quality of care that residents provide to their patients.
When merging a residency program, often times the medical students affiliated with the institution are not considered. However, their education and how they fare is just as important as the residents. Most residency programs are associated with a medical school, whether it be through an academic institution to which they both belong, or as a clinical site through which medical students regularly rotate. An essential task for the resident is being involved in the education of future physicians. In fact, residents typically spend much more time with students than do the faculty members and can provide complementary educational opportunities than that provided by faculty. In addition, many medical students will often choose a specialty based upon their experience with the residents.
Various studies have been completed and attribute approximately one-third of a medical students’ knowledge to resident teaching [12]. Educating medical students includes supervising, instructing, and evaluating medical students, which can take up a significant amount of time and effort on the part of the resident. This task, important as it may be, can then be occasionally lost in an extremely busy work week.
The merging process could lead to positive ramifications such as increased resources for medical students. By consolidating resident responsibilities, it is possible that residents may have more time available to engage with medical students. This would provide for a more satisfying experience for both the resident and the medical student, as a good rapport between resident and medical student can often be the deciding factor for whether or not the student enjoys the rotation and furthermore whether or not they decide to ultimately pursue that specialty.
Conversely, negative ramifications of the merger could include a diluted clinical experience. The same number of patients or procedures may have to be distributed among a greater number of residents, therefore decreasing the overall quality of education for each medical student. Similarly, any negative feelings or perceptions that the resident may harbor toward the merging process may impact the way that residents interact with faculty, co-residents, or medical students alike, even if only subconsciously.
There is a single study by Hines et al. in 1999 which discusses the impact of obstetrics and gynecology residency mergers on the medical student experience. Medical students from the Uniformed Services University for the Health Sciences were studied, as two new obstetrics and gynecology residency programs (one formed by two programs in San Antonio, Texas; the other formed by two programs in Washington, District of Columbia area) were clerkship sites. Medical students were given a questionnaire following the rotation. The questionnaire evaluated the students’ perceptions of the case load, instruction, and overall clinical experience. There were no statistically significant differences between experiences before the merger and after the merger.
Likewise, the National Board of Medical Examiners (NBME) subject examination in obstetrics and gynecology, which is given at the end of the rotation, was reported by the student. This served as an objective measure to evaluate the medical student experience. There was no statistically significant negative impact on NBME scores; in one program there was even a statistically significant positive impact on NBME scores. While this area could clearly use more investigation, this seemingly posits that the merger of residency programs has little to no significant deleterious impact on the education of medical students – either their satisfaction or their performance on standardized exams.
While the most obvious characters to consider during the residency merger process may be the residents, it is imperative that we too keep in mind the medical student. Doctor, after all, does have its origin in the Latin
As the authors of this chapter do originate from a surgical residency, we have a special interest in how a residency merger for a surgical residency should unfold. Additionally, surgical residencies have a factor to consider that is singular to surgery – the case log. In order to graduate from a surgical residency, trainees must meet a particular number of cases in each surgical category which is specifically set by the ACGME. This makes merging residency programs somewhat more comprehensive, as the case availability for trainees must be carefully evaluated before and after the merging process to ensure that the case mix requirements can be met for every resident, even if they are starting with vastly different numbers. This issue is one area that will need special consideration with surgical residencies.
A study published in 2015 evaluated the impact a merger between an academic surgical program (Yale New-Haven Hospital) and a community surgical program (Hospital of Saint Raphael) [13]. This publication is significant as it is one of the only studies that includes a Likert survey which was developed specifically to evaluate the perspective of the resident regarding the merging process. Categories included on the survey include relationships among residents, relationships with faculty, systems interactions, clinical training, surgical training, scholarship, and career plans. This survey, which was independently evaluated by 11 residency program directors for its generalizability, is a tool which may be valuable for future program merger evaluations.
The survey was completed at a single point in time after the merger, so the information provided by the survey responses is somewhat limited in its applicability. It was suggested by a commentary that to improve future studies a similar survey tool could be administered pre-merger and post-merger to eliminate some limitations [14]. However, responses that were received were generally positive. Community-trained residents felt as if their exposure to complex cases and scholarly or research activities had improved. Academic-trained residents, on the other hand, did not feel as if they had new deficits in their experience with the influx of new trainees; in fact, with the incorporation of community institutions, they felt as if they had an increased number of “bread and butter” surgical cases which improved their operative experience and made it easier to meet their case log numbers. Overall this study is hopeful; it identifies particular areas that should be considered in order to keep trainees satisfied with their training to make the experience as positive as possible for all involved.
Another piece of the available literature which focuses on issues unique to surgery is a survey-based study to evaluate the merging process between two general surgery programs in Grand Rapids, Michigan in 1999 [15]. A survey was administered to both faculty and residents after said merger. This survey assessed characteristics such as curriculum, administration, teaching, atmosphere, and career goals, such as graduation and preparation level for attending-ship versus fellowship.
Positives aspects of the process were identified as academic and educational opportunities. This may have been secondary to a very organized educational system, which benefited both sets of residents. Negative aspects of the process were identified as establishing a combined clinical rotation structure, defining resident coverage without significantly increasing clinical load, and reconciling program policies that were discrepant. These areas, particularly those that were identified as negative, can be a stepping stone for other surgical residencies, so that these challenges can be specifically addressed during similar program mergers.
Even surgical subspecialties are not immune to the pressures to merge or acquire one another. Two vascular surgery programs in Long Island, New York merged to form a collective program in 2001 in order to maximize their individual strengths [16]. Although there is no information on how successful their merging process was, the combined program was able to compose an educational schedule which they published with a goal of standardizing vascular surgery training as mergers and acquisitions continue to persist.
At this point, there is limited data regarding residency mergers. Additionally, those examining the impacts of hospital system mergers do raise some important issues which should be addressed with future studies regarding residency mergers. A recently published study in 2020 demonstrated a clinically significant decreased patient satisfaction score when examining multiple hospitals before and after their merger or acquisition [17]. While there have been several studies that examine the perspectives of the trainees, these have not incorporated the perspectives of other important members involved in the healthcare system – most notably the patient. Faculty are also a significant aspect of the training program; they have an essential perspective that needs to be considered.
Ideally, as residency mergers are likely to continue occurring, there should be a structure for future evaluation and studies of these mergers. A survey should be constructed to fully examine feelings of residents, faculty, and patients on the patient care experience and the academic experience (as applicable). The survey should then be administered pre-merger and post-merger in order to have a direct comparison and contrast to itself that is inherently reliable. This would not only give an assessment of the “success” of the merger, in addition to identifying areas that may be particular concerns to trainees, faculty, or patients throughout the merging process. This would allow those concerns to be addressed early so that all involved can feel as if the process is as positive as possible.
The health care industry continues to evolve. Economic pressures can have unpredictable results, including mergers in health care systems and therefore associated graduate medical education programs. While there is not a wide breadth of published information regarding previous merged programs, we can learn from the successes of those programs that have published data to set up future mergers for success. A comprehensive examination of the publications which have been reviewed in this chapter have identified some key points of importance in the process of graduate medical education program mergers: leadership, communication, and culture. Establishing an effective leader who can formulate a plan and then institute that plan is the first step to success. He or she must be a dynamic individual who is able to solicit and take advice and criticism from all those involved in the process, both residents and faculty alike. Productive communication with leadership will be key for ongoing success during the process of the merger. This will allow for the process to evolve as challenges arise, to ultimately create a program from which all will benefit. Institutional cultural differences must be acknowledged in order to create a cohesive merged program. Through establishing a positive set of attitudes, behaviors, and policies, cultural competence can be a characteristic of the newly formed program.
There is still much regarding residency mergers that is unknown. In order to have a more concrete evaluation of the success of graduate medical education mergers, a survey that is externally validated should be administered to residents and faculty. This would allow for an objective evaluation of the merging process, so that common issues could be identified and addressed in future mergers. Overall, residency mergers are not well described. The goal of this chapter is to provide a conglomerate of available information and to identify issues that may occur. As mergers continue to occur, we hope that this chapter may prove valuable to not only the leadership responsible for the merger, but also anyone involved in the process.
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"312999",title:"Dr.",name:"Bernard O.",middleName:null,surname:"Asimeng",slug:"bernard-o.-asimeng",fullName:"Bernard O. 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This will ensure that we discover ways to live in our world that allows us and other beings to flourish. We can no longer rely on medicalized approaches to health that wait for people to become ill before attempting to treat them. We need to live in harmony with nature and rediscover the beauty and balance in our everyday lives and surroundings, which contribute to our well-being and that of all other creatures on the planet. This topic will provide insights and knowledge into how to achieve this change in health care that is based on ecologically sustainable practices.
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