Gamma-emitting radiotracer for diagnostic imaging of different types of cancer and infection [1].
\r\n\t
",isbn:"978-1-83881-017-7",printIsbn:"978-1-83881-016-0",pdfIsbn:"978-1-83881-024-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"d5ac3a7054e526666a89271cef6ee869",bookSignature:"Dr. Ahmed Mourtada Elseman",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9924.jpg",keywords:"Photons, Semiconducting Materials, Photocurrent Density, Dye-Sensitized Cells, Perovskite Cells, Perovskite/Si Tandem, CIGS, CdTe, Single Crystal, Thin-Film Crystal, Single Crystal, Multicrystalline",numberOfDownloads:419,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 25th 2020",dateEndSecondStepPublish:"June 15th 2020",dateEndThirdStepPublish:"August 14th 2020",dateEndFourthStepPublish:"November 2nd 2020",dateEndFifthStepPublish:"January 1st 2021",remainingDaysToSecondStep:"7 months",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Dr. Elseman holds two diplomas, first one from Inner Mongolia Institute of Science and Technology and the second one from the Institute of New Energy, Wuhan. During his work at Southwest University, where he is currently also active, Dr. Elseman received funds from Central Universities for a project on efficient perovskite solar cells, a topic on which his research is mainly focused.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"221890",title:"Dr.",name:"Ahmed Mourtada",middleName:null,surname:"Elseman",slug:"ahmed-mourtada-elseman",fullName:"Ahmed Mourtada Elseman",profilePictureURL:"https://mts.intechopen.com/storage/users/221890/images/system/221890.jpg",biography:"Ahmed Mourtada Elseman obtained his B.Sc., M.Sc., and Ph.D. in Inorganic and Analytical Chemistry from the Faculty of Science, Al-Azhar University, Egypt. He earned his Ph.D. in perovskite solar cells in February 2017. He obtained two diplomas, first one from Inner Mongolia Institute of Science and Technology, Hohhot, China 2015, and the second one from the Institute of New Energy, Wuhan, China, 2017. He currently works as Research Assistant Professor at the Department of Electronic and Magnetic Materials, Central Metallurgical Research and Development Institute (CMRDI), Egypt. \nHe was awarded the Talent Young Scientific (TYSP) Postdoctoral Research Fellow position funded by the Chinese Ministry of Science and Technology (MOST) and organized by North China Electric Power University, Beijing, China, 2017-2018. After that, he received a lecturer position in the School of Materials and Energy, Southwest University, Chongqing. China (2018 – 2020). During his work at Southwest University, he received a project funded by Central Universities for efficient perovskite solar cells (ID: XDJK2019C005). He was also awarded the CMRDI prize for excellence scientific publication (2018). His current research focuses on understanding the mechanisms, fundamental properties, and developing scalable protocols for high-efficiency perovskite solar cells. He is a reviewer and a member of the editorial board for certain international journals.",institutionString:"Central Metallurgical Research and Development Institute",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Central Metallurgical Research and Development Institute",institutionURL:null,country:{name:"Egypt"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:[{id:"74344",title:"Solar Energy Assessment in Various Regions of Indian Sub-continent",slug:"solar-energy-assessment-in-various-regions-of-indian-sub-continent",totalDownloads:39,totalCrossrefCites:0,authors:[null]},{id:"73549",title:"Nanostructured Transition Metal Compounds as Highly Efficient Electrocatalysts for Dye-Sensitized Solar Cells",slug:"nanostructured-transition-metal-compounds-as-highly-efficient-electrocatalysts-for-dye-sensitized-so",totalDownloads:39,totalCrossrefCites:0,authors:[{id:"30213",title:"Dr.",name:"Chuan-Pei",surname:"Lee",slug:"chuan-pei-lee",fullName:"Chuan-Pei Lee"},{id:"281675",title:"Dr.",name:"Yi-June",surname:"Huang",slug:"yi-june-huang",fullName:"Yi-June Huang"}]},{id:"73730",title:"Graphene-Based Material for Fabrication of Electrodes in Dye-Sensitized Solar Cells",slug:"graphene-based-material-for-fabrication-of-electrodes-in-dye-sensitized-solar-cells",totalDownloads:61,totalCrossrefCites:0,authors:[null]},{id:"73328",title:"Optical Study of Porous Silicon Layers Produced Electrochemically for Photovoltaic Application",slug:"optical-study-of-porous-silicon-layers-produced-electrochemically-for-photovoltaic-application",totalDownloads:102,totalCrossrefCites:0,authors:[null]},{id:"73799",title:"2D Organic-Inorganic Hybrid Perovskite Light-Absorbing Layer in Solar Cells",slug:"2d-organic-inorganic-hybrid-perovskite-light-absorbing-layer-in-solar-cells",totalDownloads:80,totalCrossrefCites:0,authors:[null]},{id:"73569",title:"Excited-State Dynamics of Organic Dyes in Solar Cells",slug:"excited-state-dynamics-of-organic-dyes-in-solar-cells",totalDownloads:65,totalCrossrefCites:0,authors:[null]},{id:"74171",title:"Study of a New Hybrid Optimization-Based Method for Obtaining Parameter Values of Solar Cells",slug:"study-of-a-new-hybrid-optimization-based-method-for-obtaining-parameter-values-of-solar-cells",totalDownloads:34,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"252211",firstName:"Sara",lastName:"Debeuc",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/252211/images/7239_n.png",email:"sara.d@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{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:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],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:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],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"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3621",title:"Silver Nanoparticles",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"silver-nanoparticles",bookSignature:"David Pozo Perez",coverURL:"https://cdn.intechopen.com/books/images_new/3621.jpg",editedByType:"Edited by",editors:[{id:"6667",title:"Dr.",name:"David",surname:"Pozo",slug:"david-pozo",fullName:"David Pozo"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"73033",title:"Single-Photon Emission Computed Tomography (SPECT) Radiopharmaceuticals",doi:"10.5772/intechopen.93449",slug:"single-photon-emission-computed-tomography-spect-radiopharmaceuticals",body:'Nuclear medicine technique (NMT) is a detection process that helps in obtaining diagnostic results at molecular level of a disease. The technique is carried out by administrating target-specific radioisotope-labeled organic/biomolecule to patient and collecting the gamma signals through scintillating camera to diagnose the infected organ/tissues. In contrast to advanced instrumental procedures such as magnetic resonance imaging (MRI) and computed tomography (CT) scan, NMT offers a wide range of detection limit. For example, NMT starts working from molecular level when no morphological changes appear; however MRI and CT do this job at the appearance of morphological changes in diseased tissues.
NMT works by administration of radiolabeled molecules (commonly known as radiopharmaceuticals) to patients and acquisition of radiation collected through scintillation camera. There are two main components of radiopharmaceuticals: the organic/biomolecule and the radioisotope. The former approaches diseased cells/tissues and accumulate there at diseased cells and the latter part emits radiation to indicate the position of diseased area.
Diagnosis through NMT means the image of internal body organs like heart, kidney, lungs, breast, brain, bones, tissues, or whole body using γ-emitting radiopharmaceuticals; for example, indium-111 (111In) and technetium-99m (99mTc) labeled molecules. These radionuclides are labeled with a variety of compounds including drugs, organic species, peptides, proteins, and antibodies and then injected into the patient’s body. Intravenously administrated radiopharmaceuticals accumulate in specific body part or organ for which it is prepared and scans are obtained by single photon emission computed tomography (SPECT) camera [1]. Scan generated by SPECT camera gives very fruitful information regarding disease and tumor, which makes it easier for doctors to make decision about treatment strategies.
A large number of compounds have been labeled with γ-emitting radiotracers for imaging of different types of cancer and infection. Some of them are shown in Table 1 below [2].
Targeted agent with labeled radiotracer | Emitting radiation | Cancer type/disease |
---|---|---|
Bombesine indium-111 | γ-emitting | Endocrine organ tumor |
Pentadecapeptide Technetium-99m | γ-emitting | Breast and prostate cancer, gastro-entero-pancreatic tumors and lung cancer |
Oxdronate-99mTc | γ-emitting | Bones disease |
Tilmanocept technetium-99m | γ-emitting | Breast cancer, melanoma and oral Cavity cancer |
Pertechnetate technetium-99m | γ-emitting | Urinary and bladder thyroid cancer |
Iodinated bombesin I-125 | γ-emitting | Endocrine cancer cell growth in endocrine organ breast, prostate, ovaries and testes |
Bombesine rhenium-188 | γ-emitting | Prostate tumor |
FDG-F-18 | γ-emitting | Soft tissue cancer and prostate cancer |
Oxdronate-99mTc | γ-emitting | Bones disease |
Gamma-emitting radiotracer for diagnostic imaging of different types of cancer and infection [1].
In radiopharmaceuticals, there is a radioactive component which is used for the diagnosis and treatment of different malignancies. Only 5% of radiopharmaceuticals are used for therapeutic purposes while the remaining has diagnostic applications. Radiopharmaceutical has two components: first one is pharmaceutical part and the second is radiotracer as shown in Figure 1.
Radiopharmaceutical and its design.
Effectiveness of the radiopharmaceutical depends upon both parts. In order to prepare a good and efficient radiopharmaceutical, the first step involves the selection of a pharmaceutical component which is very critical [3]. Pharmaceuticals that have a preferable accumulation in targeted body organ, tissues, or cells should be selected. After the selection of pharmaceutical component, pharmaceutical is labeled with a suitable radiotracer. The radiopharmaceutical is subjected to administration after a routine quality control procedure. There are many disease targeted radiolabeled agents or compounds that are commonly used for diagnosis and therapeutic purpose. From diagnostic point of view, disease-targeted agents (either a drug or any other compound) are labeled with γ-emitting radiotracer, and for therapeutic purpose, these agents are labeled with β and α radiotracer like lutetium-177 (177Lu) and Yatrium-90 (90Y) [4]. In Table 2, some of the disease-targeted agents (radiopharmaceuticals) are shown which are used for diagnostic imaging and therapeutic purpose of different diseases and cancers.
Targeted agent with labeled radiotracer | Emitting radiation | Cancer type/disease |
---|---|---|
Metastron (89SrCl2) | β-emitting | Skeletal cancer |
Radium-223 dichloride | α-emitting | Bone metastasis, breast and prostate cancer |
Samarium-153-EDTMP | β-emitting | Bone and prostate cancer |
Commonly used radiopharmaceuticals for therapeutic purpose [4].
Radiopharmaceuticals which are used to diagnose the cancer and infection by using the γ-emitting radionuclides such as 111In and 99mTc are known as SPECT radiopharmaceuticals. The radiotracer which is used for diagnostic purposes should have following properties [5]:
Easy availability at nuclear medicine center
Low cost
Short effective half-life then labeled pharmaceutical
Carrier free
Nontoxic
Free from α and β particles emission (with little emission)
Biological half-life not greater than time of study
Suitable energy range
Chemically reactive to form coordinate covalent bonds with the compound which is to be labeled
Common properties of γ-emitting radionuclides for SPECT imaging are given in Table 3.
γ-emitting radiotracer | Half-life (hours) | Generator | Gamma energy | Abundance of γ-emission (%age) |
---|---|---|---|---|
Indium-111 | 67.32 | Cyclotron | 0.l7l MeV 0.245 MeV | 90.5 94 |
Technetium-99m | 6.02 | 99mMo/99mTc | 140 keV | 88.9 |
Iodine-123 | 13.22 | Cyclotron | 159 keV | 82.8 |
Common properties of γ-emitting radionuclides.
More than 85% of radiopharmaceuticals which are being used to diagnose the cancer and infection are 99mTc labeled. The reason for using the 99mTc is due to following characteristics:
Half-life of technetium is 6 hours which is sufficient to examine the catabolic as well as anabolic processes which occur in patient and minimal radiation exposure time to the patients [6].
Energy of the γ-rays emitted by technetium is very low (140 keV) which does not greatly damage the soft tissues of the patient body, although they have low energy but can be detected by any sensitive gamma camera [7].
Its excretion rate from the patient body is very fast.
Its short half-life enables us to get the imaging information very quickly.
Technetium is very reactive to make complex with compounds.
Decay of technetium takes place through isomeric transitions due to which electrons and gamma radiation of low energy is emitted. Therefore, beta radiation exposure to patent is negligible.
Due to the emission of same energy levels of gamma radiation, the detector alignment becomes very accurate as no beta radiation is emitted.
Most important property of technetium is that its oxidation state can be changed according to the desired targeted body organ and parts, which makes it possible to develop a biological technetium labeled compound which can accumulate in high amount on that targeted organ and part of body which is under investigation [8].
Technetium belongs to transition metal family; its electronic configuration and physical properties are shown in table given below (Table 4). There are 22 isotopes of the technetium, but none of them is stable in nature. Half-life of 99Tc is 0.25 million years in its ground state. Oxidation state of technetium varies from −3 to +7 as shown in Table 4 below. This happens due to the 4d and 5s loss or gain of electrons by 4d orbital. Different types of ligands which are used to label the technetium and chemical conditions under which labeling process is accomplished are responsible for steadiness of such types of oxidation state. It is observed that technetium is found in nature in the form of halides (TcF6, TcCl6 and TcBr4, oxide, [TcO2, Tc2O7], sulfides [Tc2S7], and pertechnetate 99mTcO4− in +4 to +7 oxidation states). Oxidation states of smaller values such as −1, +2, +3 are naturally stabilized during complex formation with varieties of ligands; for example, +3 oxidation state is stabilized by the chelating agent, methylene diphosphate [9]. Without the use of these chelating agents in complex formation, the oxidation state will not remain constant and technetium would oxidize to +4 oxidation state and eventually change to +7 oxidation state which is most stable state in complex. The +5 and +6 oxidation of technetium is habitually charged to +4 and +7 oxidation states as shown in the following Eqs. 1 and 2 which is most stable regardless of their proportion.
Properties of technetium | Values |
---|---|
Atomic number | 43 |
Atomic mass (amu) | 98 |
Electronic configuration | 1s2,2s2,2p6,3s2,3p6,3d10,4s2,4p6,4d6,5s1 |
Density gm/cm3 (at 25°C) | 11.5 |
Oxidation state | −3, −1, 0, +1,+2,+3,+4,+5,+6,+7 (+4 and +7 are more stable) |
Melting point in Kelvin | 2430.15 |
Boiling point in Kelvin | 5150.15 |
Occurrence | Solid state (naturally) |
Electronagetivity | 1.9 |
First, second, and third ionization energy (kJ/mol) | 702, 1472, and 2850, respectively |
Electron affinity (kJ/mol) | 58 |
Heat of vaporization kJ/mol | 660 |
Group | VIIB (7) |
Metal category | Transitions metal |
Period | Fifth |
Color | Silvery gray |
Numbers of isotopes | Twenty-two |
Physical and chemical properties of technetium.
The coordination number of the technetium during complex formation can be changed between 4 and 9.
Technetium generated by Moly generator presents in the form of sodium-pertechnetate (99mTc-NaTcO4). In this pertechnetate ion, the oxidation state of technetium is +7 and structure of the 99mTcO4− is pyramid tetrahedron in which Tc atom is present in the center of the tetrahedron with +7 oxidation state and four oxygen atoms located at the apexes of the triangular pyramid. This geometry and oxidation state is identical to the permanganate ion MnO4− and perrhenate ion ReO4− ion. Structure of the pertechnetate ion TcO4− is shown in Figure 2.
Structure of pertechnetate ion 99mTcO4−.
Pertechnetate 99mTcO4 is a nonreactive molecule and cannot be used directly for labeling; therefore, it is necessary to reduce the pertechnetate from +7 oxidation state to lower oxidation state for labeling purposes. For the reduction of the pertechnetate 99mTcO4 form +7 oxidation state to lower oxidation state, a variety of reducing agents are employed such as stannous citrate (C12H10O14Sn3), stannous tartrate (C4H4O6Sn), stannous chloride (SnCl2.2H2O), concentrated hydrochloric acid (HCl), dithionite (O4S2−2), ferrous sulfate (FeSO4), and sodium boro tetrahdride (NaBH4). However, the most frequently used reducing agent in labeling of the compounds with technetium process is stannous chloride dihydrate (SnCl2.2H2O) [10]. Electrolysis can also be utilized as a method for reducing sodium-pertechnetate (99mTc-NaTcO4) and use zirconium as an anode and labeling compound. However, following common characteristics are being considered to choose a reducing agent in 99mTc chemistry.
It should give effectual reduction at compassionate pH environment.
It should have long shelf life mean remain unaffected when they are stored for long time.
It should not incorporate within the final product of the complex.
It should give well-defined oxidation state in order to generate intrinsic complex.
It should not interfere with complex formation procedure.
Reduction of pertechnetate 99mTcO4 with the help of stannous chloride is accomplished in acidic medium, and reaction is given below.
Overall reaction
It is clear from the Eq. 4 that technetium reduces from higher oxidation state +7 to lower oxidation state +4. Under different chemical and physical conditions, other oxidation state of 99mTc such as 99mTc+3 and 99mTc+5 are likely to be formed or a mixture of all these oxidation states could possibly exist. Stannous chloride as a reducing agent is usually used in a very small amount while 99mTc is commonly administrated in the concentration ∼ 10−9 M.
Technetium-99m after reduction forms reactive species and attains the ability to bind with a variety of chelating agents to generate the labeled product. In order to form the additive bond, normally, chelating agent donates the lone pairs of the electrons to make coordinate covalent bond with 99mTc. Compounds containing the electron donating group such as carboxylic group (▬COOH), amines (▬NH2), hydroxyl (▬OH), and thiol group (▬SH) are good chelates such as DTPA (diethylenetriamine pentaacetic acid) and gluceptate.
Technetium is found in variable oxidation states ranging from −1 to +7, but it frequently forms complexes in +5 oxidation state. A number of technetium complexes with other oxidation states also exist in increasing order [10]. Complex of technetium in +6, +2 and zero oxidation state are not synthesized because they are not fruitful for medical purpose. Different complexes of technetium that they from in different oxidation states are as follows:
Complex of technetium in +7 oxidation state (Tc+7). Technetium naturally occurs in this state, and it is most stable and nonreactive toward any chelating agent in this oxidation state. Technetium in +7 oxidation state is found in the form of technetium heptasulfide and pertechnetate 99mTcO4.
Complex of technetium in +5 oxidation state (Tc+5). Technetium is present in this oxidation state in the form of complexes such as99mTc-gluconate, 99mTc-glucepetate, and 99mTc-citrate. During these complexes formation, reduction of technetium (pertechnetate 99mTcO−4) from +7 oxidation state to lower oxidation state +5 is accomplished with stannous chloride in an aqueous medium. It is observed that technetium in +5 oxidation state have tendency to form the complex with sulfur containing molecules (dithiols) in solid state. In these sulfur complexes, four sulfur atoms are located at the corner of the square planes and oxygen atom at the apex of square pyramid. Compounds with six coordination number are preferably formed in the aqueous medium, and molecules exhibit more stable structure in the form of octahedral geometry. Diaminodithiol (DATA) is one of the best examples of such compounds. In these complexes, oxidation state of technetium is +5 and complexes are neutral and stable in this oxidation state.
Complex of technetium in +4 oxidation state (Tc+4). Oxidation state of technetium in complexes of TcO2 and hexahalo is +4. The reducing agent which is used to reduce the pertechnetate 99mTcO4 from +7 oxidation state to lower oxidation state +4 (TcO2.xH2O) is zinc with HCl. However, 20% of technetium reduces to technetium metal by this method. In technetium-99m-hydroxyethylidene diphosphonate (HEDP) complex, it is observed that the oxidation state of technetium is changeable which is highly dependent upon the pH of the method which is used to synthesize the complex. In acidic medium, the oxidation state of technetium is +3; in alkaline medium, it is +5; and in neutral medium, it is +4 [11]. This means that a slight change in pH can change the oxidation state of technetium pointing to the fact that they may exist as a mixture of all oxidation states like +3, +5 and +4 in technetium-99m-hydroxyethylidene diphosphonate (HEDP) complex.
Complex of technetium in +3 oxidation state (Tc+3). A number of technetium-99m complexes exist with +3 oxidation state in acidic medium. These complexes include DTPA (diethylenetriamine pentaacetic acid, ethylenediamine tetraacetic acid (EDTA), DMSA (dimercaptosuccinic acid) and hepatobiliary iminodiacetic acid. However, the oxidation state of technetium in the complex EDTA and DTPA become +4 in alkaline as well as in neutral medium. A variety of technetium complexes in which technetium exists in +3 oxidation state are used for myocardial scanning. These include complexes of technetium-99m with phosphine, arsine and BATOs (boronic acid adduct of technetium dioxime comples).
Complex of technetium in +1 oxidation state (Tc+1). This oxidation state is stabilized with the help of coordinate covalent bond with different types of ligands in aqueous medium. In this oxidation state, compounds are usually stable in water and air.
Indium belongs to aluminum which are naturally occurring transition metals. Its chemical and physical properties are enlisted in Table 5. Indium is a soft silvery white metal which is not found in free elemental form but found in the form of combined state such as halides InCl3, InBr3 InI3 and InF3, sulphide and oxide (In2O3). Indium exists in three oxidation state +3, +2 and +1 but indium in +3 oxidation state it appears more stable. Thirty-nine isotopes of indium have been reported but only three isotopes such as indium-111, indium-113 and indium-115 are commonly found. Indium-111 with half-life of 66.32 hours are used in radiopharmaceutical for imaging purpose [12]. γ-radiation emitted by indium-111 have an energy of 247 keV and 172 keV and the percentage of γ-radiation emitted by indium-111 is 90.6% with minimal β-radiation emission that make the indium −111 a good imaging radiotracer.
Properties of indium | Values |
---|---|
Atomic number | 49 |
Atomic mass (amu) | 114.818 |
Electronic configuration | 1s2,2s2,2p6,3s2,3p6,3d10,4s2,4p6,4d10,5s2,5p1 |
Density gm/cm3 (at 25°C) | 7.31 |
Oxidation state | +1,+2,+3, (+3 more stable) |
Melting point in Kelvin | 429.75 |
Boiling point in Kelvin | 2353.15 |
Occurrence | Solid state (naturally) |
Electronegativity | 1.78 |
First, second and third ionization energy (kJ/mol) | 558, 1820, 2704, respectively |
Electron affinity (kJ/mol) | 29 |
Heat of vaporization kJ/mol | 23.2 |
Group | IIIA (13) |
Metal category | Poor metal (posttransitional) |
Period | 5th |
Color | Silvery white |
Natural isotopes (two) | Indium-113 and Indium-115 |
Artificial isotope | 39 in number but Indium-111 and Indium-113 are important |
Physical and chemical properties of indium.
These γ-emitting radionuclide labeled compounds can be utilized to identify the exact position and location of the infection in different parts and organs such as brain, arteries, joints, bones and tissues. In Table 6, a number of compounds bound with γ-emitting radionuclides (indium-111 and technetium-99m) along with their sensitivity and imaging purpose are shown.
Sr no. | Labeled compound | Labeled radioisotope | SPECT imaging model | Pathology | Sensitivity/ accuracy | Refs. |
---|---|---|---|---|---|---|
1. | Oxyquinolone-labeled leukocytes | 111In | Human model | 90% | [1] | |
2. | Exametazime-labeled leukocytes | 99mTc | Human model | Reticuloendothelialsystem visualization | 90% | [1] |
Sulfur colloid | 99mTc | Human model | osteomyelitis | |||
3. | Methylene diphosphonate | 99mTc | Human model | High sensitivity low specificity | [2] | |
4. | Labeled leukocytes | 111In | Human model | [2] | ||
5. | HMPAO labeled leukocytes | 99mTc | Human model | [2] | ||
6. | Biotin | 111In | Human model | Spinal infection | 93% | [2] |
7. | UBI | 99mTc | Human model | Soft tissue and bone infection | 95% | [3] |
8. | MDP | 99mTc | Human model | Marrow imaging | [4] | |
9. | HMPAO-labeled leukocyte | 99mTc | Human model | Prosthetic joint infections | 91% | [5] |
General radiopharmaceuticals developed based on SPECT imaging.
Isotopic exchange | Labeling of the compounds with C-14, S-35, I-135 labeling of T3 and T4 and H-3. |
Labeling with bifunctional Chelating Agent | In-111 DTPA albumin Tc-99m DTPA antibody |
Introduction of foreign label | Labellng of the proteins with I-125. Tc-99m labeled radiopharmaceuticals Labeling of the hormones with I-125 Labeling of the cells with In-111 F-18 fluorodeoxyglucose |
Biosynthesis | Labeling of the compounds with C-14 Co-57 cyanocobalamin Se-75 selenomethionine |
Excitation labeling | Labeling of the compounds with I-223 from Xe-123 decay Labeling of the compounds with Br-77 from Kr-77 decay |
Recoil labeling | Iodinated compounds Compounds label with H-3 |
Methods for labeling of the compound with radiotracers [13].
The radiolabeling of antibiotics, drugs, peptides, proteins and organic species with different radiotracer has increased reasonably from imaging point of view in medical, biochemical and other associated fields. In the field of medical imaging, compounds are labeled with two types of radionuclides: (a) compound labeled with those radionuclide that emitted the gamma radiation and have large number of application and especially used for in vivo imaging of a number of organs and (b) secondly, the compounds are labeled with radionuclide that emitted the
Sr. no. | Labeled compound | Labeled radioisotope | SPECT imaging model | Pathology | Sensitivity/accuracy | Refs. |
---|---|---|---|---|---|---|
1. | Anti-PSMA nanobody | 111In | Human model | Tumor target | [6] | |
2. | HYNIC-Glu-Urea | 99mTc | Human model | Metastatic prostate cancer | [6] | |
5. | DTPA-AMB8LK | 111In | Mice model | Pancreatic cancer | 23.6 ± 3.9% ID/g | [7] |
6. | Octreotide | 111In | Human model | Neuroendocrine tumor (NETs) | 95% | [8] |
7. | Sestamibi | 99mTc | Human model | Parathyroid adenoma | Range from 85 to 95% | [8] |
8. | MDP | 99mTc | Human model | Bone metastases | Very sensitive | [8] |
9. | (Arg11)CCMSH | 99mTc | Mice model | Murine melanoma | 3.33 ± 0.50%ID/g | [9] |
10. | DOTA-Re(Arg11)CCMSH | 111In | Mice model | Murine melanoma | 8.19 ± 1.63%ID/g | [9] |
11. | DTPA-octreotide | 111In | Mice model | Lung cancer | Bm/B was 3.1 ± 0.6 | [19] |
12. | HYNIC-TOC | 99mTc | Human model | Metastatic neuroendocrine tumors | Sensitivity 87% | [10] |
13. | DTPA-octreotide | 111In | Mice model | Somatostatin-receptor tumors: evaluation | 4.3%ID/g | [11] |
14. | HYNIC-TOC | 99mTc | Mice model | Somatostatin-receptor tumors: evaluation | 5.8 ± 9.6%ID/g | [11] |
15. | HMPAO | 99mTc | Mice model | Neuroblastoma | 88% | [12] |
16. | Oxine | 111In | Mice model | Neuroblastoma | 80% | [12] |
17. | Rhenium sulfide colloidal nanoparticles | 99mTc | Rabbit model | Sentinel lymph node | Radiolabeled 98.5 ± 0.5% | [13] |
18. | TDMPP complex | 111In | Mice model | Tumor imaging | [14] | |
19. | DOTA conjugate -TA138 | 111In | Mouse model | Tumor imaging | 9.39% ID/g | [15] |
SPECT-radiopharmaceuticals using Tc-99m and In-111 for cancer imaging.
In this type of labeling process, there is no need of bi-functional chelating agents or metal cheater. These are discussed below.
In this method, some atoms from the compound which is to be labeled is replaced by isotope of the same atom of the element having different atomic mass (more or less) such as I-123, I-124, I-125, I-127, and I-131. the compound is labeled with isotope of the same element so the compound to be labeled and radiolabeled are similar in biological properties, except for the energy emitted from different isotopes of the same element which is used for labeling [14]. This method used for in vitro study. Examples of isotope exchange labeling reactions are labeling of the triiodothyronine (T3) with I-125, labeling of thyroxine with I-125, and labeling with C-14, S-35 and H-3 labeled compounds [15].
In this process of labeling, a molecule of known biological function is labeled with a radionuclide. This labeling occurs by forming covalent bond or co-ordinate covalent bond. The attaché radiotracer is unknown (foreign) to the molecule, and labeling does not occur due to the exchange of its isotope. In most of these types of compounds, chelation is the cause for bond formation. In such bonds, more than one atom donates a pair of electrons to the foreign acceptor atom that is mostly a transition metal. Majority of Tc-99m labeled compounds are developed by this process such as binding of Tc-99m with DTPA, gluceptate, etc.
The biosynthesis method involves the growth of the microorganisms in a culture medium that contains the radiotracer. When microorganisms (bacteria) grow in such a medium, the radiotracer is introduced into the metabolites that are produced by the metabolic activity of the organism. This metabolite is then chemically separated. Example of such product is preparation of 57Co-B12 by using a bacterium Streptomyces griseus.
It is of limiting interest and cannot be preceded on large scale for labeling because it has low specific activity of the bounded molecule. The method involves generation of recoil ions or atoms as particles are emitted by the nucleus. These generated atoms or ions then form a bond with the targeted molecule. This high energy of recoil atoms gives poor yield.
Radioactive and very reactive daughter ions that are produced by nuclear decay process are used in excitation labeling process. In β-decay and electron capture processes, there is a production of highly energetic charged particle ions which have the ability to label the compound of interest. When Kr-77 undergoes the decay process, it yields Br-77. These (Br-77) energetic ions are able to bind the compound of interest when exposed to it [16]. A number of proteins are labeled with I-123 when protein is exposed to Xe-123 which decays into energetic I-123 and label the protein. Main disadvantage of this method is poor yield.
A chelating agent is a substance that has the ability to form multiple bonds with a single metal ion, thus acts as a multidendate ligand. Bi-functional chelating agent is that which has two are more separate covalent or coordinate covalent bonds with a ligand which is polydendate in nature. The labeling process using bi-functional chelating agent involves the bond formation at two sites: one bond is formed by the bi-functional chelating agent with macromolecule such as protein and antibody and other bond is formed with metal ion such as Tc-99m. There are many bi-functional chelating agents being used currently; however, most important are diethylenetriamine pentaacetic acid (DTPA), metallothionein, diamide dimercaptide (N2S2), dithiosemicarbazone, and hydrazinonicotinamide.
There are two types of labeling process by using bi-functional chelating agent.
(a) Tc-99m chelate method: In this method, a chemical is used to carry out chelation (such as diamidodithiol and cyclam) and labeling of macromolecules such as protein by forming the bond between chelating agent and protein (macromolecule).
(b) Indirect chelater antibody method: In this method, bi-functional chelating agent forms a bond with macromolecule and then it reacts with metal ion to form the complex known as metal-chelator-macromolecule complex. By using indirect chelator antibody method, a number of antibodies are labeled. The biological function of the antibodies may be affected due to the presence of the chelating agent; therefore, it is necessary to check the labeling products before a clinical trial. It is no doubt that the prelabeled chelating method gives pure metal-chelate- complex with precise structural study. However, the main drawback of this method is that it is a lengthy procedure and gives poor yield [17].
These SPECT-radiopharmaceuticals can also be developed for early and accurate diagnosis of cancer in different body parts and organs. A variety of drugs and compounds such as peptides, proteins, antibodies, and organic species were labeled with radionuclides such as indium-111 and technetium-99m, and these radiolabeled compounds are used for the successful and accurate diagnosis of different types of cancer in human and mice models [18]. In Table 8, a number of compounds which are labeled with γ-emitting radiotracer for SPECT imaging of different types of cancer with accuracy are shown.
SPECT-radiopharmaceuticals are not only used to identify infections and malignancies but are equally used to know the effectiveness of the treatment strategy which is used to cure the infections and tumors. That means, we can employ the SPECT-radiopharmaceuticals for follow-up strategy to know about the effectiveness of a treatment methods. A large numbers of radiolabeled compounds are being used to identify the effects of previous treatment strategy, for example, pentetreotide is labeled with indium-111 to follow-up of the neuroendocrine tumor therapy (tumor generated due to the hormonal cell and nerves system) in gastrointestinal tract, lungs, pancreas, and rest of the body (Table 9).
Sr no. | Labeled compound | Labeled radioisotope | SPECT imaging model | Pathology | Sensitivity/accuracy | Refs. |
---|---|---|---|---|---|---|
1 | Nano-colloids | 99mTc | Human model | Breast cancer and melanomas | Well accepted | [16] |
2 | Radio-colloid | 99mTc | Human model | Breast cancer, head/neck malignancies, prostate cancer and gynecological malignancies | [16] | |
3 | Pentetreotide | 111In | Human model | Neuroendocrine tumors | 95% | [16] |
4 | Capromab | 111In | Human model | Biochemical disease-free survival and disease-specific survival in primary prostate cancer | 46% | [16] |
5 | Medronate | 99mTc | Human model | Bone imaging | [16] | |
6 | Labeled white blood cells | 111In | Human model | Inflammation imaging | [16] | |
7 | Labeled white blood Cells | 99mTc | Human model | Inflammation imaging | [16] | |
8 | Maraciclatide | 99mTc | Human model | Angiogenesis | [16] | |
9 | 3P-RGD2 | 99mTc | [16] | |||
10 | MSAP-RGD | 111In | [1] | |||
11 | His-annexin A5 C2AcH- | 99mTc(CO)3 | Apoptosis | [2] | ||
12 | (Me)FGCDEVD | 99mTc | [16] | |||
13 | DTPA-Ac-TZ14011 | 111In | Chemokine receptor 3 expression | [1] | ||
14 | AMD3100 | 99mTc | [1] | |||
15 | DTPA-Fab-PEG24-EGF | 111In | Epidermal growth factor receptor | [1] | ||
16 | Etarfolatide | 99mTc | Folate receptor | [1] | ||
17 | DOTA-folate | 111In | [1] | |||
18 | MIP1404 | 99mTc | Prostate-specific membrane antigen | [1] | ||
19 | DPA-alendronate | 99mTc(CO)3 | Bone imaging | [1] | ||
20 | human umbilical tissue-derived cells | 111In | Mice model | Cerebral ischemia | [17] | |
21 | 99mTc-pHLIP | Mice model | Lewis lung carcinoma (LLC), lymph node carcinoma of the prostate (LNCaP) and prostate adenocarcinoma | adequate imageability and correlation with tumor extracellular acidity | [18] | |
22 | 99mTc-HHK | Rat model | Tumor microenvironment | High specificity | [18] | |
23 | nanobody (Nb cl1) against CD206 radiolabeled | 99mTc | Mice model | Macrophages in tumor | [18] | |
24 | 99mTc-PyDA | Mice model | In vivo hypoxia targeting | Selective uptake | [18] | |
25 | 99mTc-meropenem | Tumor hypoxia tissue | [18] | |||
26 | 99mTc-nitroimidazole | Mice | Differentiate from inflamed and infected tissues | [18] | ||
27 | 99mTc-SD32 | Breast tumor cells | [18] |
SPECT-radiopharmaceuticals using Tc-99m and In-111 for follow-up imaging.
A number of SPECT-radiopharmaceuticals are being used in clinical trials which are producing very fruitful results for the diagnosis of different types of cancers and infections in human beings (Table 10). These radiolabeled compounds help doctors obtain useful and precise information at a very early stage of the disease to identify the extent of problem and to take timely decisions about the treatment strategies.
Sr no. | Labeled compound | Labeled radioisotope | SPECT imaging model | Pathology | Sensitivity/accuracy/efficiency | Refs. |
---|---|---|---|---|---|---|
1. | HMPAO | 99mTc | Human model | Painful prosthetic hip | 39% (SD 12%) | [20] |
2. | Tropolonate | 111In | Human model | Painful prosthetic hip | 63% (SD 14%) | [20] |
3. | EDDA/HYNIC-TOC | 99mTc | Human model | Cancer diagnosis | High tumor to organ ratio | [21] |
4. | P829 peptide | 99mTc | Human model | Neuroendocrine tumors | 91% | [22] |
5. | Pentetreotide | 111In | Human model | Neuroendocrine tumors | 65% | [22] |
6. | labeled leukocyte | 111In | Human model | Osteomyelitis | 91% | [23] |
7. | HYNIC-TOC | 99mTc | Human model | Metastatic neuroendocrine tumors | Sensitivity 87% | [10] |
8. | HYNIC-OC | 99mTc | Human model | Tumor | 0.70 ± 0.13%ID/g | [24] |
9. | HYNIC-TOC | 99mTc | Human model | Malignancies | 3.85 ± 1.0 | [24] |
10. | HYNIC-TATE | 99mTc | Human model | Tumor | 3.99 ± 0.58%ID/g | [24] |
11. | DTPA-OC | 111In | Human model | Tumor | 0.99 ± 0.08%ID/g | [24] |
12. | DOTA-TATE | 111In | Human model | Tumor | 4.12 ± 0.74%ID/g | [24] |
13. | Depreotide | 99mTc | Human model | Lung cancer | Immuno-histochemical correlations 98% | [25, 26, 27, 28] |
14. | DTPA | 99mTc | Human model | Graves’ disease | Specificity 89% | [29] |
15. | HDP | 99mTc | Human model | Bone imaging | [30] | |
16. | Tetrofosmin | 99mTc | Human model | Glioblastoma multiforme | L/N ratio of 4.7 | [31] |
17. | ECD | 99mTc | Human model | Alzheimer’s patients | [32] | |
18. | MAA | 99mTc | Human model | Liver perfusion imaging | 100% | [33, 34, 35] |
19. | Mebrofenin | 99mTc | Human model | Hepatobiliary Scintigraphy | [36] | |
20. | HSA-DTPA | 99mTc | Human model | Gastrointestinal bleeding | 70% | [34] |
21. | GHA | 99mTc | Human model | Brain-scanning | 85% | [37] |
22. | MDP | 99mTc | Human model | Cerebral infarction | [38] | |
23. | DMSA | 99mTc | Human model | Acute pyelonephritis | [39] | |
24. | Pyrophosphate | 99mTc | Human model | Amyloidoses | 97% | [40] |
25. | Sulfur Nanocolloid | 99mTc | Human model | Lymphatic drainage from prostate | 3.9–5.2 mSv/MBq | [41] |
26. | Oxine-labeled leukocytes | 111In | Human model | Liver cysts | 87.5% | |
27. | HMPAO-labeled leukocyte | Tc-99m | Human model | Abscess | [42] | |
28. | MAA-and HAS Microspheres | 99mTc | Human model | Liver-lung shunt | [35] | |
29. | HSA-DTPA | 99mTc | Human model | Gastrointestinal bleeding | 100% | [34] |
30. | Labeled bone marrow mesenchymal stem cells | 111In | Human model | Acute brain trauma model | [43] | |
31. | Oxine | 111In | Human model | Diagnostic imaging | 80% | [42] |
32. | HMPAO | 99mTc | Human model | Diagnostic imaging | 88% | [42] |
33. | Sulfur Nanocolloid | 99mTc | Human model | Mapping of lymphatic drainage from the prostate | [41] | |
34. | HMPAO-labeled leukocyte | 99mTc | Human model | Prosthetic joint infections | 91% | [5] |
35. | Labeled chimeric monoclonal antibody Nd2 | 111In | Human model | Pancreatic cancer | 100% | [44] |
36. | Labeled GnRH-I tracer | 111In | Human model | Tumor imaging | Efficiency 11.8 ± 1.9% | [45] |
37. | Oxine labeled mesenchymal stem cells | 111In | Human model | Cirrhosis | [46] | |
38. | TRODAT-1 | 99mTc | Human model | Parkinson disease | Target the pre-synaptic dopamine transporter (DAT) | [47] |
39. | Depreotide | 99mTc | Human model | Lung cancer and other pulmonary malignancies | 96.6% | [4] |
40. | Prostascint | 99mTc | Human model | Prostate cancer | Approved | [4] |
41. | Zevalin | 111In | Human model | Diagnosis of non-Hodgkin’s lymphoma | Approved for use | [4] |
42. | CEA scan | 99mTc | Human model | Colon cancer | Approved | [4] |
Octreo Scan | 111In | Human model | Neuroendocrine tumors | [4] | ||
43. | Depreotide | 99mTc | Human model | Lung cancer | [4] | |
44. | Annexin-V | 99mTc | Human model | Acute myocardial infarction and chemotherapy response monitoring | [4] | |
45. | Neuroligands | 99mTc | Human model | Neuropsychiatric patients | [4] | |
46. | EC-MN | 99mTc | Human model | Hypoxia | [4] |
Clinical trials study of different SPECT radiopharmaceuticals.
There is a need to develop more accurate, sensitive, precise, and reliable SPECT-radiopharmaceuticals to identify the malignant infections and tumors at an early stage in order to overcome the infectious diseases and cancer all over the world. If cancer is diagnosed at an early stage, it would be easier to plan the exact treatment strategy ahead of time. Considerable advancements have been made during last decades in SPECT-radiopharmaceuticals that may take the place of instrumental imaging techniques and therapeutic strategies. In combination with existing technologies, NMT may help a lot in the diagnostic and therapeutic advancement of clinical detection methods.
When facing a dangerous or threatening situation, aggression is a behavioral response that is often appropriate and necessary. An individual who is unable to perceive the hostile intentions of others is also unable to protect him- or herself or their personal needs. Aggression can also be characterized as a vital energy that allows an individual to mobilize the physical and psychological resources necessary to compete with others in a healthy way. Finally, aggression is present in many positive forms of emotional expression; it gives rise to creativity and the establishment of new relationships. It is when aggression is out of control that it becomes unbeneficial, problematic, and potentially harmful. Lack of control over the intensity, form, and timing of aggressive behavior is thus an issue of interest to clinicians who would like to help people with uncontrolled aggression.
The defining characteristic of impulsive aggression is uncontrolled and impulsive behavioral manifestations of anger in response to a provocation [1]. Aggressive behaviors have a negative impact on social, legal, and health-care systems, and are significant predictors of long-term social dysfunction [2]. Consequently, understanding and preventing aggressive behavior is a worldwide major public health concern [3]. Impulsive aggression is also associated with violent forms of aggression, which often occur in the context of interpersonal relationships [4]. When considering the importance of the social dimension in models of impulsive aggression, this observation is not surprising. While many of these models have come from social psychology, contributions from neuroscience have increasingly allowed for the inclusion of the social component, with the aim to produce more integrative models. This has opened up the field and made it possible to explore how cerebral connectivity may vary according to distinct social inputs and the reaction to those inputs.
The purpose of this chapter is to reflect on new avenues of intervention that are based on both social psychology and neuroscience models. We believe that inhibitory control training (ICT) represents a unique opportunity by which this may happen. Indeed, ICT addresses impulse control disorders and, in this sense, may be a relevant intervention strategy for impulsive aggression. However, to adapt it to the peculiarities of impulsive aggression, one must proceed with careful deliberation. It is here that our analogy with two-person psychology comes into play. The term “two-person psychology” comes from a clinical psychology approach, which means that the emotions and subjective reactions of the client and the therapist during a psychotherapy session are not only determined by the client’s dynamics but also by the mental life of the therapist [5]. The personal reactions of the therapist are part of the session; they not only influence the interactional processes in the dyad [6] but they also contribute to the transformation and therapeutic change, as experienced by the client [7]. Inspired by this clinical approach, we will propose that ICT may be integrated into impulsive aggression treatment programs if it is extended into the social realm, and more particularly to social cognition. To do this, we believe that an intervention strategy called implementation intentions can bridge the gap between ICT and the field of social cognition.
Before discussing these methods of intervention, we will review evidence of the social determinants of aggressive impulsive behavior. We will begin by looking at the influence of aversive social environments on the development of social cognition and inhibition in children. We will then discuss how social and neurobiological models can shed light on the factors that maintain aggression in adults.
Aversive early childhood experiences and environments, which include physical or psychological abuse, inconsistent or severe discipline, parental neglect, social rejection, exposure to aggressive peers or violence, among many others, have all been identified in the literature as constituting important risk factors of disruptive and aggressive behavioral problems later in life [8, 9, 10]. Here, we will present some of the evidence-based theories that explain how early life social adversity affects the development of a child’s mental processes and is believed to increase the likelihood of future aggressive behavior.
In cognitive psychology, social information processing (SIP) models postulate that in a person’s memory, there exists a collection of memories of past experiences. In this pool of memories, accumulated information is thought to bind together, forming stable structures of concepts and sets of principles. These organized sets are often called schemas, and they guide a person’s behavior in social situations [11, 12]. An individual who was physically abused as a child may have an accumulation of aggressive social experiences stored in memory. Over time, aggressive thought and belief patterns may develop and lead to aggressive behavior.
A schema (also referred to as a “script”; [13]) can be described as a network of associative concepts that are stored in memory and function to organize past experiences—to make sense of the world and absorb new knowledge efficiently [14, 15].
Imagine a person is approaching you with a big smile and a hand raised up high. If you have had past experiences of giving someone a “high five,” then it is likely that the smile and the raised hand (which are “encoded” in the current situation) will be interpreted as a friendly gesture. Given past experiences, it is unlikely that you will assume they have harmful intentions. Now, let us imagine that this person is someone with whom you would like to become friends. You remember that past occurrences of returning a “high five” have helped you attain a similar goal with other people. This cognitive process leads you to decide to gently tap the person’s hand “up high.” From a cognitive psychology perspective, the schema in this situation contains concepts such as a “smile,” a “raised hand,” a “high five,” a “non-harmful intention,” a “friendship,” and a “positive experience,” and these concepts are associated together with past experiences.
Now, this time try to imagine the same situation, but as it might happen with a child who has experienced physical abuse. The schema evoked here would likely be quite different. It may contain concepts such as a “smile,” a “raised hand,” a “slap on the face,” a “harmful intention,” a “threat,” or a “negative experience.” While the initial situation—a person approaches with a big smile and a raised hand—is the same in both examples, it is unlikely that the child who was abused would react, or behave, in the same manner as in the situation above.
While a schema can be a cognitive structure that helps process social information efficiently, it can also omit details and induce errors. Because schemas are formed by past experiences, recurrent negative events and early aversive experiences may influence certain schemas in such a way that they become biased. As a result, a person may be misled by their interpretations and react with aggressive behavior. For example, what if the child mentioned above had decided to hit the person in order to run away. Had the person who approached the child been intending to cause harm, then the child’s aggressive behavior would have potentially helped them avoid a slap on the face. However, if the child repeatedly uses this schema and reacts aggressively in every social situation, then this will result in a chronic accessibility of hostile schemas [16, 17] and a frequent hostile interpretation of the behavior of others (hostile attribution bias; [11, 18, 19]).
Research evidence on early exposure to media violence (as depicted on television [TV], movies, video games, cell phones, online/computer sources, etc.) has shown that hostile schemas formed in childhood do not only develop from direct exposure to aggression (e.g., actual physical or verbal abuse). They can also result from indirect exposure—through the observation of aggressive acts as depicted by individuals in violent media [12, 20, 21]. Because a schema acts as an associative network of concepts, a stimulus may activate a concept, which then activates other associated concepts that are part of the same network. In this way, a schema can be implicitly activated (or “primed”) by a stimulus and trigger a chain-like reaction between associated concepts within a particular network [22, 23]. It is important to note, however, that there is a difference between schemas that occur during adulthood, and those that develop earlier in life. Adults often have schemas that were acquired through accumulated experiences, and this serves to strengthen the links between associated concepts, making them highly resistant to change. By contrast, a child’s schemas are much more flexible and impressionable, making it much easier to encode new information. While this is a key component that contributes to social learning, it can also make children more vulnerable when exposed to aggressive stimuli [24]. A child who observes a violent scene on TV will encode aggressive cues without difficulty, and often without filter. The more the child is exposed to such media violence, the more the links between concepts of aggression will be reinforced, and these aggression-related concepts will create additional links with other concepts from memory. With frequent repetition of this process, activated aggressive schemas will expand, become chronically accessible, and resistant to change. Indeed, longitudinal studies have shown that children’s early hostile schemas contribute to the stability and maintenance of later aggressive behaviors [25].
The term normative beliefs refers to an individual’s personal standard about the appropriateness of particular social behaviors [26]. In other words, they serve to determine which behavior is appropriate versus inappropriate in a given social situation. They are distinct from social norms or perceived social norms, which are the actual social consensus on a given social behavior or the individuals’ perception of the existing social consensus, respectively.
Guerra et al. proposed that normative beliefs are acquired through a socialization process, which occurs with a primary caregiver, a significant reference group, and through personal evaluation [27]. First, a child’s primary caregivers play an important role for their social development and have an incredible influence, especially on infants. Caregivers or parents are the usually the first source of verbalized rules, normative beliefs, and social norms, which are quickly encoded and integrated into early childhood cognition. They also contribute to the establishment of an infant’s personal normative beliefs. Second, children develop normative beliefs through social exchanges with other individuals as well, such as peers, extended family members, or a significant reference group. As a child interacts within these networks of people, they can be easily influenced and may accommodate new rules, socials norms, and beliefs. Third, children construct normative beliefs that are coherent with their own evaluative schemas. Briefly, this evaluative schema contains a response evaluation, outcome expectancies, and a self-efficacy assessment [11]. Respectively, these refer to an assessment of the quality of certain morally- and value-based social responses (e.g., morally good vs. morally bad responses), to personal opinions about the results of these responses (i.e., thoughts about the consequences of these responses within the social realm), and to the degree of confidence they have in their ability to successfully perform these behaviors and achieve a particular desired outcome (i.e., an assessment of one’s capacity to successfully perform a chosen social response). It has been theorized that if a child’s evaluative schema is biased toward aggression and/or hostility, then they will develop normative beliefs that approve aggressive social responses. Furthermore, these aggression-related normative beliefs are thought to crystalize over time, thus promoting an increase in aggressive behavior throughout the lifespan. Indeed, it has been found that aggressive children, as compared to their non-aggressive peers, will (1) evaluate aggressive responses more favorably [28, 29], (2) are more likely to expect a favorable outcome if physical or verbal aggression is used [30, 31, 32], and (3) feel more confident about their efficacy when performing behaviors that are physically and/or verbally aggressive [31, 32, 33].
There is now empirical evidence supporting the fact that environmental factors (such as witnessing acts of aggression) and emotion dysregulation (e.g., difficulty in controlling one’s anger) are predicted by aggressive normative beliefs, and that these beliefs predict subsequent aggressive behavior [34]. Furthermore, children who engage in these acts of aggression may provoke aggressive tendencies in others and thus create or stimulate an aversive environment. Within this hostile atmosphere, children often exchange negative social feedback, which only serves to reinforce aggressive normative beliefs and behaviors (also referred to as a “self-fulfilling prophecy effect”). As this pattern repeats itself, it becomes of a vicious cycle of aversive environmental triggers, aggressive cognitions, and aggressive behavioral responses [35].
Executive functions are higher order cognitive abilities that are responsible for the regulation of thoughts, emotions, and actions [36, 37]. While there are many different ways to define or describe executive functioning, it is generally thought to comprise (1) cognitive control of planning or organizing action(s), (2) monitoring a series of responses [38, 39, 40], (3) divided attention or attentional control, (4) abstract reasoning, (5) alertness, and importantly, (6) behavioral regulation or inhibition [41, 42, 43]. A recent study that used a behavioral assessment of reactive aggressive behavior (i.e., an emotion-driven impulsive act in response to a perceived threat) found that the degree to which a participant could inhibit their responses (also known in cognitive psychology as “response inhibition”) was the strongest predictor of reactive aggression. This finding held when compared to other cognitive processes such as working memory, cognitive flexibility, and attentional control [43, 44]. For this reason, when examining early childhood factors that play a role in the development of aggressive behavior, we have placed an important focus on cognitive processes that relate to inhibition.
As previously mentioned, inhibition is an executive function that allows a person to inhibit a dominant response [45]. It has primarily been linked to brain function involving the prefrontal cortex (PFC). Many neurocognitive researchers have shown that child maltreatment can affect specific brain regions within fronto-limbic networks [46, 47, 48, 49, 50]. The implicated brain regions include the PFC, the orbitofrontal cortex, the anterior cingular cortex, and the amygdala [46, 48, 50, 51]. According to the “Interactive Specialization model” by Johnson [52], some cortical regions, which are responsible for neuronal maturation and specialization, become functionally efficient by having sufficient neural activation. It is possible that maltreatment in infancy disturbs these activations. Also, increased density of glucocorticoid receptors due to early life stress (such as maltreatment in infancy) is theorized to negatively affect the early maturation of the PFC [53].
Numerous studies have demonstrated that impaired inhibitory control interacts with the cognitive functions involved in processing social information. More specifically, both the interpretation and response decision steps have been linked to deficits in inhibitory control, which predicts aggressive behavior [54, 55, 56, 57, 58]. Difficulties in inhibiting hostile schemas may lead children to habitually interpret others’ behavior as being hostile (hostile attribution bias), and low inhibitory control increases the probability of choosing the most salient and dominant response (e.g., behavioral aggression).
From an evolutionary-developmental perspective, low inhibitory control is not necessarily considered as an impairment in cognitive function, but rather a form of adaptation amidst an unstable environment [59, 60]. For example, one study found that individuals who grow up in harsh and unpredictable environments (e.g., dangerous, crime-ridden neighborhoods) prefer smaller immediate rewards over larger future rewards [61]. In other words, within dangerous and unstable environments, a preference for immediate rewards may be more adaptive than a preference for delayed rewards in an uncertain future [62]. From this perspective, inhibition would be an inefficient function, as it prevents people from taking advantage of immediate benefits [63]. Therefore, it is possible that early childhood adversity decreases inhibitory control in order to help a child better adapt to particular environments, which may explain the relationship between low inhibitory control, uninhibited aggressive behaviors, and early adverse social experiences.
Taken together, a solid literature links early social adversity in childhood to aggression, and this happens through socio-cognitive mediators such as aggressive schemas, normative beliefs that support aggression, and low inhibitory control. It is important to note, however, that childhood adversity is one of many risk factors related to aggressive behavior, and adverse social experiences in early age does not necessarily lead to aggressive behavior in adulthood. In the following section, we will discuss other contributing social factors, how they interact with cognitive and neurobiological function, and how they may serve to maintain aggressive behavior over time.
In most social contexts, even those involving a conflict or altercation, an impulsively aggressive act can result in unnecessary harm, serious injury, and even death [64, 65]. Having the ability to implement and execute context-appropriate regulation strategies will play an important role in shaping how a person will react to stressors or unpredictable situations later in life. As previously mentioned, human neuro-behavioral functioning is not solely influenced by early-life situational factors. Individual differences in genetic disposition, cognitive ability and flexibility, emotion regulation, and behavioral inhibition, as well as many other internal and external factors, will all have major implications for a person’s capacity to have healthy and adaptive interactions within the social realm.
Much of what we presently know regarding the brain-behavior dynamics of impulsive aggression was acquired from examining case studies of individuals who suffered from brain trauma, neural lesions, or brain tissue damage due to illness or disease [39]. A well-known example is that of Phineas Gage, a nineteenth century railroad worker who survived a horrific accident whereby a large iron rod pierced through his skull, destroying a large portion of his left frontal lobe. While this tragedy resulted in deleterious effects on his personality, social relationships and general quality of life, it also served to enable ground-breaking discoveries in the domain of neural specialization and functionality. In particular, the area damaged during the accident—the PFC—was subsequently linked to the regulation of emotional states such as anger and impulsivity, as well as maladaptive behaviors, like impulsive aggression [66].
Researchers examining the link between PFC function (or cortical regions, more generally) and impulsive aggression have looked at various components of cognitive processes such as executive functioning. Furthermore, neurochemical imbalances in the level of the steroid hormones cortisol and testosterone, as well as fluctuations in the modulation of neurotransmitters such as serotonin, have all been shown to induce physiological changes in core affective and cognitive processing brain regions, which have an important influence on the way an individual perceives and acts in response to social threats [67].
The tendency to habitually respond to a perceived threat in an aggressive manner is not governed by frontal brain regions alone; rather, it is thought to be maintained by a complex interplay of cognitive, affective, and behavioral neural systems [39, 68]. Researchers examining these mechanisms in relation to impulsive aggressive urges and behaviors have proposed that a disruption in decision-making and social-emotional information processing circuits is also a key contributor [39]. From a cognitive neuroscience approach, it is posited that an imbalance in top-down control (primarily governed by prefrontal brain regions) and activity in subcortical areas responsible for “bottom-up” processes (i.e., “feed-forward” modulation of emotional, appetitive, as well as aggressive reactivity) leads to difficulties in behavioral inhibition [68]. Abnormal activation in fronto-parietal regions may enhance impulsive drives, such as the urge to respond aggressively to a social provocation [65, 69]. For example, in an examination of aggressive behavior in relation to frontal-lobe functioning, Giancola and Zeichner used neuropsychological measures to test young men in a social-provocation paradigm [42]. Results indicated that men who performed poorly on the tests were significantly more aggressive toward peers, as compared to those who performed better. The researchers proposed the possibility that diminished frontal-lobe functioning coupled with provoking external conditions (e.g., social provocation) may lead to decreases in behavioral inhibition and a heightening of aggressive reactivity [42]. This finding is further validated by studies examining specific cognitive impairments linked to recurrent antisocial behavior and the tendency to reoffend in criminal populations (i.e., recidivism). A recent meta-analysis concluded that impairments in inhibition—the executive function that is particularly important for behavioral self-regulation and the suppression of dominant impulses—were a significant predictor of future acts of physical aggression and violent crime [70].
Researchers have also used functional magnetic resonance imaging (fMRI) to examine neural activity within the social behavior network in real time (i.e., in vivo). Numerous studies have replicated evidence of critical interconnections between frontal cortices, subcortical regions, and striatal brain regions in the maintenance of aggressive response patterns (for review, see [71]). The flow of activity within these connections regulates emotional processing, which acts to modulate behavioral reactivity [72, 73]. For example, in an fMRI study by Coccaro and colleagues, brain regions that have previously been linked to impulsive aggression were assessed for functional deficits [74]. Results indicated that individuals with high aggressivity (as compared to healthy controls) showed greater activation in the amygdala—a subcortical brain structure thought to play a key role in emotional processing, threat detection, and in activating stress-induced behavioral response [74, 75, 76]. Inversely, healthy controls showed greater activation in frontal regions when viewing the emotional faces [74]. Similarly, Nomura [77] found that healthy participants who viewed emotional images showed an inverse functional connectivity between the amygdala and brain regions thought to be responsible for integrating affective information, emotional valuation, and decision-making processes. By contrast, individuals who met criteria for intermittent explosive disorder (a psychiatric disorder characterized by emotional dysregulation and pathological impulsive aggression) failed to show such functional connectivity [71, 77]. The results suggest that individuals who have difficulty regulating emotions and inhibiting aggressive impulses may have impaired connectivity in the cortico-limbic pathway [71].
More recently, researchers have investigated the neural substrates of impulsive aggression in relation to social situations that provoke negative emotional reactivity (e.g., feelings of anger or hostility, betrayal, jealousy, social exclusion or peer rejection; [78, 79]). In addition to the importance of past social experiences, it has been suggested that rejection is one of the most common precursors of aggression and one of the most significant risk factors for adolescent violence [79, 80]. After an incidence of social rejection, studies have shown that people fail to process situational information in an efficient and adaptive manner, which leads to reductions in self-control [81].
The question of why some individuals respond to particular social exchanges by increasing their efforts to gain acceptance or reconcile a conflict, while other individuals tend to respond with increased aggression and acts of retaliation, is an area of research that is still being explored. One such investigation, by Chester and colleagues tested whether social rejection triggered aggressive reactivity through heightened activation in areas of the brain associated with emotional pain or anger. They further assessed whether individual differences in executive functioning moderated this relationship [73]. Findings were consistent with socio-cognitive models positing that for some individuals, social rejection triggers negative emotional responses such as anger, which may lead to maladaptive cognitive appraisals and deficits in decision-making strategies, thus triggering the impulse to act aggressively [13]. Similarly, in a study that included healthy female and male participants, Achterberg and colleagues investigated aggressive feelings and behaviors in relation to negative social feedback [82]. Conjunction neuroimaging findings from the study found greater activation in the right dorsal lateral PFC during negative feedback (as compared to neutral feedback), which was significantly associated with shorter noise blasts (an index of lower levels of aggression) in response to negative evaluations from peers. The results suggest that particular areas within the PFC factor into the regulation of affective impulsive actions, such as socially provoked aggression [82].
Pioneered by developmental researchers, such as Crick and Dodge [11], major advances in our understanding of social behavior more generally have emerged from studies on social cognition and social adjustment during childhood [83, 84, 85].Over the last few decades, the social information-processing model (SIP; [11]) has been extensively researched. It has paved the way for a better understanding of how social cognitive constructs formed early in childhood can perpetuate a cycle of maladaptive behavioral response patterns throughout the lifespan [25, 86]. Indeed, a considerable amount of evidence has supported a significant relationship between deficits or difficulties in social cognitive processing and higher levels of aggressive response patterns during social interactions [87, 88].
The general SIP model [11] (here, adapted for adults) proposes that when a person enters a social situation, they are already primed with a set of biologically determined cognitive capacities and a history of social experiences that are stored in long-term memory. Amidst an array of social cues, their ensuing behavioral response is thought to be a function of how they have processed those cues. In a sequential manner, it is hypothesized that the person begins the social interaction by selectively attending to cues on both an internal level (e.g., related to affective or cognitive processes) and external level (i.e., related to situational/environmental stimuli). After encoding the cues, the person interprets them according to a number of evaluative processes. They may filter the information in accordance to their own personalized knowledge structures (i.e., mental representations that are based on similar social scenarios from previous experiences). They may also make inferences and attribute intentions to the person(s) involved in the interaction, and evaluate how they handled similar social exchanges in the past. Next, they determine whether or not the strategies they used in the past were successful in achieving the goal(s) that they had set out to obtain. Depending on how they perceive their self-efficacy (i.e., self-assessment of past performance) and the degree to which they deem past strategies successful, they form predictions or expectations about the outcome of using a similar strategy in the current situation [11].
After interpreting the situation, the person then proceeds by clarifying their goals, while taking into consideration their desired outcome (e.g., settling a previous dispute, taking revenge for a past offense, asserting a sense of control or power, etc.). This evaluation is thought to be highly influenced by the person’s present state of arousal, which acts to orientate them toward achieving their goal. It is also at this step that a person may revise their goals or find different strategies that may be more appropriate to the current situation. In some circumstances, a quick response is necessary and it may be more feasible to construct a new response strategy or re-adjust their outcome expectations. According to the SIP model, once a response has been selected, the behavioral enactment ensues. However, a person may have difficulty or deficits in regulating the intensity of their affective arousal. If the person is unable or unwilling to select or produce an adaptive response, then it is likely that impulsive urges will interrupt the decision-making process and cognitive control mechanisms. As is often the case with impulsive aggressive acts, when a breakdown in inhibitory control occurs, withholding a potentially maladaptive response may prove to be difficult or unattainable [89].
When factoring in that many social interactions involve a number of uncertainties and ambiguities (e.g., knowledge of the motivations or perceptions of the other parties involved), it can be challenging to quickly process, generate, refine, and select an appropriate behavioral response. For this reason, many information-processing (IP) models have been criticized for the rigidity of their linear structure and lack of complexity in explaining actual brain function and activity (e.g., mechanistic explanations of dynamic neural systems, contingent features, nonlinear connectivity as it happens in real time, etc.; [11]). Despite these shortcomings, IP paradigms clearly have a heuristic value and one of the most effective applications of their principles are in providing a basic understanding of how active social cognitive processes may contribute to emotional and behavioral reactivity.
Since its original conception, the SIP model has been reformulated to reflect a more complex, cyclical process, whereby multiple cognitive processes may occur simultaneously and operate in a time-related sequence [11]. Some reformulated IP models have made the distinction between information that is processed “online” (working representations gathered from the immediate environment) and information that is processed “offline” (knowledge structures stored in long-term memory; [25]). The online representations are hypothesized to contain information from social cues that are encoded during the onset of interaction. Here, particular emotionally charged cues may evoke attentional biases that facilitate hostile attributions [90]. In situations where missing or ambiguous environmental data occur, online representations are thought to be supplemented or “filled in” by information taken from stored knowledge structures [25].
This revised formulation demonstrates how active cognitive processes can be directly influenced by previous social interactions. With repetition, these processes may be conditioned over time, and thus serve as a control mechanism for a variety of impulsive behaviors [11, 91, 92]. Indeed, if a person regularly evokes a particular knowledge structure (e.g., “Social encounters are inherently hostile”), then “offline” information (e.g., “When someone gives me a dirty look, it means I need to watch my back”) may repeatedly find its way into a person’s “online” representations (“They’re giving me that look. I won’t let them be the first to attack”).
Notably, personal motivations and expectations regarding social interaction are multi-factorial. Furthermore, a person’s baseline affect (i.e., their current emotional state) will play a critical role, both in how the person is likely to interpret a particular social situation and what they are likely to “select” as a response. Despite the multitude of factors that may contribute to the maintenance of impulsive aggression, one of the primary goals of this chapter is to examine and integrate evidence-based knowledge on the control mechanisms involved so that a better understanding may facilitate effective interventions.
Although an impulsive response that is aggressive in nature may appear on the surface as a simple disinhibited reaction to an internal or external trigger, the studies reviewed in the previous sections invite us to develop a conception of impulsive aggression that is much wider. Here, we underline the person as being in constant interaction with his or her social environment during the selection, or lack thereof, of his or her behavioral responses. It is during his or her social interactions that all the active social cognitive processes which underlie aggressive behaviors are being played out. In addition, early interactions experienced in childhood are gradually transformed into cognitive structures (e.g., hostile schemas or aggressive response scripts) which reflect past experiences and continue throughout development. As a person progresses into adulthood, these cognitive structures will influence his or her emotional and psychological state and affect their responses in a given social situation. This observation leads us to the necessity of placing ICT within the social domain and to question how it may be adapted to the treatment of impulsive aggression. We will present the theoretical premises of ICT as an intervention model and compare them with those of the SIP model of impulsive aggression. Thereafter, this will allow us to identify possible options of ways to adapt ICT to the treatment of impulsive aggression.
There exist several interventions that aim to reduce aggressive behavior, from early intervention in children [93, 94] to comprehensive programs for nonclinical adults [95, 96], to programs specific to individuals with psychopathology [97, 98]. Intervention programs are usually multimodal and are composed of an education component [93], and modules that target self-control [99], cognitive distortion modification [91], emotional regulation strategies [100], and the involvement of a person’s environment [93]. For its part, with the aim of reducing behaviors that may be harmful to a person’s health, ICT has taken place within the context of appetitive behaviors such as abusive relationships with food or eating [101], alcohol [102], drugs [103], and tobacco [104]. For some individuals, these behaviors have a significant reward value [105]. Although not specifically aimed at aggressive behavior, ICT targets behaviors that share a common basis with aggressive behavior. Indeed, appetitive behaviors [105] and aggressive impulsive behaviors [106] are characterized by a deficit of inhibitory control. It is therefore reasonable to believe that ICT can serve as a complementary module to interventions that are usually offered for the treatment of impulsive aggression.
ICT refers to a category of interventions in the form of cognitive training which uses computer-based tasks, such as the stop-signal task or the go/no-go task, which requires motor control functions to either restrain an action or cancel an ongoing action [107]. This training aims to increase inhibitory control skills that regulate appetitive behaviors. It is postulated that obesity and substance abuse are caused both by a hyper-valuation of an appetitive stimulus and hypo-function of inhibition mechanisms [108]. The procedure generally involves training a person to initiate an inhibition response to an external stimulus that visually represents the appetitive stimulus (i.e. unhealthy food or beer images; [109]). Meta-analysis has demonstrated a significant effect of ICT in the reduction of appetitive behaviors, as measured in a laboratory setting (ad-libitum; [105]). For some behaviors, it has been demonstrated to have generalized positive effects on the quality of a person’s daily life (e.g., food intake; [110]). However, this has not been demonstrated for all behaviors (e.g., alcohol consumption; [107, 111]). This result supports the need to adapt ICT to the nature of certain impulsive behaviors. One of the mechanisms of action postulated to account for the effects of ICT is the creation of a bottom-up association between the appetitive stimulus and the inhibitory response that bypasses the need for a more general inhibitory control [101, 112].
Although inhibitory control is an important part of the intervention to reduce impulsive aggression behavior, several determinants are not accounted for within an ICT-based intervention model. At the level of situational determinants, the aggressive response may occur as a result of an external stimulus, such as a social provocation, but it may also occur as a result of an internal stimulus. Internal stimuli include the person’s cognitions and emotions. Among cognitive determinants, for instance, when following an ambiguous social provocation, the interpretation that the other person has hostile intentions can lead to aggressive behavior [85]. Among emotional determinants, anger is well known as an internal state that can lead to reactive aggression [113]. However, it can be claimed that many other negative affective states, such as anxiety [114] or sadness [115], can also serve as an internal trigger for aggression. It has been observed that certain thoughts or strong emotions can affect the information processes of a person in a social situation [90]. The person’s processing of information becomes incomplete or erroneous, and this increases the risk that the person will respond aggressively [116]. Moreover, negative feedback from the social environment in response to aggressive behavior can maintain those erroneous cognitions and intensify the negative affect of the aggressive person [13]. Interventions resulting from the SIP model are therefore intended to improve the accuracy and depth of a person’s information processing ability. It also actively integrates the person’s environment, which enriches positive social experiences that will ultimately change the way the person perceives the world and processes social information [117]. Table 1 summarizes the main theoretical differences between the ICT and the SIP model of aggression.
ICT model | SIP model | |
---|---|---|
Postulated causal mechanisms | Hyper-valuation of appetitive stimulus, stimulus reward and reward sensitivity Temporary lessening of inhibition function, which increases in response to an appetitive stimulus | Incomplete or erroneous social information processing Hostile cognitive structures that may interact with deficient executive functions (which include inhibition) |
Triggers | External stimulus (i.e. smelling and/or viewing food or alcohol) | External (i.e., social provocation) and internal (i.e., negative affective state, such as anger) stimulus |
Behavioral Maintenance Factors | Reward value of the appetitive stimulus | Negative social feedback |
Postulated mechanisms of action | Top-down inhibitory control skill Automatic bottom-up association (stimulus-stop) Devaluation of stimulus, which follows the inhibition of stimulus | More accurate and in-depth social information processing Positive social feedback from appropriate social interactions |
Comparison between the ICT and the SIP model of aggression.
In terms of their theoretical premises, the ICT model and the SIP model may seem, at first glance, to be incompatible. However, we believe that it is possible to adapt ICT-based interventions to include the social domain. With this aim, we propose a novel approach to intervention for impulsive aggression, and consider a perspective based on two-person neuropsychology. Inspired by the two-person psychology approach, we will use the expression “two-person neuropsychology” in two ways. First, it refers to the idea that impulsive aggression occurs in the social domain and that neuropsychological interventions should aim to improve social information processes. The second meaning pertains to the transformation of cognitive structures within an individual with impulsive aggression, which we believe requires input from the other. According to SIP models of aggression, a distinction is made between two distinct components—“online situation-specific” and “offline person-specific” [117]. With “two-person neuropsychology,” the first part would involve interventions that target the cognitive processes which take place in specific social situations, whereas the second part refers to interventions which target stable cognitive structures of the person.
For individuals who are habitually aggressive, it has been shown that their social information cognitive processing is dysfunctional and influenced by erroneous cognitive structures [118]. In other words, the information being processed is largely based on pre-existing cognitive structures rather than on actual cues that are present in the social situation [13]. These structures lead to an automatic processing of the situation, which prevents the person from processing other relevant information which may be helpful in deciding the appropriate course of action in a given social situation [16]. Therefore, there is a link between a social situation and a cognitive process that appears conditioned by past experiences [119]. For example, a person who has been exposed to hostile situations in different social contexts during his or her development will be inclined to encode hostile information to the detriment of other non-hostile cues. Over time, this process becomes spontaneous and automatic [12]. For this reason, we believe that it is necessary to disengage the aggressive person from his erroneous cognitive processes, and help him or her to develop new associations between the same social situation and a new cognitive process. Given that ICT uses an external stimulus, and the automatic response which is targeted during training involves motor function, we recommended finding a comparable therapeutic strategy that would broaden ICT intervention targets. We feel that implementation intentions can serve this purpose. “Implementation intentions” is a self-regulation strategy that aims to help a person achieve their goal by implementing a series of behavioral steps. This includes (1) ensuring that behaviors are put in place in a specific situation, (2) these behaviors are designed to help the person achieve a desired goal which is planned in advance, and (3) the behaviors should take place automatically as soon as the situation is met [120, 121, 122, 123]. This technique is based on an “if-then” contingency, where “if” represents the situation and “then” represents the response. The advantage of implementation intentions in relation to ICT is that the situation can be both external and internal, and the response can be modified and improved at any stage in the cognitive processing of social information. Also, this technique does not require lengthy training. For the most part, the focus is on verbalization and visualization of a plan. During these verbalization/visualization sessions, the person determines precisely all the elements of the situation which afford an opportunity to execute the plan. They also determine how they will act or respond cognitively in this particular situation. This strategy makes it possible to create new associations between a stimulus and a response, and in this respect, it appears compatible with one of the postulated mechanisms of action of ICT (e.g., creation of automatic bottom-up association). This association circumvents the necessity to make use of a general inhibitory control skill because the will of the person is delegated to the situation. Once established, such an association happens automatically (or quickly), efficiently, and without awareness. Also, because it is determined and planned in advance, the “if-then” plan represents an action restraint in which the decision to inhibit is made from the onset. As such, it is not an action cancelation, whereby the decision to inhibit occurs after implementation of the dominant response. This allows for cognitive processes to be similar to those running during a go/no-go task—the task that appears to be the most effective among ICT tasks [124].
Applied to impulsive aggression, the first step in implementing intentions would be to make an assessment of the person who is impulsively aggressive, and determine whether there are steps in the cognitive processing of social information which may be contributing to their aggressive behaviors. Subsequently, one can imagine that it is possible to plan if-then-type strategies for the step that is in question. Given that erroneous cognitive processing related to impulsive aggression mostly concerns the first steps in SIP [116, 117], the following discussion will be applied to the encoding, interpreting, and goal selecting processes.
Imagine the following social situation: you are at work and you receive a comment from one of your colleagues about your work. Based on an ICT model of intervention, this (or a similar situation) could make use of computer tasks during the training phase. At the level of the encoding step, the task could be similar to a dot-probe task [125], which is often used in research to measure attentional biases toward hostile cues in an aggressive person. The task is to present a pair of faces (both hostile and neutral) above and below a central point, which is followed by an arrow that points to the right or left in the upper or lower part of the screen. After viewing the presented cue, the person must indicate as quickly as possible in which direction the arrow was pointing. A hostile attentional bias is characterized by a shorter reaction time for arrows that appear where an angry face was presented, as compared to where a neutral face was presented. With the help of implementation intentions, a person might want to develop an if-then plan to encode more non-hostile cues into a situation where they receive feedback from a colleague. This plan would aim to create a new association between “a colleague made a comment about my work” and the attention directed toward non-hostile cues, such as “my colleague’s facial expression.” More specifically, during the training with the dot-probe task, the implementation intentions would aim at encoding non-hostile faces such as, “When the pair of faces appears on the screen, I will only pay attention to the neutral face.” Such training could be generalized thereafter to real-life situations (e.g., “When my colleague makes a comment about my work, I will try to pay attention to his facial expression and see if he is actually criticizing me”).
At the level of interpretation, the task could be an adaption of the “Hostile Expectancy Violation Paradigm” [126, 127], which involves a written scenario containing initial sentences that are used to establish a hostile versus non-hostile context, during which a character simultaneously commits an ambiguous behavior directed at the reader. These sentences are then followed with a third sentence that ends with a word informing the reader of the nature of the character’s underlying intention for his or her behavior. The person would then be asked to guess the intention of the character before the presentation of the last word. Following a non-hostile context, a hostile interpretation of the character’s ambiguous behavior would indicate a hostile attributional bias. With the help of implementation intentions, a person might want to develop a plan in order to interpret a colleague’s comment about their work in a non-hostile manner. More specifically, during the training with the Hostile Expectancy Violation Paradigm, the implementation intentions would aim at interpreting non-hostile intention behind behaviors such as “When I read the intention sentence in which the last word reveals the intention of the character, I will think about a word that refers to a non-hostile intention”. Again, such a training could be generalized thereafter to real-life situations (e.g., “When my colleague makes a comment about my work, I will try to think that my colleague did not make the comment with malicious intent”).
Finally, in terms of goal selection and the emotions that accompany it, one can imagine that ideally, the plan is that the person does not act aggressively before the negative emotion has lessened. With the help of implementation intentions, a person might want to develop a plan to stop an impulsive behavior while experiencing a strong negative emotion. More specifically, during the training with the Hostile Expectancy Violation Paradigm (or other similar scenarios whereby a person could be asked to imagine his or her emotional response following a social provocation), the implementation intentions would aim to execute alternative behaviors to anger outbursts, such as “When I read the social provocation and I imagine that I feel anger toward the character, I will stop my reaction, breathe deeply and assess my level of anger. I will continue breathing or leave the place if my anger is still high.” Again, such training could be generalized to real-life situations (e.g., “When my colleague makes a comment about my work, I will stop my reaction, breathe, assess my anger on a scale, and then wait until my anger has diminished before responding to my colleague”).
We end this section with interventions that target the cognitive structures of aggressive individuals. We believe that only positive interactions with others or mid- to long-term psychotherapy can gradually change these relatively stable cognitive structures. In addition to cognitive therapy [128], several psychotherapy approaches have been proven effective in helping aggressive persons via the transformation of their mental structures. In order to prevent an impulsive behavioral response to an unconditioned experienced emotion, some interventions are designed to help individuals with mental elaboration (symbolization) of the emotional experience instead of acting out the emotion. The mental elaboration of the emotional experience makes the experience more tolerable and facilitates the development of more complex cognitive structures [129]. Other approaches aim to make individuals aware of their inner relational world, which influences their perceptions of people and the way they feel and relate to them [130]. When considering all the factors that are at play in an individual’s mental life, we discover a multitude of social motivations that can contribute to acts of aggression, as well as psychological issues that may be associated with these behaviors [131]. A better self-awareness of these motivations and psychological issues could help aggressive persons transform their social cognitive structures. Finally, it is recommended that these interventions be accompanied by the development of positive relationships in real life. Marriage, family, or interpersonal therapies can support this goal, and new positive social interactions and relationships are expected to help change existing maladaptive hostile cognitive structures.
We have demonstrated the importance of social determinants in the development of hostile cognitive structures and the lack of inhibition in children. We have also demonstrated the cerebral connectivity underlying aggression in adults and its influence on the processing of social information. This has prompted us to want to adapt ICT and incorporate social cognition into its scope, which has thus far remained limited to the domain of motor control. We have proposed that implementation intentions strategy represents an intervention that is promising in achieving this goal. We believe that ICT adapted to the social field represents a promising therapeutic avenue to help people who suffer from impulsive aggression. However, this chapter is only a first step in this direction. We hope that this chapter can shed light on the issue of ICT in the treatment of impulsive aggression, and that it can stimulate both a theoretical debate and the realization of empirical study on the effectiveness of ICT in the treatment of impulsive aggression. On a daily basis, humans are in continual interaction with each other. There is little doubt that society would greatly benefit from interventions that are based on a better understanding of how internal knowledge structures serve as cognitive control mechanisms that perpetuate a cycle of impulsively aggressive behaviors.
If you are associated with any of the institutions in our list below, you can apply to receive OA publication funds by following the instructions provided in the links.
",metaTitle:"List of Institutions by Country",metaDescription:"If you are associated with any of the institutions in our list below, you can apply to receive OA publication funds by following the instructions provided in the links. However, if your research is financed through any of the below-mentioned funders, please consult their Open Access policies or grant ‘terms and conditions’ to explore ways to cover your publication costs (also accessible by clicking on the link in their title).",metaKeywords:null,canonicalURL:"open-access-funding-institutions-list",contentRaw:'[{"type":"htmlEditorComponent","content":"Book Chapters and Monographs
\\n\\nBook Chapters
\\n\\nMonographs Only
\\n\\n\\n\\nBook Chapters and Monographs
\\n\\nMonographs Only
\\n\\nBook Chapters and Monographs
\\n\\n\\n\\nBook Chapters and Monographs
\\n\\n\\n\\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\\n\\nCSIC affiliated authors can also take advantage of a central Open Access fund (amounting to 10,000 EUR) to cover up to 50% of the rest of the OAPF until it expires. Effective for chapters accepted from January 1, 2020.
\\n\\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\\n\\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\\n\\n\\n\\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\\n\\nBook Chapters and Monographs
\\n\\nBook Chapters and Monographs
\\n\\nBook Chapters and Monographs
\\n\\nBook Chapters and Monographs
\\n\\nThe Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\nCorresponding authors will receive a 15% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\\n\\nThe University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\\n\\nThe University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\\n\\nMonographs Only
\\n\\n\\n\\nImportant: You must be a member or grantee of the above listed institutions in order to apply for their Open Access publication funds.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'Book Chapters and Monographs
\n\n\n\nBook Chapters
\n\nMonographs Only
\n\n\n\nBook Chapters and Monographs
\n\nMonographs Only
\n\nBook Chapters and Monographs
\n\n\n\nBook Chapters and Monographs
\n\n\n\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\nCSIC affiliated authors can also take advantage of a central Open Access fund (amounting to 10,000 EUR) to cover up to 50% of the rest of the OAPF until it expires. Effective for chapters accepted from January 1, 2020.
\n\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\n\n\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\nBook Chapters and Monographs
\n\nBook Chapters and Monographs
\n\nBook Chapters and Monographs
\n\n\n\nBook Chapters and Monographs
\n\nThe Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\nCorresponding authors will receive a 15% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\nThe University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\nThe University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\nMonographs Only
\n\n\n\nImportant: You must be a member or grantee of the above listed institutions in order to apply for their Open Access publication funds.
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. Hashim",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/6700/images/1864_n.jpg",biography:"Currently I am carrying out research in several areas of interest, mainly covering work on chemical and bio-sensors, semiconductor thin film device fabrication and characterisation.\nAt the moment I have very strong interest in radiation environmental pollution and bacteriology treatment. The teams of researchers are working very hard to bring novel results in this field. I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/55578/images/4574_n.png",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. His current research interests include the areas of mobile communication systems and channel modeling in addition to atmospheric optical communications, adaptive optics and statistics",institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:5682},{group:"region",caption:"Middle and South America",value:2,count:5165},{group:"region",caption:"Africa",value:3,count:1682},{group:"region",caption:"Asia",value:4,count:10206},{group:"region",caption:"Australia and Oceania",value:5,count:886},{group:"region",caption:"Europe",value:6,count:15610}],offset:12,limit:12,total:117097},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{sort:"dateendthirdsteppublish"},books:[],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:9},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:18},{group:"topic",caption:"Business, Management and Economics",value:7,count:2},{group:"topic",caption:"Chemistry",value:8,count:7},{group:"topic",caption:"Computer and Information Science",value:9,count:10},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:5},{group:"topic",caption:"Engineering",value:11,count:14},{group:"topic",caption:"Environmental Sciences",value:12,count:2},{group:"topic",caption:"Immunology and Microbiology",value:13,count:5},{group:"topic",caption:"Materials Science",value:14,count:4},{group:"topic",caption:"Mathematics",value:15,count:1},{group:"topic",caption:"Medicine",value:16,count:60},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:1},{group:"topic",caption:"Neuroscience",value:18,count:1},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:6},{group:"topic",caption:"Physics",value:20,count:2},{group:"topic",caption:"Psychology",value:21,count:3},{group:"topic",caption:"Robotics",value:22,count:1},{group:"topic",caption:"Social Sciences",value:23,count:3},{group:"topic",caption:"Technology",value:24,count:1},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:2}],offset:0,limit:12,total:null},popularBooks:{featuredBooks:[{type:"book",id:"9208",title:"Welding",subtitle:"Modern Topics",isOpenForSubmission:!1,hash:"7d6be076ccf3a3f8bd2ca52d86d4506b",slug:"welding-modern-topics",bookSignature:"Sadek Crisóstomo Absi Alfaro, Wojciech Borek and Błażej Tomiczek",coverURL:"https://cdn.intechopen.com/books/images_new/9208.jpg",editors:[{id:"65292",title:"Prof.",name:"Sadek Crisostomo Absi",middleName:"C. Absi",surname:"Alfaro",slug:"sadek-crisostomo-absi-alfaro",fullName:"Sadek Crisostomo Absi Alfaro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9139",title:"Topics in Primary Care Medicine",subtitle:null,isOpenForSubmission:!1,hash:"ea774a4d4c1179da92a782e0ae9cde92",slug:"topics-in-primary-care-medicine",bookSignature:"Thomas F. Heston",coverURL:"https://cdn.intechopen.com/books/images_new/9139.jpg",editors:[{id:"217926",title:"Dr.",name:"Thomas F.",middleName:null,surname:"Heston",slug:"thomas-f.-heston",fullName:"Thomas F. Heston"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8697",title:"Virtual Reality and Its Application in Education",subtitle:null,isOpenForSubmission:!1,hash:"ee01b5e387ba0062c6b0d1e9227bda05",slug:"virtual-reality-and-its-application-in-education",bookSignature:"Dragan Cvetković",coverURL:"https://cdn.intechopen.com/books/images_new/8697.jpg",editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9785",title:"Endometriosis",subtitle:null,isOpenForSubmission:!1,hash:"f457ca61f29cf7e8bc191732c50bb0ce",slug:"endometriosis",bookSignature:"Courtney Marsh",coverURL:"https://cdn.intechopen.com/books/images_new/9785.jpg",editors:[{id:"255491",title:"Dr.",name:"Courtney",middleName:null,surname:"Marsh",slug:"courtney-marsh",fullName:"Courtney Marsh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9343",title:"Trace Metals in the Environment",subtitle:"New Approaches and Recent Advances",isOpenForSubmission:!1,hash:"ae07e345bc2ce1ebbda9f70c5cd12141",slug:"trace-metals-in-the-environment-new-approaches-and-recent-advances",bookSignature:"Mario Alfonso Murillo-Tovar, Hugo Saldarriaga-Noreña and Agnieszka Saeid",coverURL:"https://cdn.intechopen.com/books/images_new/9343.jpg",editors:[{id:"255959",title:"Dr.",name:"Mario Alfonso",middleName:null,surname:"Murillo-Tovar",slug:"mario-alfonso-murillo-tovar",fullName:"Mario Alfonso Murillo-Tovar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7831",title:"Sustainability in Urban Planning and Design",subtitle:null,isOpenForSubmission:!1,hash:"c924420492c8c2c9751e178d025f4066",slug:"sustainability-in-urban-planning-and-design",bookSignature:"Amjad Almusaed, Asaad Almssad and Linh Truong - Hong",coverURL:"https://cdn.intechopen.com/books/images_new/7831.jpg",editors:[{id:"110471",title:"Dr.",name:"Amjad",middleName:"Zaki",surname:"Almusaed",slug:"amjad-almusaed",fullName:"Amjad Almusaed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8468",title:"Sheep Farming",subtitle:"An Approach to Feed, Growth and Sanity",isOpenForSubmission:!1,hash:"838f08594850bc04aa14ec873ed1b96f",slug:"sheep-farming-an-approach-to-feed-growth-and-sanity",bookSignature:"António Monteiro",coverURL:"https://cdn.intechopen.com/books/images_new/8468.jpg",editors:[{id:"190314",title:"Prof.",name:"António",middleName:"Cardoso",surname:"Monteiro",slug:"antonio-monteiro",fullName:"António Monteiro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8816",title:"Financial Crises",subtitle:"A Selection of Readings",isOpenForSubmission:!1,hash:"6f2f49fb903656e4e54280c79fabd10c",slug:"financial-crises-a-selection-of-readings",bookSignature:"Stelios Markoulis",coverURL:"https://cdn.intechopen.com/books/images_new/8816.jpg",editors:[{id:"237863",title:"Dr.",name:"Stelios",middleName:null,surname:"Markoulis",slug:"stelios-markoulis",fullName:"Stelios Markoulis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9376",title:"Contemporary Developments and Perspectives in International Health Security",subtitle:"Volume 1",isOpenForSubmission:!1,hash:"b9a00b84cd04aae458fb1d6c65795601",slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-1",bookSignature:"Stanislaw P. Stawicki, Michael S. Firstenberg, Sagar C. Galwankar, Ricardo Izurieta and Thomas Papadimos",coverURL:"https://cdn.intechopen.com/books/images_new/9376.jpg",editors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7769",title:"Medical Isotopes",subtitle:null,isOpenForSubmission:!1,hash:"f8d3c5a6c9a42398e56b4e82264753f7",slug:"medical-isotopes",bookSignature:"Syed Ali Raza Naqvi and Muhammad Babar Imrani",coverURL:"https://cdn.intechopen.com/books/images_new/7769.jpg",editors:[{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9279",title:"Concepts, Applications and Emerging Opportunities in Industrial Engineering",subtitle:null,isOpenForSubmission:!1,hash:"9bfa87f9b627a5468b7c1e30b0eea07a",slug:"concepts-applications-and-emerging-opportunities-in-industrial-engineering",bookSignature:"Gary Moynihan",coverURL:"https://cdn.intechopen.com/books/images_new/9279.jpg",editors:[{id:"16974",title:"Dr.",name:"Gary",middleName:null,surname:"Moynihan",slug:"gary-moynihan",fullName:"Gary Moynihan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7807",title:"A Closer Look at Organizational Culture in Action",subtitle:null,isOpenForSubmission:!1,hash:"05c608b9271cc2bc711f4b28748b247b",slug:"a-closer-look-at-organizational-culture-in-action",bookSignature:"Süleyman Davut Göker",coverURL:"https://cdn.intechopen.com/books/images_new/7807.jpg",editors:[{id:"190035",title:"Associate Prof.",name:"Süleyman Davut",middleName:null,surname:"Göker",slug:"suleyman-davut-goker",fullName:"Süleyman Davut Göker"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:5131},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"9208",title:"Welding",subtitle:"Modern Topics",isOpenForSubmission:!1,hash:"7d6be076ccf3a3f8bd2ca52d86d4506b",slug:"welding-modern-topics",bookSignature:"Sadek Crisóstomo Absi Alfaro, Wojciech Borek and Błażej Tomiczek",coverURL:"https://cdn.intechopen.com/books/images_new/9208.jpg",editors:[{id:"65292",title:"Prof.",name:"Sadek Crisostomo Absi",middleName:"C. Absi",surname:"Alfaro",slug:"sadek-crisostomo-absi-alfaro",fullName:"Sadek Crisostomo Absi Alfaro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9139",title:"Topics in Primary Care Medicine",subtitle:null,isOpenForSubmission:!1,hash:"ea774a4d4c1179da92a782e0ae9cde92",slug:"topics-in-primary-care-medicine",bookSignature:"Thomas F. Heston",coverURL:"https://cdn.intechopen.com/books/images_new/9139.jpg",editors:[{id:"217926",title:"Dr.",name:"Thomas F.",middleName:null,surname:"Heston",slug:"thomas-f.-heston",fullName:"Thomas F. Heston"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8697",title:"Virtual Reality and Its Application in Education",subtitle:null,isOpenForSubmission:!1,hash:"ee01b5e387ba0062c6b0d1e9227bda05",slug:"virtual-reality-and-its-application-in-education",bookSignature:"Dragan Cvetković",coverURL:"https://cdn.intechopen.com/books/images_new/8697.jpg",editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9785",title:"Endometriosis",subtitle:null,isOpenForSubmission:!1,hash:"f457ca61f29cf7e8bc191732c50bb0ce",slug:"endometriosis",bookSignature:"Courtney Marsh",coverURL:"https://cdn.intechopen.com/books/images_new/9785.jpg",editors:[{id:"255491",title:"Dr.",name:"Courtney",middleName:null,surname:"Marsh",slug:"courtney-marsh",fullName:"Courtney Marsh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9343",title:"Trace Metals in the Environment",subtitle:"New Approaches and Recent Advances",isOpenForSubmission:!1,hash:"ae07e345bc2ce1ebbda9f70c5cd12141",slug:"trace-metals-in-the-environment-new-approaches-and-recent-advances",bookSignature:"Mario Alfonso Murillo-Tovar, Hugo Saldarriaga-Noreña and Agnieszka Saeid",coverURL:"https://cdn.intechopen.com/books/images_new/9343.jpg",editors:[{id:"255959",title:"Dr.",name:"Mario Alfonso",middleName:null,surname:"Murillo-Tovar",slug:"mario-alfonso-murillo-tovar",fullName:"Mario Alfonso Murillo-Tovar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8468",title:"Sheep Farming",subtitle:"An Approach to Feed, Growth and Sanity",isOpenForSubmission:!1,hash:"838f08594850bc04aa14ec873ed1b96f",slug:"sheep-farming-an-approach-to-feed-growth-and-sanity",bookSignature:"António Monteiro",coverURL:"https://cdn.intechopen.com/books/images_new/8468.jpg",editors:[{id:"190314",title:"Prof.",name:"António",middleName:"Cardoso",surname:"Monteiro",slug:"antonio-monteiro",fullName:"António Monteiro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8816",title:"Financial Crises",subtitle:"A Selection of Readings",isOpenForSubmission:!1,hash:"6f2f49fb903656e4e54280c79fabd10c",slug:"financial-crises-a-selection-of-readings",bookSignature:"Stelios Markoulis",coverURL:"https://cdn.intechopen.com/books/images_new/8816.jpg",editors:[{id:"237863",title:"Dr.",name:"Stelios",middleName:null,surname:"Markoulis",slug:"stelios-markoulis",fullName:"Stelios Markoulis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7831",title:"Sustainability in Urban Planning and Design",subtitle:null,isOpenForSubmission:!1,hash:"c924420492c8c2c9751e178d025f4066",slug:"sustainability-in-urban-planning-and-design",bookSignature:"Amjad Almusaed, Asaad Almssad and Linh Truong - Hong",coverURL:"https://cdn.intechopen.com/books/images_new/7831.jpg",editors:[{id:"110471",title:"Dr.",name:"Amjad",middleName:"Zaki",surname:"Almusaed",slug:"amjad-almusaed",fullName:"Amjad Almusaed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9376",title:"Contemporary Developments and Perspectives in International Health Security",subtitle:"Volume 1",isOpenForSubmission:!1,hash:"b9a00b84cd04aae458fb1d6c65795601",slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-1",bookSignature:"Stanislaw P. Stawicki, Michael S. Firstenberg, Sagar C. Galwankar, Ricardo Izurieta and Thomas Papadimos",coverURL:"https://cdn.intechopen.com/books/images_new/9376.jpg",editors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7769",title:"Medical Isotopes",subtitle:null,isOpenForSubmission:!1,hash:"f8d3c5a6c9a42398e56b4e82264753f7",slug:"medical-isotopes",bookSignature:"Syed Ali Raza Naqvi and Muhammad Babar Imrani",coverURL:"https://cdn.intechopen.com/books/images_new/7769.jpg",editors:[{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"8468",title:"Sheep Farming",subtitle:"An Approach to Feed, Growth and Health",isOpenForSubmission:!1,hash:"838f08594850bc04aa14ec873ed1b96f",slug:"sheep-farming-an-approach-to-feed-growth-and-health",bookSignature:"António Monteiro",coverURL:"https://cdn.intechopen.com/books/images_new/8468.jpg",editedByType:"Edited by",editors:[{id:"190314",title:"Prof.",name:"António",middleName:"Cardoso",surname:"Monteiro",slug:"antonio-monteiro",fullName:"António Monteiro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9523",title:"Oral and Maxillofacial Surgery",subtitle:null,isOpenForSubmission:!1,hash:"5eb6ec2db961a6c8965d11180a58d5c1",slug:"oral-and-maxillofacial-surgery",bookSignature:"Gokul Sridharan",coverURL:"https://cdn.intechopen.com/books/images_new/9523.jpg",editedByType:"Edited by",editors:[{id:"82453",title:"Dr.",name:"Gokul",middleName:null,surname:"Sridharan",slug:"gokul-sridharan",fullName:"Gokul Sridharan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9785",title:"Endometriosis",subtitle:null,isOpenForSubmission:!1,hash:"f457ca61f29cf7e8bc191732c50bb0ce",slug:"endometriosis",bookSignature:"Courtney Marsh",coverURL:"https://cdn.intechopen.com/books/images_new/9785.jpg",editedByType:"Edited by",editors:[{id:"255491",title:"Dr.",name:"Courtney",middleName:null,surname:"Marsh",slug:"courtney-marsh",fullName:"Courtney Marsh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9018",title:"Some RNA Viruses",subtitle:null,isOpenForSubmission:!1,hash:"a5cae846dbe3692495fc4add2f60fd84",slug:"some-rna-viruses",bookSignature:"Yogendra Shah and Eltayb Abuelzein",coverURL:"https://cdn.intechopen.com/books/images_new/9018.jpg",editedByType:"Edited by",editors:[{id:"278914",title:"Ph.D.",name:"Yogendra",middleName:null,surname:"Shah",slug:"yogendra-shah",fullName:"Yogendra Shah"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8816",title:"Financial Crises",subtitle:"A Selection of Readings",isOpenForSubmission:!1,hash:"6f2f49fb903656e4e54280c79fabd10c",slug:"financial-crises-a-selection-of-readings",bookSignature:"Stelios Markoulis",coverURL:"https://cdn.intechopen.com/books/images_new/8816.jpg",editedByType:"Edited by",editors:[{id:"237863",title:"Dr.",name:"Stelios",middleName:null,surname:"Markoulis",slug:"stelios-markoulis",fullName:"Stelios Markoulis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9585",title:"Advances in Complex Valvular Disease",subtitle:null,isOpenForSubmission:!1,hash:"ef64f11e211621ecfe69c46e60e7ca3d",slug:"advances-in-complex-valvular-disease",bookSignature:"Michael S. Firstenberg and Imran Khan",coverURL:"https://cdn.intechopen.com/books/images_new/9585.jpg",editedByType:"Edited by",editors:[{id:"64343",title:null,name:"Michael S.",middleName:"S",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10150",title:"Smart Manufacturing",subtitle:"When Artificial Intelligence Meets the Internet of Things",isOpenForSubmission:!1,hash:"87004a19de13702d042f8ff96d454698",slug:"smart-manufacturing-when-artificial-intelligence-meets-the-internet-of-things",bookSignature:"Tan Yen Kheng",coverURL:"https://cdn.intechopen.com/books/images_new/10150.jpg",editedByType:"Edited by",editors:[{id:"78857",title:"Dr.",name:"Tan Yen",middleName:null,surname:"Kheng",slug:"tan-yen-kheng",fullName:"Tan Yen Kheng"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9386",title:"Direct Numerical Simulations",subtitle:"An Introduction and Applications",isOpenForSubmission:!1,hash:"158a3a0fdba295d21ff23326f5a072d5",slug:"direct-numerical-simulations-an-introduction-and-applications",bookSignature:"Srinivasa Rao",coverURL:"https://cdn.intechopen.com/books/images_new/9386.jpg",editedByType:"Edited by",editors:[{id:"6897",title:"Dr.",name:"Srinivasa",middleName:"P",surname:"Rao",slug:"srinivasa-rao",fullName:"Srinivasa Rao"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9139",title:"Topics in Primary Care Medicine",subtitle:null,isOpenForSubmission:!1,hash:"ea774a4d4c1179da92a782e0ae9cde92",slug:"topics-in-primary-care-medicine",bookSignature:"Thomas F. Heston",coverURL:"https://cdn.intechopen.com/books/images_new/9139.jpg",editedByType:"Edited by",editors:[{id:"217926",title:"Dr.",name:"Thomas F.",middleName:null,surname:"Heston",slug:"thomas-f.-heston",fullName:"Thomas F. Heston"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9208",title:"Welding",subtitle:"Modern Topics",isOpenForSubmission:!1,hash:"7d6be076ccf3a3f8bd2ca52d86d4506b",slug:"welding-modern-topics",bookSignature:"Sadek Crisóstomo Absi Alfaro, Wojciech Borek and Błażej Tomiczek",coverURL:"https://cdn.intechopen.com/books/images_new/9208.jpg",editedByType:"Edited by",editors:[{id:"65292",title:"Prof.",name:"Sadek Crisostomo Absi",middleName:"C. Absi",surname:"Alfaro",slug:"sadek-crisostomo-absi-alfaro",fullName:"Sadek Crisostomo Absi Alfaro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"577",title:"Educational Technology",slug:"information-and-knowledge-engineering-educational-technology",parent:{title:"Information and Knowledge Engineering",slug:"information-and-knowledge-engineering"},numberOfBooks:11,numberOfAuthorsAndEditors:182,numberOfWosCitations:128,numberOfCrossrefCitations:171,numberOfDimensionsCitations:286,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicSlug:"information-and-knowledge-engineering-educational-technology",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"4792",title:"E-Learning",subtitle:"Instructional Design, Organizational Strategy and Management",isOpenForSubmission:!1,hash:"09c4d63ffc09c72a13ab15b442a9c2b6",slug:"e-learning-instructional-design-organizational-strategy-and-management",bookSignature:"Boyka Gradinarova",coverURL:"https://cdn.intechopen.com/books/images_new/4792.jpg",editedByType:"Edited by",editors:[{id:"78424",title:"Dr.",name:"Boyka",middleName:null,surname:"Gradinarova",slug:"boyka-gradinarova",fullName:"Boyka Gradinarova"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2131",title:"eLearning",subtitle:"Theories, Design, Software and Applications",isOpenForSubmission:!1,hash:"3908775b3500496d9370ea1dd2aa97cb",slug:"elearning-theories-design-software-and-applications",bookSignature:"Patrizia Ghislandi",coverURL:"https://cdn.intechopen.com/books/images_new/2131.jpg",editedByType:"Edited by",editors:[{id:"82445",title:"Prof.",name:"Patrizia",middleName:"Maria Margherita",surname:"Ghislandi",slug:"patrizia-ghislandi",fullName:"Patrizia Ghislandi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2058",title:"E-Learning",subtitle:"Long-Distance and Lifelong Perspectives",isOpenForSubmission:!1,hash:"e3d8574297352f8aaed548a230793d19",slug:"e-learning-long-distance-and-lifelong-perspectives",bookSignature:"Elvis Pontes, Anderson Silva, Adilson Guelfi and Sergio Takeo Kofuji",coverURL:"https://cdn.intechopen.com/books/images_new/2058.jpg",editedByType:"Edited by",editors:[{id:"51858",title:"MSc",name:"Elvis",middleName:null,surname:"Pontes",slug:"elvis-pontes",fullName:"Elvis Pontes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2059",title:"E-Learning",subtitle:"Engineering, On-Job Training and Interactive Teaching",isOpenForSubmission:!1,hash:"b674f8552bb902d54b4052dc1f8a7329",slug:"e-learning-engineering-on-job-training-and-interactive-teaching",bookSignature:"Anderson Silva, Elvis Pontes, Adilson Guelfi and Sergio Takeo Kofuji",coverURL:"https://cdn.intechopen.com/books/images_new/2059.jpg",editedByType:"Edited by",editors:[{id:"51860",title:"Dr.",name:"Sergio",middleName:null,surname:"Kofuji",slug:"sergio-kofuji",fullName:"Sergio Kofuji"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2057",title:"E-Learning",subtitle:"Organizational Infrastructure and Tools for Specific Areas",isOpenForSubmission:!1,hash:"6800611ad5f36c76151e3b01e451ee3d",slug:"e-learning-organizational-infrastructure-and-tools-for-specific-areas",bookSignature:"Elvis Pontes, Anderson Silva, Adilson Guelfi and Sergio Takeo Kofuji",coverURL:"https://cdn.intechopen.com/books/images_new/2057.jpg",editedByType:"Edited by",editors:[{id:"95914",title:"Prof.",name:"Adilson",middleName:"Eduardo",surname:"Guelfi",slug:"adilson-guelfi",fullName:"Adilson Guelfi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"603",title:"Methodologies, Tools and New Developments for E-Learning",subtitle:null,isOpenForSubmission:!1,hash:"d264034a8e51ed0f264b4c935b115c81",slug:"methodologies-tools-and-new-developments-for-e-learning",bookSignature:"Elvis Pontes, Anderson Silva, Adilson Guelfi and Sérgio Takeo Kofuji",coverURL:"https://cdn.intechopen.com/books/images_new/603.jpg",editedByType:"Edited by",editors:[{id:"51858",title:"MSc",name:"Elvis",middleName:null,surname:"Pontes",slug:"elvis-pontes",fullName:"Elvis Pontes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"76",title:"Digital Libraries",subtitle:"Methods and Applications",isOpenForSubmission:!1,hash:"683699486ceb61d26610104f47184608",slug:"digital-libraries-methods-and-applications",bookSignature:"Kuo Hung Huang",coverURL:"https://cdn.intechopen.com/books/images_new/76.jpg",editedByType:"Edited by",editors:[{id:"21382",title:"Dr.",name:"Kuo Hung",middleName:null,surname:"Huang",slug:"kuo-hung-huang",fullName:"Kuo Hung Huang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3651",title:"E-learning",subtitle:"Experiences and Future",isOpenForSubmission:!1,hash:null,slug:"e-learning-experiences-and-future",bookSignature:"Safeeullah Soomro",coverURL:"https://cdn.intechopen.com/books/images_new/3651.jpg",editedByType:"Edited by",editors:[{id:"951",title:"Dr.",name:"Safeeullah",middleName:null,surname:"Soomro",slug:"safeeullah-soomro",fullName:"Safeeullah Soomro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3715",title:"E-learning",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"e-learning",bookSignature:"Marina Buzzi",coverURL:"https://cdn.intechopen.com/books/images_new/3715.jpg",editedByType:"Edited by",editors:[{id:"887",title:"Dr.",name:"Marina",middleName:null,surname:"Buzzi",slug:"marina-buzzi",fullName:"Marina Buzzi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3702",title:"Advances in Learning Processes",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"advances-in-learning-processes",bookSignature:"Mary Beth Rosson",coverURL:"https://cdn.intechopen.com/books/images_new/3702.jpg",editedByType:"Edited by",editors:[{id:"3280",title:"Dr.",name:"Mary Beth",middleName:null,surname:"Rosson",slug:"mary-beth-rosson",fullName:"Mary Beth Rosson"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3613",title:"Advanced Learning",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"advanced-learning",bookSignature:"Raquel Hijon-Neira",coverURL:"https://cdn.intechopen.com/books/images_new/3613.jpg",editedByType:"Edited by",editors:[{id:"1267",title:"Assistant Professor",name:"Raquel",middleName:null,surname:"Hijon-Neira",slug:"raquel-hijon-neira",fullName:"Raquel Hijon-Neira"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:11,mostCitedChapters:[{id:"10056",doi:"10.5772/8803",title:"Virtual Patients as a Practical Realisation of the E-learning Idea in Medicine",slug:"virtual-patients-as-a-practical-realisation-of-the-e-learning-idea-in-medicine",totalDownloads:3989,totalCrossrefCites:6,totalDimensionsCites:21,book:{slug:"e-learning-experiences-and-future",title:"E-learning",fullTitle:"E-learning Experiences and Future"},signatures:"Andrzej A. Kononowicz and Inga Hege",authors:null},{id:"28695",doi:"10.5772/28682",title:"Factors that Influence Academic Teacher's Acceptance of E-Learning Technology in Blended Learning Environment",slug:"factors-that-influence-academic-teacher-s-acceptance-of-e-learning-technology-in-blended-learning-en",totalDownloads:2750,totalCrossrefCites:15,totalDimensionsCites:19,book:{slug:"e-learning-organizational-infrastructure-and-tools-for-specific-areas",title:"E-Learning",fullTitle:"E-Learning - Organizational Infrastructure and Tools for Specific Areas"},signatures:"Snježana Babić",authors:[{id:"74969",title:"BSc.",name:"Snježana",middleName:null,surname:"Babić",slug:"snjezana-babic",fullName:"Snježana Babić"}]},{id:"10052",doi:"10.5772/8799",title:"E-Learning Indicators: A Multidimensional Model For Planning Developing And Evaluating E-Learning Software Solutions",slug:"e-learning-indicators-a-multidimensional-model-for-planning-developing-and-evaluating-e-learning-sof",totalDownloads:2205,totalCrossrefCites:4,totalDimensionsCites:11,book:{slug:"e-learning-experiences-and-future",title:"E-learning",fullTitle:"E-learning Experiences and Future"},signatures:"Bekim Fetaji and Majlinda Fetaji",authors:null}],mostDownloadedChaptersLast30Days:[{id:"48924",title:"Effective eLearning and eTeaching — A Theoretical Model",slug:"effective-elearning-and-eteaching-a-theoretical-model",totalDownloads:1782,totalCrossrefCites:3,totalDimensionsCites:3,book:{slug:"e-learning-instructional-design-organizational-strategy-and-management",title:"E-Learning",fullTitle:"E-Learning - Instructional Design, Organizational Strategy and Management"},signatures:"Maureen Snow Andrade",authors:[{id:"96902",title:"Dr.",name:"Maureen",middleName:null,surname:"Snow Andrade",slug:"maureen-snow-andrade",fullName:"Maureen Snow Andrade"}]},{id:"49215",title:"Model for Blended Supervision of Post-Graduate Students",slug:"model-for-blended-supervision-of-post-graduate-students",totalDownloads:1255,totalCrossrefCites:2,totalDimensionsCites:2,book:{slug:"e-learning-instructional-design-organizational-strategy-and-management",title:"E-Learning",fullTitle:"E-Learning - Instructional Design, Organizational Strategy and Management"},signatures:"Mildred Atieno Ayere",authors:[{id:"75897",title:"Dr.",name:"Mildred",middleName:"Atieno",surname:"Ayere",slug:"mildred-ayere",fullName:"Mildred Ayere"}]},{id:"48703",title:"Improving E-Learning in SMEs through Cloud Computing and Scenarios",slug:"improving-e-learning-in-smes-through-cloud-computing-and-scenarios",totalDownloads:1246,totalCrossrefCites:3,totalDimensionsCites:6,book:{slug:"e-learning-instructional-design-organizational-strategy-and-management",title:"E-Learning",fullTitle:"E-Learning - Instructional Design, Organizational Strategy and Management"},signatures:"Ileana Hamburg",authors:[{id:"80248",title:"Dr.",name:"Ileana",middleName:null,surname:"Hamburg",slug:"ileana-hamburg",fullName:"Ileana Hamburg"}]},{id:"48788",title:"Study of the Assessment Criteria on e-Learning Websites",slug:"study-of-the-assessment-criteria-on-e-learning-websites",totalDownloads:762,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"e-learning-instructional-design-organizational-strategy-and-management",title:"E-Learning",fullTitle:"E-Learning - Instructional Design, Organizational Strategy and Management"},signatures:"Kuei-Chih K.C. Chuang and Mei Chuan Tsai",authors:[{id:"175303",title:"Dr.",name:"Kueichih",middleName:null,surname:"Chuang",slug:"kueichih-chuang",fullName:"Kueichih Chuang"}]},{id:"28704",title:"E-Learning in Architecture: Professional and Lifelong Learning Prospects",slug:"e-learning-in-architecture-professional-and-lifelong-learning-prospects",totalDownloads:3730,totalCrossrefCites:1,totalDimensionsCites:3,book:{slug:"e-learning-organizational-infrastructure-and-tools-for-specific-areas",title:"E-Learning",fullTitle:"E-Learning - Organizational Infrastructure and Tools for Specific Areas"},signatures:"Matevz Juvancic, Michael Mullins and Tadeja Zupancic",authors:[{id:"81550",title:"Dr.",name:"Matevz",middleName:null,surname:"Juvancic",slug:"matevz-juvancic",fullName:"Matevz Juvancic"},{id:"86547",title:"Dr.",name:"Michael",middleName:null,surname:"Mullins",slug:"michael-mullins",fullName:"Michael Mullins"},{id:"86548",title:"Dr.",name:"Tadeja",middleName:null,surname:"Zupancic",slug:"tadeja-zupancic",fullName:"Tadeja Zupancic"}]},{id:"49031",title:"Challenges of Business Simulation Games — A New Approach of Teaching Business",slug:"challenges-of-business-simulation-games-a-new-approach-of-teaching-business",totalDownloads:2066,totalCrossrefCites:0,totalDimensionsCites:1,book:{slug:"e-learning-instructional-design-organizational-strategy-and-management",title:"E-Learning",fullTitle:"E-Learning - Instructional Design, Organizational Strategy and Management"},signatures:"Andrej Jerman Blažič and Franc Novak",authors:[{id:"174975",title:"M.Sc.",name:"Andrej",middleName:null,surname:"Jerman Blažič",slug:"andrej-jerman-blazic",fullName:"Andrej Jerman Blažič"},{id:"175242",title:"Dr.",name:"Borka",middleName:null,surname:"Jerman Blažič",slug:"borka-jerman-blazic",fullName:"Borka Jerman Blažič"}]},{id:"14704",title:"Multitasking Made Easy: Supporting Academic Writing in Digital Libraries with an Ambient Search System",slug:"multitasking-made-easy-supporting-academic-writing-in-digital-libraries-with-an-ambient-search-syste",totalDownloads:1731,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"digital-libraries-methods-and-applications",title:"Digital Libraries",fullTitle:"Digital Libraries - Methods and Applications"},signatures:"Anatoliy Gruzd and Michael B Twidale",authors:[{id:"20686",title:"Dr.",name:"Anatoliy",middleName:null,surname:"Gruzd",slug:"anatoliy-gruzd",fullName:"Anatoliy Gruzd"},{id:"21907",title:"Dr.",name:"Michael B.",middleName:null,surname:"Twidale",slug:"michael-b.-twidale",fullName:"Michael B. Twidale"}]},{id:"49209",title:"Quality of Undergraduate Distance Courses in Brazil — The Points of View of Human Resource Managers from Industrial Organizations",slug:"quality-of-undergraduate-distance-courses-in-brazil-the-points-of-view-of-human-resource-managers-fr",totalDownloads:826,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"e-learning-instructional-design-organizational-strategy-and-management",title:"E-Learning",fullTitle:"E-Learning - Instructional Design, Organizational Strategy and Management"},signatures:"Ana Alice Vilas Boas and Gustavo Henrique Nogueira de Andrade",authors:[{id:"175373",title:"Dr.",name:"Ana Alice",middleName:null,surname:"Vilas Boas",slug:"ana-alice-vilas-boas",fullName:"Ana Alice Vilas Boas"},{id:"175383",title:"MSc.",name:"Gustavo Henrique",middleName:null,surname:"Nogueira De Andrade",slug:"gustavo-henrique-nogueira-de-andrade",fullName:"Gustavo Henrique Nogueira De Andrade"}]},{id:"8610",title:"Managing Relevant Learning Objects' Assessments: the Right Place at the Right Time",slug:"managing-relevant-learning-objects-assessments-the-right-place-at-the-right-time",totalDownloads:1644,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"advanced-learning",title:"Advanced Learning",fullTitle:"Advanced Learning"},signatures:"Olivier Catteau, Philippe Vidal and Julien Broisin",authors:null},{id:"8738",title:"Network of Schools as a Framework to Support E-Learning within Educational Communities",slug:"network-of-schools-as-a-framework-to-support-e-learning-within-educational-communities",totalDownloads:1307,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"advances-in-learning-processes",title:"Advances in Learning Processes",fullTitle:"Advances in Learning Processes"},signatures:"Virginija Limanauskiene, Vytautas Stuikys and Christoph Hornung",authors:null}],onlineFirstChaptersFilter:{topicSlug:"information-and-knowledge-engineering-educational-technology",limit:3,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[{type:"book",id:"10176",title:"Microgrids and Local Energy Systems",subtitle:null,isOpenForSubmission:!0,hash:"c32b4a5351a88f263074b0d0ca813a9c",slug:null,bookSignature:"Prof. Nick Jenkins",coverURL:"https://cdn.intechopen.com/books/images_new/10176.jpg",editedByType:null,editors:[{id:"55219",title:"Prof.",name:"Nick",middleName:null,surname:"Jenkins",slug:"nick-jenkins",fullName:"Nick Jenkins"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:8,limit:8,total:1},route:{name:"profile.detail",path:"/profiles/312386/larisa-kolik",hash:"",query:{},params:{id:"312386",slug:"larisa-kolik"},fullPath:"/profiles/312386/larisa-kolik",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()