Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
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This achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
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We are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
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Thank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
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1. Introduction
Oxytocin, which was long thought to be a hormone exclusively involved in social bonding, parturition, and lactation; now is extensively researched for its other possible implications. Evidence indicates that oxytocin alters lipid, protein, and sugar metabolism through various ways including modulation of appetite and satiety, enzyme activity, cellular signals, secretion of metabolic hormones, and energy consumption [1, 2].
1.1 Oxytocin synthesis and secretion
Oxytocin (Oxt) a nonapeptide hormone is a member of the G-protein coupled receptor family. It regulates a range of physiologic actions in mammals other than reproductive deeds [3]. The word oxytocin was taken from the Greek words (ω k ν ξ, τ o k ox ξ) meaning “quick birth”. The uterine-contracting property of oxytocin was discovered by Dale [4], whereas the milk ejection property of oxytocin was revealed in the following years [5, 6].
Oxytocin is composed of nine amino acids (Cys-Tyr-Ile-Gln-Asn-Cys-Pro-Leu-GlyNH2) with a disulphide bridge between cysteine residues 1 and 6 [7, 8]. It is predominantly synthesized in magnocellular neurons of the hypothalamic paraventricular (PVN) and supraoptic (SON) nuclei of the brain. It is released into the blood circulation through the posterior pituitary gland where it is released to regulate parturition and lactation. In addition, oxytocin is produced and released outside the nervous system, such as the gastrointestinal tract [9] and bone marrow osteoblasts [10, 11] liver, placenta, amnion, heart [12], and subcutaneous adipose tissue. In adipose tissue, oxytocin has autocrine and paracrine effects via oxytocin receptors [9, 10, 13]. A variety of stimuli such as parturition, suckling, and certain stresses are responsible for the release of oxytocin in the circulation.
Endogenous oxytocin does not readily cross the blood–brain barrier, but circulating oxytocin may directly enter the hindbrain or act on the vagus nerve [14, 15, 16, 17]. Oxytocin can enter into the cerebrospinal fluid (CSF), as proved in an animal study [18]. A significant amount of oxytocin was found in cerebrospinal fluid when copious amounts of oxytocin were injected intravenously or intranasally in nonhuman primates [18]. Additionally, exogenous oxytocin administration may accelerate endogenous oxytocin secretion either directly through PVN oxytocin autoreceptors or indirectly through peripheral oxytocin receptors [19, 20]. Generally, oxytocin receptors are found throughout the central nervous system including the hypothalamus, basal ganglia, VTA, nucleus accumbens, frontal cortex, insula, NTS, and spinal cord. Oxytocin receptors are also present in peripheral regions (vagus nerve, anterior pituitary gland, adipocytes, gastrointestinal tract, and pancreas) that regulate food intake and metabolism [12, 21, 22, 23, 24, 25]. Infect, mRNA for oxytocin and its receptors throughout the entire human gastrointestinal (GI) tract was recently found. Such receptors are known as allosteric modulators [12] (Figure 1).
Figure 1.
Chemical structure of oxytocin [26].
1.2 The therapeutic potential of oxytocin
The therapeutic potential of oxytocin has been studied extensively for the last few years. Use of oxytocin in the treatment of autism spectrum disorder (ASD) [26, 27], schizophrenia [26, 28], and obesity [20, 28, 29, 30, 31] have been investigated and documented in leading journals. It has opened a new door for many more untouched aspects of oxytocin to be disclosed. Recently it was found that oxytocin could reverse the effects of beta-amyloid on mice hippocampal LTP in an in vitro study. ERK phosphorylation and Ca2+-permeable AMPA receptors are involved in this effect of oxytocin [32]. Beta-amyloid is the main culprit of Alzheimer’s disease, which gets deposited around the neurons of the brain and impaired cognitive functions.
1.3 Physiological role of oxytocin in feeding regulation
Oxytocin exerts a direct as well as an indirect effect on metabolism and energy balance. The direct effect is through anorexigenic activity with increased oxytocin secretion and/or signaling leading to decreased food intake via net effects on multiple different homeostatic and neurobehavioral pathways. Peripheral oxytocin induces anorexia was first demonstrated by Arletti et al. [33]. The indirect effect of oxytocin is explicitly on muscles potentiating the majority of the slow-twitch muscles.
Oxytocin not only affects food intake but also the choice of food that is consumed. Studies conducted with a variety of animal models, including rats, mice, and rhesus monkeys fed with standard chow with a substantial proportion of calories from carbohydrates. Such studies have shown that oxytocin reduced intake of sucrose [34, 35, 36], glucose, fructose-sweetened beverages), and HFDs sweetened with sucrose [19, 20, 30, 37, 38, 39], sucrose appears to activate a greater proportion of PVN oxytocin neurons relative to intake of fat (intralipid) [40]. Oxytocin has also been shown to suppress energy intake in animals fed HFDs without sucrose. Moreover, systemic administration of oxytocin antagonists (readily crosses the blood–brain barrier) [41] stimulates the intake of sucrose, but not chow or intralipid [42]. Conversely, impairments of oxytocin signaling is associated with increased consumption of carbohydrates, including sucrose [34, 43, 44], and glucose [44], as well as fat [38, 45], implicating a potential physiological role for oxytocin to limit consumption of both simple sugars and fat.
Oxytocin has a profound effect in termination of the food intake. The food intake is physiologically regulated by oxytocin neurons, responding to fasting and satiety conditions. It has been observed that food consumption activates oxytocin neurons [40, 46], whereas fasting is known to depress oxytocin neurons and recovery is possible with refeeding [29] or the leptin administration [47], conversely suppression of exocytosis of oxytocin, or genetic reduction of oxytocin expression increases food intake [29], and ablation of oxytocin neurons increase body weight gain by decreasing energy expenditure in male mice fed a high-fat diet (HFD) [48]. The ablation of the neurons that express oxytocin receptors, in the nucleus of the solitary tract (NTS) and arcuate nucleus induces hyperphagia [49, 50] and satiety [51]. Additionally, oxytocin also displays a circadian rhythmic pattern with a rise of circulating oxytocin level during the day and vice versa [52, 53].
1.4 The metabolic functions of oxytocin
Oxytocin is a potent regulator of caloric intake and metabolism. Metabolism is an exclusive attribute of living cells. Disturbance in metabolism can have a toll on both body and mind. Although, the epidemics of metabolic diseases have largely been attributed to genetic makeup, changes in diet, exercise and aging. However, other environmental factors may contribute to the rapid increase in the incidences.
Oxytocin has a direct effect on adipose tissue. It induces adipose tissue lipolysis [16, 20] and fat oxidation [20, 30, 54], subsequently leading to reduced body fat and weight gain [20] as well as glucose intolerance and insulin resistance. Moreover, oxytocin is believed to reduce visceral and liver fat deposition [30]. Such deposits are metabolically important and are known to increase the prognosis of metabolic syndrome and cardiovascular disease [55]. Sub chronic treatment of oxytocin extended improved adipocyte differentiation and increased gene expression of factors involved in adipogenesis in rats. This effect is related to an increased fatty acid-binding protein, peroxisome proliferator-activated receptor gamma, insulin-sensitive glucose transporter 4, leptin, and CD31 mRNA levels [56].
1.5 Energy balance
Energy balance is a complex physiological process that is regulated by multiple interactions between the gastrointestinal tract (GIT), adipose tissue, and the central nervous system (CNS). It requires both afferent signals from the periphery about the state of the energy stores as well as different signals that influence energy intake and expenditure [57] and is also influenced by behavioral, sensorial, autonomic, nutritional, and endocrine mechanisms [58]. Energy balance is quite essential in daily life to be in shape physically as well as metabolically. Nevertheless, at times energy balance (intake and expenditure) may alter partially or completely, leading to consequent pathological changes in body weight. Adaptations to body weight changes include modifications at the level of circulating appetite-related hormones that, in turn, may profoundly interact with the homeostatic and hedonistic neural centers. The homeostatic control system makes it possible to maintain energy reserves through signals of hunger stimulation that are usually downregulated when the body receives an adequate caloric intake. However, this homeostatic system is asymmetrical, showing greater effectiveness in defending against energy deficit in the light of reduced efficiency in the defense against the energy excess. Furthermore, the homeostatic system is strongly influenced by hedonic signals, based on reward mechanisms, frequently causing food intake even in the absence of biological needs. This review will summarize the role of the main central and peripheral hormones involved in controlling energy balance.
2. Mechanisms underlying the effects of oxytocin on energy balance
The proposed mechanisms underlying the effects of oxytocin on calorie balance are discussed under the following topics.
2.1 Oxytocin may regulate appetite
Oxytocin may induce satiety by slowing gastric emptying [59, 60, 61]. Gastric emptying is a principal trait of postprandial glycemia. A lower rate of gastric emptying and a high-fat diet rationally enhances the glycemic index of carbohydrates. Moreover, slowing of gastric emptying by fat depends on the small intestine exposed to lipolytic products. Oxytocin is released in response to a fatty meal [62], which regulates gastric emptying [63, 64].
Conversely, systemic administration of oxytocin led to enhanced gastric emptying [63, 64] also oxytocin receptor antagonist atosiban delayed gastric emptying significantly [9]. Though the results from human studies are conflicting and only one human study on diabetic gastroparesis has reported prolonged gastric emptying time (40–80 mIU/min) [65]. The prokinetic effect of oxytocin on the gut has been assumed to be similar to the one in uterine myometrium and mammary myoepithelial cells; i.e., the intracellular release of Ca2+ which leads to muscle contraction via myosin light kinase activity [12]. In normal subjects, oxytocin has been found in the gut where it is secreted after a meal [62] and stimulates colonic activity [66].
Oxytocin can influence other appetite-regulating hormones. Intravenous administration of oxytocin modulated levels of ghrelin (which is orexigenic) in human subjects [67], whereas 24 IU intranasal administration of oxytocin did not show any significant changes in fasting or postprandial levels of ghrelin [68, 69]. Ghrelin is a gastric hormone, which regulates hunger and food intake. Likewise, oxytocin administration can influence cholecystokinin concentration in circulation [60] but this change was not related to differences in caloric consumption between oxytocin and placebo conditions [35]. Oxytocin facilitates cholecystokinin elicited excitation of neurons within the nucleus of the solitary tract and reduces food intake [49].
2.2 Oxytocin and glucose homeostasis
Oxytocin influences glucose and insulin homeostasis, along with bodyweight balance. Numerous studies have shown that oxytocin encourages glucose uptake [70, 71] and stimulates insulin secretion [72, 73, 74, 75, 76] as well as pancreatic glucagon secretion [75], which extends a hint about the involvement of oxytocin in the prognosis of diabetes. Intracerebroventricular oxytocin can improve insulin levels by activation of vagal cholinergic neurons innervating pancreatic beta-cells [76]. Conversely, insulin can modulate oxytocin levels in the hypothalamus by activating the insulin-regulated aminopeptidase as well [77, 78].
Studies have suggested that oxytocin has the capacity to reduce obesity-related diabetic changes, such as glucose intolerance, insulin resistance, and pancreatic islet hypertrophy [19, 20, 30, 38, 79, 80]. Two weeks of treatment with oxytocin decreased adiposity and food intake in obese mice lacking leptin, although, it worsens glucose metabolism, most likely due to an increase in corticosterone levels and enhanced hepatic glucose production. It could be suggested that the effect of oxytocin in decreasing fat mass is independent of leptin, while the beneficial impact on glucose metabolism requires the presence of leptin [81]. Whereas, oxytocin treatment for a longer period, notably reduced body fat accumulation, fasting blood glucose levels, and improved insulin sensitivity and glucose tolerance in leptin receptor-deficient mice [82]. The hypoglycemic stimulatory effect on insulin secretion and sensitivity, and improvement of pancreatic islet cells after oxytocin administration strongly suggested that oxytocin might be a therapeutic target for treating diabetes.
Oxytocin influences glucose metabolism in various ways. It may have a direct effect on glucose metabolism through the promotion of muscle cell differentiation. It has been found that a higher oxytocin concentration is linked with the anabolic effects of steroids in bovine and ovine skeletal muscle [83, 84]. A rapid increase in muscle regeneration was observed in old mice with a cardiotoxin muscle injury, when oxytocin was administered subcutaneously [79], though, the regenerative capacity of skeletal muscle and the levels of oxytocin receptor in muscle stem cells decrease with the age [79].
Further oxytocin-induced augmentation of muscle mass directly affects glucose uptake and insulin sensitivity. Oxytocin receptors are widely distributed in adipocytes of both humans and animals, especially in rats [12, 85, 86]. Oxytocin augments the transient increase in intracellular Ca2+ and stimulates PKC activity [87, 88], which in turn increases glucose uptake in mice adipocytes [88, 89, 90]. It has been noted that oxytocin stimulates glucose oxidation via enhancement of pyruvate dehydrogenase activity in mice adipocytes [90]. Oxytocin treatment induced a higher mRNA expression for gluconeogenesis and lowered glycaemia in lean control mice, probably because of the decreased liver glycogen content [82]. So, oxytocin treatment enhances net hepatic glucose oxidation, reduced glycogen synthase activity, and increased glycogen phosphorylase activity [91].
Oxytocin modulates pancreatic function centrally via vagal cholinergic neurons innervating β-cells [76] and peripherally by stimulating phosphoinositide turnover and activating PKC in pancreatic β-cells [92]. Insulin secretion (independent of glucose concentration) was found to be stimulated in isolated mouse pancreatic islets with oxytocin infusion [91]. Additionally, oxytocin increases insulin and glucagon secretion in both in vivo and in situ conditions and appears to have a greater effect on glucagon secretion than on insulin secretion (and to a much greater extent in insulin-deficient diabetic rats) [93, 94, 95]. Peripherally oxytocin regulates whole-body glucose metabolism. Studies have shown that oxytocin-deficient (Oxt−/−) and high-fat diet-fed OTR-deficient (Oxtr−/−) mice had decreased insulin sensitivity and impaired glucose tolerance [96, 97], and both insulin sensitivity, as well as glucose tolerance, were restored after oxytocin administration in obese diabetic (db/db) mice fed with standard and high-fat diets [20, 30, 82, 98]. Improvements in glucose tolerance, lowering of postprandial plasma glucose and insulin concentrations have been reported in subjects with normal weight and obesity who were given oxytocin [33, 68, 69, 80, 99]. In contrast, increases in plasma glucose and hepatic glycogenolytic activity concurrent with an absence of effects on peripheral insulin sensitivity have also been reported [95].
2.3 The lipolytic effect of oxytocin
The lipolytic effect of oxytocin is well studied in animal models [16, 20] and human trials [100]. The intravenous administration of oxytocin (10 mIU/kg) increased plasma levels of non-esterified free fatty acids and reduced plasma levels of triglycerides in women with obese history [100]. Even the intranasal administration of oxytocin (24 IU before meals and at bedtime) in overweight or obese men and women for eight weeks resulted in improved lipid profile (lower levels of total cholesterol and LDL cholesterol), reduced waist circumference, and weight loss [80]. Oxytocin also acts as a homeostatic inhibitor of consumption, capable of mitigating multiple aspects of consumption behavior and energy metabolism [34]. Markedly, oxytocin reduces metabolically important fat for instance visceral and liver fat [30]. Such fat deposits are mostly responsible for the increased risk of metabolic syndrome and cardiovascular disease [55].
2.4 Energy expenditure
Despite the weight loss, it is believed that oxytocin contributed to the preservation of lean body mass, a key determinant of energy expenditure [54], activation of brown fat [97, 101, 102] and conversion of white adipose tissue to beige fat that is capable of thermogenesis [68, 82]. In young female athletes and non-athletes aged 14–21 years, fasting levels of oxytocin were positively associated with resting energy expenditure [68].
3. Conclusions
Metabolic disorders have reached to an explosive level and data projected by different government or non-government bodies are scary. Some alternative treatments should be adopted other than the conventional mode of treatment to coping such situations. Hormones are very powerful chemical substances and work precisely in the target organ. They mostly secrete far away from the site of action. Oxytocin is one such hormone that was long known for its reproductive involvement and is now being investigated for its multifunctional attributes. The therapeutic implications of oxytocin are gaining momentum. Studies have revealed that oxytocin alters metabolism in various ways including modulation of appetite and satiety, enzyme activity, cellular signals, secretion of hormones, and energy consumption. Despite the wealth of basic research showing broad anorexigenic effects of oxytocin, clinical studies on oxytocin’s therapeutic potential in obesity, and associated disorders are still in their infancy and exhaustive research is needed. Future replicated and validated studies will help to characterize and better understand the underlying mechanisms for the regulation/dysregulation of metabolism and would be a good approach for treating the obese population, which is the need of the hour.
Acknowledgments
All the researchers and authors referred and cited here are duly acknowledged.
Conflict of interest
The author declares no conflict of interest, financial or otherwise.
Other declarations
I am grateful to IOOS Programme of Intech Open for waiving publication fees completely.
Acronyms and abbreviations
AMP
Adenosine monophosphate
Ca
calcium
CD31
The cell adhesion molecule
CSF
Cerebrospinal fluid
CVD
Cardio vascular diseases
ERK
Extracellular signal-regulated kinase
HFDs
High fructose syrup
LDL
Low density lipoprotein
LTPL
Long term potentiation(hippocampus)
mRNA
Messenger RNA
NTS
Nucleus tractus solitarius
PKC
Protein kinase
PVN
paraventricular
VTA
Ventral tegmental area
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Conclusions",level:"1"},{id:"sec_13",title:"Acknowledgments",level:"1"},{id:"sec_16",title:"Conflict of interest",level:"1"},{id:"sec_13",title:"Other declarations",level:"1"},{id:"sec_14",title:"Acronyms and abbreviations",level:"1"}],chapterReferences:[{id:"B1",body:'Ding C, Leow MKS, Magkos F. Oxytocin in metabolic homeostasis: implications for obesity and diabetes management. Obes Rev. 2019;20(1):22-40. doi: 10.1111/obr.12757'},{id:"B2",body:'Sabatier N, Leng G, Menzies J. Oxytocin, feeding, and satiety, Fronti Endocrl. 2013; 4: 35'},{id:"B3",body:'Meyer-Lindenberg A, Domes G, Kirsch P, Heinrichs M. Oxytocin and vasopressin in the human brain: social neuropeptides for translational medicine. Nat Rev Neurosci. 2011; 12: 524-538'},{id:"B4",body:'Dale HH. On some physiological actions of ergot. J Physio. 1906; 34:163-206'},{id:"B5",body:'Ott I, Scott JC. The Action of Infundibulum upon Mammary Secretion. Proc Soc Exp Biol. 1910; 8: 48-49'},{id:"B6",body:'Schafer EA, Mackenzie K. 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Canadian Journal of Clinical Nutrition, Global Science Heritage, Ontario, Canada
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1. Introduction
Hypertension is a global health condition of developed and developing countries including South Africa. South Africa has the highest prevalence of people with hypertension (between 42% and 54%) compared with the eastern (15%) and western (25%) parts of Southern Africa. Sadly, the condition of these patients is still not controlled even while on treatment [1]. A recommendation of this study is that a regionally tailored intervention is implemented to prevent disastrous consequences relating to hypertension mortality and morbidity. While hypertension is a chronic, lifelong condition that needs regular and continued follow-up care, it also requires skilled health care providers who are supported by the treatment guidelines of the National Department of Health (NDoH), South Africa.
Approximately 17-million patients diagnosed with hypertension, a chronic, non-communicable and preventable disease, visit South PHC clinics for consultation. Hypertensive patients are initially encouraged to follow lifestyle modifications to promote control and management of the disease as part of its non-treatment management. Thereafter, if condition remains uncontrolled, hypertensive patients are informed to use daily treatment for the rest of their lives [2]. The NDoH of South Africa recommends that health professionals who are practicing in PHC clinics provide health education to enhance compliance with the management and control of hypertension [3].
Before 2006 parallel guidelines were developed by the Southern African Hypertension Society and the South African Department of Health, but the 2006 guideline is the combination task of the two bodies [4]. The guideline outlines dissimilar broad steps that health professionals should adhere on to achieve controlled blood pressure effectively, beginning from the patient risk screening/profiling, the measurements and investigations, the classification and complete treatment of hypertensive patients with or without co-morbidities, to their repeat and continuous plan [5]. A research conducted in Pretoria (Tshwane) on adherence to the hypertension guidelines among private practitioners and PHC physicians found that overall adherence to the hypertension practice guidelines used by generalists in private practice was 55%, while among PHC doctors in public-service, it was 56.4% [6].
Although two guidelines, Adult Primary Care (APC)/ Standard Treatment Guidelines (STG) and Essential Medicines List (EML), are available for use in PHC facilities when consulting patients with hypertension, the challenge is whether these guidelines are adhered to or not. To this end, the study sought to assess adherence or non-adherence to these guidelines and to describe the follow-up care received by patients in the Tshwane district of the Gauteng province, South Africa.
As far as the workshop on Diabetes Mellitus was concerned, the former Deputy Minister of Health in South Africa Dr. Joe Phaahla reported concerns about the quality of records in some clinics during auditing of patients’ records. Hypertensive patients’ medical history was recorded in two sentences, for example “For follow up. Medication issued”. The researchers noted this trend with seriousness since students following the R48 are taught comprehensive health assessment, which includes correct history taking and physical examination plus treatment of illnesses. Truly, if health assessment and treatment are done correctly, medical history could not be recorded in two sentences, which proves that if it is not recorded, it was undone. Adherence to the guidelines is stipulated throughout the R48 training programme to prove that there is standardisation regarding how hypertensive patients are treated at PHC level. During clinical practical of students, the researchers also realised that chronic services are regarded as fast track and sometimes, very incompetent nurses are assigned to that because they are considered mainly treatment collection. The South African’ health care system is predominantly nurse-based and requires nurses to have the appropriate competence and expertise to manage the country’s quadruple burden of diseases, of which hypertension forms a significant part [7]. To achieve this requirement, nursing education and training must produce safe and competent nursing professionals who are capable of making a meaningful contribution [8]. This prompted the researcher’s interest in assessing the follow-up care received by the patients with hypertension at PHC facilities in the Tshwane district.
2. Research design and methods
2.1 Patient’s history
Detailed history, physical examination and interpretation of investigations should form an integral part of the routine care of patients with hypertension. Regarding measurements, it is important to ensure that PHC nurses who take blood pressure measurements have adequate initial training and their performance periodically reviewed. Equipment for measuring blood pressure must be correctly checked, serviced and adequately recalibrated according to the companies’ instructors’ manuals. When checking blood pressure, PHC nurses in the clinics should calm the setting and provide a relaxed, temperate atmosphere, with the patients quiet and seated, and arms outstretched and supported. Use of a correct machine for the patient’s arm is important [9]. A community-based study to estimate the prevalence of hypertension and its associated factors in municipalities of Kathmandu, Nepal [10], found that factors associated with hypertension were smoking, Body Mass Index (BMI), alcohol use, poor physical activity and diabetes.
The guidelines [9] emphasise the importance of the following lifestyle modifications:
Administer continuous lifestyle advice to patients
Promote a healthy diet and regular exercise
Offer guidance and written or audiovisual materials to promote lifestyle changes
Encourage reduced alcohol consumption
Discourage excessive consumption of coffee and other caffeine-rich products
Encourage patients to keep their dietary sodium intake low
Offer advice and help smokers to stop smoking
Inform patients about support groups such as local initiatives, health care teams or patient organisations that provide support and promote life-style change [9].
In South Africa, the following lifestyle modification is also recommended [11]:
Educate patients about adequate dietary fibre intake (fruits, vegetables and unrefined carbohydrate).
2.2 Study design
The research is quantitative because it sought to measure the phenomenon by attaching numerical values to express quantity [12]. The observation was carried out in the PHC facilities whereby entries of patients’ files were evaluated. Perusal of patients’ files and documentation using checklist was also done. Furthermore, quantitative research is described as a formal, objective, systematic methodology to describe variables, to test relationships, and to examine cause and effect [13]. However, for this study, only the former is applicable. The patients whose files were perused had experienced an event that is a “follow-up consultation for hypertension”. Moreover, the patients were mostly pensioners and depending on old age grant and even the unemployed ones without the medical aids. They resided around the townships and villages of Tshwane.
2.3 Setting
The study setting was guided by the research questions and the type of data that were required to answer the following questions [14].
How is the follow-up care received by patients with hypertension at PHC facilities in the Tshwane district?
What is the adherence or non-adherence to the National Guidelines by nurses about hypertension follow-up care?
A multi-site approach was used whereby ten different PHC facilities were selected. Using multiple sites offers a larger and more diverse sample [12], which improves external validity. Both provincial and municipal facilities were included. Data collection took place at two community health centres (CHCs) and eight clinics. The total number of PHC facilities was ten. The real-life settings were natural, and uncontrolled; the researcher did not attempt to manipulate them in any way.
2.4 Units of analysis
The units of analysis were the files of male and female patients above 30-years old, who were diagnosed with hypertension at PHC facilities in the Tshwane district of Gauteng Province. As recommended [12], this was the entire aggregation of cases in which the researcher was interested.
2.5 Sampling strategy
Ten of the 74 PHC facilities in the Tshwane district were randomly selected from the list on the National Health Research Database (NHRD). All clinics in the Tshwane district appear on the NHRD. The names of the facilities were written on pieces of paper that were placed in a bowl, and jumbled. From this, the first facility was chosen. The names were jumbled again, and the second facility was chosen. The process was repeated until all ten facilities had been chosen. According to the monthly statistics, at the time of the study, an average of 300 hypertensive patients were seen in each of the ten facilities per month. Hence, a proportional sample of ten files was conveniently chosen per facility.
2.6 Pilot study
The pilot study was done a month prior data collection when the research instrument was tested with ten files which were not utilised in the actual study. This was done to check if it could yield required information. The instrument was then revised and refined after the statistician checked it for validity and reliability.
Reliability of an instrument is a major criterion for assessing quality [12]. It is defined as the consistency and accuracy with which an instrument measures what is intended to measure. When used on repeated trials, an instrument with high reliability will produce the similar results [15]. To determine usefulness reliability of the instrument, the researchers utilised South African NDoH hypertension management guidelines. The guidelines support for a consistent standard of care across all PHC facilities in the country. Thus, the measuring instrument was considered reliable because it entailed attributes that are nationally recommended as the standard of care that hypertensive patients should receive during their follow-up visits.
Content validity was proofed by aligning concepts with the hypertension management guidelines of the country’s NDoH. Prior the actual real research study was conducted, a clinic that was excluded in the final study sample was piloted to test the data collection process. Inputs from clinicians were used to amend the data collection tool where necessary. Piloting was conducted between the first two months of the year 2018.
The ethics approval certificate (HSHDC/839/2018) was granted by the University of South Africa (UNISA).
2.7 Data collection
Data were collected by auditing the files of patients who were consulted for hypertension follow-up using a checklist. A checklist itemises task descriptions in one column and provides a space besides each item to check off items that are done or not done [16]. The checklist contains activities that must be performed on a follow-up visit for hypertension according to the National Guidelines, the APC and the EML. The checklist was distributed by the researcher herself at the chosen PHC facilities. Some amendments and modifications were made to the checklist following the pilot study. Data were collected over a period of two months (June and July 2018), and all 100 checklists were completed.
The managers of the selected PHC clinics were contacted in advance to inform them of the data collection date. Ten files were chosen per PHC clinic, and from these, the data were gathered. Files were physically collected from the filing room with the help of the administrative staff of the PHC facility. The researchers examined each file to check that it belonged to hypertensive adult patient, who was non-diabetic and not pregnant in order to adhere with the inclusion criteria. Once ten files that adhered with the criteria were found, the data gathering started. All 54 questions on the checklist were ticked/not ticked in accordance with either attribute was recorded or not recorded.
2.8 Data analysis
Data were coded and checked for correctness before being entered into a Microsoft Excel codebook. The data were analysed according to the following steps:
the last year in which patient was seen at the clinic;
characteristics of the sample;
patient’s history
physical examination;
vital signs;
side room investigations;
routine blood tests;
life style assessment;
management of the patients; and
knowledge and skills of health worker.
2.9 Results
Table 1 below indicates whether the attributes listed were assessed, as evidenced by records.
Frequencies
Percentages (%)
Attributes of physical examination
Dyspnoea
Yes
1
1.0
No
0
0.0
Not recorded
98
98.0
Missing/Incomplete
1
1.0
Total
100
100.0
Jugular venous pressure
Yes
1
1.0
No
0
0.0
Not recorded
99
99.0
Total
100
100
Apex beat recorded
Yes
0
0.0
No
0
0.0
Not recorded
100
100.0
Total
100
100.0
Oedema
Yes
64
64.0
No
0
0.0
Not recorded
36
36.0
Total
100
100.0
Crepitations
Yes
17
17.0
No
0
0.0
Not recorded
83
83.0
Total
100
100.0
Heart sounds
Yes
53
53.0
No
0
0.0
Not recorded
47
47.0
Total
100
100.0
Cyanosis
Yes
28
28.0
No
0
0.0
Not recorded
72
72.0
Total
100
100.0
Clubbing
Yes
28
28.0
No
0
0.0
Not recorded
72
72.0
Total
100
100
Attributes of physical measurements
Blood pressure
Yes
100
100.0
No
0
0.0
Not recorded
0
0.0
Total
100
100.0
Pulse rate, rhythm and character
Pulse rate
Yes
96
96.0
No
0
0.0
Not recorded
4
4.0
Total
100
100.0
Pulse rhythm
Yes
0
0.0
No
0
0.0
Not recorded
100
100
Total
100
100
Pulse volume
Yes
0
0.0
No
0
0.0
Not recorded
100
100.
Total
100
100.0
Waist circumference recorded
Yes
0
0.0
No
0
0.0
Not recorded
100
100.0
Total
100
100.0
Blood glucose measured
Yes
23
23.0
No
77
77.0
Total
100
100.0
Urine tests
Yes
32
32.0
No
0
0.0
Not recorded
68
68.0
Total
100
100.0
Eye test done or recorded
Yes
0
0.0
No
0
0.0
Not recorded
100
100.0
Total
100
100.0
Attributes of routine blood tests
eGFR
Yes
70
70.0
No
0
0.0
Not recorded
30
30.0
Total
100
100.0
Cholesterol
Yes
66
66.0
No
0
0
Not recorded
34
34.0
Total
100
100
Attributes of life-style modification
Smoking
Yes
2
2.0
No
8
8.0
Not recorded
90
90.0
Total
100
100.0
Alcohol use
Yes
1
1.0
No
8
8.0
Not recorded
91
91.0
Total
100
100.0
Exercise
Yes
1
1.0
No
0
0.0
Not recorded
99
99.0
Total
100
100.0
Salt reduction
Yes
0
0.0
No
0
0.0
Not recorded
100
100.0
Total
100
100.0
Fat reduction
Yes
0
0.0
No
0
0.0
Not recorded
100
100.0
Total
100
100.0
Non-adherent attributes
Attributes
No (%)
Yes (%)
Dyspnoea
99.0
1.0
Jugular venous pressure
99.0
1.0
Apex beat recorded
100.0
0.0
Crepitations
83.0
17.0
No. of pillows used
100.0
0.0
Cyanosis
72.0
28.0
Clubbing
72.0
28.0
Chest pain recorded
100.0
0.0
Walk/climb
100.0
0.0
Pulse rhythm
100.0
0.0
Pulse volume
100.0
0.0
BMI
82.0
18.0
Waist circumference recorded
100.0
0.0
Blood glucose measured
77.0
23.0
Urine tests
68.0
32.0
Eye test done or recorded
100.0
0.0
Smoking
98.0
2.0
Alcohol Use
99.0
1.0
Exercise
99.0
1.0
Salt reduction
100.0
0.0
Fat reduction
100.0
0.0
Adherence to medication recorded
100.0
0.0
Side effects of treatment
100.0
0.0
Heart sounds recorded
47.0
53.0
Table 1.
Attributes of physical examination, measurements, routine blood tests and non-adherent attributes.
2.10 Antihypertensive medications
Antihypertensive drugs are mainly prescribed to reduce blood pressure and the complications associated with the disease. According to a study conducted among South African adult residents of Mkhondo Municipality, clinical guidelines recommend the use of multiple drugs to control blood pressure effectively and reduce the possibility of hypertension related complications [17]. The authors of this study determined that a high prevalence of uncontrolled hypertension was noted irrespective of the number of drugs and the combinations administered [17]. A plausible explanation could be non-adherence to treatment by patients. Hence, it is important for clinicians to follow evidence-based guidelines in prescribing antihypertensive drugs for patients. According to a registry-based observational study in two municipalities in Cuba on assessment of hypertension management and control [18], it found that almost half of the patients receiving treatment were taking two or more antihypertensive drugs. Figure 1 below indicates the commonly used antihypertensive medications at PHC facilities in the Tshwane district of Gauteng Province, South Africa as hydrochlorothiazide, enalapril and amlodipine.
Figure 1.
Commonly used antihypertensive medications.
2.11 Adherent and non-adherent attributes
In this study, the determination of adherence and non-adherence was done by dichotomizing whether or not nurses complied with clinical guidelines in providing healthcare services regarding hypertension follow-up care. Binary counts showing whether or not nurses made records in compliance with clinical guidelines were done using frequency statistics tables in SPSS. Based on clinical guidelines, adherence was affirmed present if at least 60% of sample records showed that nurses made records in line with guidelines. Conversely, non-adherence was affirmed if less than 60% of sample records showed that nurses made records as per the guidelines. The at least 60% threshold affirming adherence was derived from clinical guidelines. This study’s results on nurses’ adherence and non-adherence to guidelines are as follows:
Adherence: Percentages showing adherence by nurses regarding making records are as follows: Blood pressure (100%), Pulse rate (96%), Estimated glomerular filtration rate (eGFR) (70%), Cholesterol (66%) and Evaluation of oedema (64%).
Non-adherence: Percentages showing non-adherence by nurses regarding making records are as follows: Dyspnea (99%), Raised Jugular venous pressure (99%), Apex beat (100%) and Crepitations (83%). Number of pillows used to sleep at night (100%), Cyanosis (72%), Clubbing (72%), Chest pains (100%), (BMI) (82%), Waist circumference (100%), Blood glucose (77%), and Urine and eye tests in the past 12 months (68% and 100% not recorded respectively). Adherence and side effects of prescribed medication were (100%) unrecorded. Smoking (90%), Alcohol use (91%), Exercise (99%), Salt and fat reduction (100%) were unrecorded.
Moving onwards, the test for presence of significant association between compliance by nurses to clinical guidelines (adherence and non-adherence) and categories of attributes (physical examination, physical measurements, life-style modification, routine blood tests, and history) was done using the chi-square test at 5 percent level of significance. The Pearson chi-square value = 11.654 (p-value = 0.020) and Cramer’s V score = 0.634 (p-value = 0.020) indicate presence of statistically significant and strong association between compliance outcome (adherence and non-adherence) and category of attributes. The results confirm existence of significant difference between adherence and non-adherence proportions at 5 percent level.
The authors of the study conducted in Mkhondo Municipality [17] assert that the high prevalence of uncontrolled hypertension can possibly be attributed to obesity, lack of physical activity and dyslipidaemia. Moreover, the prevalence of uncontrolled hypertension and its association with low HDL-C, inadequate physical activity and obesity were reported [17].
Figure 2 below shows percentages of adherent and non-adherent attributes for this study.
Figure 2.
Adherent and non-adherent attributes.
2.12 Discussion
The aim of the study was to evaluate the follow-up care received by patients with hypertension at PHC facilities in the Tshwane district. The study found a significant percentage (93.4%) of non-adherence to hypertension guidelines among consulting nurses at selected PHC facilities. Based on the results of this study, some professional nurses could not interpret the danger related to an elevated eGFR or cholesterol. Where the BMI was measured, it was not interpreted so that interventions could be implemented. In the follow-up visit, there was total misunderstanding of lifestyle modification and how it must be implemented in the management of hypertension. It was clear that PHC facilities require greater assistance and support from the employer, the NDoH of South Africa, to enable PHC nurses in the Tshwane district to adopt more follow-up care of hypertensive patients. Furthermore, in order to assist, guide and motivate the nurses to become active partners in their care, in-service trainings, resources and equipment are needed. There should be a remediation programme for professional nurses who have been trained but are found to be non-adherent to the guidelines. In a study conducted in Kinshasa, Congo, in which knowledge of consulting nurse’s was assessed, 84% of the nurses reported to have received training [19]. The results suggest that training alone may not be enough, but continuous support and remedial actions may be necessary [19].
In addition, nurses of PHC facilities need to be supported by policy and organisational change. The results of the study [19] also supported the earlier observation made by the researcher in the research problem that chronic services are regarded as fast track and sometimes very incompetent nurses are allocated to these services since they are regarded as predominantly treatment collection with no specialised skills required. In accordance with other similar studies, most of the files of hypertensive patients that were audited for this study were found to be demonstrating positive and negative strengths regarding the follow-up care received by patients with hypertension.
A study conducted in Brazil by [16] on the association between follow-up care in health services and adherence to antihypertensive medication indicated that the level of therapeutic adherence in different populations of hypertensive patients is frequently investigated, given the severity of the problem. The adherence identified in the population was high (63%), possibly influenced by the characteristics of the participants, who had cardiovascular disease associated with arterial hypertension and, consequently, needed and sought health care more frequently. The findings indicate that higher consultation attendance has a statistically significant relationship with better medication adherence. This reinforces the notion that accessibility and frequent use of health services significantly affects the health conditions of hypertensive patients with associated cardiovascular disease [16].
Furthermore, the significance of follow-up care in clinics was analysed in relation to the level of therapeutic adherence and the prevalence of acute events [20, 21]. Patients who did not seek emergency services in the last two years had better adherence rates (p = 0.04). Since acute episodes usually lead to the introduction of new drugs in the treatment protocol of hypertensive patients, the lower adherence of the group that sought emergency services may be related to the problem in adapting to combination therapy, which demands post-discharge follow-up [20, 21].
In the study conducted in Brazil [16], the authors sought to advance knowledge concerning the correlation between health services and medication adherence when investigating attendance of hypertensive patients’ at nursing consultations, since these are mainly focused on health education [16]. Regardless of the fact that the respondents had a greater number of medical appointments than nursing consultations, drug adherence was better among those who attended nursing consultations more frequently (p = 0.022). In addition, the study indicated the number of consultations necessary to improve the therapeutic adherence of hypertension patients [16].
Repeated nursing follow-up does not necessarily result in increased therapeutic adherence, and can increase health care costs [22]. The practice revealed by the present chapter of 4 to 6 nursing consultations per annum is the preferred level of nursing follow-ups, to attain better levels of antihypertensive treatment adherence. It was also observed that hypertensive patients who attended medical and nursing consultations or who had received health orientations in the last 6 months presented greater therapeutic adherence, with a statistically significant correlation (p = 0.013). PHC professionals have a high capability and meaningful opportunity to impact the improvement of patients’ treatment adherence, through the support of guidelines and care during visits, home visits, health talk actions and tracking of non-adherent behaviours [23].
Regarding the view of impact of follow-ups in PHC services on therapeutic adherence of hypertensive patients, directed public policies are necessary to enhance this level of attention, and bring it closer to the population. Also meriting consideration is the social capital of the Brazilian population, which assists people overcome obstacles regarding the accessibility and utilisation of clinics by giving information and treatment support. For hypertensive patients, involvement into social health networks encourages them to look for specialised health care, although the decision to take part in treatment follow-up must be from the patients themselves [24]. However, treatment adherence will definitely be influenced by participation in social health networks and presence of follow-up visits in the clinics.
2.13 Limitations
The results of this chapter are valid in the specific context of the Tshwane district and cannot be generalised to the entire Gauteng province or to the whole country.
3. Conclusions
The objectives of the study were to describe the follow-up care received by patients with hypertension at PHC facilities in the Tshwane district and to determine nurses’ adherence or non-adherence to the guidelines regarding hypertension follow-up care. The conclusion drawn is that follow-up care obtained by hypertensive patients in PHC facilities in the Tshwane district was found to be insufficient, and demonstrated by a trend of non-adherence to the guidelines. This showed a considerable lack of knowledge and practice in the treatment of hypertension in PHC clinics.
4. Recommendation
4.1 Nursing practice
It is recommended that unskilled professional nurses should not be allocated to hypertension follow-up care or to a chronic section. Even if guidelines are available, they will yield better results if they are used by professional nurses who understand consultation skills such as history taking, physical examination and interpretation of investigations.
Acknowledgments
Thanks, are extended to the Tshwane district of Gauteng province, South Africa for granting permission to conducting the study and for providing support. The authors further thank the managers of the selected PHC facilities and their clerical staff for their support.
Conflict of interest
The authors declare that there are no competing interests regarding the writing of this chapter.
Authors’ contribution
M.J.M., the author of the chapter, conducted the research.
D.S.K.H., the study supervisor, assisted in writing the chapter.
Funding information
The study was self-funded.
Disclaimer
The expressed ideas pertaining to the chapter are of authors and do not indicate the policy or position of any associations with them.
Data availability statement
Data sharing is inapplicable to this book chapter since no new data were formulated or interpreted.
\n',keywords:"assessment, follow-up care, hypertension, primary health care",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/78144.pdf",chapterXML:"https://mts.intechopen.com/source/xml/78144.xml",downloadPdfUrl:"/chapter/pdf-download/78144",previewPdfUrl:"/chapter/pdf-preview/78144",totalDownloads:149,totalViews:0,totalCrossrefCites:0,dateSubmitted:"June 2nd 2021",dateReviewed:"July 23rd 2021",datePrePublished:"August 27th 2021",datePublished:"October 6th 2021",dateFinished:"August 17th 2021",readingETA:"0",abstract:"To extend the life expectancy of all South Africans to at least 70 years by 2030, hypertension follow-up care needs to be strengthened so that patients do not develop complications while in care. The aim of this study was to evaluate the follow-up care received by patients with hypertension at primary health care (PHC) facilities in Tshwane district. The study setting was ten PHC facilities in the aforesaid district. Quantitative, descriptive and retrospective methods were adopted, and simple random sampling was used to select ten PHC facilities from which ten files were conveniently sampled. Data were captured in Microsoft Excel 2010 and exported to IBM Statistical Package for the Social Sciences (SPSS) software version 21 in which data coding, outlier detection, missing value analysis and statistical data analysis were performed. In line with the study aim, frequency tables in SPSS were used to produce frequency statistics, and the chi-square test was used to test for the presence of association between compliance by nurses to clinical guidelines and categories of attributes, and further determine if there was a significant difference between adherence and non-adherence. The study found a significant proportion (93.4%) of non-adherence to hypertension guidelines among consulting nurses at selected PHC facilities.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/78144",risUrl:"/chapter/ris/78144",signatures:"Julia Manyelo and Debbie Habedi",book:{id:"10558",type:"book",title:"Lifestyle and Epidemiology",subtitle:"The Double Burden of Poverty and Cardiovascular Diseases in African Populations",fullTitle:"Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases in African Populations",slug:"lifestyle-and-epidemiology-the-double-burden-of-poverty-and-cardiovascular-diseases-in-african-populations",publishedDate:"October 6th 2021",bookSignature:"Kotsedi Daniel Monyeki and Han C.G. 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Introduction",level:"1"},{id:"sec_2",title:"2. Research design and methods",level:"1"},{id:"sec_2_2",title:"2.1 Patient’s history",level:"2"},{id:"sec_3_2",title:"2.2 Study design",level:"2"},{id:"sec_4_2",title:"2.3 Setting",level:"2"},{id:"sec_5_2",title:"2.4 Units of analysis",level:"2"},{id:"sec_6_2",title:"2.5 Sampling strategy",level:"2"},{id:"sec_7_2",title:"2.6 Pilot study",level:"2"},{id:"sec_8_2",title:"2.7 Data collection",level:"2"},{id:"sec_9_2",title:"2.8 Data analysis",level:"2"},{id:"sec_10_2",title:"2.9 Results",level:"2"},{id:"sec_11_2",title:"2.10 Antihypertensive medications",level:"2"},{id:"sec_12_2",title:"2.11 Adherent and non-adherent attributes",level:"2"},{id:"sec_13_2",title:"2.12 Discussion",level:"2"},{id:"sec_14_2",title:"2.13 Limitations",level:"2"},{id:"sec_16",title:"3. Conclusions",level:"1"},{id:"sec_17",title:"4. Recommendation",level:"1"},{id:"sec_17_2",title:"4.1 Nursing practice",level:"2"},{id:"sec_19",title:"Acknowledgments",level:"1"},{id:"sec_24",title:"Conflict of interest",level:"1"},{id:"sec_19",title:"Authors’ contribution",level:"1"},{id:"sec_20",title:"Funding information",level:"1"},{id:"sec_21",title:"Disclaimer",level:"1"},{id:"sec_22",title:"Data availability statement",level:"1"}],chapterReferences:[{id:"B1",body:'Ramsay, M, Sankoh, O. SA has the highest blood pressure in Southern Africa. Johannesburg: Wits University; 2017. Available https://www.wits.ac.zaresearch.news. [Accessed 28 June 2017].'},{id:"B2",body:'Nkosi-Mafutha NG, De Swart HC, Mogotlane S. Conveying hypertension message: an investigation into language and content used in primary health clinics in South Africa. African Journal of Primary Health Care and Family Medicine. 2020;12(1):1-7. https://doi.org/10.4102/phcfm.v12i1.2115.'},{id:"B3",body:'Nutbeam D. 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Cross-sectional study prevalence and determinants of uncontrolled hypertension among South African adult residents of Mkhondo Municipality. BMC Public Health. 2020 Dec; 20(1069):1. https://doi.org/10.1186/s12889-020-09174-7.'},{id:"B18",body:'Agudelo EL, Salva AR, Pinera AD, Roche RG, De Vos P, Battaglioli T, Van der Stuyft P. Assessment of hypertension management and control: a registry-based observational study in two municipalities in Cuba. BMC Cardiovasc Disord. 2019Dec; 19(1): 1-0. hptts://doi.org/10.1186/s12872-019-1006-6.'},{id:"B19",body:'Lulebo, AM, Mapatano, MA, Kayembe, PK, Mafuta, EM, Mutombo, PB Coppieters Y. Assessment of hypertension management in primary health care settings in Kinshasa, Democratic Republic of Congo. BMC Health Serv Res. 2015 June; 15(573):1-8.'},{id:"B20",body:'Kirchmayer U, Agabati N, Belleudi V. Socio-demographic differences in adherence to evidence-based drug therapy after hospital discharge from acute myocardial infarction: a population-based cohort study in Rome, Italy. J Clin Pharm Ther.2012Feb;37-44. https://doi.org/10.1111/j.1365-2710.2010.01242.x.'},{id:"B21",body:'Mathews R, Wang TY, Honeycutt E, Henry TD, Zettler M, Chang M et al. 2015. Persistence with secondary prevention medications after acute myocardial infarction: insights from the TRANSLATE-ACS study. Am Heart J. 2015 July; 170 (1): 62-69.doi: 10.1016/j.ahj.2015.03.019.'},{id:"B22",body:'Schroeder K, Fahey T, Hollinghurst S, Peters TJ. Nurse-led adherence support in hypertension: a randomized controlled trial. Fam Prac. 2005 Apr 1;22(2):144-51https://academic.oup.com/fampra/article/22/2/144/522313.'},{id:"B23",body:'Chang TE, Ritchey MD, Ayala C, Durthaler JM, Loustalot F. Use of strategies to improve antihypertensive medication adherence within United States outpatient health care practices. DocStyles 2015-2016. J Clin; Hypertens.2018Feb;20 (2):225-32. https:doi.org/10.1111/jch.13188.'},{id:"B24",body:'Palafox B, Goryakin Y, Stuckler D, Suhrcke M, Balabanova D, Alhabib KF et al. Does greater individual social capital improve the management of hypertension? Cross-national analysis of 61 229 individuals in 21 countries. BMJ Glob Health. 2017Dec1;2(4):e000443.'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Julia Manyelo",address:null,affiliation:'
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University of South Africa, Pretoria, South Africa
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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"
\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
\r\n
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\r\n
\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
\r\n
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
\r\n
\r\n\t
\r\n
\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
\r\n
\r\n\t
\r\n
\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
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Usha has been a keynote speaker as well as an invited speaker at national and international conferences, seminars and workshops. Her teaching experience includes teaching in Asian countries. She has advised Austrade, APEC, national, state and local governments. She serves as a reviewer and a member of the scientific committee for national and international refereed journals and refereed conferences. She is on the editorial board for refereed journals and has worked on Special Issues. Usha has served and continues to serve on the Boards of several not-for-profit organisations and she has also served as panel judge for a number of awards including the Premiers Sustainability Award in Victoria and the International Green Gown Awards. Usha has published over 100 publications, including research and consulting reports. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"25",type:"subseries",title:"Evolutionary Computation",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. 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