International mortality rates 30 days post PEG placement
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"6998",leadTitle:null,fullTitle:"Synucleins - Biochemistry and Role in Diseases",title:"Synucleins",subtitle:"Biochemistry and Role in Diseases",reviewType:"peer-reviewed",abstract:"Neurodegenerative diseases are debilitating conditions that result in degeneration and death of nerve cells. A significant group of these diseases is the synucleinopathies, which are characterized by the accumulation of aggregates of alpha-synuclein in neurons, nerve fibers, or glial cells. There are three main types of synucleinopathies: Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. Synucleins are small, naturally unfolded proteins prone to aggregate and form intracellular inclusions, which impair normal cellular functions. This book presents new data on synuclein aggregation and its effect on cholesterol transport. It also discusses the role of genetic contribution to these diseases and approaches to inhibition of synuclein aggregation.",isbn:"978-1-78984-588-4",printIsbn:"978-1-78984-565-5",pdfIsbn:"978-1-78984-589-1",doi:"10.5772/intechopen.73750",price:100,priceEur:109,priceUsd:129,slug:"synucleins-biochemistry-and-role-in-diseases",numberOfPages:96,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"2b4b802fec508928ce8ab9deebd1375f",bookSignature:"Andrei Surguchov",publishedDate:"April 8th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/6998.jpg",numberOfDownloads:5799,numberOfWosCitations:4,numberOfCrossrefCitations:13,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:26,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:43,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"July 12th 2018",dateEndSecondStepPublish:"September 13th 2018",dateEndThirdStepPublish:"November 12th 2018",dateEndFourthStepPublish:"January 31st 2019",dateEndFifthStepPublish:"April 1st 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"266540",title:"Dr.",name:"Andrei",middleName:null,surname:"Surguchov",slug:"andrei-surguchov",fullName:"Andrei Surguchov",profilePictureURL:"https://mts.intechopen.com/storage/users/266540/images/system/266540.jpeg",biography:"Andrei Surguchov joined Baylor College of Medicine, Houston, TX, as a faculty member in 1992, where he studied the mechanisms of the genetic control of lipid metabolism. At the University of Utah, his research interests were focused on the cloning of new genes encoding retinal proteins. At Washington University, St. Louis, he studied molecular and cellular mechanisms of neurodegenerative diseases and retinal degeneration. Currently, his research focuses on the structure-function relationship of proteins involved in neurodegeneration and ocular diseases. Using different animal and cellular models, his laboratory is studying the role of naturally unfolded proteins, their transcriptional regulation, processing, and posttranslational modifications. Recently, he became interested in the role of micro-RNA in posttranscriptional regulation of gene expression. Other areas of research involve the studies of synuclein family members, protein misfolding and the regulation of metalloproteinases.",institutionString:"Kansas University Medical Center",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Kansas Medical Center",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"212",title:"Molecular Neuroscience",slug:"molecular-neuroscience"}],chapters:[{id:"65344",title:"Introductory Chapter: Little Pigeons Can Carry Great Messages",doi:"10.5772/intechopen.82670",slug:"introductory-chapter-little-pigeons-can-carry-great-messages",totalDownloads:775,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Andrei Surguchov",downloadPdfUrl:"/chapter/pdf-download/65344",previewPdfUrl:"/chapter/pdf-preview/65344",authors:[{id:"266540",title:"Dr.",name:"Andrei",surname:"Surguchov",slug:"andrei-surguchov",fullName:"Andrei Surguchov"}],corrections:null},{id:"68222",title:"Alpha-Synuclein Aggregation, Cholesterol Transport, and the 18-kDa Translocator Protein",doi:"10.5772/intechopen.83459",slug:"alpha-synuclein-aggregation-cholesterol-transport-and-the-18-kda-translocator-protein",totalDownloads:773,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The molecular responses to counteract diseases, including insulting conditions such as injury and pathogen infection, involve coordinated modulation of gene expression programs. The association of alpha synuclein (α-Syn) with several progressive disorders has focused the research on its induced conformational behavior as critical for uncovering the “secrets” for progression of α-synucleinopathies. Cholesterol is one of the lipid components crucial for regular proliferation of the nervous tissue. Its interaction with α-Syn may offer other insights to α-Syn normal expression. Discovering that the molecular regulatory mechanisms responsible for prevention of α-Syn aggregation may be manifested through microRNA (miRNA) regulated gene expression is also crucial for widening the perception of neuropathology. The 18-kDa translocator protein (TSPO) localized on the outer mitochondrial membrane is able to regulate various cellular and tissue functions, with key role as cholesterol transporter for neurosteroid synthesis. TSPO up-regulation, has been connected to several diseases, including cancer, neuronal damage, and inflammation. Connection may also be established between TSPO expression and fatty acid oxidation, thus unveiling new possibilities in the research of α-Syn overexpression. However, expression of TSPO in the neuroinflammatory environment is probably the best starting point for targeting TSPO as a suitable therapeutic target.",signatures:"Jasmina Dimitrova-Shumkovska and Ljupcho Krstanoski",downloadPdfUrl:"/chapter/pdf-download/68222",previewPdfUrl:"/chapter/pdf-preview/68222",authors:[{id:"64536",title:"Prof.",name:"Jasmina",surname:"Dimitrova-Shumkovska",slug:"jasmina-dimitrova-shumkovska",fullName:"Jasmina Dimitrova-Shumkovska"},{id:"288560",title:"BSc.",name:"Ljupcho",surname:"Krstanoski",slug:"ljupcho-krstanoski",fullName:"Ljupcho Krstanoski"}],corrections:null},{id:"65009",title:"The Relationship between Alpha-Synuclein (SNCA) Gene Polymorphisms and Development Risk of Parkinson’s Disease",doi:"10.5772/intechopen.82808",slug:"the-relationship-between-alpha-synuclein-snca-gene-polymorphisms-and-development-risk-of-parkinson-s",totalDownloads:1216,totalCrossrefCites:4,totalDimensionsCites:5,hasAltmetrics:0,abstract:"Parkinson’s disease (PD) is a neurodegenerative disorder affecting the motor system and occurring in the central nervous system. One of the symptoms of PD is accumulation of Lewy bodies and Lewy neurites. The alpha-synuclein (SNCA) gene is part of the protein complex called Lewy body. The SNCA gene encoding a presynaptic protein product is thought to play a role in PD-related important pathways. It is suggested that there is a relationship between the risk of PD development and SNCA levels, and it is suggested that SNCA level is an important marker in PD diagnosis. Various polymorphisms have been identified in the 5′ and/or 3′ UTR regions of the SNCA gene, and as a result of these polymorphisms, changes occur in the binding of transcription factors. The identification of the roles of SNCA gene polymorphisms in PD development may enable the development of new methods for the treatment of PD.",signatures:"Nevra Alkanli and Arzu Ay",downloadPdfUrl:"/chapter/pdf-download/65009",previewPdfUrl:"/chapter/pdf-preview/65009",authors:[{id:"234410",title:"Dr.",name:"Nevra",surname:"Alkanli",slug:"nevra-alkanli",fullName:"Nevra Alkanli"},{id:"235954",title:"Dr.",name:"Arzu",surname:"Ay",slug:"arzu-ay",fullName:"Arzu Ay"}],corrections:null},{id:"65453",title:"Therapeutic Potential of Baicalein in Parkinson’s Disease: Focus on Inhibition of α-Synuclein Oligomerization and Aggregation",doi:"10.5772/intechopen.83589",slug:"therapeutic-potential-of-baicalein-in-parkinson-s-disease-focus-on-inhibition-of-synuclein-oligomeri",totalDownloads:1163,totalCrossrefCites:2,totalDimensionsCites:5,hasAltmetrics:0,abstract:"Parkinson’s disease (PD) is the most common neurodegenerative diseases, which affects the people in old age. The neuropathological symptoms of PD include the degeneration of dopaminergic neurons in the substantia nigra pars compacta, and presence of intracellular inclusions of α-synuclein (α-syn) aggregates. α-Syn, a natively unfolded protein, has been found to play a key role in PD pathology. Several mechanistic studies revealed the numerous aspects of α-syn fibrillation and aggregation process that lead to dopaminergic neurodegeneration in PD. Till to date, there is no complete cure of PD, but some therapeutic agents are able to halt the disease progression. Scutellaria baicalensis Georgi is a traditional Chinese medicine commonly used to treat the central nervous system diseases. Recently, it has been confirmed that root of S. baicalensis Georgi contains baicalein (5,6,7-trihydroxyflavone) as a major bioactive flavone constituent. Baicalein possess numerous pharmacological properties such as antiaggregation of amyloid proteins including α-syn, antioxidant, anti-inflammatory, and antiapoptotic. In the light of these properties, baicalein has potential therapeutic efficacy for PD. In this chapter, we explored the pharmacological protective actions of baicalein against α-syn fibrillation and aggregation that make it suitable for PD treatment and also discussed the possible mechanisms underlying the effects.",signatures:"Hayate Javed and Shreesh Ojha",downloadPdfUrl:"/chapter/pdf-download/65453",previewPdfUrl:"/chapter/pdf-preview/65453",authors:[{id:"160098",title:"Dr.",name:"Shreesh",surname:"Ojha",slug:"shreesh-ojha",fullName:"Shreesh Ojha"},{id:"270179",title:"Dr.",name:"Hayate",surname:"Javed",slug:"hayate-javed",fullName:"Hayate Javed"}],corrections:null},{id:"71337",title:"Role of Phenylalanine and Its Metabolites in Health and Neurological Disorders",doi:"10.5772/intechopen.83648",slug:"role-of-phenylalanine-and-its-metabolites-in-health-and-neurological-disorders",totalDownloads:902,totalCrossrefCites:7,totalDimensionsCites:9,hasAltmetrics:0,abstract:"Phenylalanine, an amino acid, is a “building block” of protein. Phenylalanine is a component of food sources and also derived through supplementation. In current treatment, phenylalanine is prescribed as anti-depressant agent. The present study reviewed the possible antidepressant potential of phenylalanine. We reviewed data using the major databases, namely, Web of Science, SciFinder, Google Scholar, and PubMed. This manuscript provides a brief overview of the role of phenylalanine in depressive disorders. Phenylalanine possesses anti-depressant potential. Significant anti-depressant activities have been studied both in-vitro and in-vivo models. Based on current data, phenylalanine could be recommended as a potential candidate for clinical anti-depressant trials. Phenylalanine hydroxylase (PAH) deficiency results in intolerance to the dietetic consumption of the phenylalanine and a variety of syndromes such as deep and permanent logical disability, impaired cognitive development.",signatures:"Muhammad Akram, Muhammad Daniyal, Aatiqa Ali, Rida Zainab, Syed Muhammad Ali Shah, Naveed Munir and Imtiaz Mahmood Tahir",downloadPdfUrl:"/chapter/pdf-download/71337",previewPdfUrl:"/chapter/pdf-preview/71337",authors:[{id:"275724",title:"Dr.",name:"Muhammad",surname:"Daniyal",slug:"muhammad-daniyal",fullName:"Muhammad Daniyal"},{id:"275728",title:"Dr.",name:"Muhammad",surname:"Akram",slug:"muhammad-akram",fullName:"Muhammad Akram"},{id:"285469",title:"Dr.",name:"Aatiqa",surname:"Ali",slug:"aatiqa-ali",fullName:"Aatiqa Ali"}],corrections:null},{id:"65859",title:"Role of Osmolytes in Amyloidosis",doi:"10.5772/intechopen.83647",slug:"role-of-osmolytes-in-amyloidosis",totalDownloads:970,totalCrossrefCites:0,totalDimensionsCites:6,hasAltmetrics:0,abstract:"Osmolytes are naturally occurring small organic molecules present in all kingdoms of life. These organic molecules are accumulated by living systems to circumvent stress conditions. A number of human diseases have been grouped under the protein-misfolding diseases. These entire diseases share the same hallmarks of the presence of cellular inclusions and plaques that are deposited in the cells and tissues affected by the disease. These misfolded forms of protein are responsible for initiating toxic cascades in the cell, causing vesicle dystrafficking, synaptic and cell organelle dysfunction, and ultimately cell death. Published results suggest that cells regulate many biological processes such as protein folding, protein disaggregation, and protein-protein interactions via accumulation of specific osmolytes. Since, as of now, complete cure for these protein-misfolding disorders does not exist; therefore, it becomes increasingly important to review the recent works on this aspect to develop strategies for therapeutics. It has been shown that certain osmolytes can prevent the proteins from misfolding. Thus, osmolytes can be utilized as therapeutics for such diseases. In this review article, we discuss the role of naturally occurring osmolytes in various forms of amyloidosis associated with human diseases.",signatures:"Sheeza Khan, Zeba Mueed, Ravi Deval, Pankaj Kumar Rai, Dinesh Kumar Prajapati and Nitesh Kumar Poddar",downloadPdfUrl:"/chapter/pdf-download/65859",previewPdfUrl:"/chapter/pdf-preview/65859",authors:[{id:"275668",title:"Associate Prof.",name:"Nitesh",surname:"Poddar",slug:"nitesh-poddar",fullName:"Nitesh Poddar"},{id:"284387",title:"Dr.",name:"Sheeza",surname:"Khan",slug:"sheeza-khan",fullName:"Sheeza Khan"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6237",title:"GABA And Glutamate",subtitle:"New Developments In Neurotransmission Research",isOpenForSubmission:!1,hash:"9883dc7bb642e8ae919261b2519547ba",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",bookSignature:"Janko Samardzic",coverURL:"https://cdn.intechopen.com/books/images_new/6237.jpg",editedByType:"Edited by",editors:[{id:"188756",title:"Dr.",name:"Janko",surname:"Samardzic",slug:"janko-samardzic",fullName:"Janko Samardzic"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6989",title:"Biogenic Amines in Neurotransmission and Human Disease",subtitle:null,isOpenForSubmission:!1,hash:"4c7e866a847bc30d77f37feccdf72dbf",slug:"biogenic-amines-in-neurotransmission-and-human-disease",bookSignature:"Ahmet Uçar",coverURL:"https://cdn.intechopen.com/books/images_new/6989.jpg",editedByType:"Edited by",editors:[{id:"205106",title:"Associate Prof.",name:"Ahmet",surname:"Uçar",slug:"ahmet-ucar",fullName:"Ahmet Uçar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10195",title:"Serotonin and the CNS",subtitle:"New Developments in Pharmacology and Therapeutics",isOpenForSubmission:!1,hash:"7ed9d96da98233a885bd2869a8056c36",slug:"serotonin-and-the-cns-new-developments-in-pharmacology-and-therapeutics",bookSignature:"Berend Olivier",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg",editedByType:"Edited by",editors:[{id:"71579",title:"Prof.",name:"Berend",surname:"Olivier",slug:"berend-olivier",fullName:"Berend Olivier"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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A Sustainable and Holistic Approach in Addressing Triple Challenges of Gender Inequality, Climate Change Effects, Food and Nutrition Insecurity in Rural Communities of Sub-Saharan Africa",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/81455.pdf",downloadPdfUrl:"/chapter/pdf-download/81455",previewPdfUrl:"/chapter/pdf-preview/81455",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/81455",risUrl:"/chapter/ris/81455",chapter:{id:"75448",slug:"goat-a-sustainable-and-holistic-approach-in-addressing-triple-challenges-of-gender-inequality-climat",signatures:"Never Assan",dateSubmitted:"November 24th 2020",dateReviewed:"February 4th 2021",datePrePublished:"February 26th 2021",datePublished:null,book:{id:"9706",title:"Goat Science - Environment, Health and Economy",subtitle:null,fullTitle:"Goat Science - Environment, Health and Economy",slug:null,publishedDate:null,bookSignature:"Dr. Sándor Kukovics",coverURL:"https://cdn.intechopen.com/books/images_new/9706.jpg",licenceType:"CC BY 3.0",editedByType:null,editors:[{id:"25894",title:"Dr.",name:"Sándor",middleName:null,surname:"Kukovics",slug:"sandor-kukovics",fullName:"Sándor Kukovics"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null}},chapter:{id:"75448",slug:"goat-a-sustainable-and-holistic-approach-in-addressing-triple-challenges-of-gender-inequality-climat",signatures:"Never Assan",dateSubmitted:"November 24th 2020",dateReviewed:"February 4th 2021",datePrePublished:"February 26th 2021",datePublished:null,book:{id:"9706",title:"Goat Science - Environment, Health and Economy",subtitle:null,fullTitle:"Goat Science - Environment, Health and Economy",slug:null,publishedDate:null,bookSignature:"Dr. Sándor Kukovics",coverURL:"https://cdn.intechopen.com/books/images_new/9706.jpg",licenceType:"CC BY 3.0",editedByType:null,editors:[{id:"25894",title:"Dr.",name:"Sándor",middleName:null,surname:"Kukovics",slug:"sandor-kukovics",fullName:"Sándor Kukovics"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null},book:{id:"9706",title:"Goat Science - Environment, Health and Economy",subtitle:null,fullTitle:"Goat Science - Environment, Health and Economy",slug:null,publishedDate:null,bookSignature:"Dr. Sándor Kukovics",coverURL:"https://cdn.intechopen.com/books/images_new/9706.jpg",licenceType:"CC BY 3.0",editedByType:null,editors:[{id:"25894",title:"Dr.",name:"Sándor",middleName:null,surname:"Kukovics",slug:"sandor-kukovics",fullName:"Sándor Kukovics"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"11783",leadTitle:null,title:"Motivation and Success",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tThis book will aim to be a self-contained collection of scholarly papers targeting an audience of practicing researchers, academics, psychologists, social workers, mentors, motivational speakers, life coaches, students, and other scientists. The contents of the book are intended to be written by multiple authors and experts from different related fields of psychology, philosophy, education, public health, human resource, and other human social sciences.
\r\n\r\n\tCombining Motivation and Success as a book title demonstrates that these are complementary goods. When two goods are complements, they experience join demand. Meaning that the demand for one good is linked to the demand for another good. Indeed, our esteemed authors will aim to put together their scholarly work to showcase the importance of motivation leading to success and vice versa. Defined as a drive or a need, motivation is a driving force inside an individual to pursue a designated goal. While success is a state of meeting a targeted goal. This simply implies that motivated individuals are most successful and this is the core theme of the book.
",isbn:"978-1-83768-021-4",printIsbn:"978-1-83768-020-7",pdfIsbn:"978-1-83768-022-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"f660b7cd35b9af94bdfc3564df138161",bookSignature:"Dr. Simon George Taukeni",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11783.jpg",keywords:"Inner Motivation, Self-Regulation, Self-Control, Exercise, Sport, External Motivation, Secrets Behind Success, Being Physically Active, Feeling Successful, Theories Behind Success, Adversity, Motivational Speech",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 10th 2022",dateEndSecondStepPublish:"July 15th 2022",dateEndThirdStepPublish:"September 13th 2022",dateEndFourthStepPublish:"December 2nd 2022",dateEndFifthStepPublish:"January 31st 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"a month",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"A pioneering researcher within the biopsychosocial model and health psychology. He also works as an editor, internal and external examiner, and principal project investigator.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"202046",title:"Dr.",name:"Simon George",middleName:null,surname:"Taukeni",slug:"simon-george-taukeni",fullName:"Simon George Taukeni",profilePictureURL:"https://mts.intechopen.com/storage/users/202046/images/system/202046.jpg",biography:"Simon George Taukeni is an author, editor, and academic. He has been working at the University of Namibia since 2011. He is also a part-time tutor at Namibia University of Science and Technology (NUST). He is a former post-doctoral research fellow at the University of Fort Hare, South Africa.\n\nDr. Taukeni has a Ph.D., MPH, MEd, and BEd, as well as a specialized postgraduate diploma in Behavioral and Emotional Disorders. \n\nHe has collaborated with many local and international researchers and scholars in his capacity as an editor, internal and external examiner, and principal project investigator.",institutionString:"University of Namibia",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"University of Namibia",institutionURL:null,country:{name:"Namibia"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"21",title:"Psychology",slug:"psychology"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"466998",firstName:"Dragan",lastName:"Miljak",middleName:"Anton",title:"Mr.",imageUrl:"https://mts.intechopen.com/storage/users/466998/images/21564_n.jpg",email:"dragan@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copy-editing and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. A unique name with a unique work ethic right at your service."}},relatedBooks:[{type:"book",id:"10211",title:"The Science of Emotional Intelligence",subtitle:null,isOpenForSubmission:!1,hash:"447fc7884303a10093bc189f4c82dd47",slug:"the-science-of-emotional-intelligence",bookSignature:"Simon George Taukeni",coverURL:"https://cdn.intechopen.com/books/images_new/10211.jpg",editedByType:"Edited by",editors:[{id:"202046",title:"Dr.",name:"Simon George",surname:"Taukeni",slug:"simon-george-taukeni",fullName:"Simon George Taukeni"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9136",title:"Counseling and Therapy",subtitle:null,isOpenForSubmission:!1,hash:"499608b1cf8111827e1a271e5555a6a6",slug:"counseling-and-therapy",bookSignature:"Simon George Taukeni",coverURL:"https://cdn.intechopen.com/books/images_new/9136.jpg",editedByType:"Edited by",editors:[{id:"202046",title:"Dr.",name:"Simon George",surname:"Taukeni",slug:"simon-george-taukeni",fullName:"Simon George Taukeni"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8583",title:"Psychology of Health",subtitle:"Biopsychosocial Approach",isOpenForSubmission:!1,hash:"d355e49f356bbd1ee90c228c0eef2d86",slug:"psychology-of-health-biopsychosocial-approach",bookSignature:"Simon George Taukeni",coverURL:"https://cdn.intechopen.com/books/images_new/8583.jpg",editedByType:"Edited by",editors:[{id:"202046",title:"Dr.",name:"Simon George",surname:"Taukeni",slug:"simon-george-taukeni",fullName:"Simon George Taukeni"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6494",title:"Behavior Analysis",subtitle:null,isOpenForSubmission:!1,hash:"72a81a7163705b2765f9eb0b21dec70e",slug:"behavior-analysis",bookSignature:"Huei-Tse Hou and Carolyn S. Ryan",coverURL:"https://cdn.intechopen.com/books/images_new/6494.jpg",editedByType:"Edited by",editors:[{id:"96493",title:"Prof.",name:"Huei Tse",surname:"Hou",slug:"huei-tse-hou",fullName:"Huei Tse Hou"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9052",title:"Psychoanalysis",subtitle:"A New Overview",isOpenForSubmission:!1,hash:"69cc7a085f5417038f532cf11edee22f",slug:"psychoanalysis-a-new-overview",bookSignature:"Floriana Irtelli, Barbara Marchesi and Federico Durbano",coverURL:"https://cdn.intechopen.com/books/images_new/9052.jpg",editedByType:"Edited by",editors:[{id:"174641",title:"Dr.",name:"Floriana",surname:"Irtelli",slug:"floriana-irtelli",fullName:"Floriana Irtelli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10981",title:"Sport Psychology in Sports, Exercise and Physical Activity",subtitle:null,isOpenForSubmission:!1,hash:"5214c44bdc42978449de0751ca364684",slug:"sport-psychology-in-sports-exercise-and-physical-activity",bookSignature:"Hilde G. Nielsen",coverURL:"https://cdn.intechopen.com/books/images_new/10981.jpg",editedByType:"Edited by",editors:[{id:"158692",title:"Ph.D.",name:"Hilde Dorthea Grindvik",surname:"Nielsen",slug:"hilde-dorthea-grindvik-nielsen",fullName:"Hilde Dorthea Grindvik Nielsen"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7811",title:"Beauty",subtitle:"Cosmetic Science, Cultural Issues and Creative Developments",isOpenForSubmission:!1,hash:"5f6fd59694706550db8dd1082a8e457b",slug:"beauty-cosmetic-science-cultural-issues-and-creative-developments",bookSignature:"Martha Peaslee Levine and Júlia Scherer Santos",coverURL:"https://cdn.intechopen.com/books/images_new/7811.jpg",editedByType:"Edited by",editors:[{id:"186919",title:"Dr.",name:"Martha",surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"48681",title:"Decision Making for Enteral Nutrition in Adult Patients with Dysphagia – A Guide for Health Care Professionals",doi:"10.5772/60987",slug:"decision-making-for-enteral-nutrition-in-adult-patients-with-dysphagia-a-guide-for-health-care-profe",body:'A review of current literature reveals high mortality rates post insertion of feeding tubes for the provision of long term enteral nutrition, most specifically post placement of a percutaneous endoscopic gastrostomy (PEG). The recommendation of enteral nutrition is often a complex decision, which requires the consideration of many aspects, including not only the medical need for nutritional support, but also the wishes of the patient and their families. The provision of artificial nutrition and hydration can be an emotional topic which leaves many health care professionals uncomfortable and unsure of what recommendations to make. This chapter aims to provide information about the different methods of enteral nutrition available and the indication for each one. It also hopes to present a number of factors that need to be considered by all health care professionals who are involved in the recommendation of enteral nutrition.
Enteral nutrition is the provision of sustenance into the stomach or small intestine and includes tube feedings as well as oral nutritional supplements [1]. The focus here is on enteral nutrition via tube feeding.
Optimal hydration and nutrition is required to meet the body’s daily nutritional requirements. Patients with dysphagia may be unable to attain these minimum nutritional requirements with oral intake and require enteral nutrition [2-9]. These patients include those who are unable to swallow due to neurological damage or degeneration [4, 10-15], or those who have structural abnormalities that make oral nutrition impossible, as in the case of patients with advanced stage head and neck cancer or oesophageal cancer [16-18].
The most common indicator for long term enteral nutrition is a cerebral vascular accident (CVA) [3, 5, 10-12, 19-26]. Dysphagia with resulting malnutrition and/or dehydration is common in patients who have had a CVA, explaining the high need for enteral nutrition within this population [10, 13, 27-28]. Patients with other neurological deficits such as traumatic head injury or neuro-degenerative diseases, may also require short or long term enteral nutrition as a safe method of hydration and nutrition [7, 29-33].
Certain medical conditions are more likely to predispose patients to require enteral nutrition because of concomitant dysphagia and increased nutritional needs. Patients with head and neck cancer may develop dysphagia after radiation treatment as a result of tissue damage to the swallow mechanism [18] with a resultant need for prophylactic enteral nutrition [17]. Those patients who continue on oral intake may require enteral nutrition as a supplement to ensure sufficient intake of the daily nutritional requirements while receiving radiotherapy [18]. In cases of trauma to the body or after surgery, enteral nutrition is also recommended to aid sufficient caloric intake to minimise loss of body fat and to support recovery [15, 29, 31-32, 34-35].
There are different enteral nutrition routes, and the route chosen is determined according to the length of time and the type of enteral support needed for a specific patient. The different types of enteral nutrition include nasogastric tubes (NGTs) and nasojejenal tubes (NJTs); surgically placed gastrostomy tubes (GTs) and jejenostomy tubes (JTs); and non-surgical placement methods include percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejenostomy (PEJ).
Before the development of the PEG procedure by Gauderer and Ponsky in the early 1980s, a gastrostomy tube was placed under general anaesthetic. PEG has become the most popular method of tube placement because of the ease of insertion, minimal invasiveness and no requirement for a general anaesthetic [36-38]. A surgical gastrostomy may still be performed in cases where PEG is not possible due to obstruction which makes the passing of the scope down the gastrointestinal tract impossible [39].
The placement of NGTs are recommended for the delivery of early enteral nutrition in the acute stages of disease [2, 10, 13, 40]. The benefits of early enteral nutritional have been documented within various groups of patients [41-44]. NGTs are for short term use only and should not be in situ for periods longer than 4 to 6 weeks [2, 15], as they can cause serious complications including nasal ulceration, chronic sinusitis and increased risk of aspiration pneumonia [15, 39, 45].
NGTs are easy to insert and require no surgical procedure or administration of anaesthetics for placement [10, 14, 46]. However they are poorly tolerated by patients, and are often pulled out after insertion thereby reducing the nutritional advantage which was the aim of placement [47-49]. NGTs may be placed incorrectly by the professional inserting them, with incidences reported to range from 0.3 to 27% (cited by [50] in [51]). A misplaced NGT may result in aspiration pneumonia which can be fatal [51]. Patient positioning, with most hospitalized patients being in a sedated state or lying flat, during NGT feeding can also result in aspiration pneumonia [52-53]. An increase in reflux with NGT placement has been noted [39, 46] particularly in cases with pre-existing gastro-oesophageal reflux [54]. Similar negative effects have been noted with the use of PEGs [46].
If a patient requires enteral nutrition for a period longer than 4 to 6 weeks, and the prognosis justifies the intervention, placement of a gastrostomy or PEG tube for the provision of long term enteral nutrition could be considered [14, 19, 55, 56]. However, Maitines et al. (2009) suggest a longer period of at least 6 to 8 weeks with an NGT in situ, before considering a PEG to ensure a better outcome. Others [14] consider the prognosis and argue that a patient at the end stages of a disease should not be considered for PEG but should rather receive nutrition via NGT. No difference between NGT and PEG cohorts was found in the rate of complications [46], the rate of mortality post placement [45-46] or the occurrence of pneumonia post placement [46].
Higher complication rates for gastrostomies relative to PEG placements have been reported [57-58]. Complications include internal leakage, peritonitis, fistula, dislodgement, external leakage and skin infection. Higher mortality rates in surgical gastrostomy cases (29%, n=35) compared with PEG cases (17%, n=12) were not significantly different [58].
The reasons for high mortality rates include poor patient selection. Patients with risk factors for mortality have been recommended for a PEG resulting in poor outcomes that are being linked to the PEG procedure, when in fact these patients were at risk of death regardless of PEG placement [59-60]. There is strong evidence linking certain underlying medical conditions to higher mortality post PEG [5, 15, 36, 55-56, 59, 61-63]. The highest mortality rates occurred in patients who had CVA and malignancies [22, 62].
The timing of PEG placement [24, 64] is noted also to affect the outcome. It has been suggested that there be a 30 day delay in the placement of long term enteral nutrition to ensure a better chance of survival, leaving patients on short term enteral nutrition for a longer period [24, 64]. The notion of poor timing in the placement of PEG is linked to poor patient selection. If a patient has an underlying medical condition that places them at risk for mortality, it can be argued that they would have died regardless, and early PEG insertion, at a time when they are at risk of death due to an underlying medical condition, means that they die with a PEG in situ which makes their death a statistic of mortality post PEG placement. To counteract early PEG placement, it is suggested that if a patient has survived and still requires a PEG after their condition has stabilised, only then should it be considered. Abuksis et al. (2000) noted a lower mortality rate in patients who were deferred for the placement of a PEG until they were discharged from hospital and if it was still required at 30 days post discharge.
As an example, mortality in patients with CVAs usually occurs in the acute stage when a patient is still in the hospital [65]. Dysphagia is common following a CVA [65] and many CVA patients will regain their ability to swallow within two weeks post infarct [66]. A patient who receives a PEG at this stage is at high risk of dying due to the underlying medical condition of a CVA [65]. The high mortality will be reflected as a consequence of PEG placement in cases with a CVA. The timing for the placement of a PEG in a patient with a CVA is critical, and should only be considered if a patient has not regained their ability to swallow within four weeks [13, 67]. During the acute stages post CVA, an NGT is recommended for the provision of hydration and nutrition [13].
There are also a series of risk factors such as increased age, decreased body mass index, a higher number of co-morbidities, and decreased blood albumin levels have been identified as placing a patient at greater risk of mortality post PEG. Along with the primary medical condition and timing of placement, these factors also need to be considered when recommending a patient for a PEG to reduce the likelihood of poor outcomes. One such risk factor is increased age. Patients over the age of 60 were found to have the highest mortality rate at 30-days post insertion [20, 22-25, 55-56, 68-70]. Age together with diminished mental capacity, as with patients who have dementia, tripled mortality in the period after placement [22]. Such outcomes caution against PEG placement in older patients with dementia.
The positive outcomes of long term enteral nutrition should also guide decisions for such a recommendation. One such outcome post PEG placement is the ability to return to oral intake which can occur in patient populations with a range of medical conditions and depends on factors such as the presence of dysphagia, age, and the underlying medical condition that necessitated PEG placement [12, 17, 69]. Factors that determined a return to oral intake, were the ability to take some amount of nutrition orally at 3 and 6 months post PEG placement [12], regression of the tumour that had originally caused dysphagia post chemo/radiotherapy [12, 17] regaining of the swallow post CVA [12, 69], a younger age, the absence of dysphagia and intervention by a speech therapist to regain the swallow pre PEG placement [71].
The provision of nutrition into the stomach via NGT or gastrostomy/PEG is common [5, 21]. Gastrointestinal intolerance of tube feedings, identified by the presence of large gastric residual volumes, nausea and vomiting, ileus, abdominal distension, and diarrhoea [72], is a major factor limiting adequate enteral intake in patients. In cases such as these the stomach may be bypassed and nutrition delivered to a lower part of the gastro intestinal tract [4, 39, 73]. NJT/PEJ enteral nutrition has been noted to result in better energy intake due to improved absorption in the small bowel and a decreased risk of reflux related aspiration due to feeds being delivered into an area further away from the pharynx [74]. However, Davies et al
PEGs, GTs and NGTs have advantages and possible complications. The outcomes relate to mortality and improved nutrition. Adequate nutrition is linked to better medical outcomes and survival [35, 73]. PEG is noted to be superior to NGT with regard to improvement in general medical outcomes [46] with NGT candidates being statistically more prone to intervention failure, such as tube blockage or leakage, feed interruption and recurrent displacement, than patients who were fitted with PEG, regardless of the patient’s underlying medical condition [46]. With better provision of feeds when a PEG is used, better medical outcomes may be expected as a patient is more likely to receive adequate hydration and nutrition.
When patients who had a CVA were considered as a separate group from other medical conditions, neither NGT nor PEG were superior in the delivery of nutrition. The presence of dysphagia was the key indicator for mortality rather than the type of enteral nutrition used [36].
There exists debate around which method of enteral intake is best suited for patients with head and neck cancer specifically. A large majority of patients with cancer are malnourished throughout the disease process and require enteral nutrition [75]. Determining the optimal mode of enteral nutrition in this patient population bears consideration of the benefits and drawbacks. Sobani et al. (2011) reported PEG as being superior to NGT in that it resulted in greater weight gain and lower mortality, but others [76] note a lower clinical risk of complications, and a greater chance of returning to full oral intake after a six month period, with patients left on NGT rather than fitted with a PEG. It was argued that a patient with an NGT would be more eager to feed orally in order to progress towards removal of the tube because of the visibility of an NGT, which can be unsightly to some. Beginning partial oral intake made muscle atrophy less likely and sped up the return to full oral intake, compared to those receiving nutrition exclusively via a PEG [76]. In patients with dysphagia and a range of medical conditions including neurological fallout and head and neck cancer, Gomes et al. (2012) noted no difference in mortality rates post PEG or NGT placement.
Mortality rates after PEG placement has been reported to be low as a direct result of the PEG procedure [11, 77]. However, Malmgren et al. (2011) suggest that the mortality rate in the first few weeks post PEG placement is ‘high’ and ranges between 10% and 36% depending on sample size and medical conditions [5, 22, 55-56, 69, 78-79). The greatest majority of patients died within a 30 day period post PEG placement and in patients with dementia, the mortality rate was as high as 54% [79]. The 30 day mortality rates were from both developed and developing countries where a variety of medical conditions were included in the sample.
Strong evidence links poor nutrition upon hospitalization with poor medical outcomes, such as greater incidence of morbidity and mortality [45, 73, 80]. Malnourishment is measured using the body mass index (BMI), with a BMI of <18.5 indicating malnutrition (WHO, 1995). Malnourishment can be as a result of the disease process or due to socioeconomic factors [81] and can be further exacerbated by hospitalization [13, 15, 35, 44, 48, 56, 73], because of interruptions in the provision of enteral nutrition, inadequate nutrition prescribed and the inability of a patient, who may be on oral intake, to physically eat independently [81]. Malnourishment at the time of PEG placement is a crucial factor noted to place a patient at risk for mortality [19, 45, 55-56, 70, 77].
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t \n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
15.8% | \n\t\t\t359 | \n\t\t\tHead and neck cancer (n=97) CVA (n=73) Malignancy (n=61) Head injury (n=59) Cerebral palsy (n=38) Congenital anomaly (n=19) Motor neuron disease (n=7) Dementia (n=5) | \n\t\t\tBosnia Herzegovina | \n\t\t\tVanis, Saray, Gornjakovic & Mesihovic, 2012 | \n\t\t
22% | \n\t\t\t201 | \n\t\t\tCVA (n=97) Malignant oesophageal obstruction (n=33) Dementia (n=16) Other neurologic disorders (n=13) Parkinsons (n=12) Other (n=23) Other malignancies (n=5) | \n\t\t\tSweden | \n\t\t\tMalmgren et al., 2011 | \n\t\t
10% | \n\t\t\t77 | \n\t\t\tNeurologic disorders (n=71) Head and neck cancer (n=6) | \n\t\t\tTurkey | \n\t\t\tErmis et al., 2012 | \n\t\t
20% | \n\t\t\t128 | \n\t\t\tCVA (n=34) Non neurologic cerebral hypoxia (n=30) Cranial tumour (n=23) Head and neck cancer (n=19) Motor neuron disease (n=13) Other (n=9) | \n\t\t\tTurkey | \n\t\t\tGundogan et al., 2014 | \n\t\t
19% | \n\t\t\t83 | \n\t\t\tCVA (n=83) | \n\t\t\tNorway | \n\t\t\tHa & Hauge, 2003 | \n\t\t
22% | \n\t\t\t112 | \n\t\t\tCVA (n=33) Head and neck cancer (n=27) Chronic neurological disorders (n=22) Other (n=30) | \n\t\t\tBritain | \n\t\t\tLongcroft-Wheaton et al., 2009 | \n\t\t
18.5% | \n\t\t\t187 | \n\t\t\tMalignancy (n=187) | \n\t\t\tUSA | \n\t\t\tKeung et al., 2012 | \n\t\t
36% | \n\t\t\t61 | \n\t\t\tCVA (n=50) Dementia (n=21) Malignancy (n=9) Head and neck trauma (n=3) | \n\t\t\tIsrael | \n\t\t\tAbuksis et al., 2004 | \n\t\t
28% | \n\t\t\t361 | \n\t\t\tCVA (n=120) Dementia (n=103) Oropharyngeal malignancy (n=65) Other (n=73) | \n\t\t\tUSA | \n\t\t\tSanders et al., 2000 | \n\t\t
International mortality rates 30 days post PEG placement
Upon admission to hospital an NGT may be placed to improve nutrition before placement of a PEG [77]. But NGT feeds can result in minimal improvement in nutritional status because of interrupted feeds when the patient has a procedure, late placement and commencement of feeds or accidental removal of tubes [47-48, 72]. A nutritionally compromised patient would benefit from placement of a PEG with the aim of improving nutrition, based on evidence that PEG placement facilitates better improvement in nutrition [5, 75]. However PEG placement comes with a high risk of mortality due to the patient’s initial poor nutritional status.
Based on the high mortality rate of malnourished patients, it is important to consider the nutritional status of individuals prior to PEG placement [19, 45, 55-56, 70, 77]. A review of the literature suggests that albumin levels may be used as a marker of a patient’s nutritional status [82]. Albumin is a protein made by the liver, and is a measure of protein in the body. Albumin balances the amount of blood flowing through the body’s arteries and veins and helps to transport calcium, progesterone, bilirubin and medications through the blood. A serum albumin test will measure the amount of protein in the blood and can be used as an indicator of the presence of liver or kidney disease [83] which can affect patient survival. Normal levels of albumin are considered to be in the range of 3.4-5.4 g/dL or 35-50 g/L, depending on how specific laboratories measure it. Blomberg et al., (2011) noted the link between low albumin levels pre-insertion of PEG and a high mortality rate post insertion. This link confirms that hypo- albuminaemia is a risk factor that should be considered in all patients being medically worked up for PEG placement [45, 56, 59, 77, 84]. Co morbidities like diabetes and cardiac disease were also noted to be significant risk factors for high mortality in patients post PEG placement [19, 56, 59, 70, 82].
Evidence exists to support the involvement of an SLT in the assessment and treatment of patients with dysphagia. Langmore et al. (2011) [108] suggested that it is important for an SLT to assess a patient with head and neck cancer and to determine the most optimal approach for each patient to be able to recover swallowing or to compensate for losses due to surgical or chemo-radiation intervention. The role of the SLT in the management of patients with dysphagia who may require enteral nutrition, is not to recommend the route of enteral nutrition, but rather to make a recommendation of whether or not the patient can eat orally and is safe to do so. All discussions and decisions relating to enteral nutrition, whether short or long term, should take place within an inter-professional team including the patient and caregivers.
Considering the multitude of risk factors that exist for poor outcomes post PEG insertion, it follows that a patient should be individually assessed for the presence of any risk factors before being recommended for the procedure [85-87]. A comprehensive assessment by the team needs to consider factors such as: 1) the potential benefits to the individual should they receive a PEG, 2) biochemical parameters, like blood albumin level, 3) multiple comorbidities, 4) prognosis, 5) and the presence of risk factors that may place a patient at risk of mortality post procedure, such as being over the age of 60 years and a low BMI [10, 19, 23, 25, 45, 56, 69, 87-89, 90].
Strong emphasis is placed upon a team approach when assessing patients who may be recommended for long term enteral nutrition [85-87]. A rigorous assessment, by a team, for each patient being considered for a PEG ought to be in place. The team needs to ensure that all risk factors which could affect outcome are considered and that an informed decision respects patient autonomy [60, 85-87]. A patient who is considered a high risk for mortality should not be considered a candidate for the procedure as it would be a futile intervention. Better patient selection would improve the outcome of patients who are recommended for and fitted with a PEG [91].
A patient may refuse a NGT or a PEG procedure and wish to begin/ continue oral intake, even if it means a shorter survival period. Patient’s decisions need to be honoured and respected by health care professionals [92].
Where patients opt for enteral nutrition, despite the benefits that enteral nutrition can provide a patient, such as improved nutrition and a longer survival time, quality of life is affected [93]. Health care professionals should counsel patients on the effects that a PEG tube will have on their quality of life [94], by shifting the focus of management post PEG insertion to include social aspects and not only clinical needs [95].
The placement of a PEG for the provision of enteral nutrition is considered a life-saving procedure in some cases [93, 96] and many patients who have a PEG attest to this fact and the benefit that PEG feeding provides them [96-97]. One study noted particularly positive patient reports on their experiences living with a PEG tube, with 84% (N=51) noting a positive or neutral effect of the tube on their lives, 90% (N=51) expressing a view that the tube was worthwhile and 96% (N=51) noting that they would recommend it to another patient [97].
Negative experiences that a PEG has on patients’ quality of life have been extensively reported. Common difficulties associated with having a PEG tube, which affect quality of life, include a high level of complication, like tube blockage, leakage and discomfort [94] interference with family life, social activities and hobbies [93-94, 98-99], interference with intimacy [94], negative reactions from others [95], a burden placed on family or caregivers [95] and a feeling of missing out on meal times and food [95]. Similar negative effects on quality of life are reported in patients who receive NGT feeds [98]. A study in Taiwan noted that the majority of patients are discharged home on NGT feeds because of a refusal to have a PEG placed [100]. Reasons included concern over leakage and infection following a PEG, a worry that the patient is too old and frail to undergo an operation and a cultural belief that the patient will not die “whole” if they have a PEG in situ [100].
In light of the high mortality rate post PEG placement, the concept of futility bears discussion. Futility refers to a medical intervention that would have no effect, or if there was an effect, it would not be one that the patient benefitted from [89]. Many patients receive long term enteral nutrition where no effect or benefit is proven in terms of nutritional improvement or survival [56]. All aspects linked to possible mortality must be considered, and risks and benefits weighed before a recommendation for enteral nutrition is made. If a patient is considered to be a high risk for mortality, certain procedures that will cause further suffering and no benefit may be deemed futile [7], and should be avoided [21]. The decision to place a PEG should be based on the perceived benefit it will bring to the patient [89] and if no benefit is presumed, then the procedure should not be done. A patient who is identified as a high risk for mortality post PEG placement should not receive a PEG but rather they and their families should be counselled on the risks that exist and the reasons for deferred placement. A team can make a recommendation for enteral nutrition based on their knowledge but a cognitively intact patient must make the final decision after being fully informed about the benefits and risks involved in the proposed management plans [89].
The issue of futility in PEG placement is most particularly noted in the case of patients with advanced dementia being fitted with a tube for the provision of long term enteral nutrition [101-102]. In this population, the placement of a PEG has no benefit to the patient and can actually lead to decreased survival due to complications, such as aspiration, that result from the placement [89, 102]. The use of long term enteral nutrition in patients with malignancy, with the aim of nutritional gain, needs to be questioned as there is no real nutritional gain in these patients post placement [16, 62, 78].
Azzopardi and Ellul (2013) suggest that, in certain patient populations, the insertion of a PEG will only prolong a life which is of poor quality and it needs to be determined through discussion whether this decision is ethical. A consideration in South Africa particularly, is whether it would be appropriate to perform futile procedures in a resource constrained public hospital sector [103]. If PEGs are placed in cases where patients have poor prognosis and are considered high risk for mortality post PEG placement, an argument could be made that the scarce resources would be better directed to those patients with potentially better outcomes.
The use of protocols in patient care ensures adherence with best practice. They are important documents to which health care professionals should refer to guide practice that will result in the provision of the best possible care [104]. Protocols for the assessment and management of patients with dysphagia who require enteral nutrition exist [2, 38, 66, 105] but do not include considerations like assessment of risk factors to justify the PEG procedure. Further, adherence to protocols cannot be assumed. The presence of risk factors in patients do not always deter health professionals in making a recommendation for PEG placement, as is evident by the persistence of high mortality rates, despite the known effects of risk factors and their effect on mortality [56].
The decision to refer a patient for a PEG placement or not, includes holistic consideration of many factors to make a recommendation that is in the best interests of the patient.
The provision of hydration and nutrition at the end of life care is an area of debate and can become a highly emotional topic. Delegge et al. (2005) suggest that the decision to place a feeding tube consider the basic principles of professional ethics. Informed consent from an adult who is cognitively intact is imperative, and the benefits of the placement of enteral nutrition must outweigh the risk of the procedure, which should cause the patient no harm [89].
The concept of palliative care needs to be introduced as a real alternative for patients who are not considered candidates for PEG placement due to the presence of risk factors that place them at high risk for mortality. The World Health Organisation (2002) considers palliative care as “...an all-encompassing approach to care that begins months or years before death”. PEG placement does not always benefit the patient, and although the actual PEG procedure does not harm the patient, the risk of mortality post placement is high, which in turn is harmful to the patient. The choice of refusing a PEG and remaining on oral intake as a form of palliative care should be made available to all patients and their caregivers, with provision of education and support for the decision they may make. The inclusion of a palliative care option for patients who do not wish to have a PEG placed would provide them with an alternative option, and it would also ensure that futile procedures are avoided which would uphold medical ethics.
The decisions around the recommendation of enteral nutrition, particularly in very ill patients who have a poor prognosis, are not easy for health care professionals to make. Clear guidelines that are based on evidence are crucial in order to help health care professionals navigate these difficult decisions that are often clouded with human emotion.
A role not often considered by SLTs is that of palliative care. The provision of artificial nutrition and hydration (ANH) to patients who are in the end stages of disease is debated, and can evoke emotional responses [106]. It is common for patients in the end stages of disease to have little or no oral intake [106]. Many practitioners may feel that depriving a patient of hydration and nutrition is unethical and can make health professionals uncomfortable [89,107]. A study of nurses’ perceptions on ANH in palliative care yielded more clinical reasons for withholding of ANH than for providing it [106]. Reasons supporting provision of ANH were emotive, not based on clinical fact and were not in the best interests of the patient [106].
In practice, there comes a time, when a decision needs to be made about the hydration and nutrition needs of a patient in the end stages of disease. The SLT is often the professional who, based on the assessment of the patient’s swallowing, is in a position to determine the feasibility of nutritional intake. It is important that the SLT and the inter-professional team are educated in the field of palliative care and ANH [106-107] to contribute to making an informed decision regarding a patient’s options at end of life and reduce the number of inappropriate referrals for futile procedures with poor outcomes.
Based on a review of current literature some important points have been raised around the recommendation process for enteral nutrition in adult patients with dysphagia. The key focus in any decision making process for medical procedures should be on patient autonomy. If a patient consents to placement of a PEG for the provision of long term enteral nutrition, with a full understanding of the impact it will have on them, not only medically but socially and emotionally too, then a standard assessment procedure needs to follow. Assessment should be carried out by a team of health care professionals, including the SLT, and should include a consideration of the patients underlying medical condition, indication for PEG, prognosis of survival post procedure, age, nutritional status, the presence of co-morbidities and biochemical parameters. Based on the assessment findings, the team, in conjunction with the patient and their family, need to make a recommendation. If a patient is considered to be a high risk for mortality following PEG placement then alternate methods of intake need to be discussed with and recommended to the patient and their family, with education and counselling provided on the benefits and risks of oral intake as a form of palliation. A thorough assessment procedure will help to ensure that futile procedures are avoided and only patients who consent to and who will benefit from PEG placement are recommended for the procedure.
Physical activity (PA) is one of the most accessible interventions for anxiety disorders for the public, whereas few systematic research has been done to examine its efficacy. PA is defined as a movement that causes an increase in energy expenditure in the movement of people [1], including walking, running, doing housework, jogging, or other sports that are defined as PA behaviour [2, 3]. Dollman et al. (2015) have classified PA intensity with metabolic equivalent (MET) as light PA (MET: 0–2.99), moderate-to-vigorous PA (MET:3–5.99), and vigorous PA (MET: ≥6) through a scale of energy expenditure [4, 5, 6]. PA intervention aims to promote the health of people through exercise training, sports and habit of PA [7, 8]. A PA intervention study should specify the processing target (e.g., children, adolescents, or some clinic population), PA type (e.g., aerobic exercise, resistance exercise, or yoga), PA intensity (e.g., light, moderator, moderator-to-vigorous), PA frequency (e.g., three sessions per week, 60 minutes per session), PA duration (e.g., three months, 1 years), and outcome measurement [9]. The PA intervention research is easier to quantify and more accessible to the generalised population. It is also found to benefit mental health. Therefore, research is also focused on the effect of PA intervention on panic disorder.
For example, Ensari, Petruzzello [10] conducted an RCT experiment to deliver a 40-minute yoga programme for eighteen participants with high-anxious. The result suggested a significant main effect of the task on panic and respiratory measures (p < .05). When collapsed over inhibition task and condition, there was a small reduction in cognitive anxiety from baseline to immediately post and 1-h post-condition (p < .05) [10]. Similarly, Naderi, Naderi [11] investigated the effect of physical exercise on anxiety among victims of child abuse and reported a significant reduction in anxiety (p < .001). Accordingly, the author argued that such improvement is comparable to empirically supported treatments for panic and GAD. However, such effects of PA intervention on panic disorder used a variety of PA types, intensity levels, or frequency and, therefore, produced isolated effects. The effect of PA could vary regarding individual differences, such as age and gender [12]. A most recent systematic review in 2022 tended to examine the effect of regular exercise interventions on the panic disorder in adults. They only retrieved eight studies in this field and demonstrated no clear evidence suggesting whether regular exercise programs (at least two 20-minute sessions per week for at least six weeks) reduce panic-related symptoms. The study argued for more RCT studies to support more robust and clear evidence for better understanding [11].
Moreover, there were even fewer studies focused on the effect of PA intervention on the panic disorder or general anxiety disorder (GAD) in children and adolescents, respectively. This may be because it is difficult to categorise different anxiety disorders among children. Furthermore, there is a lack of tools to measure child panic in laboratory settings. For example, there is the anxiety scale for children with autism spectrum disorder, revised children’s manifest anxiety scale and social anxiety scale for children to measure anxiety disorder in children and adolescents [9, 13, 14], whereas the panic disorder is measured based on the sensitivity of anxiety scales in children and adolescents [15]. These unclear concepts may increase the research difficulty, which supports the evidence for PA intervention on panic disorder in children and adolescents. Therefore, this chapter aims to carry out a quantitative review to clarify and explore the evidence in this area. Moreover, the secondary objective is to investigate the effect of PA intervention on anxiety disorder in children and adolescents.
The previous Machado, Telles [11] review obtained a similar outcome measurement to examine the effect of PA on anxiety disorder. Their target sample did not limit the population age, which means there is no evidence that physical activities affect panic and anxiety disorder in children and adolescents. Consequently, the current analysis aims 1) to summarise and explain the potential impact of PA interventions on panic symptoms and critically comment on the research that exists and 2) to analyse the effect of PA intervention on panic and anxiety symptoms in children, adolescents and early adulthood, through meta-analysis, which provides reference evidence for further research.
The study is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A protocol for this review was registered with PROSPERO (CRD42022334054).
The forest plot of the effect size of physical activity on panic in children, adolescents and early adulthood.
Search is conducted on 22nd April 2022, which follow databases: MEDLINE (Ovid), EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and SPORTDiscus. Search terms based on the PICO format (participants/population, intervention/exposure, comparison, outcome) were divided, and adjusted according to the respective databases’ Thesaurus and Medical Subject Headings (MeSH) terms (Bramer et al., 2018) through Ovid. Articles must be available in English, there will be no restriction on the publication period. The full list of search terms is provided in Supplementary Material 1.
The inclusion criteria of the current analysis were: 1) Population: studies included participants who primarily exhibited panic or anxiety symptoms or were diagnosed with panic or anxiety disorders in children, adolescents (5–19 years) and early adulthoods (19–22 years). Participants may present secondary comorbid other illnesses, such as diabetes; 2) Intervention: studies applied regular PA intervention (i.e. walk, jog, aerobic, strength, or multimodal training), which is prescribed to reduce panic disorder or GAD, social anxiety disorder, obsessive–compulsive disorder, post-traumatic stress disorder, and agoraphobia. PA interventions can be combined with other treatment procedures were also included; 3) Comparators: studies included a control group as a comparator, which is not received the PA intervention delivery; 4) Outcomes: studies that took panic symptoms or panic disorder as the primary outcome. And the second outcome was anxiety symptoms, GAD, social anxiety disorder, obsessive–compulsive disorder, post-traumatic stress disorder, or agoraphobia; 5) Study Design: studies carried out in randomised trials (RCT) comparing an intervention(s) encompassing PA with a group(s) without PA intervention or encompassing PA at the baseline with post PA intervention.
The exclusion criteria were: 1) studies reported in non-English language; 2) studies reported insufficient information to estimate effect size or other essential data.
Study selection: Data will be formatted in RIS format and will be managed using the endnote software. PRISMA 2020 guidelines will be applied for reporting the screening process [16]. Two researchers will undertake the removal process through an independent screen. Firstly, all duplicate articles will be removed before reviewing titles and abstracts. Those not fitting the inclusion criteria will be removed. Then, full-text versions will be collected when the articles meet the screening criteria. Discussions with a third reviewer will resolve discrepancies between the two independent reviewers.
Data extraction: Two independent reviewers will extract the following four data dimensions. Including fundamental characteristics (e.g., author, public year, country, population, sample, age, sex, weight status), intervention characteristics (e.g., PA intensity/frequency/duration, intervention program), methodology (e.g., data analysis method), and effect size.
Two reviewers will independently score the studies according to the National Institutes of Health study quality assessment tool for Quality Assessment of Controlled Intervention Studies from the National Heart, Lung, and Blood Institute (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). The quality assessment focused on the specification of eligibility criteria, generalisability, intervention description, outcome assessment and incomplete data [17]. There were 14 items assessed in the quality assessment, as shown in Appendix S1. The tool does not assign numeric values or definite judgements of the quality of the studies, although it has good, fair, and poor results. Good quality studies have less bias risk and are more valid. A fair study is prone to some bias but insufficient to invalidate its findings. A poor study has a high-risk of bias and is considered invalid [18]. The results of quality assessment are presented in Table 1.
Study | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | overall |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Kenis-Coskun et al., 2022 | Y | Y | Y | NR | NR | Y | Y | Y | Y | Y | Y | Y | Y | Y | Good |
Tanksale et al., 2021 | Y | Y | N | N | N | Y | Y | Y | N | Y | Y | NR | NA | Y | Fair |
Nazari et al., 2020 | Y | Y | N | N | N | Y | Y | Y | NR | Y | Y | Y | Y | Y | Fair |
Romero-Pérez et al., 2020 | Y | Y | N | N | N | Y | Y | Y | Y | Y | Y | NR | Y | Y | Fair |
Yu et al., 2020 | Y | Y | N | N | N | N | Y | Y | Y | Y | Y | Y | Y | Y | Fair |
Mucke et al., 2020 | Y | Y | N | N | N | Y | Y | Y | Y | Y | Y | Y | NA | Y | Good |
Akko et al., 2020 | Y | Y | N | N | N | Y | Y | Y | Y | Y | Y | Y | Y | Y | Good |
Luna et al., 2019 | Y | Y | N | N | N | Y | Y | Y | Y | Y | Y | NR | Y | Y | Fair |
Naderi et al., 2019 | Y | Y | N | N | N | Y | Y | Y | Y | Y | Y | NR | Y | Y | Fair |
Ensari et al., 2019 | Y | N | N | NR | NR | Y | Y | Y | Y | Y | Y | NR | Y | Y | Fair |
Polis et al., 2017 | Y | Y | N | N | N | Y | Y | Y | NR | Y | Y | NR | NA | Y | Fair |
Smits et al., 2009 | Y | N | NR | NR | NR | Y | Y | Y | Y | Y | Y | NR | Y | Y | Fair |
Broman-Fulks & Storey, 2008 | Y | N | NR | NR | NR | Y | Y | Y | Y | Y | Y | NR | Y | Y | Fair |
Lindwall et al., 2005 | Y | Y | N | N | N | Y | N | N | N | NA | Y | NR | Y | Y | Poor |
Crew et al., 2004 | Y | Y | N | N | N | Y | Y | Y | Y | N | Y | NR | NA | Y | Fair |
Summary of quality of included studies.
The studies we aimed to include in the current analysis were RCTs with both between-subject, within-subject and mixed designs. Consequently, a combined effect size of standard mean difference (Cohen’s d) was calculated for each study to produce a pooled effect size based on the improved method provided in Morris [19]. Firstly, the effect size of studies reported only median and interquartile range was estimated based on the improved formula [20, 21], where d refers to Cohen’s d; q1 refers to the first quartile; q3 refers to the third quartile:
Moreover, studies reported pre-calculated Cohen’s d without providing the mean or standard deviation was estimated standard error using the 95% confidence interval for meta-analysis weighting [22], where SE refers to standard error, CLup and CLlow refer to the upper and the lower bound of the confidence interval, respectively:
The effect sizes were from between-subject design, within-subject design and mixed design studies were extracted, converted and matched to Cohen’s d with an online converter tool ‘Psychometrica’ (https://www.psychometrica.de/effect_size.html), which follows the method proposed in Morris [19] and Lakens [23].
The statistical analysis was carried out in STATA v.17. The estimated effect sizes of adolescent panic and anxiety were pooled in a quantitative meta-analysis in a random effect model and Cohen’s d to determine the overall effect among the studies. A significant result of this analysis indicates that there was a significant effect of physical activities/exercise on adolescent panic or anxiety across the studies. The effect size is considered small when SMD is between 0.2 and 0.5, medium when it is between 0.5 and 0.8, and large when it is above 0.8 [24].
Then, a heterogeneity test of the available data was carried out with the random effect model. A non-significant result in the heterogeneity test would mean that the effect sizes were homogenous and measured a consistent effect on the same side. The heterogeneity I2 is considered moderate when I2 > 50%, and it is considered high when I2 > 75% [21]. Egger’s regression-based tests were then used to assess the publication bias. A significant result in this test would suggest potential publication bias in the current analysis.
Finally, exploratory meta-regression analyses were performed on the available characteristic data, including age, gender and intervention duration, to determine potential predictors of the current effect. The research method would be entered into subgroup analysis to determine whether the study design made a difference in the overall effect.
As shown in Appendix 2, keywords searching in MEDLINE (Ovid), EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and SportDiscus resulted in 1691 articles. After reviewing, based on inclusion criteria, twelve studies were identified, and four studies were excluded based on exclusion criteria, leaving eight studies for the meta-analysis. The included 11 studies were all RCTs in different designs (within-subject, between-subject and mixed design).
As shown in Table 2, 15 RCT studies with sufficient data were included. Among these studies, 14 obtained anxiety measurements, including social anxiety disorder [14, 25, 26] and GAD [10, 13, 27, 28, 29, 30, 31, 32], and 4 studies obtained panic measurements [10, 31, 32, 33]. There were 994 participants included in total, and 478 and 354 participants were allocated in the intervention and control groups, respectively. The mean age of the participants was 13.21 ± 4.16 years old, ranging from 8 to 24 years old. Physical activity intervention duration was from a minimum of 2 weeks to 8 months, and frequency was 2 or 3 sessions per week, with two studies performing a one-session intervention [10, 34]. Two studies also provided discussion and reflection sessions after the physical activity sessions [34, 35] and two studies were conducted on the school campus [14, 28].
Study | Overall sample | IG sample Pre-I (Post-I) | CG sample Pre-I (Post-I) | Overall age (SD) | Female sample | IG content | CG content | Frequency (Duration) | Panic and anxiety measurement | Study Design | Intensity measurement |
---|---|---|---|---|---|---|---|---|---|---|---|
Kenis-Coskun et al., 2022 | 28 | 14 (14) | 14 (14) | 9.90 (1.91) | 20 | Multiple rehabilitation exercises repeated 10 times each: Corner Pectoral Stretch; Scapular Retraction with External Rotation; Triceps Brachii Strengthening; Biceps Strengthening Exercise; Biceps Strengthening Exercise; Lateral Abdominal Muscle Strengthening Exercise; Push Up; Back Extensors Strengthening. | NR | 3 s/w (12 weeks) | RCADS | Mixed | NA |
Tanksale et al., 2021 | 61 | 31 (31) | 30 (30) | 9.44 (1.35) | 22 | The lead researcher delivered the Yoga program face-to-face to all participants on the university campus within a group of less than 5 parent–child dyads. | Participants were randomly allocated to a waiting list without receiving intervention | 1 s/w (6 weeks) | ASC-ASD | Between-subject | NA |
Nazari et al., 2020 | 40 | 20 (20) | 20 (20) | 11.11 (2.29) | NR | 20 mins of Pilates exercises & 20 mins of body weight-bearing exercise & 20 mins aerobic exercises (V-forward, V-back & march) | NR | 3 s/w (16 weeks) | RCMAS | Mixed | Heart rate |
Romero-Pérez et al., 2020 | 105 | 54 (54) | 51 (51) | 9.88 (0.83) | 60 | 5-min warm-up, a 40-min aerobic exercise | The CG participants continued with their usual activities at the end of the classes | 2 s/w (20 weeks) | RCMAS | Mixed | NA |
Yu et al., 2020 | 188 | 106 (99) | 82 (72) | 9.8 (0.7) | 35 | 20-min class recess in the morning and one extra gym class (40 min) after school in the afternoon, including Jogging 20 min in the morning break every weekday; Rope skipping 40 min on Monday and Thursday; Playing badminton 40 min on Wednesday and Friday; 200-m relay race 40 min on Tuesday. | Children in the control school followed their usual practice with no extra intervention | (weekday daily) 5 s/w (8 months) | SAQ-C24 | Mixed | NA |
Mucke et al., 2020 | 60 | 30 (NA) | 30 (NA) | 17.9 (1.24) | 0 | The exercise group performed an exercise session at moderate intensity on a bicycle ergometer (30 mins) | During the next 30 mins, the control group read an article from a magazine of their choice | One session | STAI | Between-subject | Heart Rate |
Akko et al., 2020 | 44 | 23 (23) | 21 (21) | 9.35 (0.6) | 39 | 45 min after school running and running-based games of moderate-intensity | preadolescent children participated in assisted homework sessions to prevent attention bias and to control for retest effects | 3 s/w (10 weeks) | STAI | Mixed | NA |
Luna et al., 2019 | 113 | 69 (69) | 44 (44) | 13.82 (0.79) | 49 | 55-minute sessions volleyball sessions, including warming-up, training and friendly matches and regular stage competition; Meetings for comprehension and reflection with the intervention of the responsibility roles | Traditional collective sport (basketball) with a conventional teaching style in which the teachers directed all tasks without students’ participation | 2–3 s/w (6 weeks) | SAS-A | Mixed | NA |
Naderi et al., 2019 | 22 | 11 (11) | 11 (11) | 8 to 11 | 22 | Aerobic dancing: Warming up (10–15 min); Basic movements (35–40 min); Cooling down (10 min) | Not receiving any intervention | 3 s/w(8 weeks) | STAI | Mixed | NA |
Ensari et al., 2019 | 18 | 9 (9) | 9 (9) | 22.1 (5.0) | 18 | 40 min Yoga session, which was designed based on published recommendations under the guidance of an instructor with the specific order of poses | Stretching exercises | One session | API & SAI | Mixed | Heart Rate |
Polis et al., 2017 | 23 | 12 (5) | 11 (8) | 11 to 18 | NR | Evening yoga session led by yoga instructor | NR | 2 s/w (6 weeks) | STAI | Mixed | NA |
Smits et al., 2009 | 92 | 48 (48) | 44 (44) | 19.43 (1.31) | 51 | 20 min treadmill exercise on a computer-controlled treadmill, maintaining 70% of max heart rate | 20-min resting period | One session | API | Mixed | Heart Rate |
Broman-Fulks & Storey, 2008 | 24 | 12 (12) | 12 (12) | 19.04 (1.90) | 19 | 20 min aerobic exercise: treadmill running | Report to the lab at the same time but no exercise | 3 s/w (2 weeks) | ASI-R | Mixed | Heart Rate |
Lindwall et al., 2005 | 110 | 56 (27) | 54 (35) | 16.35 (1.56) | 110 | Preferred multiple aerobics exercises (45 min) and discussion (15 min), including water aerobics, step-up, badminton, kickboxing, spinning dancing, climbing, bowling, karate, jujitsu, yoga and different ballgames | Control group were put on a waiting list with no forms of alternative activities organised | 2 s/w (24 weeks) | SPAS | Mixed | NA |
Crew et al., 2004 | 66 | 66 (66) | NA | NR (Grade 4) | 33 | The aerobic group exercised by means of stationary cycling, track running, and jumping on a minitrampoline. The physical activity group engaged in a variety of physical activities such as shooting baskets for skill improvement, playing a common children’s game called foursquare, and walking | NA | 3 s/w (6 weeks) | STAI | Within-subject | Heart Rate |
Overall | 994 | 561 (488) | 433 (371) | 13.21 (4.16) | 478 (51.3%) |
Characteristics of included studies.
IG = intervention group; CG = control group; Pre-I: pre-intervention; Post-I: post-intervention; s/w = sessions per week; NR = not reported; NA = not applicable; ASC-ASD: Anxiety Scale for Children–Autism Spectrum Disorder RCMAS = Revised Children’s Manifest Anxiety Scale; SAQ-C24 = Social Anxiety Scale for Children; SAS-A = Social Anxiety Scale for Adolescents; STAI = State–Trait Anxiety Inventory; SAI = State Anxiety Inventory; SPAS = Social Physique Anxiety Scale; RCADS = Anxiety and Depression Scale in Children-Revised; API = Acute Panic Inventory; ASI-R = Anxiety Sensitivity Index-Revised. The sports type are labelled in bold.
NA: not applicable, NR: not reported, CD: cannot determine, overall of Good: more than 10Y (NA = Y), Fair 8 to 10Y, Poor: Below 8.
Overall, three reports showed good quality, whereas most studies were fair. We can find that in terms of random methods, most of the studies do not report the process of random sampling and there are basically no studies that apply computer random sampling methods. In addition, the information reported on the sample power is relatively lacking.
Funnel plot of the effect size estimates of physical activity on the panic symptoms in children and adolescents.
Predictor | Coefficient B | SE | 95% CI | z | |
---|---|---|---|---|---|
Age | −.03 | .03 | [−.11 .04] | −.99 | .325 |
Gender Ratio (Female) | −.06 | .66 | [−1.35 1.23] | 0.09 | .927 |
Meta-regression analysis on age and gender predicting pooled effect sizes of PA intervention reducing panic disorder.
The forest plot of the effect size of physical activity on anxiety disorder in children and adolescents.
Funnel plot of the effect size estimates of physical activity on anxiety disorder in children and adolescents.
The research method (mixed-design vs. between-subject & within-subject design) was entered into subgroup analysis to determine whether the main effect changed between the two interactive groups. No significant group difference in homogeneity was identified in either research method, Qb(1) = 1.26,
The current chapter carried out a meta-analysis on 15 reports to investigate the pooled effect sizes of PA intervention on panic and anxiety symptoms among children, adolescents and early adulthood. Compared to the controls, we reported a small effect of PA on reducing panic symptoms and a middle effect on reducing anxiety symptoms. To our knowledge, this is the first study to summarise the effect of PA on panic and anxiety symptoms in children, adolescents and early adulthood with meta-analysis.
The primary finding of the current meta-analysis is that the pooled effect sizes from 4 reports yielded a significant small effect (
However, it is very important to bear in mind that this result is very primal and exploratory because it was summarised from four reports with limited sample sizes, of which one study targeted children (N = 28) [33], two studies targeted adolescents (N = 92; N = 24, respectively) [31, 32] and one study targeted early adulthoods (N = 18; age mean = 22.1) [10]. There is, to date, indeed a shortage of evidence in this field. A most recent 2022 systematic review only identified eight studies testing PA intervention’s effect on panic disorder among adults [11] and argued for more evidence. On the one hand, it is difficult to recruit children with panic symptoms or diagnosed with panic disorder and deliver interventions for them. Unlike general anxiety symptoms, panic disorder is often clinically diagnosed and needs to be treated with extra caution. On the other hand, the tool to measure panic symptoms are limited among children. The experiments included in the current analysis used measurements, including API, RCAD and ASI-R [10, 31, 32, 33]. Among these scales, RCAD and ASI-R are developed for anxiety and only address panic symptoms in their subscales, which were not specifically developed for panic disorder. API was developed for panic symptoms but not aimed at children. It is important to evaluate the assessment tool because the panic among children and adolescents could differ between ages [42]. In comparison, another scale developed after 2014 to measure panic symptoms, namely the Panic Disorder Severity Scale for Children, adapted for adolescents from 11 to 17 years old [43], and used in some studies testing the effect of CBT on panic disorder. Future studies could consider testing the effect of PA on children’s panic with suitable assessments.
The secondary finding of the current analysis is that PA intervention had a middle effect (
Knowing that PA intervention reduces panic and anxiety symptoms across the empirical evidence, the next question is what type of exercise produces an optimal effect. The current meta-analysis could not perform the proper subgroup analysis to determine the best PA type due to insufficient data inclusion. Among the 15 studies, three studies applied resistance training, including push up [33], weight-lifting [13] and treadmill exercises [31], whereas others applied aerobic exercise in groups or individually. Among which, the push up and weight-lifting seems to produced the large and significant effect sizes reducing anxiety symptoms (d = −1.72, p < .001; d = −1.07, p = .002, respectively) [13, 33]. The effect of resistance training seemed somewhat contradictive to the mechanism in which the high lactate level could induce panic and anxiety symptoms when such anaerobic exercise produces lactate. There are two possible reasons to explain this. One possible reason is that only lactate in the brain induces the change in brain acidosis that leads to panic and anxiety symptoms [44], whereas muscle lactate produced by anaerobic exercise is independent of that in the brain [45]. It is the blood lactate which influences brain acidosis. The second reason is that the participants were measured almost immediately after the PA intervention cooled down, where the blood lactate level remained still. Hiscock, Dawson [46] tested 4 different types of weight-lifting technic to investigate the difference in muscle activation and blood lactate. The blood lactate was measured immediately after the exercise and no change in blood lactate was detected with a significant difference in muscle activation. Consequently, blood lactate was not influenced by different exercise intensities if measured immdiately after the intervention. Hypothetically, it is the regulation of CO2 during PA that potentially attenuates panic and anxiety symptoms. Future studies could compare, first, the effect of breathing practice from CBT and PA intervention with controlled blood lactate levels. Second, future studies could investigate the long-term effect of resistance training on blood lactate and panic & anxiety symptoms.
The last point to make is that the current meta-regression analysis did not suggest evidence of whether individual differences predicted the pooled effect sizes. Although it was argued in other literature that gender or age could moderate the effect of PA [12]. Previous literature reported gender differences in PA index as age grows [47], and more mature adolescents have more autonomy in PA than children [48], such that they can initiate behaviours that enhance the positive effects of PA on anxiety. As a result, the benefits of PA on depression and anxiety may increase with age. However, the current meta-regression analysis failed to demonstrate such effects on gender or age. One possible reason is that there were only 15 experiments identified in this study, which obtained limited power to detect any individual difference. Thirteen studies reported their gender ratio, and 12 reported the distribution of age. More studies are required to investigate individual differences’ role in the effect of PA intervention on anxiety and panic symptoms.
This meta-analysis has several limitations. Firstly, we used Cohen’s d rather than Hedges’ g to estimate the SMD, which the results might be biased in small sample studies. The reason to pick Cohen’s d was that some studies already reported pre-calculated Cohen’s d and did not provide sufficient information (N, mean, SD) to carry out transformation or bias correction. With limited numbers of the study identified, it would be impossible to exclude them from the analysis, and this could only be solved by including more studies with sufficient data. Secondly, the current study did not control the comorbidity among children and adolescents, which could affect the outcome of physical activities on panic and anxiety symptoms. As a result, the current results were very primal and exploratory, which should be considered cautiously.
Conclusion(s).
The current meta-analysis reported a small effect of PA intervention on reducing panic symptoms and a middle effect on reducing anxiety symptoms in children, adolescents and early adulthood. Meta-regression analysis did not support age or gender predictors of the pooled effect size. More studies in this field are required to produce a more solid conclusion.
We thank all of the staff who contributed their time to our research.
China Scholarship Council and University of Exeter PhD Scholarship.
Appendix 1 Search strategy of systematic review.
Appendix 2 Flow chart of studies retrieved and screened according to the PRISMA.
Appendix 3 Characteristics of included studies.docx.
Appendix 4 Summary of quality of included studies.
Appendix 5 Meta-analysis of raw data.
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Ciurean, Dagmar Schröter and Thomas Glade",authors:[{id:"163703",title:"Prof.",name:"Thomas",middleName:null,surname:"Glade",slug:"thomas-glade",fullName:"Thomas Glade"},{id:"164141",title:"Ph.D. Student",name:"Roxana",middleName:"Liliana",surname:"Ciurean",slug:"roxana-ciurean",fullName:"Roxana Ciurean"},{id:"164142",title:"Dr.",name:"Dagmar",middleName:null,surname:"Schroeter",slug:"dagmar-schroeter",fullName:"Dagmar Schroeter"}]},{id:"44219",doi:"10.5772/54973",title:"Disaster Management Discourse in Bangladesh: A Shift from Post-Event Response to the Preparedness and Mitigation Approach Through Institutional Partnerships",slug:"disaster-management-discourse-in-bangladesh-a-shift-from-post-event-response-to-the-preparedness-and",totalDownloads:4124,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"3054",slug:"approaches-to-disaster-management-examining-the-implications-of-hazards-emergencies-and-disasters",title:"Approaches to Disaster Management",fullTitle:"Approaches to Disaster Management - Examining the Implications of Hazards, Emergencies and Disasters"},signatures:"C. Emdad Haque and M. Salim Uddin",authors:[{id:"163390",title:"Dr.",name:"C. Emdad",middleName:null,surname:"Haque",slug:"c.-emdad-haque",fullName:"C. Emdad Haque"},{id:"168399",title:"Mr.",name:"Mohammed S",middleName:null,surname:"Uddin",slug:"mohammed-s-uddin",fullName:"Mohammed S Uddin"}]},{id:"56731",doi:"10.5772/intechopen.70351",title:"Affective Technology Acceptance Model: Extending Technology Acceptance Model with Positive and Negative Affect",slug:"affective-technology-acceptance-model-extending-technology-acceptance-model-with-positive-and-negati",totalDownloads:2395,totalCrossrefCites:8,totalDimensionsCites:15,abstract:"Research works on TAM, TAM2, TAM3 and UTAUT has always focused on cognitive aspect of technology acceptance in the past two decades. Acceptance of technologies such as eCommerce, Mobile and ERP that considered emotion and affect are still less. This creates a gap in the technology acceptance research, which consider the role of affect into technology acceptance model. This study considers the role of affect of a knowledge worker that work in Multimedia Super Corridor (MSC)-status organizations in Malaysia on their behavioural intention to use knowledge sharing tools (KS tools) in their day-to-day tasks. Hence, Affective Technology Acceptance (A.T.A) model has been proposed. The behavioural intention on the acceptance of KS tools will be hypothesize in the Affective Technology Acceptance (A.T.A) model. Positive (PA) and Negative (NA) affect as the role of affect construct were introduce in this model to investigate its influence on KS tools usefulness and ease of use among employees in Multimedia Super Corridor organizations. The findings of this study highlighted that NA has no impact on perceive usefulness. The findings also showed that PA has very significant positive influence on PU, PEOU and BI with impact on PEOU being the greatest.",book:{id:"5491",slug:"knowledge-management-strategies-and-applications",title:"Knowledge Management Strategies and Applications",fullTitle:"Knowledge Management Strategies and Applications"},signatures:"Angela Lee Siew Hoong, Lip Sam Thi and Mei-Hua Lin",authors:[{id:"190265",title:"Associate Prof.",name:"Angela",middleName:"Siew Hoong",surname:"Lee",slug:"angela-lee",fullName:"Angela Lee"},{id:"195089",title:"Prof.",name:"Lip Sam",middleName:null,surname:"Thi",slug:"lip-sam-thi",fullName:"Lip Sam Thi"},{id:"195090",title:"Prof.",name:"Mei Hua",middleName:null,surname:"Lin",slug:"mei-hua-lin",fullName:"Mei Hua Lin"}]},{id:"55633",doi:"10.5772/intechopen.68933",title:"Parental Self-efficacy in Promoting Children Care and Parenting Quality",slug:"parental-self-efficacy-in-promoting-children-care-and-parenting-quality",totalDownloads:2117,totalCrossrefCites:9,totalDimensionsCites:14,abstract:"Parental self-efficacy (PSE) emerges as a crucial variable into exploring variability in parenting quality. After introducing the link between PSE and parental competence, the role of PSE on parenting quality, its multiple influences, and transactional effects connected to contextual or cultural variables are discussed. The chapter addresses some key issues: (a) the levels of PSE measurement (i.e., domain- or task-specific approach), their interrelationship and magnitude as mutual predictors (study 1); (b) infant-caring, parent’s adjustment, and PSE development in the transition to parenthood (study 2); (c) parenting difficult children and the role of PSE as a “buffer” variable moderating the effects of negative child’s characteristics on parenting skills; and (d) PSE beliefs in family context, the relationships with other family measures (marital self-efficacy and stress), and their associations with children’s adjustments (study 3). Finally, in the study 4, PSE is presented as an outcome variable in a parent training. In all summarized studies, a special attention was devoted to father’s PSE as a specific factor affecting childrearing and parent’s well-being. As Bandura says, PSE is not a personality trait, but a learnable set of beliefs producing positive effects on parenting quality. Suggestions for family-based interventions enhancing PSE are discussed.",book:{id:"5605",slug:"parenting-empirical-advances-and-intervention-resources",title:"Parenting",fullTitle:"Parenting - Empirical Advances and Intervention Resources"},signatures:"Loredana Benedetto and Massimo Ingrassia",authors:[{id:"193200",title:"Prof.",name:"Loredana",middleName:null,surname:"Benedetto",slug:"loredana-benedetto",fullName:"Loredana Benedetto"},{id:"193901",title:"Prof.",name:"Massimo",middleName:null,surname:"Ingrassia",slug:"massimo-ingrassia",fullName:"Massimo Ingrassia"}]},{id:"60813",doi:"10.5772/intechopen.76198",title:"Crisis Management: A Historical and Conceptual Approach for a Better Understanding of Today’s Crises",slug:"crisis-management-a-historical-and-conceptual-approach-for-a-better-understanding-of-today-s-crises",totalDownloads:4713,totalCrossrefCites:9,totalDimensionsCites:12,abstract:"We argue that the basic and contemporary concepts related to crisis management, especially in the communication field, share some similarities with what was practiced in ancient civilizations such as the importance of direct contact between the leadership and the public. Other similarities include the accurate diagnosis of the real causes of the crisis, the forbiddance of the dissemination of false news and the reassurance of the public opinion that there is a solution to the crisis, a sound management decision, and a good plan for its implementation. We link the past time crises to the contemporary era, providing a comparison framework. The history of crisis tends to show us that the study of crisis management cannot be linked to a specific civilization or era, especially when humanity had witnessed multiple and complex environmental, political, economic, and military crisis. Moreover, some of the problems and complex issues in the modern era are rooted in history. Thus, many geopolitical crises nowadays are the result of old causes. The study of crisis management from an academic point of view should be a multifaceted analysis, including a historical, a cultural, and an anthropological one, which determines the course of evolution and consequences of the crisis.",book:{id:"6620",slug:"crisis-management-theory-and-practice",title:"Crisis Management",fullTitle:"Crisis Management - Theory and Practice"},signatures:"Khaled Zamoum and Tevhide Serra Gorpe",authors:[{id:"230918",title:"Prof.",name:"T. Serra",middleName:null,surname:"Gorpe",slug:"t.-serra-gorpe",fullName:"T. 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Other similarities include the accurate diagnosis of the real causes of the crisis, the forbiddance of the dissemination of false news and the reassurance of the public opinion that there is a solution to the crisis, a sound management decision, and a good plan for its implementation. We link the past time crises to the contemporary era, providing a comparison framework. The history of crisis tends to show us that the study of crisis management cannot be linked to a specific civilization or era, especially when humanity had witnessed multiple and complex environmental, political, economic, and military crisis. Moreover, some of the problems and complex issues in the modern era are rooted in history. Thus, many geopolitical crises nowadays are the result of old causes. The study of crisis management from an academic point of view should be a multifaceted analysis, including a historical, a cultural, and an anthropological one, which determines the course of evolution and consequences of the crisis.",book:{id:"6620",slug:"crisis-management-theory-and-practice",title:"Crisis Management",fullTitle:"Crisis Management - Theory and Practice"},signatures:"Khaled Zamoum and Tevhide Serra Gorpe",authors:[{id:"230918",title:"Prof.",name:"T. Serra",middleName:null,surname:"Gorpe",slug:"t.-serra-gorpe",fullName:"T. Serra Gorpe"},{id:"230920",title:"Dr.",name:"Khaled",middleName:null,surname:"Zamoum",slug:"khaled-zamoum",fullName:"Khaled Zamoum"}]},{id:"44219",title:"Disaster Management Discourse in Bangladesh: A Shift from Post-Event Response to the Preparedness and Mitigation Approach Through Institutional Partnerships",slug:"disaster-management-discourse-in-bangladesh-a-shift-from-post-event-response-to-the-preparedness-and",totalDownloads:4123,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"3054",slug:"approaches-to-disaster-management-examining-the-implications-of-hazards-emergencies-and-disasters",title:"Approaches to Disaster Management",fullTitle:"Approaches to Disaster Management - Examining the Implications of Hazards, Emergencies and Disasters"},signatures:"C. Emdad Haque and M. Salim Uddin",authors:[{id:"163390",title:"Dr.",name:"C. Emdad",middleName:null,surname:"Haque",slug:"c.-emdad-haque",fullName:"C. Emdad Haque"},{id:"168399",title:"Mr.",name:"Mohammed S",middleName:null,surname:"Uddin",slug:"mohammed-s-uddin",fullName:"Mohammed S Uddin"}]},{id:"74444",title:"Flood Disaster Hazards; Causes, Impacts and Management: A State-of-the-Art Review",slug:"flood-disaster-hazards-causes-impacts-and-management-a-state-of-the-art-review",totalDownloads:784,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Floods are among disasters that cause widespread destruction to human lives, properties and the environment every year and occur at different places with varied scales across the globe. Flood disasters are caused by natural phenomena, but their occurrences and impacts have been intensified through human actions and inactions. The practice of flood disaster management have evolved over the years from traditional approaches of ad-hoc response measures to integrated approaches involving technologically advanced tools in flood disaster awareness, preparedness and response measures. This chapter proffers understanding into flood disaster awareness, preparedness and management, mitigation and adaptation strategies. Most importantly, the chapter presents a review on the relevance of modern technological tools namely Geographic Information System, Remote Sensing, Internet of Things and Big Data, that are available to flood managers, in the creation of efficient early warnings and Flood decision support systems that elevates the resilience of societies to flood disasters.",book:{id:"7712",slug:"natural-hazards-impacts-adjustments-and-resilience",title:"Natural Hazards",fullTitle:"Natural Hazards - Impacts, Adjustments and Resilience"},signatures:"Frank Jerome Glago",authors:[{id:"325046",title:"M.A.",name:"Frank Jerome",middleName:null,surname:"Glago",slug:"frank-jerome-glago",fullName:"Frank Jerome Glago"}]},{id:"59667",title:"Information Security Awareness in Public Administrations",slug:"information-security-awareness-in-public-administrations",totalDownloads:1657,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Government digital agendas worldwide go hand in hand with the digital transformation in businesses and public administrations as well as the digital changes taking place in society. Information security (IS) and awareness (ISA) must be an integrated part of these agendas. The goal of IS is to protect information of all types and origins. Here, the employees play a necessary and significant role in the success of IS, and the entire staff of an institution need to know about their specific roles and be aware of the information security management system (ISMS). As there are still fundamental strategic deficiencies in the institutions themselves, humans should not be called “the weakest link” in the security chain. Rather, sustainable awareness-raising and training for people should be established in the institutions using interactive, authentic, and game-based learning methods. Psychological studies show the great importance of emotionalization when communicating IS knowledge and the reliable exchange of experience about IS. However, in many institutions, a change in culture is becoming necessary. IS must be integrated into all (business) processes and projects, and viable safeguards must be included. This chapter summarizes the most important scientific findings and transfers them to the practice of public administrations in Germany. 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The use of the failure mode and effects analysis (FMEA) method in research has enabled the detection of defects in supply chain management and analysis of factors that may negatively affect the flow of goods. 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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:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:15,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:9,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. Barderas",slug:"oxidative-stress-in-cardiovascular-diseases",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Importance of Oxidative Stress and Antioxidant System in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11671.jpg",subseries:{id:"15",title:"Chemical Biology"}}}]},overviewPagePublishedBooks:{paginationCount:33,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. She has more than fifteen years of teaching and research experience. She has published more than 550 scientific publications/communications, including 15 books, 50 book chapters, 100 original research papers, 380 research communications in national and international conferences, and 12 patents. She is a member of the editorial board of five journals and acts as a reviewer for several national and international journals. 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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:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{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:'"Politechnica" University Timişoara',institution:null},{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:{name:"Tecnalia",country:{name:"Spain"}}},{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:"426586",title:"Dr.",name:"Oladunni A.",middleName:null,surname:"Daramola",slug:"oladunni-a.-daramola",fullName:"Oladunni A. Daramola",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Federal University of Technology",country:{name:"Nigeria"}}},{id:"357014",title:"Prof.",name:"Leon",middleName:null,surname:"Bobrowski",slug:"leon-bobrowski",fullName:"Leon Bobrowski",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Bialystok University of Technology",country:{name:"Poland"}}},{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:"354126",title:"Dr.",name:"Setiawan",middleName:null,surname:"Hadi",slug:"setiawan-hadi",fullName:"Setiawan Hadi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Padjadjaran University",country:{name:"Indonesia"}}},{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:"332603",title:"Prof.",name:"Kumar S.",middleName:null,surname:"Ray",slug:"kumar-s.-ray",fullName:"Kumar S. Ray",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Statistical Institute",country:{name:"India"}}},{id:"415409",title:"Prof.",name:"Maghsoud",middleName:null,surname:"Amiri",slug:"maghsoud-amiri",fullName:"Maghsoud Amiri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Allameh Tabataba'i University",country:{name:"Iran"}}},{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"}}}]}},subseries:{item:{id:"17",type:"subseries",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. Thus all studies on metabolism will be considered for publication.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11413,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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