\\n\\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\nThank you all for being part of the journey. 5,000 times thank you!
\\n\\nNow with 5,000 titles available Open Access, which one will you read next?
\\n\\nRead, share and download for free: https://www.intechopen.com/books
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\nDr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\n\nThank you all for being part of the journey. 5,000 times thank you!
\n\nNow with 5,000 titles available Open Access, which one will you read next?
\n\nRead, share and download for free: https://www.intechopen.com/books
\n\n\n\n
\n'}],latestNews:[{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"},{slug:"intechopen-s-chapter-awarded-the-guenther-von-pannewitz-preis-2020-20200715",title:"IntechOpen's Chapter Awarded the Günther-von-Pannewitz-Preis 2020"},{slug:"suf-and-intechopen-announce-collaboration-20200331",title:"SUF and IntechOpen Announce Collaboration"}]},book:{item:{type:"book",id:"1533",leadTitle:null,fullTitle:"Nd YAG Laser",title:"Nd YAG Laser",subtitle:null,reviewType:"peer-reviewed",abstract:"Discovered almost fifty years ago at Bell Labs (1964), the Nd:YAG laser has undergone an enormous evolution in the years, being now widely used in both basic research and technological applications. Nd:YAG Laser covers a wide range of topics, from new systems (diode pumping, short pulse generation) and components (a new semiorganic nonlinear crystal) to applications in material processing (coating, welding, polishing, drilling, processing of metallic thin films), medicine (treatment, drug administration) and other various fields (semiconductor nanotechnology, plasma spectroscopy, laser induced breakdown spectroscopy).",isbn:null,printIsbn:"978-953-51-0105-5",pdfIsbn:"978-953-51-4960-6",doi:"10.5772/2000",price:139,priceEur:155,priceUsd:179,slug:"nd-yag-laser",numberOfPages:330,isOpenForSubmission:!1,isInWos:1,hash:"db0c2af1b51a92668c5ab54719f12745",bookSignature:"Dan C. 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He obtained his PhD at the Institute of Atomic Physics, Bucharest in 1978. Since 1970 he has been involved in research on laser physics and applications (frequency stabilization of lasers, photoacoustic spectroscopy, laser applications in medicine and biology, material processing and ultrashort pulse, high intensity lasers - extreme light) at the Department of Lasers, Institute of Atomic Physics and at the National Institute for Laser, Plasma and Radiation Physics, Bucharest. He works as a professor at Faculty of Physics, University of Bucharest and as a professor and a PhD supervisor at the Faculty of Applied Sciences, University Politehnica, Bucharest. He is the author and/or editor of 15 books and has published more than 120 papers in scientific journals. He held more than 200 presentations at the international conferences (30 invited lectures). 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\r\n\tElectromagnetic imaging is an emerging biomedical imaging modality, which when matured, might present an effective supplement to current imaging technologies for non-invasive assessment of functional and pathological conditions of tissues. This book aims to provide a state-of-art for the most relevant advancements in the development of electromagnetic sensing and imaging for non-invasive detection, by covering all aspects related to the design, modeling, and experimentation. The authors are welcome to submit original research and review articles reporting recent advances in the application of electromagnetic waves technologies in industry and bioengineering.
\r\n\r\n\tThe scope of this book will be the collection of new and/or review results exploring the use of electromagnetic waves for industrial and biomedical applications with particular focus on inclusion detection and medical treatment as well as a diagnostic tool for disease detection. Potential topics include but are not limited to the following: Electromagnetic sensing and imaging for industry applications, Electromagnetic sensing and imaging for biomedical applications, Microwave sensing and imaging , Non-invasive electromagnetic diagnostic tools, Usage of electromagnetic waves for probing organs and advanced MRI techniques, Theoretical modeling of electromagnetic wave propagation, Application of electromagnetic waves in advanced MRI techniques, RF sensors and coils, Biomaterials for wearable sensors, In vitro and in vivo testing.
",isbn:"978-1-83968-582-8",printIsbn:"978-1-83968-581-1",pdfIsbn:"978-1-83968-583-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"e57ef4b5bada0d966637cd303d76278f",bookSignature:"Distinguished Prof. Lulu Wang",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9878.jpg",keywords:"Electromagnetic Sensing, Imaging, Biomedical Applications, Electromagnetic Measurements, Conductivity, Electromagnetic Induction Tomography, Electric Impedance Imaging, Microwave Imaging, Biomaterials, RF Coils, Electromagnetic Scattering Problems, Integral Equations",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"August 26th 2020",dateEndSecondStepPublish:"November 3rd 2020",dateEndThirdStepPublish:"January 2nd 2021",dateEndFourthStepPublish:"March 23rd 2021",dateEndFifthStepPublish:"May 22nd 2021",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"With an M.E. (Hons.) and a Ph.D. degree from the Auckland University of Technology, New Zealand, Dr. Wang is the first author of over 60 peer-reviewed publications, received multiple national and international awards from various professional societies and organizations she is a member of (ASME, IEEE, AAAS, PSNZ, and IPENZ ).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang",profilePictureURL:"https://mts.intechopen.com/storage/users/257388/images/system/257388.jpg",biography:"Lulu Wang is a Full Professor of Biomedical Engineering at Shenzhen Technology University in China. She received the M.E. (First class Hons.) and Ph.D. degrees from the Auckland University of Technology, New Zealand, in 2009 and 2013, respectively. From 2013 to 2015, she was a Research Fellow with the Institute of Biomedical Technologies, Auckland University of Technology, New Zealand. In 2015, Dr. Wang became an Associate Professor of biomedical engineering with the Hefei University of Technology. In 2019, she became a Full Professor of biomedical engineering with the College of Health Science and Environmental Engineering, Shenzhen Technology University. Her research interests include medical devices, electromagnetic sensing and imaging, and computational mechanics. Over the past five years, Dr. Wang is the first author of 60 peer-reviewed publications, 2 ASME books, 7 book chapters, and 12 innovation patents. She has edited three books and two special issues of international journals. Dr. Wang is a member of ASME, IEEE, AAAS, PSNZ, and IPENZ. She has been an active scientific reviewer for numerous journals and international conferences. She received multiple National and International Awards from various professional societies and organizations.",institutionString:"Shenzhen Technology University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"20",title:"Physics",slug:"physics"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"259492",firstName:"Sara",lastName:"Gojević-Zrnić",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/259492/images/7469_n.png",email:"sara.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6835",title:"Computer Methods and Programs in Biomedical Signal and Image Processing",subtitle:null,isOpenForSubmission:!1,hash:"19f08ef15d97900c94dc8fb04f9afb5f",slug:"computer-methods-and-programs-in-biomedical-signal-and-image-processing",bookSignature:"Lulu Wang",coverURL:"https://cdn.intechopen.com/books/images_new/6835.jpg",editedByType:"Edited by",editors:[{id:"257388",title:"Distinguished Prof.",name:"Lulu",surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8347",title:"Computer Architecture in Industrial, Biomechanical and Biomedical Engineering",subtitle:null,isOpenForSubmission:!1,hash:"3d7024a8d7d8afed093c9c79ec31f15a",slug:"computer-architecture-in-industrial-biomechanical-and-biomedical-engineering",bookSignature:"Lulu Wang and Liandong Yu",coverURL:"https://cdn.intechopen.com/books/images_new/8347.jpg",editedByType:"Edited by",editors:[{id:"257388",title:"Distinguished Prof.",name:"Lulu",surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8356",title:"Metastable, Spintronics Materials and Mechanics of Deformable Bodies",subtitle:"Recent Progress",isOpenForSubmission:!1,hash:"1550f1986ce9bcc0db87d407a8b47078",slug:"solid-state-physics-metastable-spintronics-materials-and-mechanics-of-deformable-bodies-recent-progress",bookSignature:"Subbarayan Sivasankaran, Pramoda Kumar Nayak and Ezgi Günay",coverURL:"https://cdn.intechopen.com/books/images_new/8356.jpg",editedByType:"Edited by",editors:[{id:"190989",title:"Dr.",name:"Subbarayan",surname:"Sivasankaran",slug:"subbarayan-sivasankaran",fullName:"Subbarayan Sivasankaran"}],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:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria 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by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"48956",title:"Hematopoietic Stem Cell Source and Storage",doi:"10.5772/60994",slug:"hematopoietic-stem-cell-source-and-storage",body:'Hematopoietic stem cell transplantation (HSCT) has been accepted as a feasible treatment option that prolongs survival in hematological malignancies. Bone marrow (BM) has been widely used as stem cell source in the early stem cell transplantation series. Tendency towards peripheral blood (PB) as stem cell source has been started in the beginning of 2000s. Initially, advantages of peripheral blood stem cell collection have been demonstrated in autologous stem cell transplantation (autoSCT). The introduction of peripheral blood into allogeneic stem cell transplantation (alloSCT) has been followed by allogeneic transplantation from unrelated donors. Due to the less stringent HLA matching requirement, cord blood stands out as an option for patients who do not have HLA-matched donors.
Stem cell choice can change according to the experience of physicians, mostly treated hematological diseases in the centers or ongoing clinical trials. In this chapter, we will discuss the advantages and disadvantages of three stem cell sources: peripheral blood, bone marrow, and umbilical cord blood.
Although the early transplantation series mostly used bone marrow as stem cell source, the administration of granulocyte colony-stimulating factor allowed physicians to collect stem cells from peripheral blood by apheresis procedure. Studies in autologous stem cell transplantation (autoSCT) have been reported first. Faucher et al. [1,2] compared peripheral blood and bone marrow in a series with small patient numbers and reported an improvement in hematological recovery and a decrease in hospitalization duration. Survival of the patients was found to be similar between these two stem cell sources [3]. Also, the cost-effectiveness of the procedure increased peripheral blood stem cell transplantation rates compared with bone marrow transplantation. In a study, the total cost in peripheral blood stem cell transplantation was found to be 27.5% less than bone marrow transplantation. Faster hematological recovery, fewer hospitalization days, and less antibiotic treatment created this difference in total cost [4].
Afterwards, the comparison of peripheral blood with bone marrow in allogeneic stem cell transplantation (alloSCT) setting was started. Bensinger et al. [5] reported faster hematological recovery, less transfusion numbers, less severe acute graft versus host disease (a gvhd in favor of PB), but similar chronic graft versus host disease (cGVHD) rates. Our centers’ experience also revealed faster engraftment, fewer transfusions with PB [6]. Miflin et al. [7] showed that increasing the infused CD34+ cell number over 4× 10e6/kg can significantly accelerate the engraftment kinetics.
In a multicenter randomized trial performed by the European Group for Blood and Marrow Transplantation (EBMT), transplant-related mortality and leukemia-free survival rates showed no significant difference between PB and BM [8]. Mielcarek et al. [9] reported a better 10 years disease-free survival in favor of PB but similar overall survival between two stem cell sources. In a Cochrane database review, trials including related stem cell donors were analyzed. Both neutrophil and platelet recoveries were faster in PB. Disease-free survival, nonrelapse mortality was not different between PB and BM. The advantage of relapse in PB was recorded [10].
Peripheral blood has more CD34+ cells but has also more T cells in comparison with BM. This reflects to the outcomes as more acute and chronic GVHD rates. In a study, acute grades I–IV GVHD incidences for infused CD34+ cell doses less than 2× 10e6/kg, between 2× 10e6/kg and 4× 10e6/kg, and more than 4× 10e6/kg were 21%, 35%, and 43%, respectively. In the same study, increase in CD3+ cell dose was also identified as an independent factor for acute GVHD [11]. The correlation between infused cell dose and chronic GVHD has also been shown. Zaucha et al. reported CD34+ cell doses over 8× 10e6/kg were found to be associated with increased clinical extensive chronic GVHD. However, this association could not be shown with stem cell transplantation from bone marrow [12]. cGVHD after PB transplantation has to be treated for a longer period with higher immunosuppressive regimens. The presence of cGVHD has been found to be related with fewer relapses but more treatment-related mortality [13–16].
The comparison of stem cell sources has been performed according to the diagnosis of hematological malignancies. Pidala et al. [17] performed a Markov model in which PB was found to be the optimum stem cell source for hematological malignancies, which had an advantage of 7 months in comparison with BM. BM was chosen to be superior in patients with 1-year relapse rates lower than 0.05. Patients with high-risk hematological malignancies like acute leukemia in second or later remission, chronic myeloid leukemia (CML) in blastic transformation, refractory anemia with excess blast in transformation, and heavily pretreated lymphoma patients were found to benefit from PB transplants in comparison with BM transplants [16]. A meta-analysis of nine randomized clinical trials showed better disease-free and overall survival with PB in late stage disease [18]. In a randomized study of patients with myeloid malignancies, acute myeloid leukemia AML,CML and myelodysplastic syndrome (MDS), hematological recovery was faster in PB group. Improvement in overall survival with PB was found to be related with reduction in nonrelapse deaths, with no difference in early, late relapses, or deaths in relapses [19]. In another study, which has included chronic myeloid leukemia patients, the incidence of acute and extensive chronic GVHD was similar between BM and PB patients, and there was no significant difference between survival and nonrelapse mortality rates. However, in the subgroup analysis of chronic phase patients, PB patients experienced more chronic GVHD, and BM patients had higher relapse rates [20]. The advantage of BM remains in benign hematological diseases, where chronic GVHD rates affect transplant outcomes negatively. In a study that included 537 adolescent aplastic anemia patients who had alloSCT, the survival advantage for BM recipients was reported to be significant [21]. Bacigalupo et al. [22] showed the advantage of BM also for the patients older than 50 years. The major causes of death were GVHD, infections, and graft rejection in this study. GCSF-stimulated and GCSF-unstimulated bone marrow and peripheral blood have been compared in another study that included aplastic anemia patients. Engraftment rates were not different in three treatment arms. Grades II–IV acute GVHD and chronic GVHD rates were higher with PB transplants in comparison with BM. GCSF-manipulated BM was not superior to BM in terms of mortality rates [23].
Late effects of transplantation were also analyzed in studies. Performance status, return to work, incidence of bronchiolitis obliterans, and hematopoietic functions were found to be similar between PB and BM. Also, there was no significant difference in secondary malignancies between the groups [24].
As HLA-matched siblings can be found in 25% of the patients, either PB or BM of the unrelated donors has been accepted as sources for stem cell transplantation. Eapen et al [25] reported significantly higher acute and chronic GVHD risk but similar transplant-related mortality and survival rates with PB than BM in unrelated allogeneic stem cell transplants. In a phase 3, multicenter randomized trial from 46 transplant centers in the United States and Canada, only chronic GVHD rates were significantly higher in PB transplantations. In long-term outcome analysis, chronic GVHD was graded as extensive in 85% of PB recipients compared with 76% of BM recipients. Neutrophile and platelet engraftment rates were found to be significantly higher in PB transplantations, but no difference was observed in survival outcomes [26]. In a Cochrane database review, trials including unrelated stem cell donors were also revised. Both neutrophile and platelet recovery was faster in PB transplantations. Disease-free survival, nonrelapse mortality of PB, and BM recipients were not different. The relapse advantage of PB was not proved. Acute grades II–IV incidence did not reveal a statistical significance, whereas extensive chronic GVHD rates were in favor of BM [10].
The outcomes of unrelated allogeneic stem cell transplantation were also separately assessed according to the diagnosis of hematological diseases. During an overall survival of 7 years, nonrelapse mortality and relapse rates were similar in acute myeloid leukemia and myelodysplastic syndrome patients who have received PB or BM. The only significant difference was reported in chronic myeloid leukemia patients due to higher nonrelapse mortality rates in PB transplants [27]. In a Korean study, the difference in GVHD incidence could be overcomed by risk adapted GVHD prophylaxis in AML patients [28]. In aplastic anemia patients, the risk of death was higher with unrelated donors, but peripheral blood as a stem cell source was a negative predictor for outcomes [29].
The impact of conditioning regimens in unrelated allogeneic stem cell transplantation has also been assessed in clinical trials. EBMT data showed that when reduced intensity conditioning (RIC) regimens were used in unrelated transplant settings, acute and chronic GVHD rates were higher, and relapse rates were lower in PB transplants of AML patients [30].In contradictory with these results, GVHD, relapse, and survival rates of hematological malignancies who had unrelated stem cell transplantation were reported to be similar in a recent trial [31].
The issues that have to be paid importance during hematopoietic stem cell transplantation should be the benefits of either the donor or the patient.
Both the peripheral blood and the bone marrow have advantages and disadvantages for the donors. Peripheral blood donation is a collection of HSC from peripheral blood after a 5-day course of granulocyte colony-stimulating factor administration on 1–2 days via 4–5 hours of apheresis procedure. The monitorization of circulating CD34+ cells on the first day of apheresis is predictive for stem cell yield [32].
Peripheral blood stem cell collection seems to be an easier collection method, but the central venous line can be a necessity for some of the donors if the standard peripheral venous line is not adequate. Again in NMDP experience, femoral and jugular lines were in same frequency, which was twice as the subclavian line [33]. The collection of peripheral blood stem cells via apheresis procedure has been proven to be an effective and safe method for donors [34]. Bone marrow harvesting is the collection of HSC from posterior iliac crest under anesthesia. Hospital admission can be necessary for postoperative follow-up. In a prospective study, the experience of donors for bone marrow and peripheral blood collection has been compared. Bone marrow donors were found to be less confused and more prepared for donation. They also found the process psychologically beneficial in a short term. However, the long-term health-related quality was similar between both donors [35]. In a survey of 51,024 AHSCT performed by 338 teams, five donor fatalities were observed. Severe adverse events were reported in 37 donors. Hematological malignancy rates were not different from the age and sex-adjusted general population [36]. Bone pain was the most frequent side effect of donors; in bone marrow donors, pain at the collection site and in peripheral blood donors pain at various sites of body during GCSF administration have been reported. Tiredness, light-headedness, nausea, sleeping problems, and chills were the other frequent side effects. At 12 months postdonation, the most common side effects were tiredness and muscle aches [35]. A median time to recovery in PB and BM donors were 1 and 2 weeks, respectively [37]. In a prospective trial from NMDP, females and heavier donors had more III–IV CALGB adverse events [38].
Umbilical cord remains to be a stem cell source option for patients who do not have a matched sibling or unrelated donor. The first umbilical cord blood transplantation has been performed at the end of the 1980s in a child diagnosed with Fanconi anemia [39]. Today, the storage of more than 600,000 cryopreserved cord bloods serves as an alternative option for both pediatric and adult patients. In the U.S. registry, almost all of the patients younger than 20 years and 80% of the patients older than 20 years had cord blood mismatched units in one or two HLA locus [40].
Rapid availability, no requirement for full HLA match, and being an option for ethnic minorities became the advantages of umbilical cord. Also, no harm for donor can be another important feature in stem cell source choice. Lack of sufficient cell doses for adult patients, delayed engraftment, poor immune reconstitution, and high infection rates are the major disadvantages of cord blood transplantation. Cord blood includes more naive T cells and Tregs. The first naive T cells proliferate but show a limited repertoire. Then a thymic-dependent population expands, which can be affected by conditioning regimen, GVHD, or aging [41].
The standard practice for the HLA typing of cord blood units is to analyze A-B antigens and DRB1 alleles with high resolution. The acceptable HLA match is 4 to 6/6 match for performing transplantation, but each mismatch results in increased TRM, increased severity of acute GVHD, and decreased survival [42]. Eapen et al. [43] reported the impact of level matching on TRM and neutrophile engraftment. Neutrophile recovery was found to be delayed in transplantations with more than two mismatches, and nonrelapse mortality was reported to be higher in 1–5 mismatch compared with HLA full-match transplantations. HLA C matching has also been shown to be beneficial in studies [42,44]. Barker et al. [45] analyzed 1691 MDS and AML patients who received single cord blood transplantation and found that regardless of cell dose, HLA A, B, and DR-matched transplantations result in the best outcomes. Total nucleated cell (TNC) doses greater than 2.5× 10e7/kg in one mismatch recipient and 5× 10e7/kg in two mismatch recipients have been shown to be sufficient for better survival. In another study, high-resolution DRB1 match was related with less acute GVHD and better event-free survival rates. Also, in the same study, infusing higher CD34+ cells, CD34+HLA DR+ CD38+ cells, and CD3+ cells resulted in faster engraftment [46]. The impact of HLA mismatch direction between donor and recipient has also been assessed by EUROCORD/EBMT analysis. Neither one to two mismatch in graft versus host direction nor host versus graft direction was found to be related with increased nonrelapse mortality and survival [47].
Graft failure risk remains to be a problem in 10%–20% of patients who had cord blood transplantation [48]. Neutrophile and platelet engraftment is delayed in cord blood transplantations. Engraftment is shown to correlate with cell dose infused [49]. In an analysis of 1268 patients with acute leukemia, 3 years overall survival was 47% and TRM was 16%. Delay in engraftment was associated with increased mortality and shorter survival rates [50].
Survival outcomes have been improved over years with better patient, conditioning regimen selection, and progress in HLA typing [44]. Rubinstein et al. [51] showed that 46% of the patients experienced transplant-related events by posttransplant day 100. Transplant-related events and event-free survival were related with diagnosis, number of leukocytes in the transplant, age, extent of HLA disparity, and transplant center. Cohen et al. [52] reported the outcome of 500 patients who had single-unit cord blood transplantation from 1995 to 2005 and found 1 year survival as 37%. Factors affecting early mortality following the myeloablative single-unit cord blood transplantation were cell dose, advanced disease, older age, cytomegalovirus status, female gender, and limited cord blood center experience. A Japanese study revealed that disease status and cytogenetics had an impact on event-free survival rates in AML patients [53]. For acute lymphoblastic leukemia patients who had cord blood transplantation, the factors associated with better leukemia-free survival were age, advanced disease, and conditioning regimen [54]. Brunstein et al. [55] reported 3 years event-free and overall survival as 38% and 45%, respectively, by performing transplantation with nonmyeloablative conditioning. In a comparative study, on the effect of conditioning regimen intensity, transplant-related mortality was similar with both regimens; lower risk of relapse and longer leukemia-free survival could be achieved after myeloablative regimens [56]. Fludarabine in combination with total body irradiation (TBI) concluded with high treatment-related mortality [57]. In another trial, fludarabine, TBI in combination with busulphan versus cyclophosphamide has been investigated; cyclophosphamide resulted in better transplantation outcome [58]. Also, the Japanese group used a myeloablative conditioning regimen, which included TBI, cytarabine, and cyclophosphamide, and reported 51% overall survival for high-risk hematological malignancies [59].
Graft versus host disease (GVHD) is one of the major early and late morbidity and mortality causes. It has been proven that donor source has an impact on GVHD rates. Although the HLA disparities were higher in cord blood transplantations, GVHD was found to be lower than bone marrow [60–62]. Eurocord and EBMT revealed that HLA mismatch increased the acute GVHD risk in cord blood transplantation [63]. Patient age [51], CMV status [63], nonmyeloablative conditioning, and absence of ATG were also factors thought to be related with acute GVHD. Acute GVHD was reported to be higher in double-unit cord transplants than the single-unit transplants [60]. In a study with 1072 patients, chronic GVHD in posttransplant 2 years was 28%. In multivariate analysis, risk factors were identified as myeloablative conditioning regimen, mycophenolate mofetil in GVHD prophylaxis, increased HLA mismatch, higher body weight, and previous acute GVHD [64]. Newell et al. [65] found higher chronic GVHD rates, which were analyzed according to NIH 2005 criteria and had a predominance of acute GVHD features.
Comparative trials of umbilical cord blood with different stem cell sources have been reported. Neutrophile and platelet recovery have been delayed in cord blood transplantations, and chronic GVHD rates have been observed less. Laughlin et al. [66] included patients who had received either an HLA-matched marrow transplant- a marrow transplant with a single HLA mismatch from an unrelated donor or who had received a cord blood transplant with one or two HLA mismatches in their study. Overall mortality was found to be lower in matched related BM recipients. The rate of leukemia recurrence was found to be similar, but 3 years survival for cord blood recipients was 26%, which was lower than matched BM recipients’ survival. In a recent trial, donor types have been investigated in AML patients; survival rates were similar between matched related, matched unrelated, mismatched unrelated, and cord blood transplant. Age and type of conditioning regimens were the major determinants of survival [67].
As a consequence of inadequate engraftment with single-unit cord blood transplantation in adult hematological malignancy patients, double-unit cord transplantation was introduced in the beginning of 2000s. Sustained engraftment could be achieved more than 90% of patients and one of the double-units dominate [68,69]. Barker et al. [70] observed the impact of CD3+ cell dose on engraftment, but not the CD34+ cell dose or HLA match in double cord unit transplantations.
Avery et al. [68] found an association between higher numbers of CD34+ and TNC cell dose of the dominant unit and sustained engraftment. In the same trial, unit–unit HLA match and unit–recipient HLA match were not associated with sustained engraftment. Mixed chimerism can be displayed in follow-up, especially if the HLA match of the both units is close [71]. The HOVON group showed that the unit predominance was observed by posttransplant day 11, and the role of CD4+ lymphocyte-mediated alloreactivity was suggested [72]. In another study, the cord blood bankreported pre cryopreservation and postthaw viable CD34+ cell doses were the important parameters for the engraftment [73].
Macmillan et al. [60] reported double cord transplantation as one of the risk factors for acute GVHD. Ponce et al. [74] demonstrated the acute grades II–IV rates as 53% and predominantly the gut as affected organ. Chronic GVHD rates have been reported around 30% in double cord blood transplantation trials [75,76].
Eurocord and EBMT compared single-unit transplantation with different myeloablative conditioning regimens and double-unit transplantation. Conditioning regimens were either the widely accepted Minnesota protocol, which consisted of TBI/cyclophosphamide/ fludarabine or thiotepa/busulphan/fludarabine (TBF). In this study, 2 years LFS was similar between double-unit cord and single-unit cord if the new TBF protocol was chosen [75,77]. In a prospective multicenter trial, which included 56 acute leukemia and myelodysplasia patients transplanted with double-unit cord, 3 years disease-free survival was 50% and TRM was 39% [76].
Comparative studies of different stem cell sources in the era of double-unit cord have been continued to be reported. In comparison with filgrastim mobilized peripheral blood, delay in immune reconstitution of T cells in cord blood transplantation resulted in increased infection risks. The double-unit cord blood has been compared with unrelated donor grafts; although 3 years survival analysis were similar, double cord blood was associated with less chronic GVHD but more nonrelapse mortality [78]. Brunstein et al. [79] have found comparable 5-year leukemia-free survival after HLA-matched related, unrelated, and double-unit cord blood transplantation.
Collected hematopoietic stem cells have been cryopreserved by using a cryoprotectant, dimethyl sulfoxide (DMSO), and frozen in liquid nitrogen vapor until reinfusion. DMSO penetrates to cells and binds to water molecules in order to prevent dehydration of the cells [80]. During the cryopreservation process, DMSO dilution, freezing period, storage in vapor phase, or liquid nitrogen are the important factors for optimum results. DMSO and cell suspension should be cooled down to 0°C–4°C, and after the addition of DMSO, the product should be placed in a controlled freezer subsequently. The optimum concentration of DMSO has also been analyzed in different studies because it can be toxic for stem cell viability and also may cause side effects during infusion. Although majority of transplant centers still prefer to use 10% DMSO, lower percentage of DMSO or washing the product before infusion to decrease toxicity has also been used [81]. Reducing DMSO concentration into 7.5% has been revealed as feasible [82]. Up to 10 years cryopreservation with 5% DMSO has also been found not to have a negative impact on cell viability [83]. DMSO concentration has been calculated as ml/kg body weight or ml/min, and in EBMT results from 65 centers, it has been revealed that calculation as milliliters per minute should be the preferred way to reduce side effects [84]. DMSO toxicity can result in nausea, vomiting, fever, or more severe reactions like hepatic dysfunction, cardiac arrhythmia, and neurotoxicity [85,86].
In the freezing period, cells have been mostly frozen using controlled rate freezers. Too fast cooling can result in intracellular crystallization, and too slow cooling can induce extracellular ice formation. Sputtek et al. [87] reported that the cooling rate range can vary from 1 to 5 K/min. Also, the recovery of white blood cell (WBC) recovery was found to be superior in slow rate freezing to fast rate freezing [88]. After the introduction of stem cell storage in liquid nitrogen, risks for microbial contamination of the products concluded with the usage of vapor phase for storage. However, the comparison of the two phase was found to be similar for either WBC recovery or WBC viability in comparative studies [88,89].
The major disadvantage of the umbilical cord blood processing is the potential risk for loss of progenitor cells in the collected product. The techniques that have been used for red cell separation like simple centrifugation lysis with ammonium chloride, filtration through density gradients, or collection from bags to vessels were found to have detrimental effects during cryopreservation [90–93]. Thus, Rubinstein et al. [94] initially proved that forming 20 ml cord blood units with uniform volume can be achieved by using rouleaux formation induced by hydroxyethyl starch and centrifugation. Semiautomated top–bottom systems and lately automatic devices like AXP-SEPAX have been developed [95]. Automatic systems could achieve similar cell recovery with less technical influence [96].
After the addition of 10% dimethyl sulfoxide, cord blood samples can be cooled from 4°C to –80°C mostly by controlled rate freezers [97]. It has been recently shown that cord bloods can be transferred into liquid nitrogen vapor phase directly or after storage at –80°C for 18 hours [98]. It has been demonstrated by Broxmeyer et al. that the long-term storage does not have a negative influence on in vitro function of umbilical cord blood progenitor cells. Also, the duration of cryopreservation was found to have no impact on clinical outcome like neutrophile or platelet recovery after cord blood transplantation [99].
Hematopoietic stem cell source choice is an important issue to be concerned during stem cell transplantation. Diagnosis and pretransplantation status of hematological diseases and type of conditioning regimens are the major factors in making decision for one type of stem cell source.
Processing before the storage of collected stem cells can show differences according to the source of stem cells. In particular, cord blood processing needs more attention due to the risk of hematopoietic stem cell loss.
Presenting can be considered as a core competence of the higher educated professional [1, 2, 3]. It is perceived as relevant for working in various working environments, for career success, and for effective participation in democratic societies [4]. However, young professionals entering working practice often failed to acquire public speaking skills according to the scientific literature as well as evaluations from the corporate sector. Therefore, it is crucial to critically discuss the effective and efficient integration of learning trajectories on oral presentation competence in higher education curricula [3].
A recently conducted review study revealed a comprehensive set of educational design principles for developing oral presentation competence in higher education [3, 5]. Three out of the seven principles directly refer to formative assessment strategies, of which the type of feedback, involving peers in feedback processes, and self-assessment are named as crucial learning environment characteristics. Although several empirical studies, aiming to further refine these principles, mentioned the teacher as a crucial feedback source, it might be questioned to what extent innovative technologies, such as VR, could play an essential role in both (1) facilitating presentation rehearsals and (2) providing feedback to the individual learner.
Follow-up research showed that students’ oral presentation competence can be developed by the use of VR [6]. However, still the role of the teacher remained crucial, since the produced data reports, delivered by the VR system, needed to be interpreted by the teacher into feedback messages for the student. Recent developments in technology and education managed to translate the quantitative data into qualitative feedback messages on presentation delivery aspects. As a consequence, current designers of presentation curricula are challenged if the learner is able to individually interpret automatized and personalized feedback messages after rehearsing in front of virtual audiences. In line with this, it questions to what extent teachers’ roles might change over time.
The goal of this chapter is to synthesize recent studies into a set of educational design principles for effective use of VR, to discuss practical implications and to construct a future research agenda on this topic for the higher education context.
Previous studies in this field emphasized the benefits of using VR to reduce presentation anxiety in the higher education context [7, 8]. These studies revealed that if students present in a virtual environment, they report lower self-reported levels of anxiety. Further, researchers showed that the degree of anxiety experienced by the presenter depended on the type of virtual audience. In line with this, a hostile, negative audience demonstrated a strong effect on students’ perceived presentation anxiety [8]. Other researchers focused on the relationship between VR and students’ development of oral presentation skills. It was found that immediate feedback could positively impact students’ evaluation if sparse feedback strategies were provided instead of continuous or no feedback at all [9]. In that study, feedback was delivered by a color-coded gauge above the audience. Further, another study proved that interactive audiences in VR encouraged students’ development of presentation skills [10].
Although several studies focused on the relationship between VR for delivering feedback and reducing presentation anxiety and developing oral presentation skills, cognition and attitude towards presenting were not included within the research foci. Following the construct of competence, it is stated that if students acquire more knowledge about presenting, their presentation behavior might positively develop and as a result also change their attitudes towards presenting [3]. Further, previous researchers studied immediate feedback on presentation delivery aspects within VR, while delayed feedback verbally provided by a presentation expert can be considered as an essential type of feedback in realistic presentation skills curricula. Another bias of the described studies is that the feedback is solely provided within the system. However, it remains questionable to what extent VR is as effective as presentation experts providing their feedback based on observation and interpretation of students’ actual behavior. Finally, students’ perceptions with regard to the use of VR and the provision of feedback based on these systems have scarcely been researched. Therefore, it is crucial to include this crucial intermediate variable for encouraging learning processes and outcomes in follow-up studies.
Taking the mentioned gaps in presentation literature on VR into consideration, a recent experiment studied the effectiveness of a VR-based presentation task, in which students received feedback after the presentation rehearsal in VR—on eye contact, use of voice, posture and gestures—that was traced by the VR system and interpreted by a presentation expert [6]. The results showed that the three components—cognition, behavior, and attitude towards presentation—increased significantly without a difference in impact between the experimental and control conditions consisting of a face-to-face presentation with only an expert feedback. In addition, a self-evaluation test showed that students from the experimental group highly appreciated the analytical and detailed characteristics of the VR feedback and at the same time shared suggestions regarding the integration of VR in higher education. With regard to the scientific relevance of that study, integrating both forms of feedback (VR and face-to-face feedback) could further increase the quality of feedback messages and as a result impact students’ learning outcomes focusing on presenting. In line with this, educational design principles relating to the type of feedback could be further optimized.
Recent developments in innovative technologies as well as in pedagogical and educational sciences revealed that feedback messages can be constructed by the VR computer system and delivered to the individual learner [6]. At the same time, recent trends in educational practice underscore the need to encourage personalized learning in which learning environments directly match learners’ needs and individual preferences, to adjust learning environments just-in-time and to facilitate opportunities to practice and to deliver feedback irrespective of time and place [6]. Taking the earlier published comprehensive set of seven educational design principles for developing oral presentation competence in higher education into account, how can virtual learning environments further optimize existing principles, such as instructions, learning activities, and formative assessment strategies, in order to create more effective, efficient, and challenging learning trajectories fostering students’ presentation competence in higher education curricula? (Figure 1).
Presenting in front of a virtual audience in the television studio of “Presenting with Impact.” ©Kees Rutten.
This section focuses on constructing seven educational design principles for optimizing students’ development of oral presentation competence by making use of VR. The first sentence of each paragraph formulates the particular design principle followed by conceptual and empirical argumentations.
First, learning trajectories fostering students’ presentation competence in VR should directly relate to personal learning objectives of the individual learner. As emphasized by studies in presentation literature, learners vary with respect to their learning needs and preferences [2, 3]. For instance, some students need to develop their use of voice, and others should use more supportive gestures during their presentation. In regular presentation skills courses, it is considered as a challenge for teachers to differentiate between students with varying objectives partly due to time constraints. However, VR environments can facilitate opportunities to practice and to rehearse irrespective of time and space, at students’ own preferred pace and potentially without the intervention of a presentation expert. These developments foster personalized learning and could create more effective as well as efficient learning environments.
Second, presentation learning paths should be positioned just-in-time prior to an authentic presentation task. Normally, face-to-face presentation courses are being provided at a fixed moment in time without a specific connection to a final, authentic presentation task [3]. If mobile, personalized learning environments in VR are facilitated prior to a presentation task for a real client, it could impact the motivation of the individual learner and as a consequence foster the development of students’ oral presentation competence [3]. Positioning presentation activities in VR prior to a performance for a real audience, for example, in the context of an internship, might also increase the perceived relevance resulting in more effective student learning.
Third, presentation learning environments should incorporate varying types of non-expert and expert models. In current face-to-face presentation courses, students acquire knowledge on presenting by observing non-expert models such as peers. However, the presentation literature revealed that both non-expert and expert models can foster students’ self-efficacy towards presenting [3]. Further, expert models show different types of performances with regard to eye contact, use of voice, and posture and gestures. In line with this, within VR environments, learning activities can be integrated, focusing on developing presentation behavior based on preferred expert models. Finally, learners in VR can compare their own performances on presentation delivery aspects to the averages of world leaders, CEOs, or television personalities.
Fourth, learning trajectories towards presenting should facilitate opportunities to practice in varying environments. In face-to-face presentation curricula, one of the challenges for teachers is to provide rehearsals for students, especially in times when opportunities for teacher-student interactions are diminishing. Virtual reality facilitates practicing presentations in front of interactive audiences in varying contexts, such as classroom settings, theater environments, and television studios. Although previous researchers claim that a two-presentation sequence is required, other presentation experts suggest that students need at least four or five rehearsals in order to significantly develop their behaviors [11, 12]. Practicing in front of virtual audiences in different contexts is considered as one of the crucial principles for virtual learning environments fostering students’ presentation competencies.
Fifth, students should receive immediate and delayed feedback messages on their actual presentation performances. A recently conducted experimental study revealed that feedback from VR systems can be characterized as detailed and analytic, while face-to-face feedback from teachers concerns positive and constructive messages [6]. Combining these insights and relating these to the main quality criteria of feedback could facilitate the construction of personalized high-quality feedback messages fostering students’ presentation skills [13]. Further, another study revealed that immediate feedback is as effective as delayed feedback; however, this type of feedback is especially effective for enhancing aspects such as eye contact, use of voice, and posture and gestures [14]. During presentations in front of virtual audiences, icons can be projected above these avatars informing the presenter on the extent to which they make eye contact with all audience members and their speech rate.
Sixth, students should have the opportunity to receive feedback from external feedback sources such as peers. Previous research revealed that triangulating feedback mechanisms allow for greater reflective learning [3]. Further, students that are actively involved in their learning processes and work collaboratively could feel a higher sense of responsibility and an increased attention to the performance criteria and as a result foster their presentation skills. However, the provision of peer feedback in regular educational face-to-face systems is limited. By making use of VR, students can deliver and receive feedback irrespective of time and space. Further, it could also increase the authenticity of the situation. For example, if students are required to present in English and their peers are from another country, it could increase their motivation and as a consequence also their performances.
Seventh, reflection activities facilitate the development of students’ oral presentation skills. Students’ reflection on their own behavior can be considered as essential for student learning [15]. However, quasi-experimental studies revealed that self-assessment tasks revealed a limited impact on students’ attitude towards presentation and the actual presentation skill [3, 16]. Essential argumentations refer to the lack of an external feedback source, the complexity of reflection cycles, and a lack of active reflection of the individual student [3]. VR could optimize the principle of self-assessment tasks for presentation skills development, since feedback can be delivered by the system and learning trajectories are adapted based on the input of the individual learner. Further, students can practice in front of virtual audiences without the need to be actually in environments such as classrooms, theater environments, and television studios.
Research on VR fostering presentation competence combined with recent developments in technology and education facilitated the design of a mobile, personalized, and comprehensive learning environment in VR. The following advantages for student learning can be formulated: (1) the environment relates to the personal learning objectives of the individual learner, (2) the student is able to use this VR tool for developing presentation skills just-in-time, and (3) presenters can individually rehearse their presentation performances as many times as they need and receive feedback by the VR system during or after every single presentation.
While teachers and teacher educators in varying countries, such as the Netherlands, Italy, Thailand, and the United States, are experimenting and integrating this VR tool in educational practice, several challenges appear so far.
First, teachers are challenged to critically rethink their presentation curriculum if certain parts can be facilitated by the VR system. Examples refer to (1) working with individual learning objectives, (2) learning from instructions, (3) observing presentation models, (4) rehearsing in front of different environments, and (5) receiving immediate and delayed feedback on performances.
Second, teachers are challenged to design more effective self-assessment tasks with the support of VR. In line with this, more information of the individual learner can be traced, such as big data, by monitoring their learning processes in VR. This challenges the teacher not only to act as an instructor within presentation curricula but also to further support their role as coaches by making use of both observations and interpretations and analyzing detailed information about presentation delivery aspects facilitated by the VR system.
Third, teachers are also challenged to co-design such virtual learning environments because their educational expertise and experience are key for making effective use of VR. Since expertise from several domains, such as ICT, communication, and education, is needed in order to effectively develop these environments, teachers and teacher educators should collaborate with professionals from varying domains and sectors.
Nevertheless, several implications for educational practice remain with regard to implementing VR in presentation education. Integrating VR in education means that teachers, teacher educators, curriculum designers, and coaches need to be trained before entering formative assessment processes supported by VR. Finally, working with VR means, initially, investments in terms of effort, time, and financial resources that should directly relate to strategic policies of higher education institutions [6, 17].
The following section describes five directions for future research and sets a research agenda for developing oral presentation competence supported by VR in higher education. These directions are built on the gaps concerning the foci of previous VR studies, inconsistencies in empirical and conceptual findings, and the quality of empirical evidence, taking into consideration the related study designs of the reviewed publications.
First, recent technological developments managed to convert quantitative information from the VR system into qualitative feedback messages that directly relate to the standards for high-quality feedback in presentation research [13, 18, 19]. In line with this development, the question is to what extent the presentation expert (the teacher)—as a crucial feedback source—can be replaced in certain parts of the feedback process [20]. Therefore, an empirical study should be conducted within a realistic educational setting in higher education and focuses on the impact of qualitative feedback messages in a VR system on the development of students’ ability to speak in public. Such an experimental pretest posttest study examines to what extent the development of students’ cognition, behavior, and attitude towards presentation depends on an experimental condition in which students present in front of a virtual audience and receive automated feedback that can be interpreted individually. The effects are suggested to be compared with a control condition in which students present in VR and receive feedback based on the VR system that is interpreted by the teacher. Mixed methods, such as knowledge tests, validated rubrics, and self-evaluation tests, should be used for data collection [16]. Such a study contributes both to presentation research and educational practice, since insights from this study could lead to a further refinement of educational design principle 5, with regard to the type of feedback, as previously emphasized by researchers in this field [3, 21]. Moreover, the results of the study provide insights about how teachers’ roles might change in formative assessment strategies in the higher education context with regard to ensuring personalized and automated feedback.
Second, previous studies revealed that self-assessment tasks have limited impacts on students’ development of oral presentation competence in the higher education context [3, 15, 22]. The question is whether the development of personalized learning environments in VR can enhance the quality of self-assessment tasks in higher education, since students can now (1) adjust their learning trajectory to their personal learning objectives, (2) use these VR environments just-in-time, and (3) practice their presentation skills and receive unlimited feedback. A longitudinal study should focus on students’ data obtained by the VR system. Mixed methods, consisting of quantitative analyses of VR data and qualitative research (including observations and in-depth interviews), are suggested to be used to (1) describe the learning processes of students in VR, (2) monitor the reflection processes of the individual students with the aim of strengthening self-assessment tasks in presentation education, and (3) test the relationship between (a) reflection processes of students and (b) learning outcomes focused on presenting in VR [3].
Third, previous studies emphasized that at least a two-presentation sequence is required for students to effectively develop their oral presentation competence [2, 6, 11]. However, it remains questionable how the development of students’ performances behaves after their second presentation. In the context of a business curriculum, researchers studied the optimal number of presentations and concluded that a significant increase in performance can be traced between the first and second presentation, though a three-presentation sequence revealed no significant benefits. This might be caused by the fact that students past the apex of the classical S-shaped learning curve [11]. Other researchers, however, claimed the integration of four or five performances in presentation curricula [12, 23]. These findings should be interpreted in the light of domain-specific face-to-face presentations assessing solely presentation skills instead of taking other core components of the construct of competence, such as cognition and attitude towards presenting, into account. Further, facilitating students’ presentations in curricula can be considered as a time-consuming activity. Therefore, future research should test the hypothesis of the two-presentation sequence, scarcely supported by empirical studies in presentation literature, by integrating VR in realistic educational settings. Future experimental studies could distinguish between several conditions, such as a one-presentation, two-presentation, and three-presentation sequence, and verify potential differential impacts on students’ oral presentation competence in higher education.
Fourth, a previous study on VR and the development of students’ oral presentation competence emphasized the limitation with regard to students’ unfamiliarity with adopting VR for learning purposes [6]. This could have influenced the results of that study, both in terms of impacts on developing presentation competence and perceptions towards using the innovative technology [24]. For example, certain students might have perceived the use of VR as motivating, while other students might have experienced the use of VR as evoking their presentation anxiety. Therefore, longitudinal studies could reveal if oral presentation competence can be influenced if participants first become more familiar with the technology and whether students’ perceptions change over a longer period of time while using VR.
Fifth, future studies should focus on testing the generalizability of the constructed and formulated set of principles in this chapter with regard to different student characteristics. Since researchers in this field reported that students could differ in their perceptions of VR depending on their preferred learning activities, it is suggested to incorporate the following characteristics in future experimental study designs: (1) students’ traits (such as gender, age, and educational level), (2) experienced versus non-experienced students regarding presenting in VR, (3) students from different sociocultural traditions (e.g., teacher-centered versus student-centered higher education curricula), and (4) students with varying personal goals or learning patterns that influence their perceptions of the value of feedback types for developing presentation competencies [25].
This chapter aimed to synthesize previous studies into a set of educational design principles in VR, fostering students’ presentation competence, to discuss practical implications and to construct a future research agenda on this topic. Optimizing earlier formulated principles could develop a theoretical framework situated in the context of VR for presenting to direct intervention and empirical and theoretical studies. Besides studying the optimization of the formulated principles, future studies should test the generalizability of the set by taking student characteristics, their perceptions, and sociocultural backgrounds into consideration. In line with this, it remains questionable to what extent this set of principles can also be adopted to foster other academic and communication competencies in VR, since comparable learning environment characteristics are visible for developing argumentation, negotiation, and scientific writing skills. Future scientific and practical research should also take the recent developments of technological and educational trends into account in order to create both effective and efficient virtual learning environments in higher education in which high levels of ecological validity are guaranteed.
This work was supported by a research grant of the University of Applied Sciences Utrecht. Within the VR project on developing oral presentation competence, the following partners collaborated: (1) VR-Lab of the University of Applied Sciences Utrecht, (2) CoVince Adventurous Learning, and (3) partner schools of the NOA Group in Amsterdam.
None of the authors or partners in the project report any conflict of interest.
Informed consent was obtained from all individual participants in the reported studies.
The authors would like to thank photographer Kees Rutten for producing the picture for this project.
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\\n\\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\\n\\n3. CORRECTIONS
\\n\\nA Correction will be issued by the Academic Editor when:
\\n\\n3.1. ERRATUM
\\n\\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\\n\\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n3.2. CORRIGENDUM
\\n\\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n4. FINAL REMARKS
\\n\\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\\n\\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\\n\\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\\n\\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\\n\\nPolicy last updated: 2017-09-11
\\n"}]'},components:[{type:"htmlEditorComponent",content:'IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\n\n1. RETRACTIONS
\n\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\n\nA formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\n\nPublishing of a Retraction Notice will adhere to the following guidelines:
\n\n1.2. REMOVALS AND CANCELLATIONS
\n\n2. STATEMENTS OF CONCERN
\n\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\n\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\n\n3. CORRECTIONS
\n\nA Correction will be issued by the Academic Editor when:
\n\n3.1. ERRATUM
\n\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\n\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n3.2. CORRIGENDUM
\n\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n4. FINAL REMARKS
\n\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\n\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\n\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\n\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\n\nPolicy last updated: 2017-09-11
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"105746",title:"Dr.",name:"A.W.M.M.",middleName:null,surname:"Koopman-van Gemert",slug:"a.w.m.m.-koopman-van-gemert",fullName:"A.W.M.M. Koopman-van Gemert",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105746/images/5803_n.jpg",biography:"Dr. Anna Wilhelmina Margaretha Maria Koopman-van Gemert MD, PhD, became anaesthesiologist-intensivist from the Radboud University Nijmegen (the Netherlands) in 1987. She worked for a couple of years also as a blood bank director in Nijmegen and introduced in the Netherlands the Cell Saver and blood transfusion alternatives. She performed research in perioperative autotransfusion and obtained the degree of PhD in 1993 publishing Peri-operative autotransfusion by means of a blood cell separator.\nBlood transfusion had her special interest being the president of the Haemovigilance Chamber TRIP and performing several tasks in local and national blood bank and anticoagulant-blood transfusion guidelines committees. Currently, she is working as an associate professor and up till recently was the dean at the Albert Schweitzer Hospital Dordrecht. She performed (inter)national tasks as vice-president of the Concilium Anaesthesia and related committees. \nShe performed research in several fields, with over 100 publications in (inter)national journals and numerous papers on scientific conferences. \nShe received several awards and is a member of Honour of the Dutch Society of Anaesthesia.",institutionString:null,institution:{name:"Albert Schweitzer Hospital",country:{name:"Gabon"}}},{id:"83089",title:"Prof.",name:"Aaron",middleName:null,surname:"Ojule",slug:"aaron-ojule",fullName:"Aaron Ojule",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Port Harcourt",country:{name:"Nigeria"}}},{id:"295748",title:"Mr.",name:"Abayomi",middleName:null,surname:"Modupe",slug:"abayomi-modupe",fullName:"Abayomi Modupe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:null,institutionString:null,institution:{name:"Landmark University",country:{name:"Nigeria"}}},{id:"94191",title:"Prof.",name:"Abbas",middleName:null,surname:"Moustafa",slug:"abbas-moustafa",fullName:"Abbas Moustafa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94191/images/96_n.jpg",biography:"Prof. Moustafa got his doctoral degree in earthquake engineering and structural safety from Indian Institute of Science in 2002. He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). He was born in 1969 in Naama, Algeria. He received his BS degree in 1993, the MS degree in 1997, the PhD degree in 2007 from the Electrical Engineering Institute of Djilali Liabes University of Sidi Bel Abbes (ALGERIA). He is an active member of IRECOM (Interaction Réseaux Electriques - COnvertisseurs Machines) Laboratory and IEEE senior member. He is an editor member for many international journals (IJET, RSE, MER, IJECE, etc.), he serves as a reviewer in international journals (IJAC, ECPS, COMPEL, etc.). He serves as member in technical committee (TPC) and reviewer in international conferences (CHUSER 2011, SHUSER 2012, PECON 2012, SAI 2013, SCSE2013, SDM2014, SEB2014, PEMC2014, PEAM2014, SEB (2014, 2015), ICRERA (2015, 2016, 2017, 2018,-2019), etc.). His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. 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