",isbn:null,printIsbn:null,pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"f86a9f720cc3ac0f1c385d0367ea89b9",bookSignature:"Dr. Fiaz Ahmad and Prof. Muhammad Sultan",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11624.jpg",keywords:"Agricultural Waste, Reuse, Reduction, Soil Health, Recycling, Agriculture and Environment, Modelling and Simulation, Agro-Industrial Waste, Bioresource Processing, Processing and Management, Crop Residue, Forest Waste",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 8th 2022",dateEndSecondStepPublish:"May 6th 2022",dateEndThirdStepPublish:"July 5th 2022",dateEndFourthStepPublish:"September 23rd 2022",dateEndFifthStepPublish:"November 22nd 2022",remainingDaysToSecondStep:"11 days",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Fiaz Ahmad is a researcher in the field of Agricultural Engineering with fifteen years of field and academic experience, currently in charge of the Agricultural Machinery Design Laboratory at Bahauddin Zakariya University. He applied for two patents at the national level.",coeditorOneBiosketch:"A renowned researcher in the field of Agricultural Engineering with 14 years of academic experience at Bahauddin Zakariya University. Winner of various prestigious fellowships, awards, and research grants. Published 250+ articles along with several books and chapters. Guest editor of seven ISI-SCI journals for publishers like SAGE, MDPI, and Frontiers.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"338219",title:"Dr.",name:"Fiaz",middleName:null,surname:"Ahmad",slug:"fiaz-ahmad",fullName:"Fiaz Ahmad",profilePictureURL:"https://mts.intechopen.com/storage/users/338219/images/system/338219.png",biography:"Dr. Fiaz Ahmad is an assistant professor and lecturer at the Department of Agricultural Engineering, Bahauddin Zakariya University, Multan, Pakistan. He obtained his Ph.D. in Agricultural Bioenvironmental and Energy Engineering from Nanjing Agriculture University, China, in 2015, and completed his postdoctorate in Agricultural Engineering from Jiangsu University, Zhenjiang, China, in 2020. He was awarded a fellowship from the Higher Education Commission of Pakistan for Ph.D. studies and from the Chinese Government for post-doctoral studies. He earned a BSc and MSc (Hons) in Agricultural Engineering from the University of Agriculture, Faisalabad, Pakistan, in 2004 and 2007, respectively. He is the author of more than fifty journal and conference articles. He has supervised six master’s students to date, and is currently supervising six master and two doctoral students. Dr. Ahmad has completed three research projects with his research interest focusing on the design of agricultural machinery, agricultural waste management, artificial intelligence (AI), and agricultural bioenvironment.",institutionString:"Bahauddin Zakariya University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Bahauddin Zakariya University",institutionURL:null,country:{name:"Pakistan"}}}],coeditorOne:{id:"199381",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sultan",slug:"muhammad-sultan",fullName:"Muhammad Sultan",profilePictureURL:"https://mts.intechopen.com/storage/users/199381/images/system/199381.png",biography:"Muhammad Sultan is an Assistant Professor at the Department of Agricultural\r\nEngineering, Bahauddin Zakariya University, Multan (Pakistan). He completed his Ph.D.\r\nand Postdoc from Kyushu University (Japan) in the field of Energy & Environmental\r\nEngineering. He was an awardee of MEXT and JASSO fellowships (from the Japanese\r\nGovernment) during Ph.D. and Postdoc studies, respectively. He also did a Postdoc as\r\na Canadian Queen Elizabeth Advance Scholar at Simon Fraser University (Canada) in\r\nthe field of Mechatronic Systems Engineering. He worked for Kyushu University\r\nInternational Institute for Carbon-Neutral Energy Research (WPI-I2CNER) for two years.\r\nCurrently, he is working on 4 research projects funded by the Higher Education\r\nCommission (HEC) of Pakistan. He has completed six projects in past in the field of\r\nagricultural engineering. He has supervised 10+ M.Eng. and Ph.D. thesis and 10+\r\nstudents are currently working under his supervision. He has published 120+ journal\r\narticles, 100+ conference articles, 13 book chapters, and 6 books. He is serving as guest\r\neditor for the journals like Sustainability (MDPI), Agriculture (MDPI), Energies (MDPI),\r\nAdvances in Mechanical Engineering (SAGE), Frontiers in Mechanical Engineering, and\r\nEvergreen Journal of Kyushu University. His research is focused on developing energy-\r\nefficient temperature and humidity control systems for agricultural storage, greenhouse,\r\nlivestock, and poultry applications. His research keywords include desiccant air-\r\nconditioning, evaporative cooling, adsorption heat pump, Maisotsenko cycle (M-cycle),\r\nenergy recovery ventilators; adsorption desalination; wastewater treatment.",institutionString:"Bahauddin Zakariya University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Bahauddin Zakariya University",institutionURL:null,country:{name:"Pakistan"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"5",title:"Agricultural and Biological Sciences",slug:"agricultural-and-biological-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:null},relatedBooks:[{type:"book",id:"6418",title:"Hyperspectral Imaging in Agriculture, Food and Environment",subtitle:null,isOpenForSubmission:!1,hash:"9005c36534a5dc065577a011aea13d4d",slug:"hyperspectral-imaging-in-agriculture-food-and-environment",bookSignature:"Alejandro Isabel Luna Maldonado, Humberto Rodríguez Fuentes and Juan Antonio Vidales Contreras",coverURL:"https://cdn.intechopen.com/books/images_new/6418.jpg",editedByType:"Edited by",editors:[{id:"105774",title:"Prof.",name:"Alejandro Isabel",surname:"Luna Maldonado",slug:"alejandro-isabel-luna-maldonado",fullName:"Alejandro Isabel Luna Maldonado"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10359",title:"Landraces",subtitle:"Traditional Variety and Natural Breed",isOpenForSubmission:!1,hash:"0600836fb2c422f7b624363d1e854f68",slug:"landraces-traditional-variety-and-natural-breed",bookSignature:"Amr Elkelish",coverURL:"https://cdn.intechopen.com/books/images_new/10359.jpg",editedByType:"Edited by",editors:[{id:"231337",title:"Dr.",name:"Amr",surname:"Elkelish",slug:"amr-elkelish",fullName:"Amr Elkelish"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"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:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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\n
1. Risk management
\n
Formal risk management is extremely important in achieving overall organizational goals and objectives. Risk management involves actions of identifying, analyzing, and controlling risks by organizations. Organizations undertake risk management to maximize opportunities and minimize consequences of events that may arise when implementing activities geared to achieving their goals and objectives. PMI [1] defines project risk management as the processes of conducting risk management planning, identification, analysis, response planning, and controlling risk on a project. Other explanations of risk management are found in the work of Berg [2] and Harry et al. [33]. Berg [2] explains that risk management is a systematic approach to set the best course of action under uncertainty by identifying, assessing, understanding, acting on and communicating risk issues. Harry et al. [33] point out that risk management is a continuous process where the sources of uncertainties are systematically identified, their impact assessed and qualified and their effect and likelihood managed to produce an acceptable balance between the risks and opportunities. Smith [3] explains that although there are inconsistencies between the definitions, there are noted similarities such as: it is a formal process; employs systematic and scientific methods; aims to identify risks in an operation or business; evaluates the importance or impact of those risks on the operation or business; provides mechanisms to control the individual risk to provide an acceptable level of overall exposure; and is not a one-off event. PMI [1] states that the objectives of project risk management are to increase the likelihood and impact of positive events and to decrease the likelihood and impact of negative events in the project. Generally, the risk management process mainly involves risk planning, assessment (identification and analysis), ranking, treatment and monitoring. The risk management process has been expanded by Berg [2], AbouRizk [31] and PMI [1] to include establishing goals and context (i.e., the risk environment) and preparation for risk analysis. Techniques for risk identification, analysis and handling are traced in risk management books and chapters, as well as researches conducted by Cagliano et al. [4], Chinenye et al. [5] and PMI [1]. Techniques for risk identification include but not limited to:
Documentation reviews
Information gathering techniques
Brainstorming
Delphi technique
Interviewing
Root cause analysis
SWOT analysis (strength, weakness, opportunities and threats)
Checklist analysis
\n\n
Techniques for risk analysis both quantitative and qualitative include but not limited to:
Brainstorming
Sensitivity analysis
Monte Carlo
Decision tree analysis
Decision theory
Probability analysis
Delphi technique
Expected monetary value (EMV) analysis
Simulation
SWOT analysis (strength, weakness, opportunities and threats)
Historical data
\n\n
Risk handling techniques normally adopted during risk management are:
Risk avoidance
Risk reduction (mitigation)
Risk transfer (sharing)
Risk retention (acceptance/assumption)
\n\n
In addition, Habib & Rashid [6] present another approach of risk handling techniques used in their study such as shape and mitigate (SMT), shift and allocate (SAT), influence and transfer (ITT) and diversify through portfolio (DTP) which they related to project outcomes. PMI [1] classifies risk handling options into risk strategies for dealing with negative risks or threats and those for dealing positive risks. While strategies for dealing with negative risks remain to be those listed in other studies, strategies for dealing with positives risks are exploit, enhance, share and accept. The use of any of these handling measures depends on the outcome of the analysis and rating of the risk. Qualitative and quantitative analyses determine the probability of occurrence of risk and its potential severity. \nFigure 1\n summarizes a generic risk management process and \nTable 1\n presents severity matrix used by organizations to decide on the handling option to follow.
\n
Figure 1.
Risk management process (adapted from Naphade & Bhangale [30]).
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1.1. Risk framework and risk register
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Recent developments in audit services have led to certain public organizations in Tanzania to develop risk management frameworks and registers. Risk management frameworks and risk registers are the vital tools for an organization to implement risk management activities. The risk management framework is the document that guides the implementation of risk management activity. The risk management framework covers:
Purpose
Objectives
Scope in terms of organizational activities and stakeholders
Risk policy and appetite statements
Roles and responsibilities of various organs, top management and staff in risk management in an organization
Risk management procedures
Templates for risk identification and analysis sheet, risk register, risk treatment schedule and action plan and risk treatment implementation report
\n\n
A risk register is a tool used in the risk management process to keep record of all identified risks and their respective corresponding mitigations or counter measures. It comprises of:
Purpose
Organizational goals and objectives
Risk assessment methodology
Overall risk profile of an organization
Summary of risks
Details of risks in each organization objective
Risk assessment sheets indicating causes, consequences, rating and mitigations measures
\n\n
\n\nTables 2\n, \n3\n, \n4\n, \n5\n show templates of risk identification and analysis sheet, risk register, risk treatment schedule and action plan and risk treatment implementation report adopted by some organizations.
Include title of the person managing the risk and the area where the risk falls
\n
\n
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Supporting owner(s)
\n
Provide title of other persons affected by the risk
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\n
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\nRisk category\n
\n
Is it a financial, technical etc.
\n
\n
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\nObjective/plan\n
\n
List the objective impacted by the risk
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\n
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\nDetails\n
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\nCauses: provide the causes that may lead to the risk materializing
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\nConsequence(s): Provide description of what will happen if the risk will materialize
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Inherent risk analysis (tick the appropriate ratings basing on the scenario that current controls do not exist or completely fail)
\n
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\nInherent risk\n
\n
\nImpact\n
\n
Very high
\n
High
\n
Moderate
\n
Low
\n
Very low
\n
\n
\n
\nLikelihood\n
\n
Very high
\n
High
\n
Moderate
\n
Low
\n
Very low
\n
\n
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\nRisk rating\n
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\nImpact × likelihood\n
\n
□ Multiply the ratings from impact and likelihood. □; Shade this area with appropriate color
\n
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\nKey risk mitigation/controls currently in place and their weaknesses: briefly describe the current controls existing to reduce the inherent risk, also point out the main weaknesses for the current controls.
\n
\n
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\nResidual risk analysis (tick the appropriate ratings basing remaining risk levels after the above existing controls)
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\n
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\nResidual risk\n
\n
\nImpact\n
\n
Very high
\n
High
\n
Moderate
\n
Low
\n
Very low
\n
\n
\n
\nLikelihood:\n
\n
Very high
\n
High
\n
Moderate
\n
Low
\n
Very low
\n
\n
\n
\nRisk rating\n
\n
\nI × L:\n
\n
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□ Multiply the ratings from impact and likelihood. □ Shade this area with appropriate color
\n
\n
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\nActions/mitigating controls to be taken: (propose feasible treatment actions to be put in place to reduce the risk at tolerable levels, including resources required for each treatment action—financial, physical assets or human)
\n
\n
\n
\nTreatment:\n 1. 2. 3.
\n
\nResource required\n 1. 2. 3.
\n
\n\n
Table 2.
Template for risk identification and analysis sheet.
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n\n
\n
Objective
\n
Risk title
\n
Type of risk
\n
Risk ID
\n
Risk assessment
\n
Risk rating
\n
Principal risk owner
\n
\n\n\n
\n
\n
\n
\n
\n
Impact (I)
\n
Likelihood (L)
\n
I × L
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
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\n
\n
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\n
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\n
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\n
\n
\n
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Table 3.
Template for risk register.
\n
\n
\n
\n
\n
\n
\n
\n\n
\n
Date of review: ………………………………. Compiled by: …………………………………… Date: ……………………… Reviewed by: ………………………………… Date: ………………………………………………
\n
\n
\n
Risk title and ID (from risk register in priority order)
Person responsible for implementation of treatment options (as in the risk identification sheet)
\n
Timetable for implementation (give specific start and end dates)
\n
How will this risk and treatment options be monitored
\n
Status of implementation (completed, ongoing, not done)
\n
Remarks and/or comments
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
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Table 5.
Template for risk treatment implementation report section/unit.
\n
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\n
\n
2. Critical success factor (CSFs)
\n
CSFs are selected key result areas that can facilitate achievement of organizational goals and objectives including risk management. CSFs were first defined by Rockart ([35] cited in Chen [7]) as the limited number of area in which results, if they are satisfactory, will ensure successful competitive performance for the organization. Later on, a number of CSFs definitions were given by various researchers. CSFs are certain rules, executive procedures and environmental conditions (Pinto & Covin, [36]). CSFs are the critical areas which organizations must accomplish to achieve its mission by examination and categorization of their impacts (Oakland [37] cited in Salaheldin, [34]). Deros et al. [38] defined CSFs as a range of enablers which, when put into practice, will enhance the chance for successful benchmarking implementation and adoption in an organization.
\n
\n
2.1. Critical success factors for effective risk management
\n
Effective risk management entails doing the right thing with respect to risk management process. Top management needs to embark on CSFs as means of minimizing or eliminating risks in their organizations. Studies worldwide have documented CSFs which serve as a cornerstone for managing risks. For example, Grabowski and Roberts [8] identify the four important factors for risk mitigation that are organizational structuring and design, communication, organizational culture and trust. Hasanali [9] categorizes five critical success factors into: leadership; culture; structure, roles, responsibilities; information technology infrastructure; and measurement. Na Ranong and Phuenngam [10] determined seven CSFs for the financial industry namely: commitment and support from top management, communication, culture, information technology (IT), organization structure, training and trust. Studies of Agyakwa-Baah & Chileshe [11] identified 10 CSFs for the construction industry which are: management style, awareness of risk management process (RMP), cooperative culture, positive human dynamics, customer requirements, goals and strategic objective, impact of environment, usage of tools, teamwork and communication and availability of specialist in risk management. Chileshe and Kikwasi [32] assessed the 10 CSFs and determined that awareness of risk management processes, team work and communications and management style were the top three for Tanzania. Zhao et al. [12] determine top three CSFs as commitment of the board and senior management, risk identification, analysis and response and objective setting. Tsiga et al. [13] reveal initiation, identification, assessment, response planning, response implementation and risk communication and attitude, monitoring and review as CSFs for the construction industry. The study by Renault et al. [14] reveal drivers for ERM implementation namely legal and regulatory compliance requirements, nonmandatory reports, credits rating agencies’ requirements, reduced earnings volatility, reduced cost and losses, increased profitability and earnings. Hosseini et al. [15] determine support from managers, inclusion of risk management in construction education and training courses for construction practitioners, attempting to deliver projects systematically and awareness and knowledge of the process for implementing risk management as factors for implementing risk management systems in developing countries. Chen [7] suggests four composite CSFs for the bank industry namely: bank operation management ability, developing bank trademarks ability, bank marketing ability and financial market. Collectively, CSFs identified in these studies can serve as key result areas which construction enterprises and other stakeholders can bank on to enhance risk management in their locality.
\n
The manner that the chosen CSFs influence the performance of a certain organization or sector has been a subject of discussion in researches conducted worldwide. Commitment and support from top management has been found an important aspect in achievement of organizational goals. For example, Ifinedo [16] investigated the impact of contingency factors such as top management support, business vision and external expertise and established that top management support influences the success level of the organizational system. Similarly, Zwikael [17] argues that the high importance of top management support is considered to be among the CSFs for project management. Renault et al. [14] determine that lack of support from top management and management priorities are among key obstacles to enterprise risk management (ERM). Risk management happens to be a process that an organization has to assume. Awareness of risk management process has been identified by Chileshe and Kikwasi [32] as one of the barriers to adoption and implementation of risk assessment and implementation practices (RAMP). Likewise, Agyakwa-Baah and Chileshe [11] point out that awareness of risk management processes within an organization is paramount to the sound success of the project.
\n
Communication is the backbone of any successful endeavor. Effective communication between the teams that are working on the project will enhance project success including mitigation of risks. Clutterbuck & Hirst [18] argue that communication ensures that the team members understand and support not only where the team is now but also what they want to be. Grabowski & Roberts [8] stress that communication plays an important role in risk mitigation and that provides opportunities for clarification, for making sense of the organization’s progress, and for members to discuss how to improve the organization and the impact of using different risk mitigation strategies. Culture has an influence on how organizations manage risks. This is echoed by Grabowski & Roberts [8] that risk management requires the combination of several cultures that make the system into a cohesive whole in which the deep assumptions and espoused values of each of the member organizations can be built around the need for melding a culture of reliability. Training is important in equipping trainees with knowledge on emerging issues including risk management. Carey [19] points out that the ability to respond to changing conditions in an organization’s operations relates to a range of activities including the development of risk training courses and the involvement of staff in responding to early warning systems. Advancement in technology and changing in clients’ requirements calls for embarking on information technology. Hasanali [9] points out that an organization is on such a large scale that it would be difficult for members to communicate and share information without an information technology infrastructure.
\n
\n
\n
\n
3. A case study: risk management in the construction industry
\n
\n
3.1. Overview of the case study
\n
The construction industry in Tanzania like in many other countries contributes drastically to the national growth through gross domestic product (GDP), gross fixed capital formation, creation of employment and industrial productivity. The National Bureau of Standards (NBS) [20] reveals that in volume terms, the construction industry accounted for an average of 6.8% of GDP in the 2003–2010 periods. The contribution of the industry to gross fixed capital formation in 2011 was over 50% (URT, [39]). In 2016, data indicate the construction sector contribution to GDP was about 12%, the second single sector with highest growth rate preceded by agriculture. The general outlook of the contribution of various sectors of the economy is shown in \nFigure 2\n.
\n
Figure 2.
Contribution of various sectors of the economy to GDP.
\n
Construction being one sector of the economy is prone to risks. These include technical, social, construction, economic, legal, financial, natural, commercial, logistics and political risks. These risks are also classified into internal and external risks. Internal risks emanate from activities performed within the organizations such as technical, social and construction. External risks are risks which originate outside of the organization’s undertakings and these include economic, natural and political risks. Accordingly, the construction industry needs to adopt a sound risk management system to maximize opportunities and minimize negative events in its operations for it to contribute effectively to national growth.
\n
\n
\n
3.2. Risk management in construction
\n
The risk management as part of project management is extremely important in achieving project objectives of time, cost, quality, improved health and safety and no disputes. Changes in technology and more sophisticated clients’ requirements attract more risks in construction projects which call for formal risk management process. Although there have been remarkable efforts toward risk management in construction projects, implementation of risk management process is still inadequate. Studies [5, 21, 22, 23, 24, 25] have documented risk management practice in the construction industry. Akintoye & MacLeod [23] found that risk analysis and management in construction depend mainly on intuition, judgment and experience. They also cited the reasons to be lack of knowledge coupled with doubts on the suitability of these techniques for the construction industry. Ahmed & Azhar [22] established that risk analysis and management techniques are rarely used by the general contractors due to a lack of knowledge and expertise. This is echoed by the study by Chinenye et al. [5] which established that organizations within the construction industry do not work with risk management in such a structured manner due to additional cost to be incurred when performing risk management on construction projects and lack of knowledge in the area of risk management. Mahendra et al. [25] determined that the participants used to handle the risks with an informal approach because of less knowledge and awareness among the construction industry stakeholders. Similarly, Abdul-Rahman et al. [21] found that the implementation of risk management process in Malaysian construction industry is still at a low level, due to the fact that most of the construction employees involved in risk management are not fully aware of the available risk management techniques that can be applied in construction projects. Kikwasi [24] also noted inadequate risk management knowldege among consultants and determines that most consultants use document reviews and assumptions to identify risks and contingency sum method to quantify risks. A survey by Yusuwan et al. [26] also reveals low level of awareness of risk management in the clients’ organization and that they have implemented risk management in their operations on a small scale.
\n
Previous studies in the construction industry reveal poor implementation of risk management process, as well as CSFs for effective risk management. This calls for the need to review the impact of risk management on project outcomes, assessment of implementation of previously identified CSFs and determination of a new set of CSFs.
\n
\n
\n
3.3. Methodology
\n
The study drawn a sample of 200 practitioners from the construction industry comprised of consultants, clients and contractors. The study adopted a descriptive research type that attempts to provide an insight on categories of CSFs that can enhance effective risk management in the construction industry. Data were collected using literature review and questionnaires. Two hundred questionnaires were distributed to randomly selected respondents through emails and hand delivery. Out of 200 distributed questionnaires, 100 were returned, out of which 67 were fairly filled for analysis equating to a response rate of 33.5%. A list of critical success factors for effective risk management used in the study was extracted from previous studies. Previous studies also aided in establishing gap to be filled by the current study. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to compute mean scores for project outcomes and CSFs and principal component analysis (PCA) was used to compute composite CSFs. A 5-Likert scale was used, i.e., 5 = Strong agree, 4 = Agree, 3 = Neutral, 2 = Disagree and 1 = Strong disagree.
\n
\n
\n
3.4. Results
\n
\n
3.4.1. Respondents’ profile
\n
The participation of the intended groups namely consultants, client and contractors was 36.4, 21.2 and 42.4%, respectively. The three groups comprised of 13.4% architects, 23.9% engineers, 33.5% quantity surveyors, 17.9% project managers and 9% others. Furthermore, majority (83.9%) of these respondents have experience of more than 5 years. Majority of respondents (91%) have indicated that they worked on projects that have gone over budget.
\n
\n
\n
3.4.2. Impact of risk management on project outcomes
\n
Risk management has an influence on both the risk management process and project success. This is echoed by Junior and de Carvalho [27] that risk management practices have an impact on project success. Similarly, Kishk & Ukaga [28] through their case study concluded that there is a direct relationship between the effective risk management and project success. The influence on the risk management process includes: creation of a risk sensitive organization, formalized risk reporting, improved focus and perspective on risk, efficient use of resources and compliance matters. The impact on project outcomes is aligned with fulfilling objectives of the project, mainly time, cost, quality, health and safety and no disputes.
\n
\n\nTable 6\n presents assessment of impact of risk management on project outcomes. Results reveal three significant outcomes of risk management in construction which can be adopted in other sectors namely: reduction in design/production time, improved public perception and improved team morale and productivity. The case study therefore underlines that risk management has positive results toward achievement of organizational goals and objectives.
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n\n
\n
S/N
\n
Outcome
\n
t
\n
df
\n
Sig. (2-tailed)
\n
Mean difference
\n
95% Confidence interval of the difference
\n
\n
\n
Lower
\n
Upper
\n
\n\n\n
\n
1
\n
Project completed on time
\n
−1.697
\n
47
\n
.096
\n
−.271
\n
−.59
\n
.05
\n
\n
\n
2
\n
Project completed within budget/major cost saving
\n
−1.855
\n
46
\n
.070
\n
−.234
\n
−.49
\n
.02
\n
\n
\n
3
\n
Product to the required budget
\n
−.535
\n
45
\n
.596
\n
−.065
\n
−.31
\n
.18
\n
\n
\n
4
\n
Reduced accidents on site
\n
1.273
\n
46
\n
.209
\n
.170
\n
−.10
\n
.44
\n
\n
\n
5
\n
Reduction in design/production time
\n
−3.207
\n
44
\n
.003
\n
−.400
\n
−.65
\n
−.15
\n
\n
\n
6
\n
Improved public perception
\n
−3.076
\n
46
\n
.004
\n
−.447
\n
−.74
\n
−.15
\n
\n
\n
7
\n
Reduction in contract claims
\n
−1.430
\n
45
\n
.160
\n
−.217
\n
−.52
\n
.09
\n
\n
\n
8
\n
Improved team morale and productivity
\n
−2.141
\n
46
\n
.038
\n
−.298
\n
−.58
\n
−.02
\n
\n\n
Table 6.
Impact of risk management on project outcomes.
\n
\n
\n
3.4.3. Selected areas of CSFs implementation in construction organizations
\n
\n\nFigure 3\n indicates selected areas of CSFs implementation. Among the areas assessed, the areas that seem least implemented are: understanding the risk management guideline or policy, organization has a documented risk management guideline or policy, the organization has guideline to support the goals and objectives of risk management, the organization conducts training to new employees, organization has established procedures for keeping up-to-date and informed with changes in regulations and organization use methods and tools to manage risk. This implies that organizations rarely formulate policy or guidelines for risk management and conduct training to new employees and the use of methods and tools to manage risks is at a low level.
\n
Figure 3.
Implementation of selected aspects of CSFs. Key: F1 = Aware of risk management processes. F2 = Risk management practice viable in the construction industry. F3 = The organization has a policy to support the development of risk management. F4 = Understand the risk management guideline or policy. F5 = The organization has a documented risk management guideline or policy. F6 = The organization has guideline to support the goals and objectives of risk management. F7 = The organization conducts training to new employees. F8 = Internal/external environment influences risk management in your organization. F9 = The organization has established procedures for keeping up-to-date and informed with changes in regulations. F10 = Organization use methods and tools to manage risk.
\n
\n
\n
3.4.4. CSFs effective risk management in construction
\n
Several CSFs have been listed by researchers in the financial, construction and other sectors. Most of CSFs are associated to actions by top management, communication within organizations, organization structures, policies, risk management experts and knowledge.
\n
\n\nTable 7\n below presents 25 CSFs. Using descriptives, results reveal top seven CSFs for effective risk management which are training, communication, commitment and support from top management, awareness of risk management process, teamwork, clear objectives and guidelines for risk management and management styles. Generally, there are 23 CSFs that have scored a mean score greater than 3.5 indicating a fair agreement of respondents. This result calls for further analysis to scale down the number of CSFs and thus the use of principal component analysis (PCA).
\n
\n
\n
\n
\n
\n
\n\n
\n
S/N
\n
\n
N
\n
MS
\n
Std. Dev
\n
\n\n\n
\n
CSF 1
\n
Training
\n
68
\n
4.25
\n
.760
\n
\n
\n
CSF 2
\n
Communication
\n
68
\n
4.19
\n
.697
\n
\n
\n
CSF 3
\n
Commitment and support from top management
\n
67
\n
4.15
\n
.680
\n
\n
\n
CSF 4
\n
Awareness of risk management process
\n
67
\n
4.10
\n
.741
\n
\n
\n
CSF 5
\n
Teamwork
\n
67
\n
4.10
\n
.873
\n
\n
\n
CSF 6
\n
Clear objectives and guidelines for risk management
\n
67
\n
4.03
\n
.904
\n
\n
\n
CSF 7
\n
Management style
\n
67
\n
4.01
\n
.879
\n
\n
\n
CSF 8
\n
Availability of specialist risk management consultants
\n
67
\n
3.93
\n
.804
\n
\n
\n
CSF 9
\n
Risk monitoring and review
\n
66
\n
3.92
\n
.882
\n
\n
\n
CSF 10
\n
Having documented risk management policy or guidelines
\n
67
\n
3.87
\n
.886
\n
\n
\n
CSF 11
\n
Consideration of internal and external environment
\n
67
\n
3.82
\n
.869
\n
\n
\n
CSF 12
\n
Trust
\n
65
\n
3.80
\n
.905
\n
\n
\n
CSF 13
\n
Effective usage of methods and tools
\n
67
\n
3.75
\n
.927
\n
\n
\n
CSF 14
\n
Cooperative culture
\n
67
\n
3.72
\n
.982
\n
\n
\n
CSF 15
\n
Management priorities
\n
67
\n
3.70
\n
.835
\n
\n
\n
CSF 16
\n
Impact for environment
\n
67
\n
3.66
\n
.808
\n
\n
\n
CSF 17
\n
Risk identification, analysis and response
\n
66
\n
3.62
\n
.837
\n
\n
\n
CSF 18
\n
Customer requirements
\n
67
\n
3.61
\n
.870
\n
\n
\n
CSF 19
\n
Goals and objectives of the organization
\n
67
\n
3.58
\n
1.002
\n
\n
\n
CSF 20
\n
Information technology infrastructure
\n
67
\n
3.55
\n
.942
\n
\n
\n
CSF 21
\n
Positive human dynamics
\n
67
\n
3.54
\n
.959
\n
\n
\n
CSF 22
\n
Organizational structure
\n
65
\n
3.52
\n
.868
\n
\n
\n
CSF 23
\n
Objective setting
\n
67
\n
3.51
\n
1.021
\n
\n
\n
CSF 24
\n
Allocating adequate resources
\n
66
\n
3.38
\n
.837
\n
\n
\n
CSF 25
\n
Legal and regulatory compliance requirements
\n
67
\n
3.34
\n
.845
\n
\n\n
Table 7.
CSFs mean scores (MS).
\n
Further, principal component analysis reveals nine factors of CSFs for effective risk management. \nTable 8\n reveals that about 74% of the total variance is explained by the first nine factors. The factors are arranged in decreasing order of total variance explained. To allow for flexibility in the results, the Eigen value greater or equal to 1 was assumed implying that that only factors that account for variances greater or equal to 1 are included in the factor extraction. On the coefficient display format, small coefficients with absolute value below 0.5 were suppressed. Consequently, only factor scores greater than 0.50 are shown on the rotated component matrix in \nTable 10\n.
\n
\n
\n
\n
\n
\n
\n
\n
\n\n
\n
Component
\n
Initial Eigen values
\n
Extraction sums of squared loadings
\n
\n
\n
Total
\n
% of variance
\n
Cumulative %
\n
Total
\n
% of variance
\n
Cumulative %
\n
\n\n\n
\n
CSF 1
\n
5.238
\n
20.950
\n
20.950
\n
5.238
\n
20.950
\n
20.950
\n
\n
\n
CSF 2
\n
2.895
\n
11.580
\n
32.530
\n
2.895
\n
11.580
\n
32.530
\n
\n
\n
CSF 3
\n
2.236
\n
8.944
\n
41.474
\n
2.236
\n
8.944
\n
41.474
\n
\n
\n
CSF 4
\n
1.761
\n
7.043
\n
48.517
\n
1.761
\n
7.043
\n
48.517
\n
\n
\n
CSF 5
\n
1.684
\n
6.738
\n
55.255
\n
1.684
\n
6.738
\n
55.255
\n
\n
\n
CSF 6
\n
1.421
\n
5.685
\n
60.940
\n
1.421
\n
5.685
\n
60.940
\n
\n
\n
CSF 7
\n
1.307
\n
5.229
\n
66.168
\n
1.307
\n
5.229
\n
66.168
\n
\n
\n
CSF 8
\n
1.082
\n
4.329
\n
70.498
\n
1.082
\n
4.329
\n
70.498
\n
\n
\n
CSF 9
\n
1.037
\n
4.147
\n
74.644
\n
1.037
\n
4.147
\n
74.644
\n
\n
\n
CSF 10
\n
.933
\n
3.733
\n
78.377
\n
\n
\n
\n
\n
\n
CSF 11
\n
.885
\n
3.541
\n
81.918
\n
\n
\n
\n
\n
\n
CSF 12
\n
.772
\n
3.090
\n
85.007
\n
\n
\n
\n
\n
\n
CSF 13
\n
.752
\n
3.009
\n
88.016
\n
\n
\n
\n
\n
\n
CSF 14
\n
.538
\n
2.153
\n
90.169
\n
\n
\n
\n
\n
\n
CSF 15
\n
.444
\n
1.775
\n
91.944
\n
\n
\n
\n
\n
\n
CSF 16
\n
.392
\n
1.567
\n
93.511
\n
\n
\n
\n
\n
\n
CSF 17
\n
.347
\n
1.389
\n
94.900
\n
\n
\n
\n
\n
\n
CSF 18
\n
.301
\n
1.205
\n
96.105
\n
\n
\n
\n
\n
\n
CSF 19
\n
.298
\n
1.190
\n
97.296
\n
\n
\n
\n
\n
\n
CSF 20
\n
.223
\n
.890
\n
98.186
\n
\n
\n
\n
\n
\n
CSF 21
\n
.173
\n
.694
\n
98.879
\n
\n
\n
\n
\n
\n
CSF 22
\n
.134
\n
.538
\n
99.417
\n
\n
\n
\n
\n
\n
CSF 23
\n
.069
\n
.275
\n
99.692
\n
\n
\n
\n
\n
\n
CSF 24
\n
.040
\n
.161
\n
99.853
\n
\n
\n
\n
\n
\n
CSF 25
\n
.037
\n
.147
\n
100.000
\n
\n
\n
\n
\n\n
Table 8.
Total variance explained.
\n
In \nTable 9\n, some of the variables are more highly correlated with some factors than others. In order to make it easier to assign meaning to the factors, it is ideal to see groups of variables with large coefficients for one factor and small coefficients for the others. The component matrix is therefore rotated to achieve simple structure, where each factor has large loadings in absolute value for only some of the variables, making it easier to identify.
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n\n
\n
\n
Component
\n
\n
\n
1
\n
2
\n
3
\n
4
\n
5
\n
6
\n
7
\n
8
\n
9
\n
\n\n\n
\n
CSF 1
\n
Risk identification, analysis and response
\n
.783
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 2
\n
Customer requirements
\n
.735
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 3
\n
Allocating adequate resources
\n
.654
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 4
\n
Having documented risk management policy or guidelines
\n
.632
\n
\n
.549
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 5
\n
Objective setting
\n
.611
\n
\n
\n
\n
−.501
\n
\n
\n
\n
\n
\n
\n
CSF 6
\n
Teamwork
\n
.610
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 7
\n
Consideration of internal and external environment
\n
.586
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 8
\n
Availability of specialist risk management consultants
\n
.573
\n
\n
.511
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 9
\n
Impact for environment
\n
.554
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 10
\n
Clear objectives and guidelines for risk management
\n
.521
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 11
\n
Effective usage of methods and tools
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 12
\n
Organizational structure
\n
\n
.771
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 13
\n
Information technology infrastructure
\n
\n
.705
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 14
\n
Cooperative culture
\n
\n
.688
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 15
\n
Trust
\n
\n
.594
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 16
\n
Training
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 17
\n
Management style
\n
\n
\n
.663
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 18
\n
Communication
\n
\n
\n
\n
.703
\n
\n
\n
\n
\n
\n
\n
\n
CSF 19
\n
Commitment and support from top management
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 20
\n
Goals and objectives of the organization
\n
.544
\n
\n
\n
\n
.616
\n
\n
\n
\n
\n
\n
\n
CSF 21
\n
Management priorities
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 22
\n
Legal and regulatory compliance requirements
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 23
\n
Awareness of risk management process
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 24
\n
Positive human dynamics
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 25
\n
Risk monitoring and review
\n
\n
\n
\n
\n
\n
\n
\n
\n
.526
\n
\n\n
Table 9.
Component matrix.
Extraction method: principal component analysis; 9 components extracted
\n
\n\nTable 10\n shows the rotated component matrix after varimax rotation and after the variables have been sorted by the absolute values of the loadings with nine components. Five variables are highly correlated to factor 1; variables 6 and 7 are highly correlated to factor 2; variables 9 and 10 are highly correlated to factor 3; variables 11 to 13 are highly correlated to factor 4; variables 14 and 15 are highly correlated to factor 5; variables 16 to18 are highly correlated to factor 6; variables 19 and 21 are highly correlated to factor 7; variables 22 and 24 are highly correlated to factor 8; and variable 25 is highly correlated to factor 9.
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n\n
\n
\n
Component
\n
\n
\n
1
\n
2
\n
3
\n
4
\n
5
\n
6
\n
7
\n
8
\n
9
\n
\n\n\n
\n
CSF 1
\n
Management style
\n
.823
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 2
\n
Allocating adequate resources
\n
.788
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 3
\n
Risk identification, analysis and response
\n
.737
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 4
\n
Clear objectives and guidelines for risk management
\n
.725
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 5
\n
Customer requirements
\n
.563
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 6
\n
Goals and objectives of the organization
\n
\n
.924
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 7
\n
Objective setting
\n
\n
.878
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 8
\n
Positive human dynamics
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 9
\n
Having documented risk management policy or guidelines
\n
\n
\n
.918
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 10
\n
Availability of specialist risk management consultants
\n
\n
\n
.899
\n
\n
\n
\n
\n
\n
\n
\n
\n
CSF 11
\n
Information technology infrastructure
\n
\n
\n
\n
.805
\n
\n
\n
\n
\n
\n
\n
\n
CSF 12
\n
Trust
\n
\n
\n
\n
.765
\n
\n
\n
\n
\n
\n
\n
\n
CSF 13
\n
Cooperative culture
\n
\n
\n
\n
.673
\n
\n
\n
\n
\n
\n
\n
\n
CSF 14
\n
Consideration of internal and external environment
\n
\n
\n
\n
\n
.881
\n
\n
\n
\n
\n
\n
\n
CSF 15
\n
Effective usage of methods and tools
\n
\n
\n
\n
\n
.789
\n
\n
\n
\n
\n
\n
\n
CSF 16
\n
Impact of environment
\n
\n
\n
\n
\n
.669
\n
.
\n
\n
\n
\n
\n
\n
CSF 17
\n
Teamwork
\n
\n
\n
\n
\n
\n
.634
\n
\n
\n
\n
\n
\n
CSF 18
\n
Commitment and support from top management
\n
\n
\n
\n
\n
\n
.630
\n
\n
\n
\n
\n
\n
CSF 19
\n
Communication
\n
\n
\n
\n
\n
\n
\n
.752
\n
\n
\n
\n
\n
CSF 20
\n
Management priorities
\n
\n
\n
\n
\n
\n
\n
.609
\n
\n
\n
\n
\n
CSF 21
\n
Training
\n
\n
\n
\n
\n
\n
\n
.595
\n
\n
\n
\n
\n
CSF 22
\n
Legal and regulatory compliance requirements
\n
\n
\n
\n
\n
\n
\n
\n
.717
\n
\n
\n
\n
CSF 23
\n
Awareness of risk management process
\n
\n
\n
\n
\n
\n
\n
\n
.629
\n
\n
\n
\n
CSF 24
\n
Organizational structure
\n
\n
\n
\n
\n
\n
\n
\n
.608
\n
\n
\n
\n
CSF 25
\n
Risk monitoring and review
\n
\n
\n
\n
\n
\n
\n
\n
\n
.878
\n
\n\n
Table 10.
Rotated component matrix.
Extraction method: principal component analysis
Rotation method: varimax with Kaiser normalization; Rotation converged in 12 iterations
\n
In summary, the following are categories of CSFs for effective risk management:
CSF 1 Management approach: Comprise of five CSFs with management style scoring high followed by allocating adequate resources and risk identification, analysis and response
CSF 2 Goals and objectives of the organization: Comprise of two CSFs all with high scores
CSF 3 Risk management policy and experts: Comprise of two CSFs all with high scores
CSF 4 Information technology and culture: Comprise of three CSFs with information technology infrastructure scoring high followed by trust.
CSF 5 Environment and usage of tools: Comprise of three CSFs with consideration of internal and external environment scoring high followed by effective usage of methods and tools.
CSF 6 Teamwork and commitment of the top management: Comprises of two CSFs all of them scoring fairly.
CSF 7 Communication and training: Comprise of three CSFs with communication scoring high followed by management priorities.
CSF 8 Awareness of risk management process and legal framework: Comprise of three CSFs with legal and regulatory compliance requirements scoring high followed by awareness of risk management process
CSF 9 Risk monitoring and review: Comprising of risk monitoring and review with high scores
\n\n
Collectively, the nine categories of CSFs have yielded the top eight CSFs with component loading of between 1 and 0.8:
Goals and objectives of the organization (0.924);
Having documented risk management policy or guidelines (0.918);
Availability of specialist risk management consultants (0.899);
Consideration of internal and external environment (0.881);
Objective setting (0.878);
Risk monitoring and review (0.878);
Management style (0.823);
Information technology infrastructure (0.805).
\n\n
\n
\n
\n
3.5. Discussion
\n
The case study has underlined that risk management in construction projects has positive results such as reduced accidents on sites, product to the required budget, reduction in contractual claims, project completed within budget and project completed on time. This finding is partly in line with the study by Al-Shibly et al. [29] on aspects of time. On the other hand, this finding supports the work of Kishk and Ukaga [28] that the conventional view of project success based on cost, time and quality objectives is not sufficient. They argue that the project success has to base on the predetermined and preagreed success criteria set by all stakeholders.
\n
Through description, the study identified top seven CSFs; however, about 23 CSFs were generally within acceptable limits based on the mean score. These CSFs were further reduced using PCA and nine composite CSFs for effective risk management were determined. This approach also was used by Chen [7] to suggest four composite CSFs for the banking industry. These CSFs are management approach, goals and objectives of the organization, risk management policy and experts: information technology and culture, environment and usage of tools, teamwork and commitment of the top management, communication and training, awareness of risk management process and legal requirements and risk monitoring. Collectively, the nine CSFs have yielded the top eight CSFs namely: goals and objectives of the organization, having documented risk management policy or guidelines, availability of specialist risk management consultants, consideration of internal and external environment, objective setting, risk monitoring and review, management style and information technology infrastructure. To a great extent, this finding supports the works of Grabowski and Roberts [8], Hasanali [9], Agyakwa-Baah and Chileshe [11], Chileshe and Kikwasi (2014), Zhao et al. [12] and Tsiga et al. [13]. The current study supports the work of Hosseini et al. [15] on issues of management support, training and awareness of risk management process. The study also noted lack of understanding of risk management guideline or policy, organizations lacking documented risk management guideline or policy and guideline to support the goals and objectives of risk management, organizations not conducting training to new employees, organizations lacking established procedures for keeping up-to-date and informed with changes in regulations and organizations not using methods and tools to manage risks.
\n
\n
\n
\n
4. Conclusion
\n
The chapter sought to explore theories on risk management and using the construction industry as a case study establishes CSFs for effective risk management. The case study also has explored the impact of risk management to project outcomes and the status of implementation of selected previously identified CSFs. Generally, risk management in organizations has positive results to the risk management process as well as achievement of organizational goals and objectives. Similarly, organizations at certain levels have been implementing previously determined CSFs. From a list of 25 CSFs determined previously, a new set of 9 composite CSFs have established for effective risk management. The findings of the current study provide snapshot on the composite CSFs that can be assumed by organizations in achieving their goals and objectives. The limitation of this which is worth to be acknowledged is that the study has drawn 9 composite CSFs from only 25 CSFs.
\n
\n
Conflict of interest
The author declares that there is no conflict of interests regarding the publication of this chapter.
\n',keywords:"construction, critical success factors, management, organizations, risks",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/59672.pdf",chapterXML:"https://mts.intechopen.com/source/xml/59672.xml",downloadPdfUrl:"/chapter/pdf-download/59672",previewPdfUrl:"/chapter/pdf-preview/59672",totalDownloads:2321,totalViews:2815,totalCrossrefCites:1,totalDimensionsCites:1,totalAltmetricsMentions:0,impactScore:0,impactScorePercentile:40,impactScoreQuartile:2,hasAltmetrics:0,dateSubmitted:"September 20th 2017",dateReviewed:"January 25th 2018",datePrePublished:"November 5th 2018",datePublished:"November 28th 2018",dateFinished:"March 1st 2018",readingETA:"0",abstract:"Risk management is extremely important in achieving overall organizational goals and objectives. Achieving organizational goals amid risks entails determining and implementing critical success factors (CSFs). This chapter presents composite CSFs which organizations can focus on to achieve their overall goals and objectives by portraying a case study of the construction industry. Using this case study reveals statistical significance of impact of risk management on the project as reduction in design/production time, improved public perception, and improved team morale and productivity. Similarly, CSFs mostly implemented are awareness of risk management processes, appreciating that risk management practice is viable in the construction industry, organizations have policies to support the development of risk management and organization deal with internal/external environment that influences risk management in their organizations. The chapter also presents nine composite CSFs determined by the case study namely: management approach; goals and objectives of the organization; risk management policy and experts; information technology and culture; environment and usage of tools; teamwork and commitment of the top management; communication and training; awareness of risk management process and legal requirements; and risk monitoring and review. Lastly, the conclusion is drawn on nine composite CSFs for effective risk management.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/59672",risUrl:"/chapter/ris/59672",book:{id:"5422",slug:"risk-management-treatise-for-engineering-practitioners"},signatures:"Geraldine J. Kikwasi",authors:[{id:"222345",title:"Dr.",name:"Geraldine",middleName:null,surname:"Kikwasi",fullName:"Geraldine Kikwasi",slug:"geraldine-kikwasi",email:"gkikwasi@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Ardhi University",institutionURL:null,country:{name:"Tanzania"}}}],sections:[{id:"sec_1",title:"1. Risk management",level:"1"},{id:"sec_1_2",title:"1.1. Risk framework and risk register",level:"2"},{id:"sec_3",title:"2. Critical success factor (CSFs)",level:"1"},{id:"sec_3_2",title:"2.1. Critical success factors for effective risk management",level:"2"},{id:"sec_5",title:"3. A case study: risk management in the construction industry",level:"1"},{id:"sec_5_2",title:"3.1. Overview of the case study",level:"2"},{id:"sec_6_2",title:"3.2. Risk management in construction",level:"2"},{id:"sec_7_2",title:"3.3. Methodology",level:"2"},{id:"sec_8_2",title:"3.4. Results",level:"2"},{id:"sec_8_3",title:"3.4.1. Respondents’ profile",level:"3"},{id:"sec_9_3",title:"Table 6.",level:"3"},{id:"sec_10_3",title:"3.4.3. Selected areas of CSFs implementation in construction organizations",level:"3"},{id:"sec_11_3",title:"Table 7.",level:"3"},{id:"sec_13_2",title:"3.5. Discussion",level:"2"},{id:"sec_15",title:"4. Conclusion",level:"1"},{id:"sec_19",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'\nPMI. A Guide to Project Management Body of Knowledge (PMBoK Guide). 5th ed2013 Available from: http://www2.fiit.stuba.sk/~bielik/courses/msi-slov/reporty/pmbok.pdf [Accessed: 24 March 2016]\n'},{id:"B2",body:'\nBerg H. Risk Management: Procedures, Methods And Experiences [Internet]. 2010. Available from: http://ww.gnedenko-forum.org/Journal/2010/022010/RTA_2_2010-09.p [Accessed: 24 March 2016]\n'},{id:"B3",body:'\nSmith NJ. Managing Risk in Construction Projects. Oxford: Blackwell Science; 1999\n'},{id:"B4",body:'\nCagliano AC, Grimaldi S, Rafele C. 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Risk mitigation in virtual organizations. Organization Science. 1999:704-721. DOI: 10.1287/orsc.10.6.704\n'},{id:"B9",body:'\nHasanali F. Critical Success Factors of Knowledge Management [Internet]. 2002. Available from: http://providersedge.com/docs/km_articles/Critical_Success_Factors_of_KM.pdf [Accessed: 24 March 2016]\n'},{id:"B10",body:'\nNa Ranong P, Phuenngam W. Critical Success Factors for Effective Risk Management Procedures In Financial Industries: A Study from the Perspectives of the Financial Institutions in Thailand [Internet]. 2009. Available from: http://www.diva-portal.org/smash/get/diva2:233985/fulltext01 [Accessed: 26 October 2017]\n'},{id:"B11",body:'\nAgyakwa-Baah A and Chileshe N. Critical success factors for risk assessment and management practices (RAMP) implementation within the Ghanaian construction organizations. In: Wang Y, Yang J, Shen GQP and Wong J, editors. Proceedings of the 8th International Conference on Construction and Real Estates Management (ICCREM 2010), Leading Sustainable Development Through Construction and Real Estates Management, 1-3 December 2010; Beijing. 2010. pp. 345-352\n'},{id:"B12",body:'\nZhao X, Hwang B, Sui Pheng Low SP. Critical success factors for enterprise risk management in Chinese construction companies. Journal of Construction Management and Economics. 2014;31(12):1199-1214. Available from: http://www.tandfonline.com/doi/abs/10.1080/01446193.2013.867521 [Accessed: 26 October 2017]\n'},{id:"B13",body:'\nTsiga Z, Emes M, Smith A. Critical success factors for the construction industry. PM World Journal. 2016;V(VIII):1-12. Available from: www.pmworldjournal.net [Accessed: 26 October 2017]\n'},{id:"B14",body:'\nRenault YB, Agumba JN, Balogun OA. Drivers for and obstacles to enterprise risk management in construction firms: A literature review. In: Creative Construction Conference; June 25-28; Budapest. 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School of Architecture, Construction Economics and Management, Ardhi University, Dar es Salaam, Tanzania
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1. Introduction
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Stroke is a group of diseases associated with sudden disturbance of consciousness and motor or cognitive dysfunctions induced by cerebrovascular disorder. Pathological conditions are roughly classified into three categories according to the causes: stroke occurred due to cerebrovascular occlusion, stroke induced by rupture of small cerebral vessels, and subarachnoid hemorrhage associated with rupture of brain aneurysm, etc. According to the reports of the National Stroke Association, incidence of stroke is one person every 40 s; about 800,000 and 290,000 persons develop stroke every year in the USA [1] and Japan [2], respectively.
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Medical management for stroke has changed remarkably in many ways such as rearrangement of emergency medical system, improvement of treatment methods including thrombolytic therapy and endovascular treatment of the brain, formation of medical teams in a stroke unit, and preparation of guidelines for stroke treatment, resulting in improvement of survival rate [3, 4]. More than a half of the survived patients however suffer from disabilities to a certain extent such as motor paralysis, sensory or visual impairment, cognitive disturbances including aphasia and unilateral neglect, and dysphagia, which all affect the patients’ activities of daily living.
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2. Incidence and features of dysphagia due to stroke
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It has been reported that dysphagia is observed in 39–81% of stroke patients during the acute phase [5, 6], and the results obtained from videofluoroscopic examination of swallowing (VF) or videoendoscopic examination of swallowing (VE) may reveal that even more patients are complicated by dysphagia [7]. However, it improves promptly, most of the time, in a few days or few weeks after the onset, and sever disorders may persist until the chronic stage in about 10% of the patients [7, 8, 9]. These show how important it is, for management of stroke, to prevent aspiration pneumonia and let patients regain ability to swallow safely during the acute phase.
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Pathology of dysphagia varies according to the sites of the central nervous system being affected [7, 10]. The cause of dysphagia after stroke is roughly categorized into two mechanisms: pseudobulbar palsy associated with disturbance of upper motor neurons toward nuclei in the medulla oblongata and bulbar palsy associated with lower motor neurons from nuclei in the medulla oblongata in the brain stem. In patients with pseudobulbar palsy induced by cerebrovascular events in cerebral lesions, symptoms and signs such as delayed swallowing reflex during the pharyngeal phase of swallowing, reduced laryngeal elevation, and residual food in the vallecula or pyriform sinus are observed. While in patients with bulbar palsy induced by brain stem lesions, loss of swallowing reflex and insufficient opening of the esophageal orifice are observed. In either case, patients are often complicated by disturbance of consciousness or cognitive disorder, and swallowing is also affected during the anticipatory, preparatory, and oral phases as described below.
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3. Swallowing process model
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There are two major systematic models known for normal swallowing dynamics (Figure 1). The first one is liquid swallowing model which consists of five phases including the anticipatory phase in addition to four other stages: preparatory, oral, pharyngeal, and esophageal phases [11]. During the anticipatory phase (recognition phase), characteristics of food are recognized, the posture and the way to eat are determined, and saliva secretion is induced. During the preparatory phase, mastication occurs to make the food easy to swallow (into a food bolus). During the oral phase, the food bolus is transferred to the pharynx by the tongue movement. The pharyngeal phase begins when the food bolus formed in the vallecula starts moving downward through the pharyngeal cavity until it reaches the esophageal orifice. This is an involuntary action which occurs unconsciously. Contraction of the suprahyoid muscle and thyrohyoid muscle induces elevation of the hyoid bone and larynx. The epiglottis descends and blocks the laryngeal aperture to prevent aspiration of the food. Along with contraction of the pharyngeal muscles, the food bolus is sent to the esophageal orifice. Once the food bolus enters the esophagus during the esophageal phase, the cricopharyngeus muscle (upper esophageal sphincter) contracts to close the esophageal orifice so that food reflux will not occur.
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Figure 1.
Five stage and process models for swallowing. Two paradigmatic models are commonly used to describe the physiology of normal eating and swallowing: the five-stage model for drinking and swallowing liquid and the process model for eating and swallowing solid food.
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The second one is a process model which involves mastication [12, 13]. Solid food is transported to a molar region by the tongue (Stage I transport). The food is grounded by mastication and transported actively to the oropharynx with the tongue movement (Stage II transport). Then, a food bolus is formed. Food transport occurs repeatedly even during mastication. The bolus is formed inside the oral cavity if it is command swallow of liquid food. However, if it is chew-swallow of solid food, the bolus is formed in the area between the oropharynx and the vallecula. If the bolus contains liquid, some of it reaches the pyriform sinus before swallowing reflex begins. Thus, it is important to understand that there are two different types of swallowing dynamics before making assessments.
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4. Assessment of dysphagia
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In assessment of dysphagia, the cause and onset mechanism of the condition should be revealed to understand pathology. The physical findings include observation of the level of consciousness and respiratory conditions. Neurological findings (especially on trigeminal, facial, glossopharyngeal, vagus and hypoglossal nerves), the level of cognitive functions, nutritional state, dehydration status, as well as the current status and past history of pneumonia, should be assessed. In addition, food residues inside the oral cavity, furred tongue, dental caries, characteristics of saliva, denture, and gingivitis should also be examined.
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There is a risk of food aspiration whenever food or fluid is put inside the mouth. Therefore, assessment of swallowing functions should be performed if possible before ingesting food. Even if meals have already been started, ask patients and families detailed questions whether or not the patients have symptoms associated with aspiration.
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4.1 Interviews and observational assessments
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Characteristics of dysphagia are likely to be observed in the activities of daily living. Dysphagia can be suspected by asking simple questions to patients and their families. The question items may be associated with increase of cough and sputum after meals, sputum containing food, change in voice quality after meals, pharyngeal discomfort, decreased appetite, tired feeling during meals, prolongation of meal time (over 45 min), change in the type of meals, and the way to eat, loss of weight, and fever.
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4.1.1 Eating assessment tool (EAT-10)
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This is a standardized questionnaire form which is easy to use [14]. The assessment using a questionnaire form consists of 10 questions regarding pleasure of eating meals, loss of weight, effort of swallowing, etc. which are evaluated by scores between 0 (no problem) and 4 (serious problem). The maximum score is 40.
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4.1.2 Mann assessment of swallowing ability (MASA)
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This is a highly reliable and valid assessment performed in stroke patients during the acute phase based on psychostatistic evaluations on consciousness, cooperative actions, auditory comprehension, etc. [15]. It consists of 24 items including alertness, cooperation, auditory comprehension, respiration, dyspraxia, saliva, and tongue movement, and the maximum score is 200. Allocation of scores varies according to the level of importance for each item. The risk for dysphagia or aspiration and the degree of dysphagia are evaluated by the total score to determine the food form to be recommended. No special device is required, and the assessment can be performed within 15–20 min.
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4.2 Bedside swallowing assessment
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The swallowing assessments are performed at the bedside after confirming that the level of alertness is satisfactory (<10) and that the patient’s general condition is stable without any progression of stroke.
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4.2.1 Dry swallowing
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It is a basic movement to swallow saliva, demonstrating whether or not the patient is able to swallow before conducting a screening test [16].
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4.2.2 Repetitive saliva swallowing test (RSST)
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In this test, an examiner asks a patient to swallow saliva while palpating the hyoid bone and thyroid cartilage with the index finger and the middle finger, respectively, and counts how many times the patient swallows within 30 s [17, 18]. It is considered positive when <3.
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4.2.3 Water swallowing test (WST)
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The examiner asks a patient to swallow 30 ml of water at the room temperature as usual and observes how many times he/she swallows and if he/she ever gets choked [19]. It is considered positive if the patient could swallow at once without getting choked within 5 s.
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4.2.4 Modified water swallowing test (MWST)
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The examiner asks a patient to swallow 3 ml of cold water and observes if he/she ever gets choked and if the voice or respiratory state changes. The maximum score is 5 for this test [18, 20]. If possible, the examiner asks the patient to swallow twice more. The test can be performed up to three times, and the worst swallowing activity is evaluated. It is considered abnormal when the score is <3 (swallowing present, respiration satisfactory, choking present, and/or wet hoarseness).
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4.2.5 Food test (FT)
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In this test, the examiner asks a patient to ingest a tea spoon of flan (about 4 g) [18, 21]. The content of the assessment is the same as in MWST except that there is another assessment of residual food inside the oral cavity after swallowing in this test.
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4.2.6 Simple swallowing provocation test (SSPT)
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The examiner inserts a transnasal catheter 5 Fr into the epipharynx in the supine position and injects distilled water at room temperature to induce swallowing [22]. At first, the examiner injects 0.4 ml of distilled water and observes for 3 s. If the patient does not swallow, 2 ml is additionally injected. If no swallowing was observed within 3 s, it is considered that the patient has a risk of aspiration pneumonia.
There are existing clinical assessment scales which combined clinical symptoms and WST as below. Comprehensive clinical evaluations rather than simple WSTs demonstrate higher sensitivity and specificity.
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4.3.1 Two-step thickened water test (TTWT)
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With this method proposed by Smithard et al. [23], WSTs of 5 ml (for three times) and 30 ml are performed after obtaining clinical findings such as the alert level, trunk control, soft palate movement, and voluntary coughing.
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4.3.2 Toronto Bedside Swallowing Screening Test (TOR-BSST)
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This is a comprehensive WST focusing on evaluation of dysphagia of the oropharynx in addition to assessment of three items: voice quality, tongue movement, and pharyngeal sensation [24].
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4.3.3 Gugging swallowing screen (GUSS)
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Prior to the assessment, posture control is evaluated. An examiner assesses clinical findings including the state of consciousness, coughs (wet hoarseness), and dry swallowing (saliva swallowing) (5 points), followed by assessments of the swallowing state, presence or absence of choking or drooling, and change of voice after ingesting three food forms: semisolid, liquid, and solid (15 points) [25]. The food form is determined according to the score (20, normal food; 15–19, soft food; 10–14, dysphagia food; 0–9, indirect training).
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All these tests can be easily performed to assess swallowing functions. However, not all aspirations can be detected. Simultaneous assessments using VF and WST or FT under the X-ray [26, 27] revealed that the higher the amount of fluid, the more aspirations are observed with VF, while the detection rates for choking, coughing, and wet hoarseness were not that high (Figure 2). In patients with decreased cognitive or physical functions and patients with brain stem lesions, silent aspiration cannot be denied even if there is no clinical finding of choking, coughing, or wet hoarseness [28]. VF and VE should be performed as much as possible in case where dysphagia is strongly suspected in physical examinations or BSA or when there is no effective strategy established for the treatment.
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Figure 2.
Clinical and VF findings of the food test. Simultaneous assessments using VF and WST or FT under the X-ray revealed that the higher the amount of fluid, the more aspirations are observed with VF, while the detection rates for choking, coughing, and wet hoarseness were not that high.
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4.4 Videoendoscopy (VE) and videofluorography (VF)
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4.4.1 Videoendoscopy (VE)
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Using a laryngeal fiberscope, the pharynx and larynx are primarily observed using real food (Figure 3). Although the moment of swallowing cannot be observed, early pharyngeal penetration of saliva or food bolus, timing of inducing swallowing reflex, pharyngeal residue, and laryngeal penetration/aspiration can be directly observed. This is a useful method which enables observation of the pharynx and larynx using actual food without irradiation. This can be used at the bedside as it does not require any large-scale devices [29].
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Figure 3.
Videoendoscopy (VE). Videoendoscopy can be performed on patients at bedside.
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VE can be performed without irradiation and is highly portable. In addition, it enables direct observation of mucosal and saliva conditions as well as assessment of actual meal settings. However, there is a risk of inducing pain or nasal bleeding when inserting the fiber, and it is difficult to observe oral cavity during mastication, bolus formation, and food transportation to the proximal part of the tongue; it becomes blurry at the moment of swallowing; hence, it is difficult to understand the details of laryngeal penetration/aspiration.
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4.4.2 Videofluorography (VF)
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Swallowing functions are assessed using an X-ray device. With this method, a patient is asked to ingest fluid (water) or solid/semisolid food (imitation food) which contain contrast medium (barium sulfate), and movement of the oral cavity, pharynx, and esophagus as well as structural abnormalities and movement of the food bolus are assessed [30]. The diagnostic value of this test is high as it can reveal formation of the food bolus and its transportation to the pharynx in the oral phase, the timing and the level of laryngeal elevation in the pharynx phase, and bolus passing at the esophageal orifice and the presence/absence or the level of aspiration (Figure 4). It also clarifies conditions where the risk of aspiration and pharyngeal residue is low and determines the safest food form, the method of ingestion, and the posture. Moreover, it also enables us to try various compensation methods and make detailed observations on dysphagia. Hence, this test should be considered as a gold-standard swallowing function assessment which can provide very important information to establish treatment strategy according to the findings of the observation [30].
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Figure 4.
Videofluorography (VF). VF shows that fluid is getting into the trachea from the larynx.
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4.4.3 Swallowing CT scan
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With excellent spatial resolution (0.5 mm square) and time resolution (10 frames per second), 320 Area Detector CT (320-ADCT) enables us to precisely and quantitatively observe the swallowing movement in 3D. It presents 3D images of various organs from arbitrary directions; hence, it can precisely quantify swallowing dynamics [31, 32].
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4.5 Assessment of severity in swallowing
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Taking into consideration the functional diagnosis, causative disease, and general condition of the patient, the level of feeding is determined as the final overall evaluation of swallowing. Swallowing Performance Scale [33] and Functional Oral Intake Scale (FOIS) [34] are seven-level scales used in overseas countries to assess oral feeding status during the meals. While in Japan, Dysphagia Severity Scale (DSS) [35] is often used. This is a comprehensive assessment using the ordinal scale of seven levels, which can suggest a management method to a certain extent if the severity level is determined. VF and VE are not necessarily required in an evaluation using DSS. An evaluation made on clinical findings or a screening test by a highly experienced nurse can be equivalent to the evaluation made on DSS using VE [36]. Dysphagia Outcome and Severity Scale (DOSS) is a simple and easy-to-use point scale developed only to systematically evaluate the functional level of severity. With this scale, recommendations on feeding levels can be prepared based on objective evaluations [37].
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5. Treatment of dysphagia
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There are two types of dysphagia rehabilitation: indirect training which does not require feeding and direct training which requires feeding. For a patient with severe dysphagia, rehabilitation should be started with the indirect training, and then the direct training can be added according to the progress. Likewise, for a patient who can start rehabilitation with the direct training, the indirect training may be added if necessary [38, 39].
\n
\n
5.1 Indirect training
\n
Indirect trainings which are typically used include pharyngeal cooling stimulation (ice massage), Mendelsohn maneuver with which the upper esophageal sphincter is mechanically opened by keeping the positions of the larynx and the hyoid bone elevated, blowing, supraglottic swallow (swallow while holding breath), Shaker exercise (head lift exercise), cervical anterior flexion exercise, balloon dilatation method, and pharyngeal electrical stimulation. At the same time, it is essential to conduct oral care. If a patient does not ingest food, the amount of saliva secretion decreases, and as a consequence, self-cleansing action of oral cavity with saliva decreases as well. In such cases, patients often have dry mouth covered by biofilm as seen with the furred tongue, which need to be removed by brushing. These trainings are conducted primarily by speech-language-hearing therapists and nurses. However, the concomitant use of pulmonary respiration therapy conducted by physiotherapists or trainings to improve the ability of performing daily activities conducted by occupational therapists is also very effective to prevent/relieve aspiration pneumonia and improve feeding ability. Hence, it is important to treat patients with the entire team in the rehabilitation approach for dysphagia.
\n
\n
\n
5.2 Direct training
\n
In the direct training, feeding is started as soon as safety conditions for feeding were established based on detailed evaluations. The patient is observed for 3–7 days to check if there is any sign of aspiration or pneumonia, and the meal condition is upgraded accordingly. In stroke patients, swallowing functions are likely to change according to the alert level, and facial palsy is frequently observed. As their masticatory functions have been generally decreased due to facial and lingual palsy, the patients are unable to produce a smooth and appropriately sized food bolus with adequate mastication. The poor pharyngeal clearance is likely to induce formation of food residues inside the pharynx. As the residual food may cause aspiration or suffocation, it is dangerous to offer meals which require mastication to patients with stroke in the acute phase. Therefore, it is considered safer to start feeding with a single food type such as food paste in patients suspected to have dysphagia, even if it is mild.
\n
Once the feeding started, special attention should be paid on increase of saliva/drooling and sputum, increase of coughs, tiredness after eating meals, fever, voice change (wet hoarseness) during meals, and residual food inside the oral cavity. Aspiration can occur without choking. Therefore, if there is any sign as listed above, auscultation of the chest and vital sign assessment should be performed along with chest X-ray and blood collection, if necessary. In addition, chest CT scan should also be considered if the patient is suspected to have pneumonia in the posterior side of the lung as it is often difficult to obtain remarkable findings on chest X-ray in such cases. If aspiration pneumonia is detected in these tests, direct training should be suspended for a moment, and pneumonia should be treated immediately. Once the treatment is completed, swallowing function assessments should be performed at the bedside along with VE and VE, if necessary, to reevaluate the conditions. Special attention is required especially in elderly patients with bilateral lesions who have neurological manifestations as they are likely to develop aspiration pneumonia [40, 41].
\n
\n
\n
\n
6. Conclusions
\n
In assessment and treatment of dysphagia, “not choking” and “safe feeding” are not necessarily the same in meaning. It is necessary to conduct the swallowing function assessments and understand the patients’ conditions along with the level of consciousness and physical state. Safe feeding can be achieved in stroke patients only by selecting appropriate food materials according to their pathological conditions at the optimal timing with appropriate feeding posture and efforts.
\n
\n
Conflict of interest
The authors declare that they have no competing interests.
\n',keywords:"stroke, dysphagia, swallowing assessment, pneumonia, videofluorography",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/68352.pdf",chapterXML:"https://mts.intechopen.com/source/xml/68352.xml",downloadPdfUrl:"/chapter/pdf-download/68352",previewPdfUrl:"/chapter/pdf-preview/68352",totalDownloads:1035,totalViews:0,totalCrossrefCites:0,dateSubmitted:"April 23rd 2019",dateReviewed:"July 1st 2019",datePrePublished:"July 30th 2019",datePublished:"March 11th 2020",dateFinished:"July 30th 2019",readingETA:"0",abstract:"Swallowing disturbance often causes by stroke and may predispose patients to malnutrition and dehydration, as well as increases the risk of such complications as suffocation and aspiration pneumonia. As an initial evaluation, the water swallowing test can be easily carried out, but not all of the aspiration can be excluded. Therefore, videofluorography (VF) and videoendoscopic examination (VE) of swallowing should be performed to find a safety method of oral intake for providing visualization of the pharynx and larynx dysfunction. Clinical severity scale is important because once the severity is determined, the treatment strategy is also known. Swallowing training can be divided into indirect training without food (basic training) and direct training with food (eating training). In general, it is important to select conditions and training diets that are easy to swallow and have a low risk of aspiration while using indirect training and direct training that aim at gradually improving the level of oral intake.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/68352",risUrl:"/chapter/ris/68352",signatures:"Aiko Osawa and Shinichiro Maeshima",book:{id:"7844",type:"book",title:"Voice and Swallowing Disorders",subtitle:null,fullTitle:"Voice and Swallowing Disorders",slug:"voice-and-swallowing-disorders",publishedDate:"March 11th 2020",bookSignature:"Monjur Ahmed",coverURL:"https://cdn.intechopen.com/books/images_new/7844.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-366-7",printIsbn:"978-1-83880-365-0",pdfIsbn:"978-1-83880-105-2",isAvailableForWebshopOrdering:!0,editors:[{id:"206355",title:"Associate Prof.",name:"Monjur",middleName:null,surname:"Ahmed",slug:"monjur-ahmed",fullName:"Monjur Ahmed"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. 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Assessment of dysphagia",level:"1"},{id:"sec_4_2",title:"4.1 Interviews and observational assessments",level:"2"},{id:"sec_4_3",title:"4.1.1 Eating assessment tool (EAT-10)",level:"3"},{id:"sec_5_3",title:"4.1.2 Mann assessment of swallowing ability (MASA)",level:"3"},{id:"sec_7_2",title:"4.2 Bedside swallowing assessment",level:"2"},{id:"sec_7_3",title:"4.2.1 Dry swallowing",level:"3"},{id:"sec_8_3",title:"4.2.2 Repetitive saliva swallowing test (RSST)",level:"3"},{id:"sec_9_3",title:"4.2.3 Water swallowing test (WST)",level:"3"},{id:"sec_10_3",title:"4.2.4 Modified water swallowing test (MWST)",level:"3"},{id:"sec_11_3",title:"4.2.5 Food test (FT)",level:"3"},{id:"sec_12_3",title:"4.2.6 Simple swallowing provocation test (SSPT)",level:"3"},{id:"sec_14_2",title:"4.3 Comprehensive clinical two-step swallowing assessment scales",level:"2"},{id:"sec_14_3",title:"4.3.1 Two-step thickened water test (TTWT)",level:"3"},{id:"sec_15_3",title:"4.3.2 Toronto Bedside Swallowing Screening Test (TOR-BSST)",level:"3"},{id:"sec_16_3",title:"4.3.3 Gugging swallowing screen (GUSS)",level:"3"},{id:"sec_18_2",title:"4.4 Videoendoscopy (VE) and videofluorography (VF)",level:"2"},{id:"sec_18_3",title:"4.4.1 Videoendoscopy (VE)",level:"3"},{id:"sec_19_3",title:"4.4.2 Videofluorography (VF)",level:"3"},{id:"sec_20_3",title:"4.4.3 Swallowing CT scan",level:"3"},{id:"sec_22_2",title:"4.5 Assessment of severity in swallowing",level:"2"},{id:"sec_24",title:"5. Treatment of dysphagia",level:"1"},{id:"sec_24_2",title:"5.1 Indirect training",level:"2"},{id:"sec_25_2",title:"5.2 Direct training",level:"2"},{id:"sec_27",title:"6. Conclusions",level:"1"},{id:"sec_31",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'\nInternational Stroke Association. What is Stroke? Available from: https//www.Stroke.org/understand-stroke/what-is-stroke/ [Accessed: 14 May 2019]\n'},{id:"B2",body:'\nTakashima N, Arima H, Kita Y, Fujii T, Miyamatsu N, Komiri M, et al. Incidence, management and short-term outcome of stroke in a general population of 1.4 million Japanese-Shiga Stroke Registry. Circulation Journal. 2017;81(11):1636-1646\n'},{id:"B3",body:'\nAlbright KC, Branas CC, Meyer BC, Matherne-Meyer DE, Zivin JA, Lyden PD, et al. ACCESS: Acute cerebrovascular care in emergency stroke systems. Archives of Neurology. 2010;67:1210-1218\n'},{id:"B4",body:'\nMaeshima S, Osawa A, Tanahashi N. A liaison critical pathway for stroke rehabilitation: Current status and features of western district of Saitama in Japan. Physical Medicine and Rehabilitation—International. 2015;2(1):5\n'},{id:"B5",body:'\nSteinhagen V, Grossmann A, Benecke R, Walter U. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients. Stroke. 2009;40:1903-1906\n'},{id:"B6",body:'\nMartino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756-2763\n'},{id:"B7",body:'\nLogemann JA, Shanahan T, Rademaker AW, Kahrilas PJ, Lazar R, Halper A. Oropharyngeal swallowing after stroke in the left basal ganglion/internal capsule. Dysphagia. 1993;8:230-234\n'},{id:"B8",body:'\nMaeshima S, Osawa A, Hayashi T, Tanahashi N. Factors associated with prognosis of eating and swallowing disability after stroke: A study from a community-based stroke care system. Journal of Stroke and Cerebrovascular Diseases. 2013;22:926-930\n'},{id:"B9",body:'\nMaeshima S, Osawa A, Yamane F, Ishihara S, Tanahashi N. Dysphagia following acute thalamic haemorrhage: Clinical correlates and outcomes. European Neurology. 2014;71(3-4):165-172\n'},{id:"B10",body:'\nOsawa A, Maeshima S, Matsuda H, Tanahashi N. Functional lesions in dysphagia due to acute stroke: Discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography. Neuroradiology. 2013;55:413-421\n'},{id:"B11",body:'\nLeopold NA, Kagel MC. Swallowing, ingestion and dysphagia: A reappraisal. Archives of Physical Medicine and Rehabilitation. 1983;64:371-373\n'},{id:"B12",body:'\nMatsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing normal and abnormal. Physical Medicine and Rehabilitation Clinics of North America. 2008;19(4):691-707\n'},{id:"B13",body:'\nPalmer JB. Bolus aggregation in the oropharynx does not depend on gravity. Archives of Physical Medicine and Rehabilitation. 1998;79:691-696\n'},{id:"B14",body:'\nBelafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). The Annals of Otology, Rhinology, and Laryngology. 2008;117:919-924\n'},{id:"B15",body:'\nMann G. MASA, The Mann Assessment of Swallowing Ability. Philadelphia: Delmar Thompson Learning; 2002\n'},{id:"B16",body:'\nHoriguchi S, Suzuki Y. Screening tests in evaluating swallowing function. JMAJ. 2011;54(1):31-34\n'},{id:"B17",body:'\nOguchi K, Saitoh E, Baba M, Kusudo S, Tanaka T, Onogi K. The repetitive saliva swallowing test (RSST) as a screening test of functional dysphagia (2). Validity of RSST. Japanese Association of Rehabilitation Medicine. 2000;37:383-388. (Japanese)\n'},{id:"B18",body:'\nTohara H, Saitoh E, Mays KA, Kuhlemeier K, Palmer JB. Three tests for predicting aspiration without videofluorography. Dysphagia. 2003;18:126-134\n'},{id:"B19",body:'\nKubota T, Mishima H, Hanada M, Namba I, Kojima Y. Paralytic dysphagia in cerebrovascular disorder—Screening tests and their clinical application. Sogo Rehabilitation. 1982;10:271-278. (Japanese)\n'},{id:"B20",body:'\nSaitoh E. Comprehensive Study Report. 1999 Health Labour Sciences Research Grant of the Ministry of Welfare. Comprehensive Research on Aging and Health, 1999 research report (Central Secretariat of Aging and Health Expenses). 2000. pp. 1-18. (Japanese)\n'},{id:"B21",body:'\nOsawa A, Maeshima S, Tanahashi N. Food and liquid swallowing difficulty in stroke patients: A study based on the findings of food tests a modified water swallowing test and videofluoroscopic examination of swallowing. Japanese Association of Rehabilitation Medicine. 2012;49:838-845. (Japanese)\n'},{id:"B22",body:'\nTeramoto S, Matsuse T, Fukuchi Y, Ouchi Y. Simple two-step swallowing provocation test for elderly patients with aspiration pneumonia. Lancet. 1999;353:1243\n'},{id:"B23",body:'\nSmithard DG, O’Neill PA, Park C, Morris J. Complications and outcome after acute stroke: Does dysphagia matter? Stroke. 1994;27:1200-1204\n'},{id:"B24",body:'\nMartino R, Pron G, Diamant N. Screening for oropharyngeal dysphagia in stroke: Insufficient evidence for guidelines. Dysphagia. 2000;15:19-30\n'},{id:"B25",body:'\nTrapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, et al. Dysphagia bedside screening for acute-stroke patients: The Gugging swallowing screen. Stroke. 2007;38(11):2948-2952\n'},{id:"B26",body:'\nOsawa A, Maeshima S, Tanahashi N. Water swallowing test: Screening for aspiration in stroke patients. Cerebrovascular Diseases. 2013;35:276-281\n'},{id:"B27",body:'\nTazawa Y, Maeshima S, Osawa A, Tanahashi N. Bedside screening test and videofluorography to detect aspiration in acute stroke patients. The Journal of Saitama Comprehensive Rehabilitation. 2010;10:48-50. (Japanese)\n'},{id:"B28",body:'\nMaeshima S, Osawa A, Miyazaki Y, Seki Y, Miura C, Tazawa Y, et al. Influence of dysphagia on short-term outcome in patients with acute stroke. American Journal of Physical Medicine & Rehabilitation. 2011;90(4):316-320\n'},{id:"B29",body:'\nSchiele JT, Penner H, Schneider H, Quinzler R, Reich G, Wezler N, et al. Swallowing tablets and capsules increases the risk of penetration and aspiration in patients with stroke-induced dysphagia. Dysphagia. 2015;30(5):571-582\n'},{id:"B30",body:'\nRugiu MG. Role of videofluoroscopy in evaluation of neurologic dysphagia. Acta Otorhinolaryngologica Italica. 2007;27(6):306-316\n'},{id:"B31",body:'\nFujii N, Inamoto Y, Saitoh E, Baba M, Okada S, Yoshioka S, et al. Evaluation of swallowing using 320-detector-row multislice CT. Part I: Single- and multiphase volume scanning for three-dimensional morphological and kinematic analysis. Dysphagia. 2011;26(2):99-107\n'},{id:"B32",body:'\nInamoto Y, Fujii N, Saitoh E, Baba M, Okada S, Katada K, et al. Evaluation of swallowing using 320-detector-row multislice CT. Part II: Kinematic analysis of laryngeal closure during normal swallowing. Dysphagia. 2011;26(3):209-217\n'},{id:"B33",body:'\nKarnell MP, MacCracken E. A database information storage and reporting system for videofluorographic oropharyngeal motility (OPM) swallowing evaluations. American Journal of Speech-Language Pathology. 1994;3(2):54-60\n'},{id:"B34",body:'\nCray MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Archives of Physical Medicine and Rehabilitation. 2005;86:1516-1520\n'},{id:"B35",body:'\nBaba M, Saitoh E. Indication of dysphagia rehabilitation. Rinsho Reha. 2000;9:857-863. (Japanese)\n'},{id:"B36",body:'\nNishimura K, Kagaya H, Shibata S, Onogi K, Inamoto Y, Ota K, et al. Accuracy of Dysphagia Severity Scale rating without using videoendoscopic evaluation of swallowing. Japanese Journal of Comprehensive Rehabilitation Science. 2015;6:124-128\n'},{id:"B37",body:'\nO’Neil KH, Purdy M, Falk J, Gallo L. The Dysphagia Outcome and Severity Scale. Dysphagia. 1999;14:139-145\n'},{id:"B38",body:'\nFoley N, Teasell R, Salter K, Kruger E, Martino R. Dysphagia treatment post stroke: A systemic review of randomized controlled trials. Age and Ageing. 2008;37(3):258-264\n'},{id:"B39",body:'\nLogemann JA. Dysphagia: Evaluation and treatment. Folia Phoniatrica et Logopaedica. 1995;47(3):140-164\n'},{id:"B40",body:'\nMaeshima S, Osawa A, Hayashi T, Tanahashi N. Elderly age, bilateral lesions, and severe neurological deficit are correlated with stroke-associated pneumonia. Journal of Stroke and Cerebrovascular Diseases. 2014;23(3):484-489\n'},{id:"B41",body:'\nMaeshima S, Osawa A, Yamane F, Ishihara S, Tanahashi N. Association between microbleeds observed on T2*-weighted magnetic resonance images and dysphagia in patients with acute supratentorial cerebral hemorrhage. Journal of Stroke and Cerebrovascular Diseases. 2014;23(9):2458-2463\n'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Aiko Osawa",address:null,affiliation:'
National Center for Geriatrics and Gerontology, Japan
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The Open Access Publishing Fee (OAPF) is payable only after your book chapter, monograph or journal article is accepted for publication.
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*These prices do not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT as long as provision of the VAT registration number is made during the application process. This is made possible by the EU reverse charge method.
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Services included are:
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An online manuscript tracking system to facilitate your work
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Personal contact and support throughout the publishing process from your dedicated Author Service Manager
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XML Typesetting and pagination - web (PDF, HTML) and print files preparation
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Discoverability - electronic citation and linking via DOI
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Permanent and unrestricted online access to your work
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What isn't covered by the Open Access Publishing Fee?
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If your manuscript:
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If a manuscript requires Heavy Editing or Language Polishing, this will incur additional fees.
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Your Author Service Manager will inform you of any items not covered by the OAPF and provide exact information regarding those additional costs before proceeding.
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Open Access Funding
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To explore funding opportunities and learn more about how you can finance your IntechOpen publication, go to our Open Access Funding page. IntechOpen offers expert assistance to all of its Authors. We can support you in approaching funding bodies and institutions in relation to publishing fees by providing information about compliance with the Open Access policies of your funder or institution. We can also assist with communicating the benefits of Open Access in order to support and strengthen your funding request and provide personal guidance through your application process. You can contact us at funders@intechopen.com for further details or assistance.
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For Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
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Added Value of Publishing with IntechOpen
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Choosing to publish with IntechOpen ensures the following benefits:
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Indexing and listing across major repositories, see details ...
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Long-term archiving
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Dissemination and Promotion
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Benefits of Publishing with IntechOpen
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Proven world leader in Open Access book publishing with over 10 years experience
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+5,700 OA books published
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Most competitive prices in the market
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This chapter summarizes the scientific literature regarding the manufacture and the evaluation of the properties of this group “emerging prebiotics”.",book:{id:"5193",slug:"probiotics-and-prebiotics-in-human-nutrition-and-health",title:"Probiotics and Prebiotics in Human Nutrition and Health",fullTitle:"Probiotics and Prebiotics in Human Nutrition and Health"},signatures:"Beatriz Míguez, Belén Gómez, Patricia Gullón, Beatriz Gullón and\nJosé Luis Alonso",authors:[{id:"181223",title:"Dr.",name:"José Luis",middleName:null,surname:"Alonso",slug:"jose-luis-alonso",fullName:"José Luis Alonso"},{id:"185296",title:"Ms.",name:"Beatriz",middleName:null,surname:"Miguez",slug:"beatriz-miguez",fullName:"Beatriz Miguez"},{id:"185297",title:"Dr.",name:"Belén",middleName:null,surname:"Gómez",slug:"belen-gomez",fullName:"Belén Gómez"},{id:"185299",title:"Dr.",name:"Patricia",middleName:null,surname:"Gullón",slug:"patricia-gullon",fullName:"Patricia Gullón"},{id:"185300",title:"Dr.",name:"Beatriz",middleName:null,surname:"Gullon",slug:"beatriz-gullon",fullName:"Beatriz Gullon"}]},{id:"68305",doi:"10.5772/intechopen.88381",title:"Introductory Chapter: Alginates - A General Overview",slug:"introductory-chapter-alginates-a-general-overview",totalDownloads:1430,totalCrossrefCites:14,totalDimensionsCites:29,abstract:null,book:{id:"8019",slug:"alginates-recent-uses-of-this-natural-polymer",title:"Alginates",fullTitle:"Alginates - Recent Uses of This Natural Polymer"},signatures:"Leonel Pereira and João Cotas",authors:[{id:"279788",title:"Dr.",name:"Leonel",middleName:null,surname:"Pereira",slug:"leonel-pereira",fullName:"Leonel Pereira"},{id:"279792",title:"Dr.",name:"João",middleName:null,surname:"Cotas",slug:"joao-cotas",fullName:"João Cotas"}]},{id:"50992",doi:"10.5772/63646",title:"Probiotics: A Comprehensive Review of Their Classification, Mode of Action and Role in Human Nutrition",slug:"probiotics-a-comprehensive-review-of-their-classification-mode-of-action-and-role-in-human-nutrition",totalDownloads:5308,totalCrossrefCites:14,totalDimensionsCites:26,abstract:"Probiotics are live microorganisms that live in gastrointestinal (GI) tract and are beneficial for their hosts and prevent certain diseases. In this chapter, after a complete introduction to probiotics, definition, mechanism of action, and their classification, currently used organisms will be discussed in detail. Moreover, different kinds of nutritional synthetic products of probiotics along with their safety and drug interaction will be noticed. This chapter mentions all clinical trial studies that have been done to evaluate probiotic efficacy with a focus on gastrointestinal diseases.",book:{id:"5193",slug:"probiotics-and-prebiotics-in-human-nutrition-and-health",title:"Probiotics and Prebiotics in Human Nutrition and Health",fullTitle:"Probiotics and Prebiotics in Human Nutrition and Health"},signatures:"Amirreza Khalighi, Reza Behdani and Shabnam Kouhestani",authors:[{id:"179560",title:"Dr.",name:"Amirreza",middleName:null,surname:"Khalighi",slug:"amirreza-khalighi",fullName:"Amirreza Khalighi"},{id:"185238",title:"Dr.",name:"Reza",middleName:null,surname:"Behdani",slug:"reza-behdani",fullName:"Reza Behdani"},{id:"185239",title:"Dr.",name:"Shabnam",middleName:null,surname:"Kouhestani",slug:"shabnam-kouhestani",fullName:"Shabnam Kouhestani"}]}],mostDownloadedChaptersLast30Days:[{id:"50992",title:"Probiotics: A Comprehensive Review of Their Classification, Mode of Action and Role in Human Nutrition",slug:"probiotics-a-comprehensive-review-of-their-classification-mode-of-action-and-role-in-human-nutrition",totalDownloads:5325,totalCrossrefCites:14,totalDimensionsCites:26,abstract:"Probiotics are live microorganisms that live in gastrointestinal (GI) tract and are beneficial for their hosts and prevent certain diseases. In this chapter, after a complete introduction to probiotics, definition, mechanism of action, and their classification, currently used organisms will be discussed in detail. Moreover, different kinds of nutritional synthetic products of probiotics along with their safety and drug interaction will be noticed. This chapter mentions all clinical trial studies that have been done to evaluate probiotic efficacy with a focus on gastrointestinal diseases.",book:{id:"5193",slug:"probiotics-and-prebiotics-in-human-nutrition-and-health",title:"Probiotics and Prebiotics in Human Nutrition and Health",fullTitle:"Probiotics and Prebiotics in Human Nutrition and Health"},signatures:"Amirreza Khalighi, Reza Behdani and Shabnam Kouhestani",authors:[{id:"179560",title:"Dr.",name:"Amirreza",middleName:null,surname:"Khalighi",slug:"amirreza-khalighi",fullName:"Amirreza Khalighi"},{id:"185238",title:"Dr.",name:"Reza",middleName:null,surname:"Behdani",slug:"reza-behdani",fullName:"Reza Behdani"},{id:"185239",title:"Dr.",name:"Shabnam",middleName:null,surname:"Kouhestani",slug:"shabnam-kouhestani",fullName:"Shabnam Kouhestani"}]},{id:"51065",title:"Role of the Biofilms in Wastewater Treatment",slug:"role-of-the-biofilms-in-wastewater-treatment",totalDownloads:6759,totalCrossrefCites:24,totalDimensionsCites:55,abstract:"Biological wastewater treatment systems play an important role in improving water quality and human health. This chapter thus briefly discusses different biological methods, specially biofilm technologies, the development of biofilms on different filter media, factors affecting their development as well as their structure and function. It also tackles various conventional and modern molecular techniques for detailed exploration of the composition, diversity and dynamics of biofilms. These data are crucial to improve the performance, robustness and stability of biofilm-based wastewater treatment technologies.",book:{id:"5197",slug:"microbial-biofilms-importance-and-applications",title:"Microbial Biofilms",fullTitle:"Microbial Biofilms - Importance and Applications"},signatures:"Shama Sehar and Iffat Naz",authors:[{id:"180364",title:"Dr.",name:"Iffat",middleName:null,surname:"Naz",slug:"iffat-naz",fullName:"Iffat Naz"},{id:"183345",title:"Dr.",name:"Shama",middleName:null,surname:"Sehar",slug:"shama-sehar",fullName:"Shama Sehar"}]},{id:"50610",title:"Antimicrobial Effect of Probiotics against Common Pathogens",slug:"antimicrobial-effect-of-probiotics-against-common-pathogens",totalDownloads:4708,totalCrossrefCites:24,totalDimensionsCites:31,abstract:"The antimicrobial or antagonistic activity of probiotics is an important property that includes the production of antimicrobial compounds, competitive exclusion of pathogens, enhancement of the intestinal barrier function and others. There are many methods to ascertain probiotic properties, including various in vitro and in vivo methods. The in vivo methods include various modifications of the spot‐on lawn assay, agar well diffusion assay (AWDA), co‐culturing methods, usage of cell lines and others. In many cases in vitro antagonist activity is observed, but in real settings it is not observed. The in vivo methods mainly used are animal models; however, their use is being restricted according to the European legislation OJ L136. The justification of animal models is also questionable as the results of studies on animals do not predict the same results for humans. The use of replacement alternative methods, for example incorporating human cells and tissues, avoids such confounding variables. Most important studies are double‐blinded randomized clinical trials; however, these studies are difficult to perform as it is not easy to achieve uniform conditions. There is a clear need for more elaborate assays that would better represent the complex interactions between the probiotics and the final host. This complex situation is a challenge for scientists.",book:{id:"5193",slug:"probiotics-and-prebiotics-in-human-nutrition-and-health",title:"Probiotics and Prebiotics in Human Nutrition and Health",fullTitle:"Probiotics and Prebiotics in Human Nutrition and Health"},signatures:"Sabina Fijan",authors:[{id:"179312",title:"Prof.",name:"Sabina",middleName:null,surname:"Fijan",slug:"sabina-fijan",fullName:"Sabina Fijan"}]},{id:"68305",title:"Introductory Chapter: Alginates - A General Overview",slug:"introductory-chapter-alginates-a-general-overview",totalDownloads:1437,totalCrossrefCites:14,totalDimensionsCites:29,abstract:null,book:{id:"8019",slug:"alginates-recent-uses-of-this-natural-polymer",title:"Alginates",fullTitle:"Alginates - Recent Uses of This Natural Polymer"},signatures:"Leonel Pereira and João Cotas",authors:[{id:"279788",title:"Dr.",name:"Leonel",middleName:null,surname:"Pereira",slug:"leonel-pereira",fullName:"Leonel Pereira"},{id:"279792",title:"Dr.",name:"João",middleName:null,surname:"Cotas",slug:"joao-cotas",fullName:"João Cotas"}]},{id:"55889",title:"The Physiology of Mycobacterium tuberculosis in the Context of Drug Resistance: A System Biology Perspective",slug:"the-physiology-of-mycobacterium-tuberculosis-in-the-context-of-drug-resistance-a-system-biology-pers",totalDownloads:1539,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Tuberculosis (TB), a disease caused by Mycobacterium tuberculosis (Mtb), is the main cause of death due to an infectious disease. After more than 100 years of the discovery of Mtb, clinicians still face difficulties finding an effective treatment for the increasing number of drug-resistant cases. The difficulties in the clinical setting can be related to the slow pace at which the understanding of the physiology of this bacterium has occurred. Mtb is distinct from other microorganisms not only due to its slow growth and difficulties to study in the laboratory, but also due to its inherent physiology such as its complex cell envelope and its metabolic pathways. Understanding the physiology of drug susceptible and resistant Mtb strains is crucial for the design of an effective chemotherapy against TB. This chapter will review the mycobacterial cell envelope and major physiological pathways together with recent discoveries in Mtb drug resistance through different “omics” disciplines.",book:{id:"5853",slug:"mycobacterium-research-and-development",title:"Mycobacterium",fullTitle:"Mycobacterium - Research and Development"},signatures:"Luisa Maria Nieto, Carolina Mehaffy and Karen M. Dobos",authors:[{id:"198240",title:"Dr.",name:"Carolina",middleName:null,surname:"Mehaffy",slug:"carolina-mehaffy",fullName:"Carolina Mehaffy"},{id:"221619",title:"Dr.",name:"Luisa",middleName:null,surname:"Nieto",slug:"luisa-nieto",fullName:"Luisa Nieto"}]}],onlineFirstChaptersFilter:{topicId:"895",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81375",title:"Environmental Persistence of SARS-CoV-2 and Disinfection of Work Surfaces in View of Pandemic Outbreak of COVID-19",slug:"environmental-persistence-of-sars-cov-2-and-disinfection-of-work-surfaces-in-view-of-pandemic-outbre",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.104520",abstract:"Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pandemic outbreak of SARS-CoV-2 across the world has been responsible for high morbidity and mortality, which emphasizes the role of the environment on virus persistence and propagation to the human population. Since environmental factors may play important roles in viral outbreaks, and the severity of the resulting diseases, it is essential to take into account the role of the environment in the COVID-19 pandemic. The SARS-CoV-2 may survive outside the human body from a few hours to a few days, depending upon environmental conditions, probably due to the relatively fragile envelope of the virus. The shedding and persistence of SARS-CoV-2 in the environment on animate and inanimate objects contributes to the risk of indirect transmission of the virus to healthy individuals, emphasizing the importance of various disinfectants in reducing the viral load on environmental surface and subsequently control of SARS-CoV-2 in the human population.",book:{id:"11006",title:"Disinfection of Viruses",coverURL:"https://cdn.intechopen.com/books/images_new/11006.jpg"},signatures:"Koushlesh Ranjan"},{id:"81019",title:"Physical Inactivation of SARS-CoV-2 and Other Coronaviruses: A Review",slug:"physical-inactivation-of-sars-cov-2-and-other-coronaviruses-a-review",totalDownloads:34,totalDimensionsCites:0,doi:"10.5772/intechopen.103161",abstract:"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for the ongoing pandemic of Coronavirus Disease 2019 (COVID-19). Other members of the enveloped RNA virus family Coronaviridae have been responsible for a variety of human diseases and economically important animal diseases. Disinfection of air, environmental surfaces, and solutions is part of infection prevention and control (IPAC) for such viruses and their associated diseases. This article reviews the literature on physical inactivation (disinfection) approaches for SARS-CoV-2 and other coronaviruses. Data for thermal (heat) inactivation, gamma irradiation, and ultraviolet light in the C range (UVC) irradiation have been reviewed. As expected, the susceptibilities of different members of the Coronaviridae to these physical inactivation approaches are similar. This implies that knowledge gained for SARS-CoV-2 should be applicable also to its emerging mutational variants and to other future emerging coronaviruses. The information is applicable to a variety of disinfection applications, including IPAC, inactivation of live virus for vaccine or laboratory analytical use, and waste stream disinfection.",book:{id:"11006",title:"Disinfection of Viruses",coverURL:"https://cdn.intechopen.com/books/images_new/11006.jpg"},signatures:"Raymond W. Nims and Mark Plavsic"},{id:"80772",title:"Variability and Relative Order of Susceptibility of Non-Enveloped Viruses to Chemical Inactivation",slug:"variability-and-relative-order-of-susceptibility-of-non-enveloped-viruses-to-chemical-inactivation",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.102727",abstract:"Viruses exhibit a marked variation in their susceptibilities to chemical and physical inactivation. Identifying a trend within these variations, if possible, could be valuable in the establishment of an effective and efficient infection control or risk mitigation strategy. It has been observed that non-enveloped viruses are generally less susceptible than enveloped viruses and that smaller sized viruses seem less susceptible than larger viruses. A theory of a “hierarchy” of pathogen susceptibility has been proposed and widely referenced. This concept provides a useful general guide for predicting the susceptibility of a newly emerged pathogen. It also serves as a theoretical basis for implementing a limited scale viral inactivation study that is to be extrapolated onto many other viruses. The hierarchy concept should be interpreted with caution since the actual viral inactivation efficacy may, in some cases, be different from the general prediction. The actual efficacy is dependent on the type of chemistry and application conditions. The order of susceptibility is not always fixed; and viruses within the same family or even the same genus may exhibit drastic differences. This chapter reviews viral inactivation data for several commonly used chemistries against non-enveloped viruses, highlighting the cases wherein the order of susceptibility varied or even flipped. Possible underlying mechanisms are also discussed.",book:{id:"11006",title:"Disinfection of Viruses",coverURL:"https://cdn.intechopen.com/books/images_new/11006.jpg"},signatures:"Sifang Steve Zhou"},{id:"80523",title:"Predicted and Measured Virucidal Efficacies of Microbicides for Emerging and Re-emerging Viruses Associated with WHO Priority Diseases",slug:"predicted-and-measured-virucidal-efficacies-of-microbicides-for-emerging-and-re-emerging-viruses-ass",totalDownloads:38,totalDimensionsCites:0,doi:"10.5772/intechopen.102365",abstract:"The World Health Organization has updated its list of priority diseases for 2021 to currently include the following: Ebola virus disease and Marburg virus disease (Filoviridae), Nipah and henipaviral diseases (Paramyxoviridae), Lassa fever (Arenaviridae), Rift Valley fever and Crimean-Congo hemorrhagic fever (Bunyaviridae), Zika (Flaviviridae), COVID-19 (SARS-CoV-2) including Delta, Omicron, and other variants of concern, Middle East respiratory syndrome, severe acute respiratory syndrome (Coronaviridae), and the always present “disease X,” which is a term used for the next emerging pathogen of concern that is not known about today. In this chapter, we review the virucidal efficacy data for microbicides (disinfectants and antiseptics, also known as surface and hand hygiene agents or collectively hygiene agents) for the viruses associated with these diseases. As these diseases are each caused by lipid-enveloped viruses, the susceptibilities of the viruses to virucidal agents are informed by the known hierarchy of susceptibility of pathogens to microbicides. The unique susceptibility of lipid-enveloped viruses to most classes of microbicides is based on the common mechanism of action of envelope-disrupting microbicides. Empirical data supporting this principle and the mitigational role of targeted hygiene in infection prevention and control (IPAC) discussed are presented.",book:{id:"11006",title:"Disinfection of Viruses",coverURL:"https://cdn.intechopen.com/books/images_new/11006.jpg"},signatures:"M. Khalid Ijaz, Raymond W. Nims, Todd A. Cutts, Julie McKinney and Charles P. Gerba"},{id:"79842",title:"Antiviral Coatings as Continuously Active Disinfectants",slug:"antiviral-coatings-as-continuously-active-disinfectants",totalDownloads:81,totalDimensionsCites:0,doi:"10.5772/intechopen.101752",abstract:"Antimicrobial surfaces and coatings have been available for many decades and have largely been designed to kill or prevent the growth of bacteria and fungi. Antiviral coatings have become of particular interest more recently during the COVID-19 pandemic as they are designed to act as continuously active disinfectants. The most studied antiviral coatings have been metal-based or are comprised of silane quaternary ammonium formulations. Copper and silver interact directly with proteins and nucleic acids, and influence the production of reactive free radicals. Titanium dioxide acts as a photocatalyst in the presence of water and oxygen to produce free radicals in the presence of UV light or visible light when alloyed with copper or silver. Silane quaternary ammonium formulations can be applied to surfaces using sprays or wipes, and are particularly effective against enveloped viruses. Continuously active disinfectants offer an extra barrier against fomite-mediated transmission of respiratory and enteric viruses to reduce exposure between routine disinfection and cleaning events. To take advantage of this technology, testing methods need to be standardized and the benefits quantified in terms of reduction of virus transmission.",book:{id:"11006",title:"Disinfection of Viruses",coverURL:"https://cdn.intechopen.com/books/images_new/11006.jpg"},signatures:"Luisa A. Ikner and Charles P. Gerba"},{id:"79247",title:"Hybrid Hydrogen Peroxide for Viral Disinfection",slug:"hybrid-hydrogen-peroxide-for-viral-disinfection",totalDownloads:124,totalDimensionsCites:0,doi:"10.5772/intechopen.100237",abstract:"Decontamination is often necessary in facilities with sensitive spaces where pathogen elimination is critical. Historically, high concentration vaporized hydrogen peroxide technologies have been applied in these areas for pathogen disinfection. While effective, these high concentration solutions come with inherent risks to human health and safety. Alternatively, one recent innovation is a hybrid hydrogen peroxide system which combines a 7% hydrogen peroxide solution with a calibrated fogging device that delivers a mixture of vaporous and micro aerosolized particles, significantly lowering the risk of exposure to high-concentration hazardous chemicals. Studies performed with this technology demonstrate high level pathogen decontamination across a variety of tested pathogens and substrates. This chapter will cover a brief history of hydrogen peroxide technologies and their application processes; examine the correlations between viral inactivation, viral disinfection, and biological indicators for validation; demonstrate the necessity of dwell time for optimal efficacy; discuss the effects of viral disinfectant use on laboratory surfaces; and examine various studies, including virologic work performed in Biosafety Level 3 facilities and good laboratory practice (GLP) data performed by EPA-approved laboratories. This chapter will provide readers a deeper understanding of essential components and considerations when implementing hydrogen peroxide systems for viral decontamination.",book:{id:"11006",title:"Disinfection of Viruses",coverURL:"https://cdn.intechopen.com/books/images_new/11006.jpg"},signatures:"Meaghan Hislop, Frances Grinstead and John R. Henneman"}],onlineFirstChaptersTotal:8},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"May 11th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,annualVolume:11410,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,annualVolume:11411,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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This includes, but is not limited to: single-neuron modeling, sensory processing, motor control, memory, and synaptic plasticity, attention, identification, categorization, discrimination, learning, development, axonal patterning, guidance, neural architecture, behaviors, and dynamics of networks, cognition and the neuroscientific basis of consciousness. 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Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",keywords:"Image Analysis, Scene Understanding, Biometrics, Deep Learning, Software Implementation, Hardware Implementation, Natural Images, Medical Images, Robotics, VR/AR"},{id:"25",title:"Evolutionary Computation",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization"},{id:"26",title:"Machine Learning and Data Mining",scope:"The scope of machine learning and data mining is immense and is growing every day. It has become a massive part of our daily lives, making predictions based on experience, making this a fascinating area that solves problems that otherwise would not be possible or easy to solve. This topic aims to encompass algorithms that learn from experience (supervised and unsupervised), improve their performance over time and enable machines to make data-driven decisions. It is not limited to any particular applications, but contributions are encouraged from all disciplines.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",keywords:"Intelligent Systems, Machine Learning, Data Science, Data Mining, Artificial Intelligence"},{id:"27",title:"Multi-Agent Systems",scope:"Multi-agent systems are recognised as a state of the art field in Artificial Intelligence studies, which is popular due to the usefulness in facilitation capabilities to handle real-world problem-solving in a distributed fashion. The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Artificial Intelligence",id:"14"},selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. 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Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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