SME employment and GDP contribution per country.
\r\n\t
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The industrialisation of rural entrepreneurship is perceived as an idea that will assist entrepreneurs operating in rural locations to survive and grow beyond the next decade. Today, rural entrepreneurship significantly impacts many issues, including economic development, employment, food supply and social security. With increasing numbers of people moving from rural to urban areas due to poor employment opportunities, and the complexity of running their own businesses, the problem of potential social unrest, amongst others, becomes more credible. It is therefore crucial that researchers, particularly in those countries with large rural populations, investigate this problem and provide ways of solving it. Such challenges facing entrepreneurship in remote or rural places require modern, innovative business leaders, skilful political thinkers, greater numbers of trained professionals, and academics who can think dynamically, and bring their ideas into broader societal use.
New approaches to enhance innovation and invention within rural businesses are required in the contemporary world of business, and a broad knowledge and understanding of digital technology, how it can be used, when it can be used, where it can be used and why it is used, by rural entrepreneurs should be properly defined in order to achieve this. Promotional marketing strategies using digital technology should be a central issue, and their benefit should be better understood by business owners and managers worldwide. Access to global markets, efficient distribution of products and higher brand awareness can also provide competitive advantage and ensure effective business communication.
Many studies conducted in the rural places of South Africa indicated that rural enterprises are confront by many challenges. However, it is also anticipated that this could be a global problem that needs to be addressed by professionals as well as academics. Therefore, this writing aims to provide some workable solution to these challenges.
This study aimed to establish the understanding and knowledge of digitalisation of rural entrepreneurship, and how it can be used by rural entrepreneurs for the survival and growth, and its implications.
Enterprises operating in rural environments disconnected from primary metropolitan sites can be defined as part of rural entrepreneurship, and such enterprises function under extremely complex and turbulent business conditions presented by remote and underdeveloped areas, where local production is primarily committed to subsistence farming. Rural areas are perceived to be entirely different from intensively settled urban and suburban areas, and are also distinct from natural landscapes or wilderness, such as forests or mountains. Rural enterprises can benefit from the use of local resources and can produce products or services to meet local demands, since they are able to access cheap labour from within their communities. Although it is acknowledged that no single, unified and accepted definition for the term ‘entrepreneurship’ exists, it is one dimension of strategic posture, which encompasses the risk-taking propensity of businesses, their ability to compete aggressively, their proactive initiatives and their product innovations, which are all entrepreneurial activities, and which indicates that all manner of organisations therefore behave entrepreneurially [2, 3].
Rural entrepreneurship implies the emergence or establishment of entrepreneurial activities in rural areas; in other words, the establishment of industries; which also implies that rural entrepreneurship is synonymous with rural industrialisation [4, 5]. Rural entrepreneurship represents the informal sector of the economy, characterised by small-scale businesses, including small traders and artisans. Rural entrepreneurship can be considered an important solution for reducing poverty, minimising rural-urban migration, addressing economic disparities and alleviating unemployment in developing rural and underdeveloped areas. Rural entrepreneurship presents a major opportunity for those who instead migrate from rural to semi-urban or urban areas, and most rural entrepreneurs are faced with the multiple problems presented by the unavailability of primary amenities in these areas of developing countries [6]. Due to this exodus of skills, a lack of educated individuals, financial limitations and insufficient technical and conceptual abilities, together make it difficult for rural entrepreneurs to successfully establish locally based industries.
In most practical cases, individuals who conduct their businesses in rural areas do so by utilising locally available resources [7]. Their business activities improve the standard of living for local communities by creating employment opportunities for people living in proximate villages and provide sources of entrepreneurial activity to establish industrial and business units in this rural sector of the economy. Similarly, rural entrepreneurship can further be described in terms of rural industrialisation [8]. The existence of rural entrepreneurship which leads to viable economies in rural areas is therefore of extreme importance. Regardless of the extent to which rural entrepreneurs engage in a variety of activities, which range far beyond simply agriculture, they are still not fully industrialised in their thinking and approach, due to the number of challenges that confront them in rural regions worldwide [9].
Such challenges lead to the success of ambitious start-ups remaining low, with factors such as market sizes, government policies and geographical profiles continuing to influence their long-term performance [10]. There is ostensibly little difference between rural and urban enterprises in terms of their structure, of how such businesses are organised and managed, and of how the characteristics of individual entrepreneurs are exhibited. Thus, it would appear that there is no specific category for, or definition of, rural entrepreneurs, beyond being individuals who manage business ventures in rural settings. Rural areas are, however, no longer found to be dominated by employment in agriculture and production farming but cover a kaleidoscope of economic activities which increasingly mirror those found in more urban areas [11].
The process of growth in enterprises is defined by their development from small to large, and from weak to strong [12]. Enterprise growth encompasses the development process which enterprises follow in encouraging tendencies for balanced and stable growth in total performance levels, including their outputs, sales volumes, profits and gross assets, and whose benefits continue to be realised by significant enhancements to their total performance in stages spanning their levels of quality development. Strong principles exist that govern the survival and growth of enterprises, which are treated as collections of internal and external resources that assist enterprises in growing and realising their competitive advantage [13].
The size of businesses is incidental to their process of growth, and whereas business growth is determined by the effective and innovative management of internal resources, the external availability of top managerial and technical talent is also an important factor in their growth [13]. Ignorance of such factors can result in loss of competitive advantage and business failure, however, and many different non-geographically focused approaches have been used to identify factors which affect the survival and growth of small businesses, with considerable variation in results. Such approaches have identified many factors, both internal, but particularly also environmental and external to small and medium enterprises (SMEs), that exist beyond the ability of these businesses to control [14], and which impact significantly on their performance and growth [15].
The growth experienced by enterprises can be identified using four theoretical perspectives, which include the resource-based, motivation, strategic adaptation and configuration perspectives [10]. The resource-based perspective focuses on the use and management of enterprise resources for the expansion of business activities, and of financial resources, and the availability of specifically educated staff. This indicates that, to identify successive phases of growth and development, business resources need to be restructured during transitions between growth stages. The resource-based perspective also relates to the theories of social capital and innovation, because the analysis of social networks has, in the preceding few decades, evolved into one of the most important tools employed for business estimation of enterprise growth, competitive strength and innovation. The resource-based perspective is a conception of strategic management which attempts to clarify the background for enterprise existence, and its various occurrences in the broader context of enterprise theory. The broad layer of productive resource definitions available includes such factors as the teamwork abilities of senior management, their entrepreneurial capabilities and their ability to perceive the benefits of implementing new products or services, although the full impact of these factors remains untested in rural business environments.
The characteristics of small businesses situated in rural contexts include them being in locations that face various challenges which can impede economic development, and which are not frequently encountered in urban settings [16]. What is highlighted is that rural areas tend to be characterised by low population densities, economic dependence on natural resources and agriculture, and operating in locations isolated by distance and time (Deavies, 1992). The concept of entrepreneurial individuals with distinguishing characteristics is, however, central to entrepreneurial theory, and the existing division is based on both psychological and non-psychological motivational factors, which determine the distinguishing personal characteristics of rurally based entrepreneurs [17].
An adoption of the correct set of entrepreneurial characteristics is crucial to the survival and growth of rural SMEs, with psychological motivating factors furthermore including the need to achieve risk tolerance, autonomy/independence, self-esteem, self-efficacy and locus control. The need to achieve is the principal determinant of entrepreneurial behavioural orientation. Many theories have been forwarded which demonstrate that the need to achieve survival and growth in business reflects individuals’ orientation, their willingness to assume risk and their drive for satisfaction from a sense of accomplishment. This can be achieved by employing foresight in remaining dedicated to the tasks involved in succeeding, which frequently require prioritisation and the sacrificing of personal activities and time. Based on these theories, SME owners/managers operating in rural areas need to demonstrate their tolerance for risk-taking, entrepreneurial orientation (EO) and entrepreneurial attitude towards growth, internal loci of control in their networking, human and financial and other relevant resources, when confronted with uncertain circumstances or conditions.
Human capital is considered to comprise non-psychological motivation factors, which include explicit knowledge, tacit knowledge and experience, age and marital status, and is also considered extremely important for entrepreneurial growth [18]. The theoretical literature is, however, limited in describing how these factors affect the survival and growth of rural SMEs. Configuration perspective focuses on the need for SMEs to collaborate in external networks to be successful, where it is considered that they should focus on their core competencies to achieve more efficient operations and co-operate with external partners to compensate for certain competencies or resources which they lack [19]. This is especially true for the development of new products, in which SMEs encounter specific problems when compared to larger businesses. In recognising the increasing importance of collaboration, however, the question remains how to organise these external networks to accommodate specifically rural SMEs. Entrepreneurial education and training is a major determinant in the growth and survival of enterprises, and according to the theory of human capital, by investing in the acquisition of knowledge, these increased skills and abilities will enhance the productive capabilities of individuals [20]. Rural environments are faced with challenges that tend to differ from those encountered in urban contexts, and because of this business, education and training cannot simply replicate that delivered in urban locations but must instead address the unique needs and perspectives of rural business owners.
Furthermore, in keeping with the theories already discussed, most literature supports the notion that the many constraints experienced by SMEs in developing countries, including South Africa, are the result of internal and external organisational barriers, which require in-depth examination [21]. Those impediments found within organisations, and which hinder the adoption of new technologies, are considered internal barriers, while those found outside of organisations are considered external barriers, and relate to infrastructure, politics, legalities, society and culture. It has been suggested that enterprises are collections of internal and external resources which assist them in achieving competitive advantage, since in the long term, these factors can limit the growth of enterprises, but not their size, since growth is determined by the rate at which experienced managerial staff design and implement strategic business plans [13].
It is held that EO is a multidimensional measure for business-level entrepreneurship, comprising innovation, proactivity and autonomy, all of which require to be implemented by SME owners/managers, including those operating in rural environments, to enable survival and growth [22]. Today’s dynamic business environment demands that businesses be entrepreneurially oriented to ensure their survival and growth [23]. Enterprises with high levels of EO tend to possess enhanced abilities in identifying new opportunities for growth, which increase their competitive advantage [24]. EO contains two conceptual approaches, namely unidimensional and multidimensional, with operational methods shaped by how individual EO approaches are appraised [25]. In the unidimensional approach, EO is regarded as a unified conceptual entity, where its dimensions, although varying, complement one another. It is considered that high levels of risk in both dimensions need to be reduced immediately by entrepreneurially oriented enterprises, because this is a prime ingredient for the success of businesses, including those operating in rural contexts [26].
EO is therefore seen as a significant predictor of business growth, which indicates that positive EO in SME owners/managers supports business survival and growth [27]. Investigating this influence of EO on the success of those operating in rural environments is therefore crucially important. EO furthermore includes the processes, practices and decision-making activities which lead to fresh entrepreneurial endeavours, such as SME owners/managers launching and operating business in their respective areas. These entrepreneurial activities are informed and guided by experience gained from previously observed business practices and theories [14].
Primary concepts in entrepreneurial practice involve independence, innovation, decision-making, forecasting, implementation and achieving success. However, rural entrepreneurship needs to be better developed to improve its broader economic participation. A transformation in how rural entrepreneurship is practised could attract greater business success, but effective economic activities can only be achieved by the digitalisation of rural entrepreneurship. Digitalisation can be described in terms of the infrastructural processes associated with digital technologies, in which analogue information is transcribed to digital form and applied in broader social and institutional contexts.
Understanding and implementation of rural entrepreneurial digitalisation are of critical importance if they are to be of benefit in the economic growth of the country. The digitalisation of EO in rural environments must be broadened and capacitated by the relevant authorities, because such endeavours are currently either very limited or absent, and little data are available on rural areas of many countries. The involvement in promoting this type of development in rural areas by policymakers, government agencies, relevant business stakeholders, as well as rural entrepreneurs themselves, is therefore regarded as essential.
The importance of digitalisation is not restricted to products, services and manufacturing processes, but includes a broad spectrum of competencies, including marketing, business networking, promotional mix, product distribution, supply chain management, access to international markets and the management of growth to achieve competitive advantage. Digitalisation of all business processes is possible, and the outsourcing of certain services, or a shortage of human capital available to rural businesses, can thereby be easily surmounted, since digitalisation can be used to positively enable new start-ups and potential young entrepreneurs willing to operate in rural environments in this way.
Few investigations have been performed into how digitalisation could improve the survival and development of rural enterprises, which has resulted in a lack of knowledge and understanding of its relationship with improving the success of rural industries. Knowledge concerning the benefits of digitalising rural businesses, and how this can improve business operation capacities, remains mostly assumptive amongst professionals and policymakers. Much evidence from an international perspective exists, however, to indicate that small business, which is generally found in rural areas, plays a crucial role in the creation of a variety of different economies. Table 1 indicates significant statistics in justification of this claim.
Country | Employment contributed by small industries | Industry contribution to GDP (%) |
---|---|---|
European Union (EU) | 75 million people | 99 |
Latin American | 60 | |
China | 13 million people | 60 |
Singapore | 47 | |
Asian Pacific | 90 | |
Ireland | 90 | |
South Africa | 40 |
SME employment and GDP contribution per country.
Since small, micro- and medium enterprises (SMMEs) represent most of rural businesses and are also the largest employers of rural dwellers in many countries, digitalisation must be considered a primary strategic growth path for rural businesses, and its incorporation into the efficient formulation of policies and subsequent implementation should be a priority for governments in attaining the various goals that would essentially include balanced rural development in the country. This change in methods can encourage small rural businesses to adopt the use of digital technologies in conducting their business activities and could also assist in enhancing their use of human resources, and in realising the benefits to their survival and growth. Many challenges, such as insufficient working capital and marketing difficulties, inadequate social infrastructure, a lack of managerial skills and little support for SMME development from government programmes can easily be overcome by the digitalisation of rural businesses.
The digitalisation of rural entrepreneurship is of extreme importance for the development and competitiveness of rural businesses [28]. Digitalisation is a highly effective strategic growth strategy for businesses in emerging markets of the word, and there is much evidence that, in many countries, the improvement of entrepreneurial activities is regarded as a strategy to boost national productivity and job creation, which also improves their economic independence. Entrepreneurial endeavours strengthen personal and collective capabilities amongst local communities, and SMEs are currently regarded as mechanisms for economic growth and equitable development in creating labour-intensive, capital-saving initiatives that ensure the creation of many new jobs [29].
Small-scale businesses play a survival role for poorer households in the development of self-confidence, business and other skills, and the socio-economic upliftment of women [30]. Small businesses provide employment opportunities for rural communities, specifically by minimising migration of rural populations to urban areas, improving standards of living for local communities and promoting rural tourism-related art activities [5]. Enterprise and entrepreneurship are the drivers of economic growth in rural Europe [31], which indicate that the ongoing challenges facing traditional rural sectors, and the future success of rural economies, are inextricably linked to the capacity rural entrepreneurs possess to innovate and identify new business opportunities that create jobs and income in these areas. In Vietnam, entrepreneurial development in the form of rural SMMEs has also emerged as a strong agent for socio-economic diversification [32].
Small enterprises are not only important in contributing to local economies, but, from an international perspective, play a vital role in the creation of national marketplace employment [33]. In the enlarged European Union (EU), amongst the 25 countries included, some 23 million SMEs provide approximately 75 million jobs, comprising 99% of all enterprise. The trend for job creation by the small business sector found in many EU countries has resulted in overall economies of growth, and improved standards of living are apparent within rural communities in these countries [34]. In Britain, for instance, small enterprises are regarded as the backbone of the British economy, which is a result of their productivity, despite having access to minimal resources and little formalised support [35]. In Asia-Pacific Economic Cooperation-member countries, approximately 90% of all enterprises fall into the category of SMMEs, which employ most of their working populations [36]. China’s economy, which is amongst the largest in the world, is likewise largely supported by SMMEs, and the advanced technology employed in both China and India has assisted in industrialising their vast rural areas and allowed national penetration into widely diverse international markets [37].
In Vietnam, rural opportunity entrepreneurs are not often employment growth oriented, and therefore have limited capacity to generate non-arable employment for all households [38]. Contrarily, in Peru, many rural entrepreneurs create opportunities for employment, and rural entrepreneurship in the country is growing [39]. Further indicated is that where government and international funding organisations have provided training and financial support, this has enhanced the survival and growth of rural entrepreneurship. SMEs account for almost 99.8% of active enterprises in Ireland, where most of companies (90.8%) active in the economy are micro-enterprises employing less than 10 people [40].
Micro-enterprises are particularly prevalent in rural areas, where SMEs tend to be small and include a high number of sole proprietor businesses. It is possible to promote better economic and social conditions through entrepreneurial activities which benefit both the individuals involved and their communities [41]. Most of Latin American nations exhibit high levels of entrepreneurial activity, and more than 60% of working-age populations in most Latin American countries view entrepreneurship as a desirable career choice. This entrepreneurial spirit is due to their use of well-developed technologies for connectivity in the past 5 years, which has seen the percentage of Latin American households connected to the Internet to jump from 16% to more than 50% of total populations. In 2015, Latin America’s cellular telephone traffic grew by 87% which, as a region, spent more time on social media than any other in the world [42]. Both past and recent experiences demonstrating the failure or non-performance of micro-businesses and enterprises underscore the importance of entrepreneurial competencies in both rural and urban environments, indicating that approximately half of the global population cannot simply be ignored, which includes rural women, who make important contributions to business creation, particularly in these areas [43].
Although the percentage of female entrepreneurs in the South Asian region [44], for example, is less than 13%, it contains 37% of all businesses globally, and generates USD 29–36 billion annually from business concerns operating in this region alone [45]. However, this percentage does not reflect the situation for the African region, including South Africa, where inadequate and unreliable infrastructure services, including a lack of online connectivity, transport, communication services and energy, are common in most of rural communities, and which influences the survival and development of SMEs in the rural areas of African countries immensely [46].
Since environmental factors are directly related to SME performance [47], and therefore affect how SMEs operate and how strategic entrepreneurial decisions are made by their owners/managers, the use of digital technologies would assist in bringing new strategic business approaches to bear in rural areas, because such technologies would assist in obtaining a broader understanding of the environmental challenges confronting rural businesses in their survival and development in such environments.
A propensity for entrepreneurial activity is conditioned by the evolution of institutional frameworks and good industry environments [48, 49], for which it is maintained that the growth of SMEs within broader economic frameworks requires public administrations from all political ideologies and administrative levels to develop policies favouring and stimulating the creation of new enterprises. SMEs, as opposed to larger businesses, utilise different approaches to implement strategies that guide them through industry life cycles [50]. Conducive business environments are therefore required for them to articulate their strategies and attain good performances (The ILO, 1998, in [51]). In assessing strategy policies, legal and regulatory environments are therefore important, because small enterprises do not possess the managerial and monetary resources to deal with implementing complex procedures, or frequently variable fiscal policies.
The approach required is to improve regulatory environments and instigate policy initiatives that promote entrepreneurship and foster SMEs, encourage governments to take a co-ordinated and inclusive approach in promoting entrepreneurship, emphasise partnerships with the private sector and partner with other states in the region to strengthen entrepreneurship-promotion initiatives [52]. These initiatives will further encourage countries with significant rural populations to consider the establishment or strengthening of national centres for excellence in entrepreneurship, even calling upon the United Nations system to recognise entrepreneurship as a legitimate concern, and integrate its various forms into their policies, programmes and reports in support of national efforts in this regard.
Rural businesses do not operate in a vacuum [31], however, and there is a strong link between rural development policies and the growth of entrepreneurial activities in such areas. It is recognised that rural development policies contribute to achieving the objectives of social and territorial cohesion within the EU, for example, which implies that creating the conditions under which innovative rural businesses can thrive requires new approaches to the governance of these areas, the reorganisation of local markets and changes in consumer behaviour. In France, for example, communities and their support structures actively seek ways of removing potential barriers to job creation in rural areas, such as the high cost of land, although it is unclear if this reflects the problems found in corresponding South African areas.
Romania has demonstrated important rural growth potential and has experienced substantial improvement in both its rural business and socio-economic environments [53]. This indicates that industry life cycles for small businesses in rural Romania have changed from those ensuring survival to those associated with medium-sized enterprises. The impact of the rural business environment on SMEs shows that the survival and growth of micro-businesses are acutely dependent on responding appropriately to external conditions over which they have little or no control [54]. Environments in which families, societies and support systems operate are therefore not always favourable for encouraging rurally based individuals to take up entrepreneurship as a career, which may be due to a lack of awareness or knowledge of the entrepreneurial opportunities available to them [4].
It is important to consider the impact of environmental dynamism, which comprises both internal and external environmental factors, on rural SME survival and growth in South Africa. Environmental dynamism represents the rate of change within environments [55] and can be used when describing the pace at which customer preferences, and the products and services offered by enterprises, change over time [56]. Environmental dynamism is therefore also a measure of the levels of factor instability within business environments, and rural SME owners/managers therefore need to be cognizant of the rates of change and levels of factor instability in their operational areas to ensure the survival and development of their businesses addition [57]. Emergent levels of environmental dynamism lead to uncertainty in service development, and reduce the predictability of the effects of change, which make it important to obtain a broad understanding of how both internal and external environmental dynamic factors affect the EO, survival and growth of rural SMEs [58].
Internal factors, such as business entity size, business life cycle stage, technological and product innovation, organisational autonomy, centralisation and formalisation, market role and the importance of goal types, as well as all attendant external factors, exercise a significant impact on SME performance and effectiveness, including sales growth and the achievement of business goals. External factors include, for instance, the state of economic sectors and customer types [59]. Depending on the stage of business life cycle periods, and the general state of the economy, the activities of enterprises are frequently governed by opportunities for productivity, which represent dynamic interactions between internal and external environments, although external environmental factors are primarily considered to affect the survival and growth of small business entities [60]. EO is influenced by both internal and external factors, which indicates that a correlational relationship that should be tested exists between these areas that can directly influence the survival and growth of rural SMEs.
Part of the internal and external resources of any enterprise should be treated as strategically important, although, realistically, all resources can be considered strategic, depending on enterprise and industry type [61]. The complexity of the dynamics in external environments causes businesses not to rely solely on internal resources for their competitive advantages. SMEs, which are largely rural and agriculturally based, are faced with unique problems that affect their growth and reduce their ability to contribute effectively to national economic development. These unique problems range from a lack of access to credit, inadequate managerial and technical skills, and low levels of education, to poor access to market information and inhibitive regulatory environments. Electricity, government policies and fraudulent practices are found to be critical factors which negatively impact the survival and growth of such businesses [62]. Considering the relationship between EO and business performance in small companies, and the moderating effects of their external environments, rural SMEs owners/managers should utilise their resources more carefully in promoting innovation, proactivity, competitiveness and autonomy [63]. Proactive strategies should therefore be employed during product development stages, or when approaching new markets, or responding to competitor strategies, including being responsible when making business decisions.
Environmental dynamism and heterogeneity are found to be significant predictors of EO and exert a positive influence on it [64]. Access to resources enables entrepreneurs to aggressively exploit opportunities well in advance of their competitors because of environmental pressures [65]. A better understanding of environmental characteristics, in terms of resource availability and competition, as well as those conditions imposed by institutions governing economic activities, will assist entrepreneurs not only in identifying new business opportunities but also to exploit them in establishing businesses that achieve profitability and generate wealth. Business performance is further found to be influenced by external environmental dynamic factors, which include industry, competitive and consumer changes [66]. Furthermore, eight factors have been identified which influence the success of SMEs as businesses, which include SME characteristics; management and skills; products and services; customers and markets; business methods; research and finance; and business strategies and external environments [67].
In parts of the world, such as South Africa, which are characterised by high levels of poverty, especially in rural areas, where approximately 70% of the country’s impoverished population reside, incomes are constrained because rural economies are insufficiently vibrant to provide them with well-paying jobs or self-employment opportunities. External factors are more dominant than internal factors in contributing to entrepreneurial success in the case of rural SMEs. Table 2 contains a more thorough breakdown of these internal and external environmental factors.
External factors | Internal factors |
---|---|
The lack of AIS in SMEs can result in high lead times for business processes, high cycle times for business transactions, poor consumption of business resources [77], and a lack of overall productivity, amongst other problems. Poor telecommunication infrastructures and a lack of broadband connectivity in the rural areas of KwaZulu-Natal have, however, limited the use of technology by SME owners/managers [78]. Competition therefore presents a risk to the survival of independent enterprises, although it is what motivates companies towards higher productivity, which results in their growth and development. A primary barrier to SME survival is seen as ‘unfair competition’, which includes tax systems, informal economies and public services, and this has persisted with the same intensity throughout the post-war period [83]. | Many common factors exist within the category of business management which are, however, considered to play a role in determining the growth of small businesses, and which include financial management and marketing management skills. Management skills for small business growth should concentrate on identification of owner/manager policies and strategies for the operation and development of businesses, and the subsequent translation of such policies into managerial action. The growth of enterprises is limited by the available scope of managerial skills resources, specifically their ability to co-ordinate capabilities and to introduce new people into enterprises. Considerable doubt exists regarding the quality of strategic planning and management in this crucial economic development sector, with policymakers indicating that particular weaknesses exist in innovation, financial acumen, marketing ability, entrepreneurial flair, practical planning, management knowledge and human resource management, and many businesses do not therefore reach their full potential and fail to grow [86, 87]. Rural markets offer great scope for concentrated marketing efforts due to recent increases in rural incomes, and the likelihood that such incomes will increase faster based on better production and higher prices for agricultural commodities [88]. Rural marketing is a developing concept of which marketers have recently realised the advantages, and, as a part of any economy, displays untapped potential. Improvements in infrastructure will also provide opportunities in ensuring a successful future for those operating rurally ([89]: 55; [90]). Entrepreneurial education and training entails developing a philosophy of self-reliance and includes the creation of new cultural and productive environments, and the promotion of fresh sets of attitudes and business cultures for dealing with future challenges [95]. A major obstacle to economic growth for poor nations is a lack of educated entrepreneurs able to mobilise and co-ordinate production inputs [73]. By inference, financial institutions who lend funds to uneducated entrepreneurs who also lack managerial expertise are making unwise investments, since it is not financial capital that is lacking, but rather knowledge, ability and entrepreneurial skill. In South African schools, various problems exist which hinder the effective implementation of entrepreneurial education, some of which are poorly trained educators and a lack of adequate resources [96]. Better entrepreneurial education could make a significant contribution to job creation and, ultimately, to poverty alleviation. |
Classical determinants of business dynamics include company size, location, innovative capacity, prior owner experience and state institutions, which provide for both survival and growth, since the receipt of government support during start-ups has an independently positive influence on long-term business growth, especially for rural and non-household enterprises. Government policies are highlighted as a potential focus for absorbing some of the transaction costs, through the improvement of education, physical infrastructures and technology transfer. Other such important interventions include the provision of both formal and informal mentoring and training services for new managers, along with legal and financial management instruction. Public-private sector institutions can identify policies and strategies to increase the survival and growth rates of SMMEs if they are provided with more information concerning factors that constrain business performance, and the link between entrepreneurial quality and enterprise.
The significance of the location factor in the development of entrepreneurship and small business performance is critical and should therefore be given urgent consideration because it can positively affect SME performance. South African rural economic development has been impeded by poor infrastructure provision and unemployment, with little or no access to vibrant markets characterising many South African rural communities.
The effectiveness of rural SME owners/managers can be measured by investigating their entrepreneurial actions and attitudes, and it is necessary for these rural entrepreneurial actions to be positive in order for SMEs to survive and grow [97]. Small business owners conceptualise the different barriers to their growth differently to those of larger businesses, whose perceptions and mindsets are influenced by their practical experience of growth [98]. An industry-level EO measurement instrument can be used to assist in entrepreneurial education, which implies that such an instrument can also be used by rural SMEs to improve their innovation orientation, risk-taking and proactivity, as these correlate statistically with measures of entrepreneurial intention. Entrepreneurial education, training and skills can assist in the growth of rural entrepreneurship intentions in underdeveloped and isolated areas. There are various impacts of the dimensions of individual EO, cost leadership and performance differentiation, on competitive strategy, which can also be interpreted as the leadership style contributed by rural SMEs owners/managers to the overall business performance percentage, including SME survival and growth.
Economic development is not the only factor that determines rates of entrepreneurial success, since entrepreneurial attitudes and perceptions also play an important role in creating entrepreneurial cultures, and are strong indicators of such attitudes and perceptions in efficiency-driven economies. Most policymakers recognise that entrepreneurs usually commence business with limited finances, due to SMEs operating in a range of industries and environments, which results in their policies generally supporting a broader scope of entrepreneurs. Policymakers often fail to recognise that benefits for entrepreneurs can vary dramatically, however, depending on entrepreneurial desires to build high-growth businesses in rural areas, which often lack such high-growth entrepreneurial endeavours.
A positive relationship exists between the attitudes of managers and actual growth outcomes of SMEs, since SME managers/owners are required to accommodate greater changes than managers of larger companies, and growth requires change and its effective management to ensure business success. Managing change effectively, the recognition that change requires altered attitudes and the positive behaviour of involved individuals are therefore all of prime importance, although it is generally accepted that many managers are unable to easily change their attitudes and behaviour to fit the changing needs of organisations.
Acceleration of manufacturing initiatives;
Empowerment of indigenous entrepreneurs;
Access to global markets;
Marketing connections;
Wider distribution of customer service improvements;
Improved business transactions;
Time-saving; and
Minimisation of business costs.
Advanced skills are required;
High installation costs;
Absence of privacy and data protection laws; and
Lack of safe cybersecurity intelligence.
In order to achieve community development opportunities, academic improvements, social change and political and entrepreneurial growth, governments should prioritise the installation of fibre optic technologies, thereby making broadband connectivity accessible to rural communities. The provision of fibre optic connectivity to all residences in rural areas would not only cater for household communication but allow for the digitisation of rural business initiatives. It is believed that through strategic private sector partnership alliances, the public sector and governments of both developed and developing countries are enabling to create digital infrastructures that will ensure the digitalisation of all rural areas [1].
Socio-economic factors are core aspects influencing entrepreneurial behaviour and the operation of businesses. Economic growth is a function of both growth in resources and the rate of technological change, with land, labour, capital and entrepreneurship being resources in the factors of production. Economists, who have studied the effects of these resources or inputs in identifying the causes of economic growth, recognise the growth of entrepreneurship as their primary source. A primary contribution to the economic growth of all nations is that made by the entrepreneurial factor, because it is entrepreneurs who contribute methods for achieving specific objectives, which include those innovations responsible for technological progress. It is therefore not an increase in the quantity of the other inputs that fosters economic development, but rather the efforts of entrepreneurs, who assume the risks for innovation, and organise and co-ordinate all business inputs.
Entrepreneurial education and training entails developing a philosophy of self-reliance, such as the creation of new cultural and productive environments, and the promotion of fresh sets of business attitudes and paradigms for the achievement of future challenges. Economists maintain that a major obstacle to the economic growth of poor nations is a lack of educated entrepreneurs able to mobilise and co-ordinate all relevant production inputs.
The importance of SMEs to a country’s economy also indicates the significance of government policies that support SME initiatives, including regulations that enable them to operate efficiently, and reduce their administrative costs (Harvie and Lee [68], in Govori [69])). Governments hence need to adopt friendly policies for rural SMEs to enable their survival and growth. Currently, many underdeveloped and developing countries in Africa have not focused SME policies to address the needs of businesses operating in rural and underdeveloped areas. Government initiatives which promote and support SMEs in enhancing their development and reducing poverty lack a proper legal framework and are hindered by bureaucratic processes and other barriers, such as genuinely affective administrative procedures, including access to relevant government agencies. Politics intrinsically involves government attitudes towards business, and the operational freedom allowed to companies, and it is indicated that the types of governmental policy which may constitute potential political risks to businesses fall into three main categories. These include operational restrictions, exchange controls and employment policies, where requirements may exist dictating locally shared ownership, and also particular product requirements. Governments therefore need to implement business policies that allow rural entrepreneurs to remain operational, without having to contend with overburdening bureaucratic restrictions [71].
Rural entrepreneurship is faced with the challenges of financial shortages, deficiencies in networking, electricity, equipment, marketing, small and distant markets, poor transport systems and also corruption. In many countries, meagre infrastructural facilities, poor access to technology and a lack of broadband connectivity and serviceable roads are major developmental challenges for rurally based SMMEs. The productivity and effectiveness of SMEs in developing countries is primarily affected by the diffusion rate of technology in many rural communities. Even where the belief exists that the availability of state-of-the-art technology is an important driver for business expansion in rural areas, more resources are nevertheless required to ensure that fragmented rural villages are effectively digitalised and well positioned to access international markets. The essence of technology should therefore not be ignored, since it enables small companies to access mass markets, connect with global supply chains, cost-effectively track customers and enhance their internal operations.
The productivity and effectiveness of SMEs in developing countries are affected by the diffusion rate of technology, which is considered an important driver for business expansion in rural environments [99]. Technology should be regarded as an essential tool for business owners/managers, which cannot be ignored, since it enables small businesses to access mass markets, connect with global supply chains, cost-effectively track customers and enhance their internal operations [100]. In many countries, Information Communication Technology (ICT) can be used as an instrument for driving socio-economic development, such as poverty reduction, and more particularly in the SME environment to enable growth. Poor infrastructural facilities, such as roads and technology, have been mentioned as major obstacles for SME development and growth, and a need remains for both infrastructural (social, economic, ICT and other enabling infrastructures) and SMME development (agricultural processing, village markets and finance/credit facilities) [101].
Infrastructural developments include the ongoing expansions required for ICT in terms of bringing about improvements in the quality of life, empowerment and economic development of rural communities [102]. It is, however, not regarded as economically viable for SMEs to incur significant infrastructural costs, due to the fact that they are often located far from commercial centres, which can have a direct negative impact from any infrastructural shortfalls that exist [103]. Consequently, the inadequacy of infrastructural components, such as power supply, transportation, industrial estates and telecommunications, is a major barrier to effective SME start-ups in rural areas.
Various resources, such as those of finance, human and social capital and also networking, have direct or indirect impacts on the survival and growth of SMEs, whose owners/managers must also possess the necessary capabilities to acquire and effectively utilise their business resources [104]. Rural SMEs must therefore demonstrate such capabilities if they intend to survive and develop, and the inability of small business owners/managers to match their products or services with the demands of external environments is therefore a major challenge to their strategic growth. SME owner/manager levels of formal education, access to and use of new technologies, along with poor management skills also contribute to limiting SME survival and growth ([13], and more recently [105, 106].
SME owners/managers themselves lack the necessary skills and capabilities required for business start-ups and operations, and with rural enterprises characterised by many difficult factors, such as limited resources, their small sizes and scattered and remote locations, the transaction costs for rural activities are high, which is largely the result of the time required to ensure that business standards are met [107]. Rural enterprises face risks that range from managing the power imbalances they experience compared to larger businesses, to buyers that can influence terms, conditions and standard requirements for making sales. In addition, rural enterprises have limited access to current market information, mainly due to weak transport and communication infrastructures, specifically in rural environments, which makes it extremely difficult for such enterprises to participate in high-value markets [108].
The growth of SMEs has been hampered by a variety of barriers, created directly or indirectly by the state of their operational environments [109]. Due to fiscal policy constraints, specifically high taxation, financial constraints in institutional environments remain major barriers to the success of SMEs, since their influence encourages many SMEs to conduct their activities in informal economic sectors, because the managers/owners of many SMEs are survivalists who require continuation of existence and growth beyond their business start-up phases. The informal sector is, however, often faced with challenges, such as market deficiencies and institutional faint-heartedness, which impede their growth. Governments should therefore encourage the growth of ‘knowledge networks’, which offer SMEs the opportunities to more easily exchange information with both domestic, and also in particular, large international companies.
Network relations can be a source for achieving a higher degree of EO and business performance, and rural SMEs therefore need to belong to properly formulated and reliable networks if they are to survive and develop [110]. Networking plays an important role in the managerial skills of SME owners/managers operating in informal settings, as is the case with many rural entrepreneurs, and strong relationships are thus built with other business individuals or organisations in order to survive and enhance their competitiveness [111]. SME owners/managers often identify new opportunities and gain valuable ideas, information and resources from the networks to which they belong [112].
How rural SMEs engage in networking in many countries is, however, largely unknown, and the improvement of networking between business leaders is suggested as an appropriate arrangement to improve business success in rural areas [113]. Operating within networks, through which formal arrangements between independent businesses are established to enhance member success, is generally accepted as an important strategy to assist small businesses to survive and prosper, because networking enables entrepreneurs to make significant contributions to social capital and increases the long-term likelihood of their success [114, 115].
In the past, the location of businesses was considered an important factor by business owners when launching their enterprises [116]. This is true only in highly populated urban areas, and not in rural areas, where networking is entirely dependent on word-of-mouth for referrals and increases in patronage, due largely to a lack of Internet connectivity, which suggests that rural entrepreneurs need to alter their business practices with regard to promotional marketing strategies in order to increase their business networking, and should begin by making use of modern technologies, such as social media, as their business networking tools [117].
The human capital of enterprises is an important internal determinant of their survival and growth [118]. Human capital in entrepreneurship is defined as the attitudes, commitments, values, knowledge, experience, education, capabilities, skills and abilities that aid entrepreneurs in starting, running and growing their businesses [119]. Human capital is therefore a critical factor for the development and survival of enterprises, including the competitiveness of ventures, since its use directly affects SME performance, and is therefore a crucial determinant of their performance ([120–122]. It is a fact that the vast majority of SMEs still hold negative training philosophies, and as such, merely pay lip service to human resource development.
Furthermore, human capital is generally regarded as a critical agent in SME performance to empower owners/managers with training that enables them to make the correct managerial decisions when dealing with factors from both external and internal business environments [123]. There is therefore a definite need to investigate the effects of training and human capital development management with regard to the growth and survival of rural SMEs [124]. The promotion of modernisation, capacity building and the sizing-up of SMEs are required, and human capital therefore remains the most important factor for productivity in today’s economy, including the small business sector [125, 126].
South Africa’s institutional restrictions take a variety of forms, including high borrowing costs, complex tax regimes and a cumbersome bureaucracy, which can lead to low entrepreneurial growth in transitional economies. SMEs are therefore confronted by many challenges, such as environmental legislation, inefficiency in supply chain networking, increased local and global market competition, uncertain domestic market conditions and shortages of funding and sustainability in expansion [127]. The growth and survival of rurally based SMEs particularly are largely affected by problems associated with government-imposed regulatory frameworks, relative to their urban counterparts. Rurally based entrepreneurs have demonstrated a rare ability to start, grow, compete and survive in business longer than many urban SMEs, even when voluntarily complying with government regulations and procedures. The basic policies, laws and regulations of the country influence the survival and growth of its SMMEs, and a lack of collateral and institutional support are factors that heavily impede the survival and growth of SMME agribusinesses in developing countries, such as South Africa, where many rural SMMEs fail to meet collateral requirements that qualify them for bank loans.
The unleashing of entrepreneurship requires an environment that enables entrepreneurs to create, operate, manage and, if necessary, close businesses, within a context where compliance with the rule of law governing disclosure, licencing and registration procedures and the protection of physical and intellectual property are guaranteed. The existing regulatory environment should encourage people to launch their own businesses, attempt new business ideas and to take calculated risks, while keeping administrative burdens to the minimum required to support sustainable public policy and development objectives.
A comprehensive literature was conducted, and it was used as sources of questionnaire formulation for the empirical data collection. A total of 501 people who own or manage small and medium enterprise (SMEs) were asked to complete 10-page questionnaires to get empirical data. Mixed technique of quantitative and qualitative was employed composing closed and open-ended questionnaire together. Questionnaires were distributed to the owners’/managers’ business premises with the help of research assistants. The participants were giving 7 days to complete questionnaire. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0 to test significance of the results and later presented (Table 3).
Research area | Questions |
---|---|
Knowledge and understanding of digitalization | |
Attitude towards new social media networks | |
Benefits of digitalization | |
Factors contributing to the adaption of digitalization | |
Methods of digitalization | |
Implications of digitalization |
Summary of key questions.
The findings are outlined in this section based on the empirical research conducted in the various rural places in KwaZulu-Natal province of South Africa. All tested variables were constructed from the international literature review presented in the previous section, on the numerous problems confronting rural entrepreneurs in diffusing and adopting the use of modern technologies to achieve growth. The pick variables were scientifically tested and results are presented in Tables 4 and 5.
Attitude towards rural entrepreneurial digitalization | Method of digitalization | Benefits of rural entrepreneurial digitalization | ||||||
---|---|---|---|---|---|---|---|---|
Variables | Frequency | Percentage | Variables | Frequency | Percentage | Variables | Frequency | Percentage |
Costs of Internet are very high | 291 | 58 | Emails | 85 | 17 | Access to international markets | 210 | 42 |
Internet is time-consuming | 55 | 11 | Social media | 246 | 49 | Increase brand popularity | 30 | 6 |
Rural entrepreneurship can do without digitalization | 75 | 15 | Text message | 110 | 22 | Reduce marketing costs | 100 | 20 |
Rural entrepreneurship requires special skills | 80 | 16 | Viral marketing | 40 | 8 | Easy business networking | 55 | 11 |
Total number of participant | 501 | 100 | Affiliate marketing | 25 | 5 | Increase sales | 105 | 21 |
Variables tested on digitalisation of rural entrepreneurship.
Knowledge and understanding of rural entrepreneurial digitalization | Factors affecting rural entrepreneurial digitalization | Implications of rural entrepreneurial digitalization | ||||||
---|---|---|---|---|---|---|---|---|
Variables | Frequency | Percentage | Variables | Frequency | Percentage | Variables | Frequency | Percentage |
Modern technologies | 110 | 22 | Political factors | 37 | 7 | Minimise costs | 40 | 8 |
Forms of electronic media | 65 | 13 | Economic factors | 251 | 50 | Promote brand | 170 | 34 |
Viral marketing | 25 | 5 | Social factors | 37 | 7 | Reduce advertising costs | 291 | 58 |
Internet marketing | 261 | 52 | Technological factors | 150 | 30 | |||
Using all business activities electronically | 40 | 8 | Legal factors | 25 | 5 |
Variables tested on other critical issues on digitalisation of rural entrepreneurship.
The results presented in Table 4 show the various aspects associated with the attitude towards rural entrepreneurial digitalisation. The high costs of Internet 291 (58%) and special skills needed 80 (16%), followed by time-consuming in the Internet seem to be most concern amongst the respondents; however, there was also considerable number of 75 (15%) who still believe that rural entrepreneurship can do without been digitalised. This perception can be due to the resistance to change from old business practice or lack of knowledge and understanding of the benefits of digitalisation. About digital methods used by respondents, social media with 246 (49%) is dominating with high number, followed by text messages with 110 (22%). These findings indicate clear picture that digitalisation of the rural business is at the fancy stage, and therefore, need to be encouraged and managed more effectively. A large number of respondents believe that rural entrepreneurs can benefit in the access to international markets. They also think that it can reduce marketing costs while increasing sales.
The results shown in Table 5 revealed that 110 (22%) as well as 261 (52%) of the respondents have knowledge and understanding of modern technologies and Internet marketing. Therefore, these are making significant impact in promoting brand and reducing advertising costs. However, they are critical external factors influencing the diffusion and adoption of digital concept in the sector, these include economic factors with 251 (50%) and technological factors with 150 (30%) of the respondents affected by them. There are also concerns raised by respondents about political factors, social factors and legal factors that they are influencing their business strategies of doing day-to-day running of the business.
The results used in this work are completely based on the survey conducted in rural places of KwaZulu-Natal province in South Africa. Therefore, the generalisation of these findings should be done with care. The survey was only done on the formal registered SMEs without considering informal businesses. The complexity of the South African geographical profiles also played significant rule.
All over the world, many entrepreneurs operating in rural places including those in urban as well as peripheral areas will benefit from this work. This work will provide most needed knowledge and understanding of rural entrepreneurship digitalization and how it can benefit their business popularity. The marketers and all business interest parties need to obtain broad understanding of the relevant theories such as rural entrepreneurial digitalization which can be applied when addressing complex problems faced by rural communities everywhere in the world. This brings new thinking about implementing concept of digitalization of rural businesses as a promotional strategy to connect fragment rural places with the international markets and business society. On the practical side, the utilisation of recommendation from this survey will help in providing what is lacking and what needs to be done about the digitalization of rural entrepreneurship and what are the pro and cons of these concepts.
This study recommends that due to the various challenges such as lack of broadband availability and electricity in many rural places, there is a lot of improvements need to be done to improve rural business and lifehood of rural communities as well. It has been found that rural entrepreneurs are also faced with barriers including poor telecommunications infrastructure, management incompetence, lack of marketing skills and insufficient entrepreneurial knowledge, therefore, this study recommends that governments and private sector should be encouraged to work together to improve ICT co-ordination and its policy development for the rural places. National governments should establish steering agencies responsible for championing and ordinating rural entrepreneurial digitalisation and modern technologies networking systems for rural communities. Since the use and awareness of social media and social network gained significant growth in many countries thus, can be good promotional tool for rural enterprises, as these will help in minimising marketing while speeding up the sales of the products. The study recommends the use of digitalisation to an able rural business to reach out international market and enhance competitive advantage. Digitalisation will improve entrepreneurial knowledge skills, will help them to know their customers better, to know their customers need, who they are, where they buy, when they buy and how they buy.
Since the inception of Internet throughout the world, the use of new technologies such as social media and social network has shown rapid growth from the business and social sectors. However, it has been noticed that many rural enterprises are still not using modern technologies in promoting their businesses. Hence, the cost benefits and importance of digitalisation of rural entrepreneurship must be clearly understood and be encouraged as this will be an important promotional tool for strengthening company brand. The concept of digitalisation will improve and bring new changing trends in emerging markets including rural industries and scale up product development and product diversification, as well as promoting idea generation through use of Facebook, company emails, Company Tweets and Instagram.
Although lacking a consensus definition, the concurrent use of two or more medications is described polypharmacy [1]. However, in many researches investigating the use of multiple medications and their effects, the concurrent use of 5 or more drugs is defined as “polypharmacy” [2, 3, 4]. The concurrent use of 2 or 3 medications does not cause a significant problem if they are chosen correctly, but the use of 4 or more medications carries a significant risk. Although polypharmacy is seen in all age groups, it is more common with increasing age. Nearly half of the older people use at least 1 drug even though it is not necessary [5, 6]. One of the most important causes for the increase in the number of medications used in the elderly is the coexistence of more than one chronic disease.
Increase in the number of medications used may cause many health problems. As the metabolism and elimination of drugs will be affected by the decrease in kidney and liver functions with increasing age, the older people are more susceptible to the negative effects of polypharmacy. In addition, with increasing age, the onset of amnesia, decreased visual acuity, and the onset of physical disabilities cause the elderly, who already use many drugs, to make mistakes in the use of drugs. As a result, the elderly are more likely to encounter many health problems caused by the use of multiple drugs. Therefore, polypharmacy is accepted as one of the geriatric syndromes.
Apart from increasing age and the presence of chronic disease, other risk factors for polypharmacy are listed below [7, 8]:
Follow-up of patients by more than one physician and lack of communication between physicians
Patients’ drug expectations for their illness
Medical guidelines specific to diseases, not to patients
Pharmaceutical advertisements
Recent hospitalization
Over-the-counter drug sales
Prescribing medication for symptoms rather than diagnosis
Failure to adequately explain the medication changes to the patients by the doctors
Residing in long-term care facilities
Prescription cascade (addition of new medications to counter adverse drug reactions or drug side effects. For example, addition of an antitussive agent to relieve cough caused by angiotensin converting enzyme inhibitors, or addition of an antihypertensive due to increased blood pressure with NSAID use.
The increase in the number of medications used may result many negative consequences for patients and health system. For example, overall, 30% of hospital admissions are related in some way to medications in people aged over 65 years and half of these could be prevented [9]. Also, with increasing age, compliance to drug usage declines due to increase in the number of the drugs used, the beginning of memory loss, weakness of vision and the onset of physical incapabilities. The most common health problems reported in the elderly people associated with polypharmacy are listed below [10, 11, 12, 13, 14, 15]:
Increase risk of:
Drug interactions
Advers drug events
Morbidity and mortality
Physical and cognitive dysfunction
Falls and associated harms (hip fracture, etc)
Prescribing cascade
Increase in use of the health care system and hospitalizations
Decreased compliance to medication use
Increased treatment cost
Increased need of residing in long-term care facilities
As can be seen above, most of the problems caused by polypharmacy can be prevented. Visits for prescribing the medications used regularly, health maintanece and control visits are the convenient opportunities for physicians to evaluate drug interactions. In addition, while making a differential diagnosis for a new complaint or symptom, polypharmacy and drug interactions, should be evaluated and kept in mind that changes in the patient’s condition may be associated with drug interactions or an adverse effect of a medication.
Although polypharmacy is referred to prescribed medications, the number of over-the-counter and herbal/dietary supplements used should be also considered. It should be noted that beside the all medications used by the patient, over-the-counter drugs with dietary or herbal supplements should be evaluated in terms of interactions. For example, garlic or
Even not recommended by a physician, elderly people self-medicate more than the other age groups. This leads to an increased risk of adverse events and side effects. For example, the use of non-steroidal anti-inflammatory drugs, which are used common nonprescription, may lead to hypertension, decreased effect of the antihypertensives or a gastrointestinal bleeding.
There are many web-based applications developed for the physicians to control drug interactions. The addresses of some free applications that can be easily used on smartphones and tablets are listed below:
Probably most of the medications used by the patients were prescribed and clinically indicated. However, some medications may be unnecessary or cause harm over time due to physiological changes occur with aging or added health problems. These physiological changes that occur with aging affect the sensitivity of drugs mainly by causing changes in the pharmacokinetics of the drug. Pharmacodynamic changes also play a role, although to a lesser extent. The changes in the number and sensitivity of the receptors due to aging or some diseases that occur with aging, and the change of post-receptor events are the main reasons for the changes in pharmacodynamic responses of the medications. In general, these changes cause the effect of the drug to occur more or less and the emergence of drug toxicity and adverse drug reactions. Because of all these changes, the beneficial effects of drug use and the potential harmful effects of drug use should be evaluated together. The decrease in body functions, which occurs with aging is not the same in people of the same age. Therefore, the concept of “
Another problem encountered with the polypharmacy in the elderly is the use of narrow therapeutic index drugs. As a result of interaction of these drugs with other drugs the therapeutic dose can be easily increased to the toxic dose due to reduction in metabolism, increase in absorption or decrease in elimination. So, the medications with narrow therapeutic index may cause death even use in therapeutic doses. Small changes in the dosage of narrow therapeutic index drugs can lead to significant changes in pharmacodynamic response, particularly in elderly patients with comorbidities or using multiple medications. Therefore, recognizing the narrow therapeutic index drugs is very important issue in terms of preventing serious problems. Narrow therapeutic index drugs commonly used are shown in Table 1.
|
Common narrow therapeutic ındex drugs.
In the light of these information, each visit of an elderly patient should be considered as an opportunity to evaluate the unnecessary use or harms of the prescribed or nonprescribed medications. Studies showed that reducing the number of medications has many positive outcomes in older people such as decrease in the risk of falls, improvement in cognition, and improvement in patients’ global health status [21, 22, 23]. Moreover, approxymately, over half of the people over 70 years of age medicines could be discontinued [24].
In some cases, it is necessary to use multiple drugs for therapeutic purposes at once. For example, concomitant use of aspirin, beta-blockers, ACE inhibitors and lipid-lowering drugs is inevitable in cardiovascular diseases. For this reason, what needs to be done is to try to keep the number of drugs as few as possible by making a risk–benefit assessment by considering the personal treatment goals [25, 26].
In addition to the unnecessary and excessive use of drugs in the elderly, another important problem is that some drugs are not prescribed by physicians or are not used by patients, even though they are necessary. For example, it has been reported that only half of the patients take an anticoagulant in atrial fibrillation, although the guidelines suggest. It has also been reported that inhaled anticholinergic bronchodilators in COPD, SSRIs in depression, ACE inhibitors in the presence of diabetes mellitus and hypertension are not prescribed although necessary [27]. The other medications that are often underprescribed in the elderly include those used to Alzheimer disease, pain (eg, opioids), heart failure, post-MI (β-blockers), glaucoma, and incontinence. In addition to the medications, vaccines are not prescribed as recommended.
Deprescribing, the process of tapering, withdrawing, discontinuing, or stopping medications, is important in reducing polypharmacy, adverse drug effects, inappropriate or ineffective medication use, and costs [28]. The first step in deprescription is the identifing the patients with risk. To identifying the patients with risk, a comprehensive geriatric assessment should be necessery. Comprehensive geriatric assessment is a systematic evaluation of older people by a multidisciplinary health professionals to determine the medical, psychological and functional capabilities and develop a coordinated and integrated personalized follow up plan. Comprehensive geriatric assessment of the elderly patient in primary care should include multimorbidity, cognitive changes, functional status changes, frailty, risk of falling, medication nonadherence, polypharmacy, transitions in care setting, unexplained weight loss, and family concerns for safety [29]. Although comprehensive geriatric assessment expected to be performed by a multidisciplinary health professionals, family physicians have a central role in comprehensive geriatric assessment and coordinating the care. Comprehensive geriatric assessment can be performed in over time with regularly scheduled visits in primary care. During each visit, it should be targeted at least one domain and evaluation of polypharmacy risk and polypharmacy related problems prioritized. Periodic evaluation of a patient’s drug regimen and risk of polypharmacy and adverse drug events is an essential component of comprehensive geriatric assessment. Patients need to be specifically told to bring all of the over-the-counter products, ointments, vitamins, ophthalmic preparations, or herbal medicines, used by them to the visit.
It should be aimed to reduce the number of drugs, particularly in those use 7 or more drugs, a history of adverse drug reactions or falls, develope confusion or lethargy as a new symptom, worsen general health status, transfered to nursing homes, have multiple care providers or cared by more than one institutions. Anticipation of polypharmacy and inappropriate drug use is a part of deprescription process. Approximately one-fifth of the drugs used in elderly people are inappropriate drugs [30].
To reduce the number of medications used in older patients, Beers Criteria, Screening Tool of Older Person’s Potentially Inappropriate Prescriptions (STOPP), Screening Tool to Alert to Right Treatment (START) and The Medication Appropriateness Index-MAI can be used by the physicians [18, 19, 20]. The STOPP/START guideline contributes to the recognition of potentially inappropriate drugs for use in elderly patients and to drug selection in common diseases with evidence-based recommendations. The Beers Criteria is a guide to identify the inappropriate drugs that should be avoided in the elderly. The criteria include three categories: those that should always be avoided (regardless of disease or condition (eg, diphenhidramine, benzodiazepines); those that are potentially inappropriate in older adults with particular health conditions or syndromes; and those that should be used with caution (eg, carbamazepines, SSRIs) [19]. Medical Appropriateness Index, contributes to the evaluation of each medications in terms of indication, efficacy, appropriate dose and correct use, drug interactions, presence of medications with similar effect, appropriate treatment duration and cost [20].
It can be predicted that polypharmacy and unnecessary drugs may be used by the patients recently discharged from the hospital. It is known that medications used temporarily during hospitalization are also continued to use after discharge by the patients. Therefore, after discharge from the hospital, medications used by the patients should be reviewed. Additionally, increasing age, female gender, higher levels of education, cognitive dysfunction, general poor health, having cardiovascular disease, hypertension, asthma, diabetes or using high-risk drugs (antithrombotic agents, insulin, oral hypoglycaemic agents, cardiovascular and central nervous system drugs, anticolinergics) are the risks for polypharmacy and adverse drug events.
After the risk identification, the physician should prepare the patient and their closers to deprescribing. Asking the elderly and caregivers, which medications they prefer to use, and getting their opinion will make it easier for the physician. Because the passion of the elderly to some drugs can be an obstacle in the process of deprescribing, and the insistent attitude of the physician to discontinue the drug may reduce the trust to the doctor. Moreover, learning the patients’ and caregivers’ preferences are the first step of shared decision making process, that be very important in patient centered approachment in primary care.
Prioritization of the medicines to cease or doses to reduce is the second step of deprescription [31, 32]. For this, it should be checked the medications in terms of there is still a valid indication and benefit, presence of adverse drug reactions or new symptoms and risky drugs eg. anticholinergic and sedating drugs.
If there is a medication that is not preferred by the patient among the medications considered for discontinuation, deprescription can be started by discontinuing this medication.
If any adverse drug reaction or new symptom are suspected, the suspected drug should be discontinued first, and the next target medication to discotinue should be anticholinergic and sadative drugs. Because elderly patients are particularly susceptible of anticholinergic and sedating drugs advers effects. Adverse effects associated with anticholinergic use in older adults include memory impairment, confusion, hallucinations, dry mouth, blurred vision, constipation, nausea, urinary retention, impaired sweating, and tachycardia [33, 34]. Moreover, it was reported an association between anticholinergic use and risk of community acquired pneumonia [35]. Presence of these symptoms should be a warning to the physician. Some examples of anticholinergic drugs are shown in Table 2.
|
Anticholinergic drugs.
Discontinuation of the drugs with similar effects is another step in reducing the number of drugs. Then, the presence of drugs that can be used in combination among the drugs used should be reviewed, and if possible, the number of drugs should be reduced by prescribing the medications in combination.
Physicians should assess whether treatment goals have changed for the patient at each visit. In updated guidelines, treatment goals may change based on new evidence or depending on the patient’s age or other intervening disease. For example, after recognizing that strict targeting for hemoglobin A1c and blood pressure values was harmful in the elderly, the guidelines were updated on this issue [36, 37]. In addition to goals of care, the patients’ life expectancy also considered in deprescription process. The patient’s life expectancy may have been decrease by an intervening cancer or other serious illness. In this case, some medications that are expected to show their effects in long term (eg statins), can be discontinued. Clinicians should decide to discontinuation process by individualized treatment goals in line with current guidelines.
It is known that non-pharmacological treatments are even more effective than drug treatment in several chronic diseases. Therefore, while prescribing, non-pharmacologic treatment options should always be considered first [26]. If the patient can apply non-pharmacologic options, it will be easier to reduce the number of drugs. For example, in many patients, hypertension can be controlled only by sodium restriction or weight loss. In diabetes mellitus patients the number and dose of the medications can be reduced by low glycemic index diet and exercise.
The steps of deprescription process was shown in Table 3.
|
The steps of deprescription.
If it is not possible to cease of medications, it should be considered whether it is possible to reduce their dose. Because, many adverse drug reactions are dose-related. While prescribing it is important to use the minimal dose required to obtain clinical benefit.
A comprehensive geriatric assessment should be necessery to detect the risk of polypharmacy, polypharmacy related problems, possibility to reduce the number of medications and anticipate the consequences of withdrawal. Although consern of withdrawal reactions may be a barrier to deprescription, withdrawal reactions are seen rare when discontinuation is carried slowly and carefully [38].
While reducing the number of drugs, it is very important that some drugs should be discontinued by tapering over time. Anticonvulsants, benzodiazepines, corticosteroids, antidepressants, beta blockers, levodopa, opiates, proton pump inhibitors, and gabapentin are the examples of drugs that should not be stopped abruptly. Abrupt discontinuation of these drugs may cause withdrawal syndrome and a rebound effect.
Only stop or reduce one medicine at a time.
Possible problems that may occur in case of discontinuation of the drug should be anticipated.
Drug interactions should also be considered while reducing the number of drugs. For example, when using warfarin with omeprazole, discontinuation of omeprazole, the INR may decrease because omeprazole had been inhibiting the metabolism of warfarin.
In cases where it cannot be decided which medication should be discontinued, a collaboration with other physicians following the patient should be established.
The necessity of drug discontinuation should be explained to the patient and their closers with an appropriate communication language.
Effort should be made to improve communication in transition of the patients between health care centers or caregivers. Sharing the medication lists used by the patients or planned to withdrawal, between health providers at the time of care transition may be help to prevent adverse drug events.
After the drug is withdrawal, warning messages about the discontinuation of the medications should be given to the patients in writing, a follow-up appointment should be planned, and should be informed about when to consult a doctor [39].
Patients and their closers should be informed about the monitoring of blood parameters that may change after drug withdrawal.
While trying to prevent polypharmacy and polypharmacy-related problems in elderly patients and to reduce unnecessary and inappropriate drug use, care should be taken not to discontinue the drugs that the patient really needs. START criteria is developed to help the identify potential prescribing omissions in older patients can be used in this regard [18].
If treatment is indicated, the current regimen with a higher probability of adverse effects can be replaced with a safer alternative medication. As an example, acetaminophen instead of NSAID.
The patient’s condition and goals of care changed over time are the key principles to be considered in deprescription. A comprehensive geriatric assessment should be necessery to detect the risk of polypharmacy, polypharmacy related problems, possibility to reduce the number of medications and anticipate the consequences of withdrawal. Avoiding from over-prescribing and inappropriate medications in older patients is the key step to prevent negative health problems due to polypharmacy. It should be kept in mind that in addition to over-prescribing, under-prescribing appropriate medications is also of concern in older patients. Therefore, a balance is required between over- and under-prescribing.
It should be kept in mind that reducing the number of drugs in the elderly patients in accordance with the evidence based guidelines can be carried without any serious problems and this situation can improve the health parameters of the older patients. In conclusion, prevention of polypharmacy and withdrawing unneccesary and inappropriate medications may be the best clinical decision in older patients.
IntechOpen - where academia and industry create content with global impact
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\\n\\nDr Alex Lazinica
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\n\nSara Uhac, COO
\n\nSara Uhac was appointed Managing Director of IntechOpen at the beginning of 2014. She directs and controls the company’s operations. Sara joined IntechOpen in 2010 as Head of Journal Publishing, a new strategically underdeveloped department at that time. After obtaining a Master's degree in Media Management, she completed her Ph.D. at the University of Lugano, Switzerland. She holds a BA in Financial Market Management from the Bocconi University in Milan, Italy, where she started her career in the American publishing house Condé Nast and further collaborated with the UK-based publishing company Time Out. Sara was awarded a professional degree in Publishing from Yale University (2012). She is a member of the professional branch association of "Publishers, Designers and Graphic Artists" at the Croatian Chamber of Commerce.
\n\nAdrian Assad De Marco
\n\nAdrian Assad De Marco joined the company as a Director in 2017. With his extensive experience in management, acquired while working for regional and global leaders, he took over direction and control of all the company's publishing processes. Adrian holds a degree in Economy and Management from the University of Zagreb, School of Economics, Croatia. A former sportsman, he continually strives to develop his skills through professional courses and specializations such as NLP (Neuro-linguistic programming).
\n\nDr Alex Lazinica
\n\nAlex Lazinica is co-founder and Board member of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his Ph.D. in Robotics at the Vienna University of Technology. There, he worked as a robotics researcher with the university's Intelligent Manufacturing Systems Group, as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and, most importantly, co-founded and built the International Journal of Advanced Robotic Systems, the world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career since it proved to be the pathway to the foundation of IntechOpen with its focus on addressing academic researchers’ needs. Alex personifies many of IntechOpen´s key values, including the commitment to developing mutual trust, openness, and a spirit of entrepreneurialism. Today, his focus is on defining the growth and development strategy for the company.
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His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. 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Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192666,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. 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Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3478,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3601,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81998",title:"Understanding the Neuropathophysiology of Psychiatry Disorder Using Transcranial Magnetic Stimulation",slug:"understanding-the-neuropathophysiology-of-psychiatry-disorder-using-transcranial-magnetic-stimulatio",totalDownloads:0,totalDimensionsCites:0,doi:"10.5772/intechopen.103748",abstract:"Transcranial magnetic stimulation (TMS) is a safe and non-invasive tool that allows researchers to probe and modulate intracortical circuits. The most important aspect of TMS is its ability to directly stimulate the cortical neurons, generating action potentials, without much effect on intervening tissue. This property can be leveraged to provide insight into the pathophysiology of various neuropsychiatric disorders. Using multiple patterns of stimulations (single, paired, or repetitive), different neurophysiological parameters can be elicited. Various TMS protocol helps in understanding the neurobiological basis of disorder and specific behaviors by allowing direct probing of the cortical areas and their interconnected networks. While single-pulse TMS can provide insight into the excitability and integrity of the corticospinal tract, paired-pulse TMS (ppTMS) can provide further insight into cortico-cortical connections and repetitive TMS (rTMS) into cortical mapping and modulating plasticity.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Jitender Jakhar, Manish Sarkar and Nand Kumar"},{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:24,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81488",title:"Aggression and Sexual Behavior: Overlapping or Distinct Roles of 5-HT1A and 5-HT1B Receptors",slug:"aggression-and-sexual-behavior-overlapping-or-distinct-roles-of-5-ht1a-and-5-ht1b-receptors",totalDownloads:20,totalDimensionsCites:0,doi:"10.5772/intechopen.104872",abstract:"Distinct brain mechanisms for male aggressive and sexual behavior are present in mammalian species, including man. However, recent evidence suggests a strong connection and even overlap in the central nervous system (CNS) circuitry involved in aggressive and sexual behavior. The serotonergic system in the CNS is strongly involved in male aggressive and sexual behavior. In particular, 5-HT1A and 5-HT1B receptors seem to play a critical role in the modulation of these behaviors. The present chapter focuses on the effects of 5-HT1A- and 5-HT1B-receptor ligands in male rodent aggression and sexual behavior. Results indicate that 5-HT1B-heteroreceptors play a critical role in the modulation of male offensive behavior, although a definite role of 5-HT1A-auto- or heteroreceptors cannot be ruled out. 5-HT1A receptors are clearly involved in male sexual behavior, although it has to be yet unraveled whether 5-HT1A-auto- or heteroreceptors are important. Although several key nodes in the complex circuitry of aggression and sexual behavior are known, in particular in the medial hypothalamus, a clear link or connection to these critical structures and the serotonergic key receptors is yet to be determined. This information is urgently needed to detect and develop new selective anti-aggressive (serenic) and pro-sexual drugs for human applications.",book:{id:"10195",title:"Serotonin and the CNS - New Developments in Pharmacology and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg"},signatures:"Berend Olivier and Jocelien D.A. Olivier"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517",scope:"Paralleling similar advances in the medical field, astounding advances occurred in Veterinary Medicine and Science in recent decades. These advances have helped foster better support for animal health, more humane animal production, and a better understanding of the physiology of endangered species to improve the assisted reproductive technologies or the pathogenesis of certain diseases, where animals can be used as models for human diseases (like cancer, degenerative diseases or fertility), and even as a guarantee of public health. Bridging Human, Animal, and Environmental health, the holistic and integrative “One Health” concept intimately associates the developments within those fields, projecting its advancements into practice. This book series aims to tackle various animal-related medicine and sciences fields, providing thematic volumes consisting of high-quality significant research directed to researchers and postgraduates. It aims to give us a glimpse into the new accomplishments in the Veterinary Medicine and Science field. By addressing hot topics in veterinary sciences, we aim to gather authoritative texts within each issue of this series, providing in-depth overviews and analysis for graduates, academics, and practitioners and foreseeing a deeper understanding of the subject. Forthcoming texts, written and edited by experienced researchers from both industry and academia, will also discuss scientific challenges faced today in Veterinary Medicine and Science. In brief, we hope that books in this series will provide accessible references for those interested or working in this field and encourage learning in a range of different topics.",coverUrl:"https://cdn.intechopen.com/series/covers/13.jpg",latestPublicationDate:"May 25th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:11,editor:{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"19",title:"Animal Science",coverUrl:"https://cdn.intechopen.com/series_topics/covers/19.jpg",isOpenForSubmission:!0,annualVolume:11415,editor:{id:"259298",title:"Dr.",name:"Edward",middleName:null,surname:"Narayan",slug:"edward-narayan",fullName:"Edward Narayan",profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",biography:"Dr. Edward Narayan graduated with Ph.D. degree in Biology from the University of the South Pacific and pioneered non-invasive reproductive and stress endocrinology tools for amphibians - the novel development and validation of non-invasive enzyme immunoassays for the evaluation of reproductive hormonal cycle and stress hormone responses to environmental stressors. \nDr. Narayan leads the Stress Lab (Comparative Physiology and Endocrinology) at the University of Queensland. A dynamic career research platform which is based on the thematic areas of comparative vertebrate physiology, stress endocrinology, reproductive endocrinology, animal health and welfare, and conservation biology. \nEdward has supervised 40 research students and published over 60 peer reviewed research.",institutionString:null,institution:{name:"University of Queensland",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},{id:"20",title:"Animal Nutrition",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",isOpenForSubmission:!0,annualVolume:11416,editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. He is a research professor at the Faculty of Veterinary Medicine and Animal Husbandry, Autonomous University of the State of Mexico. He is also a level-2 researcher. He received a Fulbright-Garcia Robles fellowship for a postdoctoral stay at the US Dairy Forage Research Center, Madison, Wisconsin, USA in 2008–2009. He received grants from Alianza del Pacifico for a stay at the University of Magallanes, Chile, in 2014, and from Consejo Nacional de Ciencia y Tecnología (CONACyT) to work in the Food and Agriculture Organization’s Animal Production and Health Division (AGA), Rome, Italy, in 2014–2015. He has collaborated with researchers from different countries and published ninety-eight journal articles. He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"28",title:"Animal Reproductive Biology and Technology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/28.jpg",isOpenForSubmission:!0,annualVolume:11417,editor:{id:"177225",title:"Prof.",name:"Rosa Maria Lino Neto",middleName:null,surname:"Pereira",slug:"rosa-maria-lino-neto-pereira",fullName:"Rosa Maria Lino Neto Pereira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9wkQAC/Profile_Picture_1624519982291",biography:"Rosa Maria Lino Neto Pereira (DVM, MsC, PhD and) is currently a researcher at the Genetic Resources and Biotechnology Unit of the National Institute of Agrarian and Veterinarian Research (INIAV, Portugal). 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Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}},{id:"351158",title:"Prof.",name:"David W.",middleName:null,surname:"Anderson",slug:"david-w.-anderson",fullName:"David W. Anderson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Calgary",country:{name:"Canada"}}}]}},subseries:{item:{id:"24",type:"subseries",title:"Computer Vision",keywords:"Image Analysis, Scene Understanding, Biometrics, Deep Learning, Software Implementation, Hardware Implementation, Natural Images, Medical Images, Robotics, VR/AR",scope:"The scope of this topic is to disseminate the recent advances in the rapidly growing field of computer vision from both the theoretical and practical points of view. Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",hasOnlineFirst:!0,hasPublishedBooks:!1,annualVolume:11420,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). 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