\r\n\t \r\n\tRecently in 2019, International Council on Systems Engineering (INCOSE) has released the latest version of the “Guidelines for the Utilization of ISO/IEC/IEEE 15288 in the Context of System of Systems (SoS) Engineering” to industry for review and comments. The document was developed under the Partner Standards Development Organization cooperation agreement between ISO and IEEE, as it was approved by Council Resolution 49/2007. This document provides guidance for the utilization of ISO/IEC/IEEE 15288 in the context of SoS in many domains, including healthcare, transportation, energy, defense, corporations, cities, and governments. This document treats an SoS as a system whose elements are managerially and/or operationally independent systems, and which together usually produce results that cannot be achieved by the individual systems alone. This INCOSE guide book perceives that SoS engineering demands a balance between linear procedural procedures for systematic activity and holistic nonlinear procedures due to additional complexity from SoS perspectives. \r\n\tThe objective of this book is to provide a comprehensive reference on Systems-of-Systems Engineering, Modeling, Simulation and Analysis (MS&A) for engineers and researchers in both system engineering and advanced mathematical modeling fields. \r\n\tThe book is organized in two parts, namely Part I and Part II. Part I presents an overview of SOS, SOS Engineering, SOS Enterprise Architecture (SOSEA) and SOS Enterprise (SOSE) Concept of Operations (CONOPS). Part II discusses SOSE MS&A approaches for assessing SOS Enterprise CONOPS (SOSE-CONOPS) and characterizing SOSE performance behavior. Part II focuses on advanced mathematical application concepts to address future complex space SOS challenges that require interdisciplinary research involving game theory, probability and statistics, non-linear programming and mathematical modeling components.
\r\n
\r\n\tPart I should include topics related to the following areas: \r\n\t- SOS and SOS Engineering Introduction \r\n\t- Taxonomy of SOS \r\n\t- SOS Enterprise (SOSE), SOSE CONOPS, Architecture Frameworks and Decision Support Tools
\r\n
\r\n\tPart II should address the following research areas: \r\n\t- SOS Modeling, Simulation & Analysis (SOS M&SA) Methods \r\n\t- SOS Enterprise Architecture Design Frameworks and Decision Support Tools \r\n\t- SOS Enterprise CONOPS Assessment Frameworks and Decision Support Tools.
",isbn:null,printIsbn:null,pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,hash:"677fbbd5fc2550e8be540f40c0969a62",bookSignature:"Dr. Tien Manh Nguyen",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/7772.jpg",keywords:"Autonomy of Constituents, Operational Independence, Taxonomy, Acquisition Classification, SOS Enterprise Architecture Design, Decision Support Tools, State Modeling, SOS Simulation Methods, DOD Architecture Framework, Enterprise System Engineering, SOS Enterprise CONOPS, Satellite Operations (SATOPS)",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 31st 2019",dateEndSecondStepPublish:"November 21st 2019",dateEndThirdStepPublish:"January 20th 2020",dateEndFourthStepPublish:"April 9th 2020",dateEndFifthStepPublish:"June 8th 2020",remainingDaysToSecondStep:"21 days",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,editors:[{id:"210657",title:"Dr.",name:"Tien",middleName:"Manh",surname:"Nguyen",slug:"tien-nguyen",fullName:"Tien Nguyen",profilePictureURL:"https://mts.intechopen.com/storage/users/210657/images/system/210657.jpg",biography:"Dr. Tien M. Nguyen received his M.A. in Mathematics, and his Ph.D. in Applied Mathematics from the Claremont Graduate University; M.S.E.E. in Communication Systems Theory from University of California San Diego; and B.S.E. in Electronics and M.S.E. in Electromagnetic Field Theory from California State University Fullerton (CSUF). He also completed all course requirements and passed the comprehensive exam for his M.S.E.E. in Digital Signal Processing from California State University Long Beach. Dr. Nguyen is an expert in Satellite Operations (SATOPS), Satellite Communications (SATCOMs), advanced mathematical modeling for complex systems-of-systems, sensing and communication networks.\nCurrently, he serves as Adjunct Research Professor at CSUF, Mathematics Dept. Concurrently, he is also with the Aerospace Corporation, serving as a Sr. P.E. in Space System Group Program Office, Space System Architect Division, Global Partnerships Subdivision. He has more than 13-years of service at Aerospace, and prior to his current position; he has served as Sr. Engineering Specialist, Sr. Project Lead, Section Manager, Associate Director, Interim Director, and Principal Technical Staff (the highest technical level at the corporation). At Aerospace, he invented HPA linearizer, GMSK synchronizers and developed advanced optimization techniques using game theory for achieving affordable and low-risk acquisition strategy. Prior to CSUF, he had also held a Research Assistant Professor at the Catholic University of America in concurrent with The Aerospace Corporation positions. \nHe was a Engineering Fellow from Raytheon, where he had 10-year of services at Raytheon, serving as Program Area Chief Engineer, Program Chief Engineer, PI, Technical Director, Program Manager, Lead Architect and Lead System Engineer for many advanced programs and pursuits related to sensing and communication networks. At Raytheon, he invented radar-communication technology and gun barrel detector using millimeter-wave. Previous to Raytheon and Aerospace Corporation, Dr. Nguyen was with NASA/JPL for more than 11-years, where he served as the NASA delegate to the international Consultative Committee for Space Data System (CCSDS). Many of his works on RF and Modulation were adopted as the CCSDS standards for USB waveforms and space RF systems. At JPL he invented QPSK phase ambiguity resolver and developed innovative optimization technique for simultaneous range-command-telemetry operation. He built the first laser lab and automated manufacturing lab when he was with ITT Technical Services in the early ’80s. \nHe has published more than 250 technical reports and papers. His work has appeared in NASA TechBrief, textbook, Open Access Book, SIAM Publication, CCSDS Blue Book, and Wiley & Sons Encyclopedia of Electrical and Electronics Engineering. He was selected as a Vietnamese-American Role Model by KCSI-TV, Channel 18 in 2002, and Recognition Honoree at 50-Year Celebration of CSUF in 2007. He received numerous Raytheon, Aerospace and NASA awards, and Air Force commendations. He holds 16 patents. His biography has been listed in Marquis Who’sWho in Science and Engineering in America.",institutionString:"The Aerospace Corporation",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"California State University, Fullerton",institutionURL:null,country:{name:"United States of America"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"305835",firstName:"Ketrin",lastName:"Polesak",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/305835/images/9351_n.png",email:"ketrin@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3794",title:"Swarm Intelligence",subtitle:"Focus on Ant and Particle Swarm Optimization",isOpenForSubmission:!1,hash:"5332a71035a274ecbf1c308df633a8ed",slug:"swarm_intelligence_focus_on_ant_and_particle_swarm_optimization",bookSignature:"Felix T.S. Chan and Manoj Kumar Tiwari",coverURL:"https://cdn.intechopen.com/books/images_new/3794.jpg",editedByType:"Edited by",editors:[{id:"252210",title:"Dr.",name:"Felix",surname:"Chan",slug:"felix-chan",fullName:"Felix Chan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3621",title:"Silver Nanoparticles",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"silver-nanoparticles",bookSignature:"David Pozo Perez",coverURL:"https://cdn.intechopen.com/books/images_new/3621.jpg",editedByType:"Edited by",editors:[{id:"6667",title:"Dr.",name:"David",surname:"Pozo",slug:"david-pozo",fullName:"David Pozo"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"45635",title:"Application of Cellulose and Cellulose Derivatives in Pharmaceutical Industries",doi:"10.5772/55178",slug:"application-of-cellulose-and-cellulose-derivatives-in-pharmaceutical-industries",body:'
1. Introduction
Cellulose probably is the most abundant organic compound in the world which mostly produced by plants. It is the most structural component in herbal cells and tissues. Cellulose is a natural long chain polymer that plays an important role in human food cycle indirectly. This polymer has versatile uses in many industries such as veterinary foods, wood and paper, fibers and clothes, cosmetic and pharmaceutical industries as excipient. Cellulose has very semi-synthetic derivatives which is extensively used in pharmaceutical and cosmetic industries. Cellulose ethers and cellulose esters are two main groups of cellulose derivatives with different physicochemical and mechanical properties. These polymers are broadly used in the formulation of dosage forms and healthcare products. These compounds are playing important roles in different types of pharmaceuticals such as extended and delayed release coated dosage forms, extended and controlled release matrices, osmotic drug delivery systems, bioadhesives and mucoadhesives, compression tablets as compressibility enhancers, liquid dosage forms as thickening agents and stabilizers, granules and tablets as binders, semisolid preparations as gelling agents and many other applications. These polymeric materials have also been used as filler, taste masker, free-flowing agents and pressure sensitive adhesives in transdermal patches. Nowadays cellulose and cellulose based polymers have gained agreat popularity in pharmaceutical industries and become more and more important in this field owing to production of the new derivatives and finding new applications for existed compounds by pharmaceutical researchers.
2. Classification of cellulose-based polymers
2.1. Cellulose
Pure cellulose is available in different forms in the market with very different mechanical and pharmaceutical properties. The difference between various forms of cellulose is related to the shape, size and degree of crystallinity of their particles (fibrous or agglomerated). Microcrystalline cellulose (MCC) is the most known cellulose which extensively used in pharmaceutical industries. MCC grades are multifunctional pharmaceutical excipients which can be used as compressibility enhancer, binder in wet and dry granulation processes, thickener and viscosity builder in liquid dosage forms and free-flowing agents in solid dosage forms. Mechanical properties of MCC grades are greatly influenced by their particle size and degree of crystallization. In recent years the new grades of MCC are prepared with improved pharmaceutical characteristics such as silisified MCC (SMCC) and second generation MCC grades or MCC type II (MCC-II). These grades are prepared by co-processing of cellulose with other substances such as colloidal silicon dioxide or by special chemical procedures. Other types of available pure cellulose are powdered cellulose (PC) and low crystallinity powdered cellulose (LCPC).
Regenerated cellulose is one of the other forms of processed cellulose which produced by chemical processing on natural cellulose. In the first step, cellulose dissolves in alkali and carbon disulfide to make a solution called "viscose". Viscose reconverted to cellulose by passing through a bath of dilute sulfuric acid and sodium sulphate. Reconverted cellulose passed through several more baths for sulfur removing, bleaching and adding a plasticizer (glycerin) to form a transparent film called cellophane. Cellophane has several applications in pharmaceutical packaging due to its suitable characteristics such as good compatibility, durability, transparency and elasticity.
2.2. Cellulose ether derivatives
Cellulose ethers are high molecular weight compounds produced by replacing the hydrogen atoms of hydroxyl groups in the anhydroglucose units of cellulose with alkyl or substituted alkyl groups. The commercially important properties of cellulose ethers are determined by their molecular weights, chemical structure and distribution of the substituent groups, degree of substitution and molar substitution (where applicable). These properties generally include solubility, viscosity in solution, surface activity, thermoplastic film characteristics and stability against biodegradation, heat, hydrolysis and oxidation. Viscosity of cellulose ether solutions is directly related with their molecular weights. Examples of mostly used cellulose ethers are: Methyl cellulose (MC), Ethyl cellulose (EC), Hydroxyethyl cellulose (HEC), Hydroxypropyl cellulose (HPC), hydroxypropylmethyl cellulose (HPMC), carboxymethyl cellulose (CMC) and sodium carboxymethyl cellulose (NaCMC).
2.3. Cellulose ester derivatives
Cellulose esters are generally water insoluble polymers with good film forming characteristics. Cellulose esters are widely used in pharmaceutical controlled release preparations such as osmotic and enteric coated drug delivery systems. These polymers are often used with cellulose ethers concurrently for preparation of micro-porous delivery membranes. Cellulose esters categorized in organic and inorganic groups. Organic cellulose esters are more important in pharmaceutical industries. Various types of organic cellulose esters have been used in commercial products or in pharmaceutical investigations such as cellulose acetate (CA), cellulose acetate phthalate (CAP), Cellulose acetate butyrate (CAB), Cellulose acetate trimelitate (CAT), hydroxupropylmethyl cellulose phthalate (HPMCP) and so on (Heinämäki et al., 1994). The most available formulations in market which made by these polymers are enteric coated dosage forms which are usually produced applying acid resistant polymeric coats containing phthalate derivatives of cellulose esters especially cellulose acetate phthalate (Lecomte et al., 2003; Liu & Williams III, 2002). Inorganic cellulose esters such as cellulose nitrate and cellulose sulphate are less important than organic cellulose esters in pharmaceutical industries. Cellulose nitrate or pyroxylin is a transparent compound with good film forming ability but rarely applied alone in pharmaceutical formulations due to its very low solubility in currently used pharmaceutical solvents as well as their very high flammability. The use of pure cellulose nitrate in drug formulations only limited to one topical anti-wart solution named collodion that made with 4%w/v concentration in diethyl ether/ethanol mixture as solvent. Cellulose nitrate/cellulose acetate mixture are also exploited to prepare micro-porous membrane filters used in pharmaceutical industries.
3. Applications of cellulose and its derivatives in pharmaceutical industries
3.1. Application in bioadhesive and mucoadhesive drug delivery systems
Bioadhesives and mucoadhesives are drug containing polymeric films with ability of adhering to biological membranes after combining with moisture or mucus compounds. Bioadhesives were developed in mid 1980s as a new idea in drug delivery and nowadays they have been accepted as a promising strategies to prolong the residence time and to improve specific localization of drug delivery systems on various biological membranes (Lehr, 2000; Grabovac et al., 2005; Movassaghian et al., 2011).
In compared with tablets, these dosage forms have higher patient compliance due to their small size and thickness. Other advantage of these drug delivery systems is their potential to prolong residence time at the site of drug absorption and thus they can reduce the dosing frequency in controlled release drug formulations. These dosage forms can also intensify the contact of their drug contents with underlying mucosal barrier and improve the epithelial transport of drugs across mucus membranes especially in the case if poorly absorbed drugs (Ludwig, 2005; Lehr, 2000). Some special polymers can be used in these formulations with epithelial permeability modulation ability by loosening the tight intercellular junctions. Some of these polymers also can act as proteolytic enzymes inhibitor in orally used adhesive formulations of sensitive drugs (Lehr, 2000).
Bioadhesives considered as novel drug delivery systems. These dosage forms are formulated to use on the skin and mucus membranes of gastrointestinal, ear, nose, eye, rectum and vagina. The main excipients of these formulations are adhesive and film-former polymer(s). Adhesive polymers are synthetic, semi synthetic or natural macromolecules with capablility of attaching to skin or mucosal surfaces. Very different types of polymers have been used as bioadhesive polymers. Synthetic polymers such as acrylic derivatives, carbopols and polycarbophil, natural polymers such as carageenan, pectin, acacia and alginates and semi-synthetic polymers like chitosan and cellulose derivatives are used in bioadhesive formulations (Deshpande et al., 2009; Grabovac et al., 2005). Cellulose derivatives especially cellulose ethers are widely used in bioadhesives. There are used in various types of these formulations such as buccal, ocular, vaginal, nasal and transdermal formulations alone or with combination of other polymers. More recently used cellulose ethers in bioadhesives include nonionic cellulose ethers such as ethyl cellulose (EC), hydroxyethyl cellulose, hydoxypropyl cellulose (HPC), methyl cellulose (MC), carboxymethyl cellulose (CMC) or hydroxylpropylmethyl cellulose (HPMC) and anionic ether derivatives like sodium carboxymethyl cellulose (NaCMC). Ability of polymer to take up water from mucus and pH of target place are important factors determining the adhesive power of polymers. Some bioadhesive polymers such as polyacrylates show very different adhesion ability in various pH values thus the selection of adhesive polymer should be made based on the type of bioadhesive preparation. One advantage of cellulose ethers such as NaCMC and HPC is lesser dependency of adhesion time and adhesion force of them to pH of medium in compared with polyacrylate and thiolated bioadhesive polymers (Grabovac et al., 2005). Cellulose ethers, alone or their mixtures with other polymers, have been studied in oral (Deshpande et al., 2009; Venkatesan et al., 2006), buccal (Perioli et al 2004), ocular (Ludwig, 2005), vaginal (Karasulu et al., 2004) and transdermal (Sensoy et al., 2009) bioadhesives. In some studies, other groups of adhesive polymers or polysaccharides are used with cellulose ethers to improve their adhesion characteristics such as adhesion time and adhesion force. Concurrent use of polyvinyl pyrrolidone (PVP), hydroxypropyl beta cyclodextrin, polycarbophil, carbopol(s), pectin, dextran and mannitol with HPMC, HEC or NaCMC have been reported in the literatures. (Karavas et al., 2006).
3.2. Application in pharmaceutical coating processes
Solid dosage forms such as tablets, pellets, pills, beads, spherules, granules and microcapsules are often coated for different reasons such as protection of sensitive drugs from humidity, oxygen and all of inappropriate environmental conditions, protection against acidic or enzymatic degradation of drugs, odor or taste masking or making site or time specific release characteristics in pharmaceuticals to prepare various modified release drug delivery systems such as sustained release, delayed release, extended release, immediate release, pulsatile release or step-by-step release dosage forms (Barzegar jalali et al., 2007; Gafourian et al., 2007). Both ether and ester derivatives of cellulose are widely used as coating of solid pharmaceuticals. Cellulose ethers are generally hydrophil and convert to hydrogel after exposing to water. Although, some of the cellulose ethers e.g. ethyl cellulose are insoluble in water but majority of them such as methyl, hydroxypropyl and hydroxylpropylmethyl cellulose are water soluble. Both of soluble and insoluble cellulose ethers can absorb water and form a gel. After exposing of these coated dosage forms with water, the coating polymers form to hyrogel and gradually dissolve in water until disappear but the insoluble cellulose ether coatings remain as a viscose gel around tablets and drug release is performed by diffusion of drug molecules within this layer. These two types of dosage forms called dissolution-controlled and diffusion-controlled drug delivery systems, respectively. Despite cellulose ethers, the cellulose esters are generally water insoluble or water soluble in a distinct pH range. These polymers like cellulose acetate (CA), cellulose acetate phthalate (CAP) and cellulose acetate butyrate (CAB) do not form gel in presence of water and they are widely used for preparing of pH sensitive and semi-permeable micro-porous membranes. These membranes are employed for wide variety of controlled release coating of pharmaceuticals especially in enteric or osmotic drug delivery devices. These polymers are benefited to make different cellulosic membrane filters applied in pharmaceutical industries.
3.3. Application in extended release (ER) solid dosage forms
3.3.1. In coated extended release formulations
Extended release pharmaceuticals refer to dosage forms that allow a twofold or greater reduction in frequency of the drug administration in comparison with conventional dosage forms. These formulations can be made as coated or matrix type. Coated ER formulations are generally made with water insoluble polymeric film coating with or without gel-forming ability. The dominant mechanism of drug release in coated ERs is diffusion whereas in matrix type of ERs, erosion of matrix is the main mechanism of drug release. The most used cellulosic polymer in these modified release dosage forms is ethyl cellulose. Ethyl cellulose is completely insoluble in water, glycerin and propylene glycol and soluble in some organic solvents such as ethanol, methanol, toluene, chloroform and methyl acetate. Aqueous dispersions of ethyl cellulose such as Surelease® (Colorcon) or Aquacoat® (FMC BioPolymer) or its organic solutions can be used for coating of extended release formulations. After ingestion of these formulations, an insoluble viscose gel is forming around the tablet which doesn’t allow to drug to freely release from dosage form. Drug molecules should pass across this barrier by diffusion mechanism to enter the bulk dissolution medium and thusthe release duration is extended much more than the same uncoated conventional formulation. Larger solid pharmaceuticals like tablets can be coated with rotating pan coaters whereas the smaller types as pills, beads or granules are coated with fluidized bed or air-suspension coater equipments. Because of water insolubility of EC, it is often used in conjunction with water soluble polymers such as MC and HPMC in aqueous coating liquids (Frohoff-Hülsmann et al., 1999a, 1999b). EC solutions in organic solvents such as ethanol can be thickened by HPMC or HPC (Rowe, 1986; Larsson et al., 2010). Water soluble cellulosic polymers with higher amounts can be used as pore former in micro-porous types of extended release and enteric systems. Using of plasticizers is necessary for achieving acceptable coating of pharmaceuticals by these polymers. EC is compatible with commonly used plasticizers such as dibutyl phthalate, diethyl phthalate, dicyclohexyl phthalate, butyl phthalyl butyl glycolate, benzyl phthalate, butyl stearate and castor oil. Other plasticizers such as triacetin, cholecalciferol and α-tocopherol also have been used in EC film coats (Arwidson et al., 1990; Kangarlou et al., 2008). The molecular weights of ECs are in a wide range and different grades of them are existed from 4 to 350 (Colorcon official website). Concentration of 5%w/v from these EC grades in toluene/ethanol mixture at 25°C can produce about 3 to 380 cp viscosity.
3.3.2. In extended release polymeric matrices
Matrices are very simple and efficient systems for controlling drug release from dosage forms. Production of these systems is less time consuming and no needs to special or sophisticated equipments. Majority of ER matrices are made by a simple mixing of drug, polymer(s) and filler followed by one or two stage compaction process. Polymeric matrices as drug delivery systems are very important in developing of modified release dosage forms. In these devices, the drug is dispersed either molecularly or in particulate form within a polymeric network. The main types of drug delivery matrices included swellable and hydrophilic monolithic, erosion controlled and non-erodible matrices (Roy et al., 2002). The use of hydrophilic matrices has become extremely popular in controlling the release rate of drugs from solid dosage forms due to their attractiveness in the case of economic and process development points of view (Conti et al., 2007). During the last two decades, hydrophilic swellable polymers have been widely used for preparation of controlled release matrix tablet formulations. Although various types of rate controlling polymers have been used in hydrophilic matrices, cellulose derivatives especially cellulose ethers are probably the most frequently encountered in pharmaceutical literatures and the most popular polymers in formulation of commercially available oral controlled release matrices. They good compressibility characteristics so they are easily converted to matrices by direct compression technique. In contact with an aqueous liquid, i.e., dissolution medium or gastrointestinal fluid, the hydrophilic polymers present in the matrix swell and a viscose gelatinous layer formed in outer surface of matrix. This layer controls the drug release from matrix. Drug molecules can release out of system by diffusion across this layer. Viscosity of the gel layer is a critical rate-controlling factor in drug release rate from matrices. Erosion of polymeric matrices also can influence the release of the drug from system. Increasing viscosity of the gel, gives rise to increase the resistance against polymer erosion and drug diffusion resulting in reduction of the drug release rate. Various types of cellulose derivatives have been used in formulation of hydrophilic polymeric matrices such as HPMC, NaCMC, CMC, HEC, HPC and EC with different molecular weights (Barzegar-jalali et al., 2010; Javadzadeh et al., 2010; adibkia et al., 2011; Asnaashari et al., 2011). Both of soluble and insoluble cellulose ethers can be used in hydrophilic polymeric matrices due to their hydrophilic nature and ability of them to forming gel in aqueous media. The highest swelling power and hydration rate among cellulose ethers is related to HEC (Saša et al., 2006) but the mostly used cellulose ether is hydrophilic matrices is HPMC due to its excellent swelling properties, good compressibility and fast hydration in contact with water (Ferrero et al., 2008, 2010; Nerurcar et al., 2005). For achieving the good release characteristics, mixtures of various cellulose ethers or mixtures of different grades of a distinct polymer with different ratios can be used based on the intended release rate of controlled release system (Chopra et al., 2007). Some specialized hydrophilic matrices can be made with cellulose ethers for special purposes for example, HPMC matrices with alkalizing buffers like sodium citrate for protection of acid labile drugs have been investigated (Pygall et al., 2009).
3.4. Application in osmotic drug delivery systems
In recent years, considerable attention has been focused on development of novel drug delivery systems (NDDS). Among various NDDS available in the market, oral controlled release (CR) systems hold the major market share because of their advantages over others. Majority of oral CR systems fall in the category of matrices, reservoirs and osmotic devices. Among various types of CR systems, osmotic devices are considered as novel CR systems (J. Shokri et al., 2008a). These formulations utilize osmotic pressure as energy source and driving force for delivery of drugs. Some physiological factors such as pH, presence of food and gastrointestinal motility may affect drug release from conventional CR systems (matrices and reservoirs), whereas, drug release from oral osmotic systems is independent of these factors to a large extent. A classic osmotic device basically consists of an osmotically active core surrounded by a semi-permeable membrane (SPM) and a small orifice drilled through SPM using LASER or mechanical drills. In fact, this system is really a coated tablet with an aperture which acts as drug delivery port (figure 1). This type of devices is called monolithic or elementary osmotic pumps (EOPs). The more sophisticated osmotic devices have bi-layer (push-pull systems) or tri-layer (sandwich osmotic pumps) cores consisted of an osmotically active drug layer and polymeric layer(s) in one or two sides. Some of osmotic systems called asymmetric membrane or controlled porosity osmotic pumps have not any orifice in their SPM (wang et al., 2005). In these devices, water soluble polymers are used in their SPM as pore formers. Pore formers dissolve after exposing of dosage form to aqueous media and numerous micro pores are created in SPM for drug delivery reason. When an osmotic tablet exposed to an aqueous environment, water pumps from outside into the system due to the great osmotic pressure difference between two sides of SPM. Pumping of water into the system increases the inner hydrostatic pressure leading the saturated drug solution to flow through the small drug delivery orifice or micro pores (in the case of asymmetric membrane devices). Because of high difference of osmotic pressure between two sides of SPM, the osmotic pressure gradient remain constant and thus, the release rate of drug from these devices is almost constant and independent to environmental conditions. EOPs are the most commercially important osmotic devices so that more than 240 patents have been devoted. Procardia XL® and Adalat CR (nifedipine), Acutrium® (phenylpropanolamine), Minipress XL® (prazocine) and Volmax® (salbutamol) are examples of EOPs available in the market (J. Shokri et al., 2008a; Nokhodchi et al., 2008).
Figure 1.
Schematic diagram of an EOP osmotic system.
3.4.1. In SPM formulation of osmotic systems
As noted earlier, each osmotic delivery system is consisted of two main components included osmotically active core and semi-permeable membrane (SPM). Cellulose acetate (CA) is the mostly used polymer in formulation of SPM in all types of osmotic drug delivery devices. This polymer is the most important cellulose ester derivative with good film forming ability and mechanical characteristics for using in osmotic systems. CA is insoluble in water in both acidic and alkaline conditions. The CA films are only permeable to small molecules such as water while larger molecules like organic drugs can not pass through them. Plasticizers are used in SPM composition for improving the flexibility and mechanical properties of membrane. Various types of plasticizers have been used in formulation of osmotic pharmaceuticals such as castor oil, low and medium molecular weights polyethylenglycols (PEGs), sorbitol, glycerin, propylene glycol, triacetine, ethylene glycol monoacetate, diethyl phthalate, diethyl tartrate and trimethyl phosphate (J. Shokri et al., 2008a, 2008b; Prabakaran et al., 2004; Makhija & Vavia, 2003; Liu et al., 2000a, 2000b; Okimoto et al., 1999). Generally, the mixture of hydrophilic and hydrophobic plasticizers is used for producing the intended drug release characteristics. In controlled porosity osmotic pumps (CPOPs), the additional components such as pore formers are needed. The most efficient pore formers are hydrophilic polymers with high water solubility properties. Water soluble cellulose ether derivatives can be used as pore former in SPM of these devices. Low molecular weight grades of these polymers are suitable for this purpose due to their faster dissolution rate and lower viscosities. Low molecular weight MCs and HPMCs have been used as pore former in CPOP formulations. Central cores are coated with a coating formulation containing SPM components such as film former (CA), pore former(s) and plasticizer(s) dissolved or dispersed in a suitable liquid base. Acetone/ethanol mixtures are generally used as solvent system to dissolve cellulose acetate in coating liquid (J. Shokri et al., 2008a; Nokhodchi et al., 2008; M.H. Shokri et al., 2011). In some studies, cellulose acetate is used as fine particles suspended in an aqueous medium for coating of osmotic cores (Liu et al., 2000b). Ethyl cellulose (EC) and ethylhydroxyl propyl cellulose also have been used as SPM of osmotic devices in some studies but permeability of these membranes is lower than CA membranes. In these formulations, hydrophilic cellulose ether derivatives such as HPMC have been used for improving SPM permeability (Marucci et al., 2010; Wang et al., 2005; Hjärtstam et al., 1990).
3.4.2. In central core of osmotic systems
Central core of an osmotic pump is generally a simple compressed tablet basically consisted of the active drug(s), osmotically active agent(s), hydrophilic polymer(s) and other commonly used ingredients such as filler, compressibility enhancer, free flowing agent and lubricant. In one compartment devices (EOPs and controlled porosity OP), these polymers mixed with other ingredients and compressed to a tablet whereas in two layered (Push-Pull systems), or tri layered (Sandwich systems) cores, these polymers compressed in one or two separated layer in one or both sides of drug layer (J. Shokri et al., 2008b; Kumaravelrajan et al., 2010). These polymers should have high water uptake and swelling capacity. Cellulose derivatives play an important role in core formulations of osmotic devices. Water soluble cellulose ethers commonly used as core polymers due to their hydrophilicity and good swelling properties. Most currently used polymers for this purpose are MC, HEC, HPC and HPMC with various molecular weights. After exposing of system to water, water move into the system due to great osmotic pressure difference between outer and inner part of device. This water is imbibed to polymer(s) and causes swelling of them. Swelling of core polymer(s) produce the driving force for ejecting the drug solution from drug release orifice with constant rate (J. Shokri et al., 2008a, 2008b; Prabakaran et al., 2004; Makhija & Vavia, 2003; Liu et al., 2000a, 2000b). Among cellulose ethers, different grades of HPMC have been used more than others in core formulation. Microcrystalline cellulose (MCC) has also frequently used the core formulations as compressibility enhancer. MCC is one of the most compressibility enhancers that widely used in direct compression as well as wet granulation techniques for preparing various types of tablets, pellets and pills.
3.5. Application in enteric coated solid dosage form
Enteric coated solid dosage forms are the main groups of delayed release drug delivery systems which designed for releasing of their drug(s) content in the lower parts of gastrointestinal tract such as small intestine and colon. Enteric dosage forms can be considered as a type of oral site specific pharmaceuticals that initiate drug release after passing from stomach. Enteric oral dosage forms are suitable for formulation of acid-labile drugs or drugs with irritancy potential for inner protective layer of stomach such as non-steroidal anti inflammatory drugs (NSAIDs). The commonly used materials in enteric coated formulations are pH-dependent polymers containing carboxylic acid groups. These polymers remain un-ionized in low pH conditions like environment of stomach and become ionized with increasing of pH toward natural and light alkaline zone similar to the small intestine condition (Liu et al., 2011). These polymers also should have the good film forming properties to produce smooth coats with good integrity. Various polymers have been used for production of enteric coated dosage forms such as Eudragit® polymers and pH-dependent cellulose derivatives. Cellulose derivatives which commonly used as enteric coating polymers include cellulose acetate phthalate (CAP), cellulose acetate trimelitate (CAT), hydroxypropylmethyl cellulose phthalate (HPMCP), carboxymethylethyl cellulose (CMEC) and hydroxypropylmethyl cellulose acetate succinate (HPMCAP) (Williams III & Liu, 2000). Apart from the main enteric polymer, the type and amount o plasticizer(s) is very important for achieving uniform, smooth and resistant enteric films. Some of mostly used plasticizers in enteric coated formulations are diethyl phthalate, glyceryl triacetate, glyceryl monocaprylate and triethyl citrate (Williams III & Liu, 2000; Gosh et al., 2011). In some cases, hydrophilic cellulose ether derivatives especially HPMC are used with enteric polymer for improving the film forming and plasticity of main enteric polymer. HPMC is also used in enteric coating process as pre-coating or sub-coating polymer due to its very good film forming properties and suitable polymer-to-polymer adhesion with enteric coating polymers especially with cellulose ester derivatives such as CAP, HPMCP, HPMCAS, CMEC and CAT (Williams III & Liu, 2000). Three commercially available enteric coating preparations included solid forms of enteric polymers which should be dissolved in suitable organic solvent mixture before coating process, ready-to-use organic enteric coating solutions and aqueous polymeric dispersions. Aqueous nanodispersions of enteric coating polymers such as HPMCP have also been investigated for improving physicochemical and mechanical characteristics of coating (Kim et al., 2003).
3.6. Application as compressibility enhancers
More than 80 percent of all dosage forms available or administered to man are tablets. The main reason of this great popularity is the advantages of tablets over other forms of pharmaceuticals. Ease of manufacturing, convenience dosing and greater stability in compared with liquid or semisolid dosage forms are some of these advantages. Two common ways for tablet manufacturing are compression and molding. Except of a few cases, tablets are made by compression technique. The simplest and fastest kind of compression is named direct compression method in which the drug and all of other excipients are mixed and compressed in one-stage process with proper compression force to form tablet. This method commonly used for tabletting of medium to high potency drugs where the drug content in them is less than 30% of formulation (Jivari et al., 2000). In the other cases with higher amounts of low compactable drugs, dry or wet granulation techniques are used for preparing tablets. In dry granulation method, compression of ingredients are performed in two or multi-stage process to improve compressibility of the ingredients. Slugging and roller compaction techniques used for initial compression of powder mixtures before final tabletting process.
One of the common difficulties in direct compression and dry granulation is low compactability of the drug content especially when the drug amount is higher than 30% of formulation. In these cases, an efficient compressibility enhancer can help to achieving a good tablet with pharmaceutically accepted characteristics. Although, all of the cellulose based polymers are good compactable, however special grades of microcrystalline cellulose exhibit excellent compatibility. These grades can significantly improve compressibility of low compactable powder mixtures so they are widely used as compressibility enhancers in tablet manufacturing by direct compression and dry granulation methods. Various grades of MCC have different fundamental properties including their morphology, particle size, surface area, porosity and density (Rojas & Kumar, 2011). These physicochemical properties poses the different characteristics to them for example, smaller particle size MCC grades have good compressibility and poor flowability whereas the larger particle size grades have poor compressibility and excellent flowability. Particle size of MCC varies from 20 to 270 micrometer based on the manufacturer and type of application. MCC is available in three public brand names including Avicel® (FMC BioPolymer), VIVAPUR®/EMCOCEL® (JRS Pharma) and TABULOSE® (Blanver). Various grades of commercially available Avicel® and their particle size are shown in table 1 (Colorcon official website).
brand name
Application
MCC grade
Particle size
Avicel®
Roller compaction
DG
45
Wet granulation
PH-101
50
Direct compression
PH-102
100
HFE-102
100
Superior compactability
PH-105
20
Superior Flowability
PH-102 SCG
150
PH-200
180
High Density
PH-301
50
PH-302
100
Low Humidity
PH-103
50
PH-113
50
PH-112
100
PH-200LM
180
Mouthfeel improvement
CE-15
75
Table 1
Various grenades of Avicel®
The effects of size, shape and porosity of MCC particles on flowability and compatibility have also been investigated by several researchers (Johansson et al., 2001). Various types of MCCs are extensively used in direct compression and dry granulation methods especially in roller compaction for preparing compressed tablets or pellets (Strydom et al., 2011; Bultmann, 2002). Microcrystalline cellulose type II (MCC-II) was recently introduced as new pharmaceutical excipients. MCC-II has a fibrous structure with lower compactability than MCC grades and suitable for using in rapid disintegrating dosage forms (Rojas et al., 2011; Reus-Medina & Kumar, 2006). In recent years, the new methods have been established for improving mechanical characteristics of MCCs. One of these innovative methods is lubricating or silisfying for improving compactability of low compressible grades of MCCs such as MCC-II or large particle size MCC grades. In this method, amorphous silicon dioxide (SiO2) is used as companion excipient for co-processing with low compressible MCC grades. Cellulose/SiO2 ratio is 98:2 and resulted product is called lubricated or silisified microcrystalline cellulose (SMCC). This method can be used for both MCC-I or MCC-II for production SMCC-I or SMCC-II (Rojas & Kumar, 2011; Van Veen et al., 2005). SMCC-I have excellent compaction properties and less stickiness to the lower punches over MCC-I or MCC-I/SiO2 physical mixtures (Rojas & Kumar, 2011). SMCC-II has also better mechanical properties especially higher compactability than MCC-II without detriment if it\'s self-disintegrating characteristics. SMCC-I grades are commercially available under trade name of ProSolv® (JRS Pharma) but SMCC-II is not commercialized yet. Apart from MCC, other forms of cellulose are existed such as powdered cellulose (PC) and low cristallinity powdered cellulose (LCPC). LCPC and MCC have agglomerated and PC has fibrous structure. PC applications in pharmaceutical industries is similar that MCC. It is widely used in direct compression formulation and in dry granulation by either slugging or roller compaction methods. LCPC is a new direct compression cellulose excipient which is prepared by controlled decrystallization and depolymerization of cellulose with phosphoric acid (Rojas & Kumar, 2011). LCPC was shown superior tabletting properties than direct compression grades of MCC like Avicel®PH-101 (Kothari et al., 2002).
3.7. Application as gelling agents
Gels are semisolid systems consisting of dispersions of very small particles or large molecules in an aqueous liquid vehicle rendered jellylike by the addition of a gelling agent. In recent decades, synthetic and semi-synthetic macromolecules are mostly used as gelling agents in pharmaceutical dosage forms. Some of these agents include: carbomers, cellulose derivatives and natural gums. Cellulose derivatives such as HPMC and CMC are the most popular gelling agents used in drug formulations. These polymers are less sensitive for microbial contamination than natural gelling agents such as tragacanth, acacia, sodium algininate, agar, pectin and gelatin. Cellulose derivatives generally dissolve better in hot water (except MC grades) and their mechanisms of jellification is thermal. For preparing gel, powder of these polymers with suitable amount initially dispersed in cold water by using mechanical mixture and then, the dispersion is heated to about 60-80°C and gradually cooled to normal room temperature to form a gel (except MC grades). The resulted gels from these polymers are single-phase gels. Adding of electrolytes in the low concentrations increase the viscosity of these gels by salting out mechanism and higher concentrations (above 3-4%) can precipitate the polymer and breakup the gel system (Allen, et al., 1995). Maximum stability and transparency of the gels prepared by these polymers is about neutral range (pH= 7-9) and acidic pHs can precipitate them from gel system. Minimum gel-forming concentrations of cellulose derivatives are different based on the type and the molecular weights of them but the medium range is about 4-6%w/v. The type of cellulose derivative in pharmaceutical gels can significantly affect drug release from gel formulations (Tas, et al., 2003). These gels also can be used as the base of novel drug delivery systems such as liposomal formulations (Gupta, et al., 2012).
3.8. Application as thickening and stabilizing agents
Cellulose derivatives are extensively used for thickening of pharmaceutical solutions and disperse systems such as emulsions and suspensions (Adibkia et al., 2007a, 2007b). Furthermore, these polymers can increase viscosity of non-aqueous pharmaceutical solution likes organic-based coating solutions. Viscosity enhancing of drug solutions poses many advantages such as improving consuming controllability and increasing residence time of drugs in topical and mucosal solutions which lead to improve bioavailability of topical, nasal or ocular preparations (Grove et al., 1990; Adibkia et al., 2007a, 2007b). It has been revealed that viscosity enhancement, in some cases, can increase absorption of some poorly-absorb drugs like insulin from oral dosage forms (Mesiha, M. & Sidhom, M.). Cellulose ethers in concentrations lower than minimum gel-forming amounts are used as thickening agents or viscosity builder. These polymers play an important role in stabilizing of pharmaceutical disperse systems especially in suspensions and coarse emulsions. By increasing the viscosity of suspension, based on the stock\'s equation, the sedimentation rate of dispersant decreased and thus, the uniformity of dispersion after shaking of product will improve. In the case of emulsions, these polymers can increase the shelf life and their resistance against mechanical and thermal shocks. Among cellulose derivatives, cellulose ethers especially their higher molecular weight grades are more suitable for using as viscosity enhancer and stabilizer for liquid pharmaceutical disperse systems such as suspensions and emulsions. There is a direct proportionality between viscosity of cellulose ether solutions and molecular weights of them.
3.9. Application as fillers in solid dosage forms
Cellulose and related polymers are commonly used in solid dosage forms like tablets and capsules as filler. Various forms of cellulose have been used in pharmaceutical preparations as multifunctional ingredients thus; they are concerned as precious excipients for formulation of solid dosage forms. Cellulose and its derivatives have many advantages in using as filler in solid pharmaceuticals such as their compatibility with the most of other excipients, pharmacologically inert nature and indigestibility by human gastrointestinal enzymes. These polymers do not cause any irritancy potential on stomach and esophagus protective mucosa. Various forms of pure cellulose and cellulose ether derivatives can be used as filler in these formulations.
3.10. Application as binders in granulation process
Binders are the essential components of solid drug formulations made by wet granulation process. In wet granulation process, drug substance is combined with other excipients and processed with the use of a solvent (aqueous or organic) with subsequent drying and milling to produce granules. Cellulose and some derivatives have excellent binding effects in wet granulation process. A number of MCC grades such as PH-101 are widely used as binder in wet granulation. Other cellulose derivatives such as MC, HPMC and HPC have good binding properties in wet granulation. Low substituted cellulose ethers such as low substituted HPC (L-HPC) also used as binder in wet granulation process (Desai et al., 2006; Wan & Prasad, 1988). Even though, low substituted cellulose ethers have lower water solubility compared with normal grades, however they have very good binding efficacy. Cross-linked cellulose (CLC) and cross-linked cellulose derivatives such as cross-linked NaCMC can be used as excellent binders in pharmaceuticals as well (Chebli & Cartilier, 1998).
3.11. Application as disintegrating agents
Solid oral dosage forms such as tablets undergo several steps before systemic absorption of the drug. Disintegration is the first step immediately after administration of oral dosage forms that breakup the dosage forms into the smaller fragments in an aqueous environment. Converting of solid dosage forms to smaller fragments, increase the available surface area and promote a more rapid release of the drug substances from dosage forms. The earliest known disintegrant is Starch. Corn Starch or Potato Starch was recognized as being the ingredient in tablet formulations responsible for disintegration as early as 1906. Due to low compressibility of starch, pre-gelatinized starch was invented for using as disintegrant. Pre-gelatinized starch and MCC are two main types of classic disintegrants. In recent years, the classic disintegrnts have been gradually replaced with the newer ones called super disintegrants. Super disintegrants can acts in lower concentrations than starch and have not detriment effect on compressibility and flowability of formulations. Three main groups of these excipients are: modified starches like sodium starch glycolate (Primogel®, Explotab®) with 4-6% effective concentration, cross-linked polyvinyl pyrrolidones like crospovidone (Polyplasdone XL, Kollidon CL) with 2-4% effective concentration and modifies cellulose like cross-linked sodium carboxymethyl cellulose or croscarmellose (Ac-Di-SolTM and Nymcel) with 2-4% effective concentration in wet granulation process. Modified cellulose compounds are very efficient disintegrants and additionally, can accelerate the dissolution rate of drugs in aqueous environment (Chebli & Cartilier, 1998).
3.12. Application as taste masking agents
There are numerous drugs with unfavorable tastes. The most prevalent unpleasant taste of the drugs is bitter taste. Unpleasant-tasting dosage forms leads to lack of patient compliance of oral drug preparations. Various tastes are feeling by taste buds on the tongue. Taste buds are onion-shaped structures containing between 50 to 100 taste cells. Chemicals from food or oral ingested medicine are dissolved by the saliva and enter via the taste pore. They either interact with surface proteins known as taste receptors or with pore-like proteins called ion channels. These interactions cause electrical changes within the taste cells that trigger them to send chemical signals that translate into neurotransmission to the brain. Salt and sour responses are of the ion channel type of responses, while sweet and bitter are surface protein responses.
Taste masking is an important consideration in formulation of oral dosage forms especially in the case of high dose, poorly tasting drugs. Improving the taste of liquid dosage forms is more important because of better sensitivity and faster stimulation of taste receptors by liquids in compared than solids. Taste masking in solid dosage forms can be performed by coating (in the case of tablets, pellets, pills or coarse granules) or micro-coating (in the case of fine granules, powders or microcapsules) of them by a gastro-soluble polymeric coating. These coats can prevent from contacting of the drug with taste buds without detriment of release characteristics of the drug formulations in gastrointestinal tract. Soluble cellulose ether derivatives are suitable for this purpose. These polymers like HPMC, HEC, MC and HPC are completely water soluble and they have very good film forming properties. Some grades of MCC also can improve tooth-feel such as Avicel® CE-15. These coats can produce additional benefits in drug formulations such as protection of the active ingredients against moisture, oxygen of the air and light due to their barrier effects. Masking of the taste in liquid dosage forms especially in drug solutions is more sophisticated. In these cases test receptor blockers, flavoring agents and viscosity enhancers are simultaneously needed.
\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/45635.pdf",chapterXML:"https://mts.intechopen.com/source/xml/45635.xml",downloadPdfUrl:"/chapter/pdf-download/45635",previewPdfUrl:"/chapter/pdf-preview/45635",totalDownloads:8552,totalViews:6030,totalCrossrefCites:22,totalDimensionsCites:56,hasAltmetrics:0,dateSubmitted:"November 10th 2011",dateReviewed:"November 21st 2012",datePrePublished:null,datePublished:"August 29th 2013",readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/45635",risUrl:"/chapter/ris/45635",book:{slug:"cellulose-medical-pharmaceutical-and-electronic-applications"},signatures:"Javad Shokri and Khosro Adibkia",authors:[{id:"140056",title:"Prof.",name:"Javad",middleName:null,surname:"Shokri",fullName:"Javad Shokri",slug:"javad-shokri",email:"shokri.j@gmail.com",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Classification of cellulose-based polymers",level:"1"},{id:"sec_2_2",title:"2.1. Cellulose",level:"2"},{id:"sec_3_2",title:"2.2. Cellulose ether derivatives",level:"2"},{id:"sec_4_2",title:"2.3. Cellulose ester derivatives",level:"2"},{id:"sec_6",title:"3. Applications of cellulose and its derivatives in pharmaceutical industries",level:"1"},{id:"sec_6_2",title:"3.1. Application in bioadhesive and mucoadhesive drug delivery systems",level:"2"},{id:"sec_7_2",title:"3.2. Application in pharmaceutical coating processes",level:"2"},{id:"sec_8_2",title:"3.3. Application in extended release (ER) solid dosage forms",level:"2"},{id:"sec_8_3",title:"3.3.1. In coated extended release formulations",level:"3"},{id:"sec_9_3",title:"3.3.2. In extended release polymeric matrices",level:"3"},{id:"sec_11_2",title:"3.4. Application in osmotic drug delivery systems",level:"2"},{id:"sec_11_3",title:"3.4.1. In SPM formulation of osmotic systems",level:"3"},{id:"sec_12_3",title:"3.4.2. In central core of osmotic systems",level:"3"},{id:"sec_14_2",title:"3.5. Application in enteric coated solid dosage form",level:"2"},{id:"sec_15_2",title:"3.6. Application as compressibility enhancers",level:"2"},{id:"sec_16_2",title:"3.7. Application as gelling agents",level:"2"},{id:"sec_17_2",title:"3.8. Application as thickening and stabilizing agents",level:"2"},{id:"sec_18_2",title:"3.9. Application as fillers in solid dosage forms",level:"2"},{id:"sec_19_2",title:"3.10. Application as binders in granulation process",level:"2"},{id:"sec_20_2",title:"3.11. Application as disintegrating agents",level:"2"},{id:"sec_21_2",title:"3.12. Application as taste masking agents",level:"2"}],chapterReferences:[{id:"B1",body:'Adibkiak.HamedeyazdanS.JavadzadehY.2011Drug release kinetics and physicochemical characteristics of floating drug delivery systems.Expert Opinion on Drug Delivery87July), 891903\n\t\t\t'},{id:"B2",body:'AdibkiaK.OmidiY.Siahi Shadbad, MR.; Nokhodchi, A.; Javadzedeh, A.; Barzegar-Jalali, M.; Barar, J.; Mohammadi, G. (2007bInhibition of endotoxin-induced uveitis by methylprednisolone acetate nanosuspension in rabbits.Journal of Ocular Pharmacology and Therapeutics,\n\t\t\t\t\t235May), 421432\n\t\t\t'},{id:"B3",body:'AdibkiaK.Siahi Shadbad, MR.; Nokhodchi, A.; Javadzedeh, A.; Barzegar-Jalali, M.; Barar, J.; Mohammadi, G.; Omidi, Y. (2007aPiroxicam nanoparticles for ocular delivery: Physicochemical characterization and implementation in endotoxin-induced uveitis.Journal of Drug Targeting156June), 407416'},{id:"B4",body:'Allen, L.V.; Popovich, N.G.; Ansel, H.C. (1995). Ansels Pharmaceutical Dosage Forms and Drug Delivery ayatems (8th Edition), Lippincott Williams & Wilkins, 0-78174-612-4 States of America '},{id:"B5",body:'ArwidssonH.NicklassonM.1990Application of intrinsic viscosity and interaction constant as a formulation tool for film coating II. Studies on different grades of ethyl cellulose in organic solvent systemsInternational Journal of Pharmaceutics581January), 7377'},{id:"B6",body:'AsnaashariS.KhoeiN. S.ZarrintanM. H.AdibkiaK.JavadzadehY.2011Preparation and evaluation of novel metronidazole sustained release and floating matrix tablets.Pharmaceutical Development and Technology164April), 400407\n\t\t\t'},{id:"B7",body:'Barzegar-jalaliM.ValizadehaH.DastmalchiS.Siahi Shadbad, MR.; Barzegar-Jalal, A.; Adibkia, K.; Mohammadi, G. (2007Enhancing dissolution rate of carbamazepine via cogrinding with crospovidone and hydroxy propyl methyl cellulose. Iranian Journal of Pharmaceutical Research,\n\t\t\t\t\t63March), 159165\n\t\t\t'},{id:"B8",body:'Barzegar-jalaliM.ValizadehaH.Siahi Shadbad, MR.; Adibkia, K.; Mohammadi, G.; Farahani, A.; Arash, Z.; Nokhodchi, A. (2010Cogrinding as an approach to enhance dissolution rate of a poorly water-soluble drug (gliclazide)Powder Technology1973March), 150158\n\t\t\t'},{id:"B9",body:'BultmannJ. M.2002Multiple compaction of microcrystalline cellulose in a roller compactorEuropean Journal of Pharmaceutics and Biopharmaceutics545964'},{id:"B10",body:'ChebliC.CartilierR.1998Cross-linked cellulose as a tablet excipient: A binding/disintegrating agentInternational Journal of Pharmaceutics171101110'},{id:"B11",body:'ChopraSh.; Patil, G.V.; Motwani, S.K. (2007Release modulating hydrophilic matrix systems of losartan potassium: Optimization of formulation using statistical experimental designEuropean Journal of Pharmaceutics and Biopharmaceutics661April), 7382'},{id:"B12",body:'Colorcon official website, http//fmcbiopolymer.com/pharmaceutical/product/Avicelforsoliddosageforms/ASPX'},{id:"B13",body:'ContiS.MaggiL.SegaleL.MachisteE. O.ConteU.GrenierP.VergnaultG.2007Matrices containing NaCMC and HPMC: 1. Dissolution performance characterizationInternational Journal of Pharmaceutics3331-2March), 136142'},{id:"B14",body:'DesaiD.RinaldiF.KothariS.ParuchuriS.LiM.LaiD.FungS.BothD.2006Effect of hydroxypropyl cellulose (HPC) on dissolution rate of hydrochlorothiazide tablets International Journal of Pharmaceutics, 3084045'},{id:"B15",body:'DeshpandeM. C.VenkateswarluV.BabuR. K.TrivediR. K.2009Design and evaluation of oral bioadhesive controlled release formulations of miglitol, intended for prolonged inhibition of intestinal α-glucosidases and enhancement of plasma glucagon like peptide-1 levels. International Journal of Pharmaceutics, 3801-2October), 1624\n\t\t\t'},{id:"B16",body:'FerreroC.MassuelleD.DoelkerE.2010Towards elucidation of the drug release mechanism from compressed hydrophilic matrices made of cellulose ethers. II. Evaluation of a possible swelling-controlled drug release mechanism using dimensionless analysis. Journal of Controlled Release, 1412January), 223233'},{id:"B17",body:'FerreroC.MassuelleD.JeanneratD.DoelkerE.2008Towards elucidation of the drug release mechanism from compressed hydrophilic matrices made of cellulose ethers. I. Pulse-field-gradient spin-echo NMR study of sodium salicylate diffusivity in swollen hydrogels with respect to polymermatrix physical structure. Journal of Controlled Release, 1281May), 7179'},{id:"B18",body:'Frohoff-hülsmannM. A.LippoldB. C.McginityJ. W.1999aAqueous ethyl cellulose dispersion containing plasticizers of different water solubility and hydroxypropyl methyl- cellulose as coating material for diffusion pellets II: properties of sprayed films. European Journal of Pharmaceutics and Biopharmaceutics481July), 6775'},{id:"B19",body:'Frohoff-hülsmannM. A.SchmitzA.LippoldB. C.1999bAqueous ethyl cellulose dispersions containing plasticizers of different water solubility and hydroxypropyl methylcellulose as coating material for diffusion pellets: I. Drug release rates from coated pellets. International Journal of Pharmaceutics1771January), 6982'},{id:"B20",body:'GhoshI.SnyderJ.VippaguntaR.AlvineA.VakilR.TongW-Q.VippaguntaS.2011Comparison of HPMC based polymers performance as carriers for manufacture of solid dispersions using the melt extruderInternational Journal of Pharmaceutics4191-2October), 1219\n\t\t\t'},{id:"B21",body:'GrabovacV.GuggiD.Bernkop-schnurchA.2005Comparison of the mucoadhesive properties of various polymersAdvanced Drug Delivery Reviews5717131723'},{id:"B22",body:'GroveJ.DurrM.QuintM-P.PlazonnetB.1990The effect of vehicle viscosity on the ocular bioavailability of L-653,328International Journal of Pharmaceutics661-3December 1990), 2328\n\t\t\t'},{id:"B23",body:'GuptaP. N.PattaniA.CurranR. M.KettV. L.AndrewsG. P.MorrowR. J.WoolfsonA. D.MalcolmR. K.2012Development of liposome gel based formulations for ntravaginal delivery of the recombinant HIV-1 envelope protein CN54gp140, European Journal of Pharmaceutical Sciences, In Press, Corrected Proof, Available online 14 February 2012.'},{id:"B24",body:'HeinämäkiJ. T.Iraizoz Colarte, A.; Nordström, A.J.; Yliruusi, J.K. (1994Comparative evaluation of ammoniated aqueous and organic-solvent-based celluloseester enteric coating systems: a study on free films. International Journal of Pharmaceutics,\n\t\t\t\t\t1091August), 916'},{id:"B25",body:'HjärtstamJ.BorgK.LindstedtB.1990The effect of tensile stress on permeability of free films of ethyl cellulose containing hydroxypropyl methylcelluloseInternational Journal of Pharmaceutics611-2June), 101107\n\t\t\t'},{id:"B26",body:'JavadzadehY.HamedeyazdanS.AdibkiaK.KiafarF.ZarrintanM. H.Barzegar-jalaliM.2010Evaluation of drug release kinetics and physicochemical characteristics of metronidazole floating beads based on calcium silicate and gas forming agents. Pharmaceutical Development and Technology, 154April), 329338\n\t\t\t'},{id:"B27",body:'JivrajM.MartiniL. G.ThomsonC. M.2000An overview of the different excipients useful for the direct compression of tabletsPharmaceutical Science & Technology Today32February), 5863'},{id:"B28",body:'JohanssonB.AlderbornG.2001The effect of shape and porosity on the compression behavior and tablet forming ability of granular materials formed from microcrystalline cellulose, European Journal of Pharmaceutics and Biopharmaceutics, 523November), 347357'},{id:"B29",body:'KangarlouS.HaririanI.GholipourY.2008Physico-mechanical analysis of free ethyl cellulose films comprised with novelplasticizers of vitamin resources. International Journal of Pharmaceutics,\n\t\t\t\t\t3561-2May), 153166'},{id:"B30",body:'KarasuluY. H.HilmiogluS.MetinD. Y.GüneriT.2004Efficacy of a new ketoconazole bioadhesive vaginal tablet on Candida albicans.Il Farmaco, 592February), 163167'},{id:"B31",body:'KaravasE.GeorgarakisE.BikiarisD.2006Application of PVP/HPMC miscible blends with enhanced mucoadhesive properties for adjusting drug release in predictable pulsatile chronotherapeuticsEuropean Journal of Pharmaceutics and Biopharmaceutics641August), 115126\n\t\t\t'},{id:"B32",body:'KimH.ParkJ. H.CheongI. W.KimJ. H.2003Swelling and drug release behavior of tablets coated with aqueous hydroxypropyl methylcellulose phthalate (HPMCP) nanoparticlesJournal of Controlled Release892April), 225233'},{id:"B33",body:'KothariS. H.KumarV.BankerG. S.2002Comparative evaluations of powder and mechanical properties of low crystallinity celluloses, microcrystalline celluloses, and powdered celluloses.International Journal of Pharmaceutics2321-2January), 6980\n\t\t\t'},{id:"B34",body:'KumaravelrajanR.NarayananN.SubaV.BhaskarK.2010Simultaneous delivery of Nifedipine and Metoprolol tartarate using sandwiched osmoticpump tablet system. International Journal of Pharmaceutics, 3991-2October), 6070'},{id:"B35",body:'LarssonM.HjärtstamJ.BerndtssonJ.StadingM.LarssonA.2010Effect of ethanol on the water permeability of controlled release films composed of ethyl cellulose and hydroxypropyl celluloseEuropean Journal of Pharmaceutics and Biopharmaceutics763November), 428432'},{id:"B36",body:'LecomteF.SiepmannJ.WaltherM.MacRae, R.J.; Bodmeier, R. (2003Blends of enteric and GIT-insoluble polymers used for film coating: physicochemical characterization and drug release patternsJournal of Controlled Release893May), 457471'},{id:"B37",body:'LehrClaus-Michael. (2000Lectin-mediated drug delivery: The second generation of bioadhesives Journal of Controlled Release. 65, 1929'},{id:"B38",body:'LiuF.MerchantH. A.KulkarniR. P.AlkademiM.BasitA. W.2011Evolution of a physiological pH 6.8 bicarbonate buffer system: Application to the dissolution testing of enteric coated productsEuropean Journal of Pharmaceutics and Biopharmaceutics781May), 151157'},{id:"B39",body:'LiuJ.WilliamsR. O.2002Long-term stability of heat-humidity cured cellulose acetate phthalate coatedbeads. European Journal of Pharmaceut cs and Biopharmaceutics,\n\t\t\t\t\t532March), 167173'},{id:"B40",body:'LiuL.KhangG.RheeJ. M.LeeH. B.2000aMonolithic osmotic tablet system for nifedipine delivery.Journal of Controlled Release, 672-3July), 309322'},{id:"B41",body:'LiuL.KuJ.KhangG.LeeB.RheeJ. M.LeeH. B.2000bNifedipine controlled delivery by sandwiched osmotic tabletsystem. Journal of Controlled Release, 682August), 145156'},{id:"B42",body:'LudwigAnnick.; (2005The use of mucoadhesive polymers in ocular drug deliveryAdvanced Drug Delivery Reviews5715951639'},{id:"B43",body:'MakhijaS. N.VaviaP. R.2003Controlled porosity osmotic pump-based controlled release systems ofpseudoephedrine: I. Cellulose acetate as a semipermeable membrane. Journal of Controlled Release, 891Apri), 518'},{id:"B44",body:'MarucciM.RagnarssonG.NilssonB.AxelssonA.2010Osmotic pumping release from ethyl-hydroxypropyl- cellulose-coated pellets: A new mechanistic model. Journal of Controlled Release, 1421February), 5360'},{id:"B45",body:'MesihaM.SidhomM.1995Increased oral absorption enhancement of insulin by medium viscosity hydroxypropyl celluloseInternational Journal of Pharmaceutics1142February), 137140'},{id:"B46",body:'MovassaghianS.Barzegar-jalaliM.AlaeddiniM.HamedyazdanS.AfzalifarR.Zakeri-milaniP.MohammadiG.AdibkiaK.2011Development of amitriptyline buccoadhesive tablets in management of pain in dental procedures.Drug Development and Industrial Pharmacy377June), 112'},{id:"B47",body:'NerurkarJ.JunH. W.PriceJ. C.ParkM. O.2005Controlled-release matrix tablets of ibuprofen using cellulose ethers and carrageenans: effect of formulation factors on dissolution rates.European Journal of Pharmaceutics and Biopharmaceutics, 611-2September), 5668'},{id:"B48",body:'NokhodchiA.MominM. N.ShokriJ.ShahsavariM.RashidiP. A.2008Factors Affecting the Release of Nifedipine from a Swellable Elementary Osmotic PumpDrug Delivery,\n\t\t\t\t\t154348\n\t\t\t'},{id:"B49",body:'OkimotoK.OhikeA.IbukiR.AokiO.OhnishiN.RajewskiR. A.StellaV. J.IrieT.UekamaK.1999Factors affecting membrane-controlled drug release for an osmotic pump tablet (OPT) utilizing (SBE)7m-β-CD as both a solubilizer and osmotic agent. Journal of Controlled Release, 602-3August), 311319'},{id:"B50",body:'PerioliL.AmbrogiV.RubiniD.GiovagnoliS.RicciM.BlasiP.RossiC.2004Novel mucoadhesive buccal formulation containing metronidazole for the treatment of periodontal diseaseJournal of Controlled Release953March), 521533\n\t\t\t'},{id:"B51",body:'PrabakaranD.SinghP.KanaujiaP.JaganathanK. S.RawatA.VyasS. P.2004Modified push-pull osmotic system for simultaneous delivery of theophylline andsalbutamol: development and in vitro characterization. International Journal of Pharmaceutics,\n\t\t\t\t\t2841-2October), 95108\n\t\t\t'},{id:"B52",body:'PygallS. R.KujawinskiS.TimminsP.MeliaC. D.2009Mechanisms of drug release in citrate buffered HPMC matricesInternational Journal of Pharmaceutics3701-2March), 110120\n\t\t\t'},{id:"B53",body:'Reus MedinaM.L. & Kumar, 2006Evaluation of cellulose II powders as a potential multifunctional excipient in tablet formulationsInternational Journal of PharmaceuticsVolume 322, 3135'},{id:"B54",body:'RojasJ.KumarV.2011Comparative evaluation of silicified microcrystalline cellulose II as a direct compression vehicle.International Journal of Pharmaceutics4161September), 120128'},{id:"B55",body:'RoweR. C.1986The effect of the molecular weight of ethyl cellulose on the drug release properties ofmixed films of ethyl cellulose andhydroxypropylmethylcellulose. International Journal of Pharmaceutics, 291March), 3741'},{id:"B56",body:'RoyD. S.RoheraB. D.2002Comparative evaluation of rate of hydration and matrix erosion of HEC and HPC and study of drug release from their matricesEuropean Journal of Pharmaceutical Sciences163August 2002, 193199'},{id:"B57",body:'SašaB.OdonP.StaneS.JulijanaK.2006Analysis of surface properties of cellulose ethers and drug release from their matrix tabletsEuropean Journal of Pharmaceutical Sciences274March), 375383'},{id:"B58",body:'SensoyD.CevherH.SariciA.YilmazM.ÖzdamarA.BergisadiN.2009Bioadhesive sulfacetamide sodium microspheres: Evaluation of their effectiveness inthe treatment of bacterial keratitis caused by Staphylococcus aureus and Pseudomonasaeruginosa in a rabbit model. European Journal of Pharmaceutics and Biopharmaceutics, 723August), 487495\n\t\t\t'},{id:"B59",body:'ShokriJ.AhmadiP.RashidiP.ShahsavariM.Rajabi-siahboomiA.NokhodchiA.2008aSwellable elementary osmotic pump (SEOP): An effective device for delivery of poorly water-soluble drugs.European Journal of Pharmaceutics and Biopharmaceutics,\n\t\t\t\t\t68289297\n\t\t\t'},{id:"B60",body:'ShokriJ.AlizadehM.HassanzadehD.MotavalliF.2008bEvaluation of various parameters on release of indomethacin from two-layered core osmotic pump. Pharmaceutical Sciences (Tabriz Faculty of Pharmacy Journal),\n\t\t\t\t\t3winter), 1322'},{id:"B61",body:'ShokriM. H.AramiZ.ShokriJ.2011Evaluation of formulation related parameters on the release of gliclazide from controlled porosity osmotic pump systemPharmaceutical SciencesTabriz Faculty of Pharmacy Journal), 2011, 16249260'},{id:"B62",body:'StrydomS. J.OttoD. P.LiebenbergW.LvovY. M.VilliersM. M.2011Preparation and characterization of directly compactible layer-by-layer nanocoated cellulose.International Journal of Pharmaceutics4041-2February), 5765'},{id:"B63",body:'TasÇ.ÖzkanY.SavaserA.BaykaraT.2003In vitro release studies of chlorpheniramine maleate from gels prepared by different cellulose derivativesIl Farmaco588August), 605611'},{id:"B64",body:'Van VeenB.BolhuisG. K.WuY. S.ZuurmanK.FrijlinkH. W.2005Compaction mechanism and tablet strength of unlubricated and lubricated (silicified) microcrystalline celluloseEuropean Journal of Pharmaceutics and Biopharmaceutics591January), 133138'},{id:"B65",body:'VenkatesanN.YoshimitsuJ.OhashiY.ItoY.SugiokaN.ShibataN.TakadaK.2006Pharmacokinetic and pharmacodynamic studies following oral administration of erythropoietin mucoadhesive tablets to beagle dogsInternational Journal of Pharmaceutics3101-2March), 4652\n\t\t\t'},{id:"B66",body:'WanL. S. C.PrasadK. P. P.1988Effect of microcrystalline cellulose and cross-linked sodium carboxymethylcellulose on the properties of tablets with methylcellulose as a binderInternafronal Journal of Pharmaceutics,41159167'},{id:"B67",body:'WangC. Y.HoH-O.LinL-H.LinY-K.SheuM-T.2005Asymmetric membrane capsules for delivery of poorly water-soluble drugs byosmotic effects. International Journal of Pharmaceutics, 2971-2June), 8997\n\t\t\t'},{id:"B68",body:'Williams IIIR.O & Liu, J. (2000Influence of processing and curing conditions on beads coated with an aqueous dispersion of cellulose acetate phthalateEuropean Journal of Pharmaceutics and Biopharmaceutics49243252'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Javad Shokri",address:null,affiliation:'
'}],corrections:null},book:{id:"3173",title:"Cellulose",subtitle:"Medical, Pharmaceutical and Electronic Applications",fullTitle:"Cellulose - Medical, Pharmaceutical and Electronic Applications",slug:"cellulose-medical-pharmaceutical-and-electronic-applications",publishedDate:"August 29th 2013",bookSignature:"Theo van de Ven and Louis Godbout",coverURL:"https://cdn.intechopen.com/books/images_new/3173.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"130492",title:"Dr.",name:"Theo G.M.",middleName:null,surname:"Van De Ven",slug:"theo-g.m.-van-de-ven",fullName:"Theo G.M. Van De Ven"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"45637",title:"Cellulose Expression in Pseudomonas fluorescens SBW25 and Other Environmental Pseudomonads",slug:"cellulose-expression-in-pseudomonas-fluorescens-sbw25-and-other-environmental-pseudomonads",totalDownloads:2508,totalCrossrefCites:1,signatures:"Andrew J. Spiers, Yusuf Y. Deeni, Ayorinde O. Folorunso,\nAnna Koza, Olena Moshynets and Kamil Zawadzki",authors:[{id:"139367",title:"Dr.",name:"Andrew",middleName:null,surname:"Spiers",fullName:"Andrew Spiers",slug:"andrew-spiers"}]},{id:"45648",title:"Effect of Polymorphism on the Particle and Compaction Properties of Microcrystalline Cellulose",slug:"effect-of-polymorphism-on-the-particle-and-compaction-properties-of-microcrystalline-cellulose",totalDownloads:3004,totalCrossrefCites:2,signatures:"John Rojas",authors:[{id:"143552",title:"Dr",name:null,middleName:null,surname:"John Rojas",fullName:"John Rojas",slug:"john-rojas"}]},{id:"45635",title:"Application of Cellulose and Cellulose Derivatives in Pharmaceutical Industries",slug:"application-of-cellulose-and-cellulose-derivatives-in-pharmaceutical-industries",totalDownloads:8552,totalCrossrefCites:22,signatures:"Javad Shokri and Khosro Adibkia",authors:[{id:"140056",title:"Prof.",name:"Javad",middleName:null,surname:"Shokri",fullName:"Javad Shokri",slug:"javad-shokri"}]},{id:"45443",title:"Cellulose-Based Bioelectronic Devices",slug:"cellulose-based-bioelectronic-devices",totalDownloads:4236,totalCrossrefCites:5,signatures:"Ana Baptista, Isabel Ferreira and João Borges",authors:[{id:"141547",title:"Prof.",name:"João",middleName:null,surname:"Borges",fullName:"João Borges",slug:"joao-borges"},{id:"148218",title:"MSc.",name:"Ana",middleName:null,surname:"Baptista",fullName:"Ana Baptista",slug:"ana-baptista"},{id:"148219",title:"Prof.",name:"Isabel",middleName:null,surname:"Ferreira",fullName:"Isabel Ferreira",slug:"isabel-ferreira"}]},{id:"45634",title:"Cellulose - A Biomaterial with Cell-Guiding Property",slug:"cellulose-a-biomaterial-with-cell-guiding-property",totalDownloads:2368,totalCrossrefCites:2,signatures:"Miretta Tommila, Anne Jokilammi,\nRisto Penttinen and Erika Ekholm",authors:[{id:"140777",title:"Dr.",name:"Erika",middleName:null,surname:"Ekholm",fullName:"Erika Ekholm",slug:"erika-ekholm"},{id:"142768",title:"Dr.",name:"Anne",middleName:null,surname:"Jokilammi",fullName:"Anne Jokilammi",slug:"anne-jokilammi"},{id:"142769",title:"Prof.",name:"Risto",middleName:null,surname:"Penttinen",fullName:"Risto Penttinen",slug:"risto-penttinen"},{id:"142771",title:"Dr.",name:"Miretta",middleName:null,surname:"Tommila",fullName:"Miretta Tommila",slug:"miretta-tommila"}]},{id:"45641",title:"Magnetic Responsive Cellulose Nanocomposites and Their Applications",slug:"magnetic-responsive-cellulose-nanocomposites-and-their-applications",totalDownloads:3390,totalCrossrefCites:5,signatures:"Shilin Liu, Xiaogang Luo and Jinping Zhou",authors:[{id:"139847",title:"Prof.",name:"Shilin",middleName:null,surname:"Liu",fullName:"Shilin Liu",slug:"shilin-liu"}]},{id:"45640",title:"Probing the Interaction Between Cellulose and Cellulase with a Nanomechanical Sensor",slug:"probing-the-interaction-between-cellulose-and-cellulase-with-a-nanomechanical-sensor",totalDownloads:2190,totalCrossrefCites:5,signatures:"Jun Xi, Wenjian Du, and Linghao Zhong",authors:[{id:"139001",title:"Dr.",name:"Jun",middleName:null,surname:"Xi",fullName:"Jun Xi",slug:"jun-xi"},{id:"157430",title:"Mr.",name:"Wenjian",middleName:null,surname:"Du",fullName:"Wenjian Du",slug:"wenjian-du"},{id:"157431",title:"Prof.",name:"Linghao",middleName:null,surname:"Zhong",fullName:"Linghao Zhong",slug:"linghao-zhong"}]},{id:"45627",title:"Cellulose and Its Derivatives Use in the Pharmaceutical Compounding Practice",slug:"cellulose-and-its-derivatives-use-in-the-pharmaceutical-compounding-practice",totalDownloads:5299,totalCrossrefCites:1,signatures:"Flávia Dias Marques-Marinho and Cristina Duarte Vianna-Soares",authors:[{id:"149498",title:"Ph.D.",name:"Flávia",middleName:"Dias",surname:"Marques-Marinho",fullName:"Flávia Marques-Marinho",slug:"flavia-marques-marinho"},{id:"157311",title:"Prof.",name:"Cristina",middleName:null,surname:"Vianna-Soares",fullName:"Cristina Vianna-Soares",slug:"cristina-vianna-soares"}]},{id:"45633",title:"Plasma Induced Hydrophilic Cellulose Wound Dressing",slug:"plasma-induced-hydrophilic-cellulose-wound-dressing",totalDownloads:1961,totalCrossrefCites:1,signatures:"Zdenka Persin, Miran Mozetic, Alenka Vesel, Tina Maver,\nUros Maver and Karin Stana Kleinschek",authors:[{id:"20510",title:"Prof.",name:"Karin",middleName:null,surname:"Stana-Kleinschek",fullName:"Karin Stana-Kleinschek",slug:"karin-stana-kleinschek"}]},{id:"45626",title:"Bioactive Bead Type Cellulosic Adsorbent for Blood Purification",slug:"bioactive-bead-type-cellulosic-adsorbent-for-blood-purification",totalDownloads:2494,totalCrossrefCites:1,signatures:"Shenqi Wang and Yaoting Yu",authors:[{id:"142165",title:"Prof.",name:"Yaoting",middleName:null,surname:"Yu",fullName:"Yaoting Yu",slug:"yaoting-yu"},{id:"168640",title:"Prof.",name:"Shenqi",middleName:null,surname:"Wang",fullName:"Shenqi Wang",slug:"shenqi-wang"}]},{id:"45643",title:"The Development and Application of Cellulose-Based Stationary Phases in Stereoselective Separation of Chiral Pesticides",slug:"the-development-and-application-of-cellulose-based-stationary-phases-in-stereoselective-separation-o",totalDownloads:3749,totalCrossrefCites:0,signatures:"Jing Qiu, Shouhui Dai, Tingting Chai, Wenwen Yang,\nShuming Yang and Hualin Zhao",authors:[{id:"142801",title:"Dr.",name:"Jing",middleName:null,surname:"Qiu",fullName:"Jing Qiu",slug:"jing-qiu"}]},{id:"45631",title:"Cellulose Functionalysed with Grafted Oligopeptides",slug:"cellulose-functionalysed-with-grafted-oligopeptides",totalDownloads:2142,totalCrossrefCites:2,signatures:"Justyna Fraczyk, Beata Kolesinska,\nInga Relich and Zbigniew J. Kaminski",authors:[{id:"143304",title:"Prof.",name:"Zbigniew J.",middleName:null,surname:"Kaminski",fullName:"Zbigniew J. Kaminski",slug:"zbigniew-j.-kaminski"}]},{id:"45629",title:"Antiquarian Books as Source of Environment Historical Data",slug:"antiquarian-books-as-source-of-environment-historical-data",totalDownloads:1003,totalCrossrefCites:0,signatures:"Jürgen Schram, Rasmus Horst, Mario Schneider,\nMarion Tegelkamp, Hagen Thieme and Michael Witte",authors:[{id:"143028",title:"Prof.",name:"Jürgen",middleName:null,surname:"Schram",fullName:"Jürgen Schram",slug:"jurgen-schram"}]}]},relatedBooks:[{type:"book",id:"2326",title:"Cellulose",subtitle:"Fundamental Aspects",isOpenForSubmission:!1,hash:"de85a5810169999b1c069d863593e56a",slug:"cellulose-fundamental-aspects",bookSignature:"Theo van de Ven and Louis Godbout",coverURL:"https://cdn.intechopen.com/books/images_new/2326.jpg",editedByType:"Edited by",editors:[{id:"130492",title:"Dr.",name:"Theo G.M.",surname:"Van De Ven",slug:"theo-g.m.-van-de-ven",fullName:"Theo G.M. Van De Ven"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"45621",title:"Advanced-Microscopy Techniques for the Characterization of Cellulose Structure and Cellulose-Cellulase Interactions",slug:"advanced-microscopy-techniques-for-the-characterization-of-cellulose-structure-and-cellulose-cellula",signatures:"Jose M. Moran-Mirabal",authors:[{id:"138967",title:"Prof.",name:"Jose",middleName:null,surname:"Moran-Mirabal",fullName:"Jose Moran-Mirabal",slug:"jose-moran-mirabal"}]},{id:"45613",title:"Structural Characteristics and Thermal Properties of Native Cellulose",slug:"structural-characteristics-and-thermal-properties-of-native-cellulose",signatures:"Matheus Poletto, Vinícios Pistor and Ademir J. Zattera",authors:[{id:"140017",title:"Dr.",name:"Matheus",middleName:null,surname:"Poletto",fullName:"Matheus Poletto",slug:"matheus-poletto"},{id:"142401",title:"Mr.",name:"Vinícios",middleName:null,surname:"Pistor",fullName:"Vinícios Pistor",slug:"vinicios-pistor"},{id:"142402",title:"Prof.",name:"Ademir José",middleName:null,surname:"Zattera",fullName:"Ademir José Zattera",slug:"ademir-jose-zattera"}]},{id:"45616",title:"Supra-Molecular Structure and Chemical Reactivity of Cellulose I Studied Using CP/MAS 13C-NMR",slug:"supra-molecular-structure-and-chemical-reactivity-of-cellulose-i-studied-using-cp-mas-13c-nmr",signatures:"Viren Chunilall, Tamara Bush and Per Tomas Larsson",authors:[{id:"140101",title:"Dr.",name:"Viren",middleName:null,surname:"Chunilall",fullName:"Viren Chunilall",slug:"viren-chunilall"},{id:"141333",title:"Prof.",name:"Per Tomas",middleName:null,surname:"Larsson",fullName:"Per Tomas Larsson",slug:"per-tomas-larsson"},{id:"142631",title:"Dr.",name:"Tamara",middleName:null,surname:"Bush",fullName:"Tamara Bush",slug:"tamara-bush"}]},{id:"45622",title:"Cellulosic Fibers: Role of Matrix Polysaccharides in Structure and Function",slug:"cellulosic-fibers-role-of-matrix-polysaccharides-in-structure-and-function",signatures:"Polina Mikshina, Tatyana Chernova, Svetlana Chemikosova,\nNadezhda Ibragimova, Natalia Mokshina and Tatyana Gorshkova",authors:[{id:"140418",title:"Prof.",name:"Tatyana",middleName:null,surname:"Gorshkova",fullName:"Tatyana Gorshkova",slug:"tatyana-gorshkova"},{id:"158371",title:"Dr.",name:"Polina",middleName:null,surname:"Mikshina",fullName:"Polina Mikshina",slug:"polina-mikshina"},{id:"158372",title:"Dr.",name:"Tatyana",middleName:null,surname:"Chernova",fullName:"Tatyana Chernova",slug:"tatyana-chernova"},{id:"158374",title:"Dr.",name:"Svetlana",middleName:null,surname:"Chemikosova",fullName:"Svetlana Chemikosova",slug:"svetlana-chemikosova"},{id:"158375",title:"Dr.",name:"Nadezhda",middleName:null,surname:"Ibragimova",fullName:"Nadezhda Ibragimova",slug:"nadezhda-ibragimova"},{id:"158376",title:"Dr.",name:"Natalia",middleName:null,surname:"Mokshina",fullName:"Natalia Mokshina",slug:"natalia-mokshina"}]},{id:"45624",title:"Cellulose Microfibril Angle in Wood and Its Dynamic Mechanical Significance",slug:"cellulose-microfibril-angle-in-wood-and-its-dynamic-mechanical-significance",signatures:"Tamer A. Tabet and Fauziah Abdul Aziz",authors:[{id:"139204",title:"Dr.",name:"Tamer",middleName:null,surname:"Tabet",fullName:"Tamer Tabet",slug:"tamer-tabet"}]},{id:"45614",title:"Direct Dissolution of Cellulose: Background, Means and Applications",slug:"direct-dissolution-of-cellulose-background-means-and-applications",signatures:"Carina Olsson and Gunnar Westman",authors:[{id:"142372",title:"Prof.",name:"Gunnar",middleName:null,surname:"Westman",fullName:"Gunnar Westman",slug:"gunnar-westman"},{id:"142946",title:"MSc.",name:"Carina",middleName:null,surname:"Olsson",fullName:"Carina Olsson",slug:"carina-olsson"}]},{id:"45620",title:"Rapid Dissolution of Cellulose in Ionic Liquid with Different Methods",slug:"rapid-dissolution-of-cellulose-in-ionic-liquid-with-different-methods",signatures:"Wu Lan, Chuan-Fu Liu, Feng-Xia Yue and Run-Cang Sun",authors:[{id:"149715",title:"Dr.",name:"Chuan-Fu",middleName:null,surname:"Liu",fullName:"Chuan-Fu Liu",slug:"chuan-fu-liu"}]},{id:"45490",title:"Electric Properties of Carboxymethyl Cellulose",slug:"electric-properties-of-carboxymethyl-cellulose",signatures:"Alexandar Metodiev Zhivkov",authors:[{id:"149661",title:"Prof.",name:"Alexandar",middleName:"Metodiev",surname:"Zhivkov",fullName:"Alexandar Zhivkov",slug:"alexandar-zhivkov"}]},{id:"45618",title:"Implications of Cellulose in Modeling the Behavior of Vegetal Additive Materials in Clay Based Ceramics: Technical and Archaeological Issues",slug:"implications-of-cellulose-in-modeling-the-behavior-of-vegetal-additive-materials-in-clay-based-ceram",signatures:"Ferenc Kristály",authors:[{id:"140571",title:"Ph.D.",name:"Ferenc",middleName:null,surname:"Kristály",fullName:"Ferenc Kristály",slug:"ferenc-kristaly"}]},{id:"45623",title:"Removal of Excess Cellulose and Associated Polysaccharides in Fruit and Vegetable By-Products – Implication for Use in Feed for Monogastric Farm Animals",slug:"removal-of-excess-cellulose-and-associated-polysaccharides-in-fruit-and-vegetable-by-products-implic",signatures:"Annie King",authors:[{id:"141955",title:"Prof.",name:"Annie",middleName:null,surname:"King",fullName:"Annie King",slug:"annie-king"}]},{id:"45615",title:"Cellulose Langmuir-Blodgett Films for Moisture and Gaseous Molecular Sensing System",slug:"cellulose-langmuir-blodgett-films-for-moisture-and-gaseous-molecular-sensing-system",signatures:"Hiroyuki Kusano, Shin-ichi Kimura and Masahiko Kitagawa",authors:[{id:"139934",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kusano",fullName:"Hiroyuki Kusano",slug:"hiroyuki-kusano"}]},{id:"45617",title:"Analysis of Relaxation Behavior of Free Radicals in Irradiated Cellulose Using Pulse and Continuous-Wave Electron Spin Resonance",slug:"analysis-of-relaxation-behavior-of-free-radicals-in-irradiated-cellulose-using-pulse-and-continuous-",signatures:"Hiromi Kameya and Mitsuko Ukai",authors:[{id:"140701",title:"Dr.",name:"Hiromi",middleName:null,surname:"Kameya",fullName:"Hiromi Kameya",slug:"hiromi-kameya"}]},{id:"45619",title:"Structure - Properties Interrelationships in Multicomponent Solutions Based on Cellulose and Fibers Spun Therefrom",slug:"structure-properties-interrelationships-in-multicomponent-solutions-based-on-cellulose-and-fibers-sp",signatures:"Ludmila Golova, Igor Makarov, Ludmila Kuznetsova,\nElena Plotnikova and Valery Kulichikhin",authors:[{id:"20377",title:"Prof.",name:"Valery",middleName:null,surname:"Kulichikhin",fullName:"Valery Kulichikhin",slug:"valery-kulichikhin"},{id:"140772",title:"Dr.",name:"Ludmila",middleName:null,surname:"Golova",fullName:"Ludmila Golova",slug:"ludmila-golova"},{id:"143123",title:"Mrs.",name:"Ludmila",middleName:null,surname:"Kuznetsova",fullName:"Ludmila Kuznetsova",slug:"ludmila-kuznetsova"},{id:"143127",title:"Ms.",name:"Elena",middleName:null,surname:"Plotnikova",fullName:"Elena Plotnikova",slug:"elena-plotnikova"},{id:"143128",title:"Mr.",name:"Igor",middleName:null,surname:"Makarov",fullName:"Igor Makarov",slug:"igor-makarov"}]},{id:"45625",title:"Cellulose Nanofibers and Its Applications for Resin Reinforcements",slug:"cellulose-nanofibers-and-its-applications-for-resin-reinforcements",signatures:"Mariko Yoshioka, Yoshiyuki Nishio, Satoru Nakamura,\nYoshiyuki Kushizaki, Ryo Ishiguro, Toshiki Kabutomori,\nTakeo Imanishi and Nobuo Shiraishi",authors:[{id:"139952",title:"Dr.",name:"Mariko",middleName:null,surname:"Yoshioka",fullName:"Mariko Yoshioka",slug:"mariko-yoshioka"}]}]}]},onlineFirst:{chapter:{type:"chapter",id:"62277",title:"Basic Antenatal Care Approach to Antenatal Care Service Provision",doi:"10.5772/intechopen.79361",slug:"basic-antenatal-care-approach-to-antenatal-care-service-provision",body:'
1. Introduction
Antenatal care (ANC) is an umbrella term used to describe medical care and procedures that are carried out to and for the pregnant women [1]. It is the health care that is rendered to the pregnant women throughout pregnancy until the child’s birth and is aimed at detecting the already existing problems and/or problems that can develop during pregnancy, affecting the pregnant woman and/or her unborn child [2]. The care includes various screening tests, diagnostic procedures, prophylactic treatments, some of which are done routinely, and others are provided to the women based on identified problems and risk factors.
2. Importance of antenatal care
According to Pattinson [2], ANC benefits both the mother and the baby; it assists in screening, diagnosing and managing or controlling the risk factors that might adversely affect the pregnant women and/or the pregnancy outcome. Maternal and perinatal death rates remain the major challenge of health care in South Africa. During 2005–2007, triennium maternal deaths had increased by 20% when comparing them to the 2002–2004 triennium [3]. However, due to changes in the treatment programmes for HIV-positive pregnant women and the focus on reducing deaths in specific categories such as obstetric haemorrhage, a significant fall in both the numbers of maternal deaths and mortality ratios has since been reported in South Africa. An overall reduction of 24% (1152 from 2008–2010 to 2014–2016) has been achieved [4]. Nevertheless, much more still needs to be done for the country to be able to maintain this fall and to obtain an exponential fall. Several major challenges still remain mainly relating to the quality of care, inter-facility transport, and knowledge and skills of health professionals [4]. Furthermore, the majority of preventable deaths during pregnancy and childbirth have been attributed to poor ANC [5]. According to these authors, non-attendance of ANC clinics carries an approximately four times increased risk of maternal deaths compared with the general pregnant population who attend ANC clinics. The provision of adequate ANC is advocated by most authors worldwide as the cornerstone for maternal and perinatal care. The detection of high-risk pregnancies through ANC has been advocated as a good tool for reducing maternal and perinatal mortality rates [6].
The purpose of ANC is to screen, diagnose and manage or control the risk factors that might adversely affect the pregnant woman and/or the pregnancy outcome. Both Pattinson and Snyman [2, 7] attest to this by saying: ‘The quality of health care that a pregnant woman receives during ANC has an impact on the health of the woman and on the outcome of pregnancy’. Ekabua et al. [1] highlight the four major goals of ANC as being (a) promotion and maintenance of the physical and social health of the mother and the baby, (b) detection and management of complications during pregnancy, (c) development of birth preparedness and complication readiness plan and (d) preparation of the women for normal puerperium. The World Health Organisation (WHO) identifies ANC as one of the most widely used strategies to improve maternal and child health [8]. It was also one of the worldwide strategies towards the achievement of millennium development goal (MDGs numbers 4 and 5, which were to reduce child deaths by 75% and improve maternal health by 50% by 2015 [9].
Three South African reports, namely the Saving Mothers report by the National Committee on Confidential Enquiry into Causes of Maternal Deaths (NCCEMD), Saving Babies report for the Perinatal Problem Identification Programme (PPIP) and Saving Children report for the Child Health Problem Identification Programme (CHPIP), review the health care provided to the mothers, babies and children in South Africa [10]. The findings of these reports highlight avoidable causes of the deaths of mothers, babies and children and make recommendations to improve the quality of care provided to mothers, babies and children at the time when they need it most. All three committees highlight, in their triennial reports, the importance of ANC for reducing maternal, perinatal and children’s deaths. Bradshaw et al. [10] further emphasise that addressing the health challenges should involve strengthening the provision of healthcare packages within the continuum of care and recognise that the effectiveness of each package depends on whether it provides high-impact, evidence-based interventions and also on the coverage and quality of the service rendered. ANC can screen for, detect and thus prevent many maternal complications that might occur before childbirth and could significantly improve the outcomes for unborn infants [2].
The one document by the NCCEMD, which might appear old but which conveys a very important message for South Africa, is the Saving Mothers Policy and Management Guidelines for Common Causes of Maternal Deaths [11]. This policy document highlights that one of the major areas of substandard care identified in South Africa is the poor initial assessment of patients during ANC visits. The authors attribute this to the fact that the midwives are trained in the traditional method of history taking, clinical examination and special investigations when assessing patients. This might make it difficult to assimilate the multiple abnormalities found and to formulate a management plan for a patient with multiple organ disease, the very type of cases described in the maternity mortality reports [12].
South Africa has a burden of high maternal and perinatal mortality rates and therefore needs to work very hard to address this problem. The number of reported maternal mortalities had increased by 20% during the 2005–2007 triennium compared to the 2002–2004 trienniums [3]. The constant rise in maternal and perinatal mortality rates resulted in South Africa’s inclusion of the MNCWH programme as one of the priority programmes in the 10-year strategic plan for the country [12]. The majority of the provider-related preventable deaths in South Africa have been attributed to poor ANC.
South Africa can address the problem of the constantly rising maternal and perinatal mortality rates because the majority of avoidable provider-related maternal deaths can be avoided through providing proper and good-quality ANC services [13]. The Saving Mothers Report 2008–2010 indicates that a total of (16.6%, n = 713) of women who died during this triennium did not attend ANC clinics and (7.0%, n = 300) attended ANC clinics infrequently [14]. The Saving Mothers’ Report indicates that the avoidable causes of maternal deaths included a number of health provider-related issues such as poor initial assessments, problems with recognising problems, delays in referring the pregnant women to different healthcare facilities causing pregnant women to be managed at inappropriate healthcare levels, incorrect management, substandard management/care and failure to take actions when abnormalities were found [14].
3. Approaches to antenatal care
Several approaches to ANC are used in different countries including the traditional approach, goal-directed ANC, focussed ANC (FANC) and the basic ANC (BANC) approach. While some countries structure and develop their own approaches to suit their unique circumstances, other countries might simply adopt an approach existing elsewhere. This could create problems if the situations in the two countries differ. Developing countries (like South Africa, Botswana, Swaziland, Kenya and Zimbabwe) adopted ANC programmes modelled on the approaches used in developed countries [15]. These approaches use risk assessments to identify women who are likely to experience complications during their pregnancies and assume that more clinic visits imply better pregnancy outcomes. In these approaches, scarce resources of developing countries might be devoted to women with high-risk pregnancies, implying that women with low-risk pregnancies might not receive optimal care [16]. This approach has been challenged by the WHO [17]. The Maternal and Neonatal Programme [18] argues that frequent ANC visits are often logically and financially impossible for women to manage and place additional burdens on the healthcare system. Frequent ANC visits do not necessarily improve pregnancy outcomes [1]. The WHO realised that traditional ANC programmes, meant for developed countries, were poorly implemented and largely ineffective when used in developing countries [16].
The WHO designed and tested an FANC package that included only counselling, examinations and tests serving an immediate purpose and having a proven health benefit as an ideal approach to be used by developing countries [19]. In the FANC approach, the WHO recommends reducing the number of ANC visits to four, and this has not been found to pose risks to the health of mothers or babies [19]. The FANC approach recognises that every pregnant woman is at risk of experiencing complications and therefore emphasises that all pregnant women should receive the same basic care and monitoring for complications [18]. However, the WHO emphasises that once a pregnant woman has been identified to have high-risk factors, she should be referred to a higher level of care [18]. The WHO therefore advocates that after the initial assessment, pregnant women should be categorised into two groups: those who have low-risk factors who should follow the FANC reduced number of ANC visits approach and those who have high-risk factors who should be referred for hospital management of their pregnancies [19]. The Maternal, Child and Women’s Health Unit of the KwaZulu-Natal (KZN) Department of Health reviewed and revised its ANC guidelines on the basis of the WHO’s model of FANC to improve the quality of ANC provided at the clinics in the KZN province [20].
According to the MNH Programme [18], the FANC approach is one of several essential maternal and neonatal care interventions that are evidence-based and that build on global lessons learned about saving the lives of mothers and newborn babies. The FANC approach also includes a classifying form designed to assist ANC health-care providers to identify women who have conditions requiring treatment and more frequent monitoring. It also includes classifying forms needed to implement the package and instructions for its use [19].
The WHO provided key recommendations which form standards for maternal and neonatal care service delivery, providing guidance for assisting countries to improve the health and survival of women and newborn babies during pregnancy, childbirth and the postnatal period and can be modified to suit the circumstances of a specific country [21]. These WHO provisions allow each country, intending to adopt the FANC approach, to modify the guidelines to suit the circumstances of the specific country. The WHO indicates that it might be necessary, when introducing the FANC package in practice (depending on the specific country), that the country’s national clinical standards and guidelines for ANC might require updating, the pre-service training curricula in ANC and in-service training for ANC providers and their supervisors might need to be modified, and a plan for implementing changes with regard to medications, equipment and supplies to implement the package should be assessed [21].
4. Approaches to antenatal care services in South Africa
Until 2007, South Africa used the traditional approach to ANC. Historically, this traditional ANC service model was developed in the early 1900s. This model assumed that frequent ANC visit, and classifying pregnant women into low- and high-risk groups by predicting potential obstetric complications, was the best way to care for the mother and the foetus [22]. The use of the traditional ANC approach in South Africa was prescribed by the South African Nursing Council (SANC) in the scope of practice for midwives [23]. The SANC prescribed that the midwives should ensure that pregnant women attend ANC clinics once a month until 28 weeks’ gestation and thereafter every fortnight until 36 weeks’ gestation. Thereafter, a pregnant woman should continue attending the clinic at PHC level every week until her baby is born or until she reached 42 weeks’ gestation whichever comes first. Should the woman not give birth by 42 weeks’ gestation, she had to be referred for hospital management [23]. With the traditional approach, a pregnant woman could have up to 12 ANC visits conducted at a PHC clinic level during one pregnancy. This is one of the aspects that have been challenged by the WHO [24].
The traditional ANC approach was replaced by the FANC approach which is a goal-oriented ANC approach that was recommended by researchers during 2001 and adopted by the WHO in 2002 [21]. The NDoH identified BANC as the ideal approach to ensure that quality and effective ANC is provided [25]. According to the Saving Babies Report 2008–2009, improvement in access to good-quality ANC services could make a major contribution towards reducing perinatal and child deaths [26].
South Africa adopted and modified the FANC model to suit the South African circumstances and referred to it as the BANC approach [27, 28]. This followed the realisation by the NDoH that the traditional ANC approach was not working well for South Africa. Midwives, the key providers of ANC services, requested for a programme based on the principles used in the Integrated Management of Childhood Illnesses (IMCI) programme with flow diagrams and protocols [2]. In 2007, the NDoH advised that all health facilities providing ANC services had to adopt the BANC approach by the end of 2008 [29]. The BANC approach is used in the public health institutions of South Africa to provide healthcare services to pregnant women and is listed as one of the priority interventions for reducing maternal and child mortality in this country [25]. South Africa’s NDoH introduced the BANC approach in 2007 and advised that all health facilities providing antenatal care (ANC) services should have adopted this approach by the end of 2008 [29]. The NDoH provided training for the lead trainers from all the provinces and made available various documents such as a handbook, guidelines and guides for facility managers [2, 28, 29]. The lead trainers were expected to cascade the training into their respective provinces and to institute and facilitate the implementation of the BANC approach.
5. The basic antenatal care (BANC) approach
Pattinson [28] describes the BANC approach as the minimum level of ANC that every pregnant woman should receive. Every aspect of the BANC approach has been developed from the best research evidence, and the only aspects of ANC that have been shown to be effective are included in the BANC approach [28]. The BANC approach does not intend to replace any existing programme but aims to combine all resources and to facilitate their use [28]. The BANC approach was introduced as a quality improvement strategy based on the belief that good-quality ANC could reduce maternal and perinatal mortalities and improve maternal health, aiming to achieve MDGs 4 and 5 [30]. This then led to the introduction of the BANC approach in the PHC clinics. Thus, the BANC was an approach being used in South Africa to render ANC services during the time of this study.
The BANC approach has been simplified to the bare minimum so that ANC services can be provided by every PHC clinic’s midwives [28]. Because the BANC approach is a modified version of the FANC approach, it has many characteristics similar to the FANC approach. These include the approach focusing on early ANC attendance by all pregnant women and on limiting the total number of ANC visits to a minimum of four or five visits per pregnancy for low-risk women. This requires that ANC services should be provided daily at every facility frequented by pregnant women so that the first ANC visit takes place as soon as the pregnancy has been confirmed or the very first time that a pregnant woman visits a health facility [28]. If a pregnant woman is brought into the health system early, her health problems could be detected and managed or controlled early and treatment then has a greater chance of success. Pattinson [28] also states that all pregnant women with high-risk factors should be referred to the next level of care so that nurses at PHC level have sufficient time to attend to women with low-risk factors. Every site where pregnant women make contact with health services should be utilised because if all PHC clinics are providing BANC, then ANC could be started as soon as the pregnancy had been confirmed [2].
The BANC approach requires that two sets of checklists be used for recording purposes during ANC visits: one checklist to record the first visit and the other to use during subsequent follow-up visits. Pattinson [28] recommends that before commencing implementation of the BANC approach, each facility has to develop its own specific protocols for the management of obstetric conditions which must be in line with the South African National Maternity Care Guidelines and should be displayed in the facility. All the protocols should be counter-signed by the head of the obstetric unit from the hospital to which the facility refers the women with high-risk factors or complications during pregnancy. The protocols should be reviewed annually. Regular auditing of the ANC service should be an on-going process to ensure continuous improvement based on identifying and addressing potential shortcomings [2].
The BANC approach focuses on the quality rather than on the quantity of visits, with special emphasis on the fact that every visit should be goal directed [31]. The approach is included in the list of strategies provided by the NDoH to achieve MDGs 4 and 5 which are to reduce perinatal deaths and improve maternal health by 2015 [32]. A baseline audit of the ANC service and an analysis of the strengths, weaknesses, opportunities and threats (SWOT) of the facility should be conducted before commencing the implementation of the BANC approach. This enables the midwives to compile a realistic plan and process map for the implementation of the BANC approach [2]. Documents such as the handbook, guidelines and facility manager’s guides are available to be used by the midwives during the implementation of the BANC approach [2]. According to the BANC handbook, each clinic should have one or more supervisors to perform the clinical supervision and the administrative tasks [2]. The manager is responsible for providing supportive supervision to the staff members in order to ensure that the clinic’s programmes are implemented successfully [2].
6. Provision of antenatal care services according to the basic antenatal care approach
While the BANC approach is adapted from the WHO’s FANC model, it is also designed similar to the IMCI programme [2]. This decision was taken in response to the midwives’ request for an ANC programme that has flow diagrams and protocols similar to the IMCI programme. The midwives hoped that having such a programme would assist them to render safer and better quality health care to the pregnant women [2]. It is for this reason that the BANC approach is sometimes referred to as the integrated management of pregnancy and childbirth [2, 33].
The NDoH also identified BANC as an ideal approach to ensure that quality and effective ANC is provided [25]. The implementation of BANC is seen as a positive measure to improve the quality of ANC in PHC clinics [7]. Effective and quality ANC could assist South Africa to address the problem of constantly increasing maternal and perinatal mortalities. Snyman [6] stated that the BANC quality improvement package is designed to assist ANC-related clinical management and decision-making at PHC level. This author conducted a qualitative study to assess the effectiveness of the BANC package for improving the quality of ANC services rendered at PHC facilities. With the implementation of the BANC approach, the organisational changes required at the facility level for the improvement of ANC services are facilitated with tools like the integrated flow charts for pregnant women’s management, referral protocols and checklists. This could potentially have a positive impact on the outcomes of pregnancies [7].
Guidelines on how to conduct ANC visits are detailed in the Basic Antenatal Care Principles of Good Care and Guidelines [28]. These guidelines have been adapted from a guide for essential practice by the WHO titled ‘Pregnancy, Childbirth, Postpartum and Newborn Care’ [28]. According to the BANC Principles of Good Care and Guidelines, the principles of good care include communication, workplace and administrative procedures, universal precautions, and cleanliness and organisation of ANC visits [28].
It is stated in the guidelines that communication, privacy and confidentiality during examination and counselling should be ensured at each ANC visit [28]. The importance of service hours, the availability of equipment and drugs, record keeping, and infection prevention and control are highlighted as part of the workplace and administrative procedures [28]. The guidelines describe how the ANC visits should be organised, highlighting that ANC should always begin with rapid assessment and management. All pregnant women, except those with high-risk factors, should have four to five routine ANC visits.
A pregnancy status and birth plan chart, which should be used to assess the pregnant women at each of the four ANC visits, are provided [28]. The chart is used during the first ANC visit to prepare the birth and emergency plan and reviewed and modified according to the need at each subsequent ANC visit. ‘Ask, check, look listen and feel’ criteria should always be followed during assessments of pregnant women. All pregnant women should be screened for preeclampsia, anaemia, foetal growth and post-maturity at all ANC visits [28]. All women should also be screened for syphilis, Human Immunodeficiency Virus (HIV) and Rhesus factor (RH) [28]. All routine investigations, including the rapid plasma reagent (RPR) test, haemoglobin (Hb) level test, HIV and RH tests should be done using rapid test kits. The guidelines highlight the importance of responding to observed signs and/or problems reported by the pregnant women and contain a guide on how to respond to these signs [28].
Standard preventative therapy, including tetanus toxoid injections, iron preparations and calcium supplements, should be issued to all pregnant women at each ANC [28]. A guide is included on how to advise women about nutrition and self-care [28]. The guidelines highlight the importance of preparing individualised ANC and delivery plans for each woman at the first ANC visit and that the plans should be reviewed during each subsequent visit and adjusted based on the identified needs. The plan should be prepared in consultation with the woman concerned. This ensures that the woman is involved in her own care. The plans should also include transport arrangements, infant feeding options and future contraception. A description of how the first and the follow-up visits should be conducted is provided [28].
The guidelines state that the first ANC visit should take place as early in pregnancy as possible, before 12 weeks’ gestation, preferably at the confirmation of pregnancy [28]. During the first ANC visit, all women should be classified for BANC using the classifying form/first visit checklist provided. Only women with low-risk factors should follow the BANC approach. All women with risk factors should either be referred to an appropriate level of care or follow a specially prepared schedule based on the risk factors identified. Four follow-up visits should be scheduled at 20, 26, 32 and 38 weeks’ gestation. Specific times are scheduled for performing repeat routine tests such as Hb, HIV and RPR, and these times coincide with specific routine follow-up visits. It is therefore important to schedule the follow-up visits as specified by the BANC guidelines in order to ensure the correct timing of repeat tests.
Pattinson [2] suggests that each PHC clinic should have one or more people in the role of ANC supervisor to ensure clinical and administrative supervision. The clinical supervisor should be the person with most ANC skills and should check each pregnant woman’s ANC card at the first visit and again at the 32 weeks’ visit to ensure that the clinic provides adequate care [2].
All information regarding pregnancy and consultation should be recorded in an ANC card which should not be filed at the clinic but which should be kept by the pregnant woman. The woman is advised to always carry the ANC card with her, wherever she goes, and to produce the card each time she visits any health-care institution. This practice facilitates communication between the different health-care providers involved in the care of women during pregnancy and childbirth [2].
7. Discussion
Several factors have been identified to be positively influencing the implementation of the BANC approach. These include the availability and accessibility of BANC services, policies, guidelines and protocol; various means of communication; a comprehensive package of and the integration of primary healthcare services; training and in-service education; human and material resources; the support and supervision offered to the midwives by the primary health-care supervisors; supervisors’ understanding of the approach and the levels of experience of midwives involved in the implementation of the BANC approach [34] Nevertheless, evidence still shows that not all PHC clinics have been able to successfully implement and sustain the BANC approach [35]. Ngxongo [35] discovered that out of 59 Municipal PHC clinics in eThekwini District in KwaZulu-Natal, 46% (n = 27) were successfully implementing the BANC approach. Midwives face various challenges during the implementation of the BANC approach which has resulted in some PHC clinics abandoning the BANC approach and reverting to the traditional approach to ANC [35]. These challenges include shortage of staff, lack of cooperation from referral hospitals, lack of in-service training, problems with transportation of specimens to laboratories, lack of material resources, unavailability of Basic Antenatal Care programme guidelines and lack of management support [35].
Although the BANC approach emphasises quality over quantity of visits [36], reducing the number of ANC visits has posed numerous challenges in the pregnancy outcomes. According to Hofmeyr and Mentrop [37], too few visits and the long interval between routine ANC visits in late pregnancy in the BANC approach have been responsible for a number of maternal and perinatal deaths. Hofmeyr and Mentrop [37] argue that the more frequent and closely spaced ANC visits as pregnancy advances in the traditional approach assisted in early diagnosis and management of selected ANC problems such as preeclampsia, foetal growth impairment and others and that too few visits result in missed opportunities to detect and treat asymptomatic pregnancy complications. These authors recommend modification of the BANC approach into what they call ‘BANC plus’. Their proposal is that a reasonable compromise for a middle-income country such as South Africa would be to continue to implement the WHO BANC approach with reduced, goal-orientated visits up to 32 weeks’ gestation and thereafter to revert to routine visits every 2–36 or 38 weeks, followed by weekly checks.
The international evidence supports a more regular contact between healthcare workers and pregnant women. Therefore, South Africa is gradually switching to an eight-contact model (three more visits than the current five contact Basic Antenatal Care (BANC) policy) [38]. It is envisaged that this intervention will improve the pregnancy experience as well as the outcomes of pregnant women and their babies in South Africa. The BANC + continues to emphasise the importance of conducting the first visit as early as possible, with the next visit scheduled at 20 weeks and then repeat visits at 26 weeks. The adjustments include the 30 weeks and 34 weeks and then a 2-week visit until delivery. An audit of the current BANC system has shown that two important principles of good care were often missing: a plan for further antenatal care and the delivery plan (including delivery at the appropriate level of care or hospital). Therefore, appropriate planning for the pregnancy as well as for the delivery, based on information obtained and correctly interpreted at every visit, will ensure that women and their families are ready and prepared when the big day arrives. The purpose of BANC+ is not just to increase the number of visits but also an opportunity to look again at how that care is given [38].
8. Conclusion
The introduction of the BANC approach has been a positive milestone for South Africa. Studies show that many African countries such as Ghana, Kenya, Tanzania and others have seen positive results with the implementation of the WHO FANC model [1, 8, 17]. Although South Africa is still experiencing numerous challenges with the BANC approach, there is hope that this country will also achieve positive results as the country continues to adjust and improve the BANC approach to suit its circumstances.
Acknowledgments
The author would like to acknowledge the following: Prof. NS Sibiya and Prof. NS Gwele; Durban University of Technology; SANTRUST, Fundisa and NRF.
Conflict of interest
The author declares that she has no financial or personal relationship which may have inappropriately influenced her in writing this chapter.
\n',keywords:"antenatal care, approach to health care, basic antenatal care, pregnancy, pregnancy outcome, South Africa",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/62277.pdf",chapterXML:"https://mts.intechopen.com/source/xml/62277.xml",downloadPdfUrl:"/chapter/pdf-download/62277",previewPdfUrl:"/chapter/pdf-preview/62277",totalDownloads:1042,totalViews:1666,totalCrossrefCites:0,dateSubmitted:"February 1st 2018",dateReviewed:"June 7th 2018",datePrePublished:"November 5th 2018",datePublished:"February 8th 2019",readingETA:"0",abstract:"Globally, antenatal care is advocated as the cornerstone for reducing children’s deaths and improving maternal health. The basic antenatal care approach is used in the public health institutions in South Africa to provide healthcare services to the pregnant women. The basic antenatal care approach is a modified version of the focused antenatal care approach that was recommended by researchers during 2001 and adopted by the World Health Organisation in 2002 following realisation that traditional antenatal care programmes that were meant for developed countries were poorly implemented and largely ineffective when used in developing countries. The basic antenatal care approach is listed as one of the priority interventions for reducing maternal and child mortality in the country and is recommended as the minimum level of antenatal care that every pregnant woman should receive. Every site where pregnant women make contact with healthcare services should provide antenatal care services daily using this approach so that the first antenatal care visit consultation takes place as soon as the pregnancy has been confirmed or the very first time that a pregnant woman visits a health facility. The introductions of the basic antenatal care approach have been a positive milestone for South Africa.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/62277",risUrl:"/chapter/ris/62277",signatures:"Thembelihle Sylvia Patience Ngxongo",book:{id:"7259",title:"Selected Topics in Midwifery Care",subtitle:null,fullTitle:"Selected Topics in Midwifery Care",slug:"selected-topics-in-midwifery-care",publishedDate:"February 8th 2019",bookSignature:"Ana Polona Mivšek",coverURL:"https://cdn.intechopen.com/books/images_new/7259.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"85109",title:"Dr.",name:"Ana Polona",middleName:null,surname:"Mivšek",slug:"ana-polona-mivsek",fullName:"Ana Polona Mivšek"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"243711",title:"Dr.",name:"Thembelihle Sylvia Patience",middleName:null,surname:"Ngxongo",fullName:"Thembelihle Sylvia Patience Ngxongo",slug:"thembelihle-sylvia-patience-ngxongo",email:"thembelihlen@dut.ac.za",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Importance of antenatal care",level:"1"},{id:"sec_3",title:"3. Approaches to antenatal care",level:"1"},{id:"sec_4",title:"4. Approaches to antenatal care services in South Africa",level:"1"},{id:"sec_5",title:"5. The basic antenatal care (BANC) approach",level:"1"},{id:"sec_6",title:"6. Provision of antenatal care services according to the basic antenatal care approach",level:"1"},{id:"sec_7",title:"7. Discussion",level:"1"},{id:"sec_8",title:"8. Conclusion",level:"1"},{id:"sec_9",title:"Acknowledgments",level:"1"},{id:"sec_12",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Ekabua J, Ekabua K, Njoku C. Proposed framework for making focussed antenatal care services accessible: A review of the Nigerian setting. ISRN Obstetrics and Gynecology. 2011. DOI: 10.5402/2011/253964'},{id:"B2",body:'Pattinson RC. Basic Antenatal Care Handbook. Pretoria: University of Pretoria; 2007'},{id:"B3",body:'National Committee on Confidential Enquiry into Causes of Maternal Deaths. Saving Mothers 2005-2007: Fourth Report on Confidential Enquiries into Maternal Deaths in South Africa. Pretoria: National Department of Health; 2009'},{id:"B4",body:'National Committee on Confidential Enquiry into Causes of Maternal Deaths. Saving Mothers 2014-2016: Seventh Report on Confidential Enquiries into Maternal Deaths in South Africa. Pretoria: National Department of Health; 2017'},{id:"B5",body:'National Committee on Confidential Enquiry into Causes of Maternal Deaths. Saving Mothers 2002-2004: Third Report on Confidential Enquiries into Maternal Deaths in South Africa. Pretoria: National Department of Health; 2005'},{id:"B6",body:'Hoque MM, Hoque E, Kader S. Audit of antenatal care in a rural district of KZN, South Africa. South African Family Practice. 2008;50:66'},{id:"B7",body:'Snyman JS. Effectiveness of the basic antenatal care package in primary health care clinics [Magister Curationis dissertation thesis]. Port Elizabeth: Nelson Mandela Metropolitan University; 2007'},{id:"B8",body:'World Health Organization. Antenatal Care in Developing Countries: Promises Achievements and Missed Opportunities. An analysis of trends level and differentials 1999-2001 [Internet]. 2003. Available from: http://www.childinfo.org/files/antenatal_care.pd [Accessed: 2014-07-04]'},{id:"B9",body:'National Department of Health (of South Africa). MRC unit for maternal and infant care strategies, PPIP users, and saving babies technical task team. 2007: Saving Babies 2003-2005 Fifth Report on Perinatal Care in South Africa. Pretoria: Government Printer; 2007'},{id:"B10",body:'Bradshaw D, Copra M, Kerber K, Lawn J, Moodley J, Pattinson J, Patrick M, Stephen C, Velaphi S. Every Death Counts: Saving the Lives of Mothers, Babies and Children in South Africa. Cape Town: Mills Litho; 2008'},{id:"B11",body:'National Committee on Confidential Enquiry into Causes of Maternal Deaths. Saving Mothers Policy and Management Guidelines for Common Causes of Maternal Deaths. Pretoria; 2001'},{id:"B12",body:'South Africa: National Department of Health. National Department of Health. National Department of Health strategic plan 2010; 2010//11-2012/13'},{id:"B13",body:'Chandni JCS, Hodgson R, Hayen A. Factors associated with the use and quality of antenatal care in Nepal: A population-based study using the demographic and health survey data. BioMed Central Pregnancy and Childbirth. 2014;14:94'},{id:"B14",body:'National Committee on Confidential Enquiry into Causes of Maternal Deaths. Saving Mothers 2008-2010: Fifth Report on Confidential Enquiries into Maternal Deaths in South Africa. Pretoria: National Department of Health; 2012'},{id:"B15",body:'Villar J, Carroli G, Khan-Neelofur D, Piaggo G, Gulmezoglu M. Patterns of routine antenatal care for low-risk pregnancies: Database of systematic review [Internet]. 2007. Available from: www.who.int/rhl/reviews/langs/CD000934.pdf [Accessed: 2013-08-09]'},{id:"B16",body:'The Free Library Population brief: Focussed ANC acceptable, tricky to implement [Internet]. 2007. Available from: www.popcouncil.org/uploads/pdfs/…/RH_FocussedAntenatalCare_A4.pdf [Accessed: 2013-02-02]'},{id:"B17",body:'Mathole T, Lindmark G, Ahlberg BM. Dilemmas and paradoxes in providing and changing antenatal care. Health Policy and Planning. 2005;20(6):385-393. DOI: 10.1093/heapol/czi046'},{id:"B18",body:'Maternal and Neonatal Health Programme. Focused antenatal care: Planning and providing care during pregnancy. [Internet]. 2004. Available from: www.mnh.jhpiego.org [Accessed: 2004-09-21]'},{id:"B19",body:'World Health Organization. WHO Programme to Map Best Reproductive Health Practices—WHO Antenatal Care Randomized Trial: Manual for Implementation of the New Model. Geneva: WHO; 2002'},{id:"B20",body:'Population Council. Adapting focussed antenatal lessons from three African countries. Program Brief No. 11. July 2008. [Internet]. 2008. Available from: www.popcouncil.org/uploads/pdfs/frontiers/pbriefs/PB11.pdf [Accessed: 2013-08-28]'},{id:"B21",body:'World Health Organization. Standards for maternal and neonatal care: Making pregnancy safer [Internet]. 2007. Available from: www.who.int/reproductivehealth/publications/maternal…health/…/en/ [Accessed: 2014-07-09]'},{id:"B22",body:'Ethiopia Health Education and Training (HEAT) Module. Antenatal Care Ethiopia HEAT Module [Internet]. 2004. Available from: www.open.edu/openlearnworks/mod/oucontent/view.php?id=28 [Accessed: 2014-10-19]'},{id:"B23",body:'South African Nursing Council. R2598. Regulations relating to the scope of practice of persons who are registered or enrolled [Internet]. 1991. Available from: www.sanc.co.za/regulat/Reg-scp.htm [Accessed: 2013-07-08]'},{id:"B24",body:'Pell C, Menaca A, Were F, Afrah NA, Chatio S, Manda-Taylo L, Hamel MJ, Hogson A, Tagbor H, Kalilani L, Ouma P, Pool R. Factors affecting antenatal care attendance: Results from qualitative studies in Ghana, Kenya and Malawi. PLoS One. 2013;8(1):e53747. DOI: 10.1371/journal.pone.0053747'},{id:"B25",body:'National Department of Health (of South Africa). Strategic plan for maternal, newborn, child and women’s health (MNCWH) and nutrition in South Africa 2012-2016 [Internet]. 2012. Available from: www.doh.gov.za/docs/stratdocs/2012/MNCWHstratplan.pdf [Accessed: 2014-10-13]'},{id:"B26",body:'National Department of Health (of South Africa). MRC Unit for Maternal and Infant Care Strategies, PPIP Users, and Saving Babies Technical Task Team. Saving Babies 2008-2009 Sixth Report on Perinatal Care in South Africa. Pretoria: Government Printer; 2010'},{id:"B27",body:'Beksinska M, Kunene B, Mullick S. Maternal care: Antenatal, peri and postnatal: Women\'s health. In: Ijumba P, Padarath A, editors. South African Health Review. Durban: Health Systems Trust. ISSN 102517515 [Internet]. Available from: http://www.hst.org.za/uploads/files/chap18_06.pdf; 2006. pp. 297-314 [Accessed: 2013-06-18]'},{id:"B28",body:'Pattinson RC. Basic Antenatal Care Principles of Good Care and Guidelines. Pretoria: University of Pretoria; 2005'},{id:"B29",body:'Pattinson RC. Basic Ante Natal Care: Facility manager’s Notes. Pretoria: University of Pretoria; 2005'},{id:"B30",body:'National Department of Health (of South Africa). Framework for Accelerating Community-Based Maternal, Neonatal, Child and women’s Health and Nutrition Interventions. Pretoria: Government Printer; 2008'},{id:"B31",body:'National Department of Health (of South Africa). Maternity Case Record Guidelines. Pretoria: Government Printer; 2008'},{id:"B32",body:'National Department of Health (of South Africa). Guidelines for Maternity Care in South Africa. A Manual for Clinics, Community Health Care Centres and District Hospitals. 3rd ed. Pretoria: Government Printer; 2007'},{id:"B33",body:'Mhlanga E. Maternal, Newborn and Child Health: 30 Years on. [Internet]. 2012. Available from: www.hst.org.za/uploads/files/chap8 08.pdf [Accessed: 2013-07-08]'},{id:"B34",body:'Ngxongo TSP. Factors influencing successful implementation of basic antenatal care in eThekwini district [thesis M. Tech dissertation]. Durban: Durban University of Technology; 2011'},{id:"B35",body:'Ngxongo TSP, Sibiya MN. Challenges regarding the implementation of basic antenatal care in eThekwini district, KwaZulu-Natal. Journal of Nursing. 2013;22(7):906-913'},{id:"B36",body:'Kinze B, Gomez P. Basic Maternal and Newborn Car: A Guide for Skilled Providers. Baltimore, MD: JHPIEGO/MNH Program; 2004'},{id:"B37",body:'Hofmeyr GJ, Mentrop L. Time for ‘basic antenatal care plus’ in South Africa? South African Medical Journal. 2015;105(11):902-903. DOI: 10.7196/SAMJ.2015.v105i11.10186'},{id:"B38",body:'World Health Organization. What’s new? Decreasing deaths during pregnancy in South Africa by improving antenatal care [Internet]. 2018. Available from: www.who.int [Accessed: 2018-02-11]'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Thembelihle Sylvia Patience Ngxongo",address:"thembelihlen@dut.ac.za",affiliation:'
Durban University of Technology, KwaZulu-Natal, South Africa
'}],corrections:null},book:{id:"7259",title:"Selected Topics in Midwifery Care",subtitle:null,fullTitle:"Selected Topics in Midwifery Care",slug:"selected-topics-in-midwifery-care",publishedDate:"February 8th 2019",bookSignature:"Ana Polona Mivšek",coverURL:"https://cdn.intechopen.com/books/images_new/7259.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"85109",title:"Dr.",name:"Ana Polona",middleName:null,surname:"Mivšek",slug:"ana-polona-mivsek",fullName:"Ana Polona Mivšek"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"44823",title:"Dr.",name:"Sung-Wook",middleName:null,surname:"Kim",email:"mrwoo11@kaist.ac.kr",fullName:"Sung-Wook Kim",slug:"sung-wook-kim",position:null,biography:null,institutionString:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"1",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:null},booksEdited:[],chaptersAuthored:[{title:"Bio-Inspired Synthesis of Electrode Materials for Lithium Rechargeable Batteries",slug:"bio-inspired-synthesis-of-electrode-materials-for-lithium-rechargeable-batteries",abstract:null,signatures:"Kisuk Kang and Sung-Wook Kim",authors:[{id:"32158",title:"Dr.",name:"Kisuk",surname:"Kang",fullName:"Kisuk Kang",slug:"kisuk-kang",email:"matlgen1@kaist.ac.kr"},{id:"44823",title:"Dr.",name:"Sung-Wook",surname:"Kim",fullName:"Sung-Wook Kim",slug:"sung-wook-kim",email:"mrwoo11@kaist.ac.kr"}],book:{title:"Energy Storage in the Emerging Era of Smart Grids",slug:"energy-storage-in-the-emerging-era-of-smart-grids",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"24989",title:"Prof.",name:"Ricardo",surname:"de Andrade Lira Rabêlo",slug:"ricardo-de-andrade-lira-rabelo",fullName:"Ricardo de Andrade Lira Rabêlo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"27726",title:"Prof.",name:"Ricardo",surname:"Souza Fernandes",slug:"ricardo-souza-fernandes",fullName:"Ricardo Souza Fernandes",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"31261",title:"Dr.",name:"Pierre",surname:"Mertiny",slug:"pierre-mertiny",fullName:"Pierre Mertiny",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/31261/images/186_n.jpg",biography:null,institutionString:null,institution:{name:"University of Alberta",institutionURL:null,country:{name:"Canada"}}},{id:"32176",title:"Dr.",name:"Masatoshi",surname:"Uno",slug:"masatoshi-uno",fullName:"Masatoshi Uno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32176/images/2389_n.jpg",biography:"Masatoshi Uno received the B.E. degree in electronics engineering and the M.E. degree in electrical engineering from Doshisha University, Kyoto, Japan, and the Ph.D. degree from the Graduate University for Advanced Studies, Japan, in 2002, 2004, and 2012, respectively. \nIn April 2004, he joined Japan Aerospace Exploration Agency where he is currently a development researcher for spacecraft power systems. His current research interests include power electronics for energy storage applications, evaluations for electric double-layer capacitors and lithium-ion batteries, and development of fuel cell systems for spacecraft power systems.",institutionString:null,institution:{name:"Japan Aerospace Exploration Agency",institutionURL:null,country:{name:"Japan"}}},{id:"41906",title:"Mr",name:"Adriano",surname:"Alber de França Mendes Carneiro",slug:"adriano-alber-de-franca-mendes-carneiro",fullName:"Adriano Alber de França Mendes Carneiro",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"41909",title:"Ms",name:"Rosana",surname:"Teresinha Vaccare Braga",slug:"rosana-teresinha-vaccare-braga",fullName:"Rosana Teresinha Vaccare Braga",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"42836",title:"Mr.",name:"Malte",surname:"Krack",slug:"malte-krack",fullName:"Malte Krack",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Leibniz University of Applied Sciences",institutionURL:null,country:{name:"Germany"}}},{id:"42837",title:"Dr.",name:"Marc",surname:"Secanell",slug:"marc-secanell",fullName:"Marc Secanell",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"52087",title:"Prof.",name:"Pier Luigi",surname:"Antonucci",slug:"pier-luigi-antonucci",fullName:"Pier Luigi Antonucci",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"52095",title:"Dr.",name:"Vincenzo",surname:"Antonucci",slug:"vincenzo-antonucci",fullName:"Vincenzo Antonucci",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"WIS-cost",title:"What Does It Cost?",intro:"
Open Access publishing helps remove barriers and allows everyone to access valuable information, but article and book processing charges also exclude talented authors and editors who can’t afford to pay. The goal of our Women in Science program is to charge zero APCs, so none of our authors or editors have to pay for publication.
",metaTitle:"What Does It Cost?",metaDescription:"Open Access publishing helps remove barriers and allows everyone to access valuable information, but article and book processing charges also exclude talented authors and editors who can’t afford to pay. The goal of our Women in Science program is to charge zero APCs, so none of our authors or editors have to pay for publication.",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"
We are currently in the process of collecting sponsorship. If you have any ideas or would like to help sponsor this ambitious program, we’d love to hear from you. Contact Dr. Anke Beck at anke@intechopen.com.
\\n\\n
All of our IntechOpen sponsors are in good company! The research in past IntechOpen books and chapters have been funded by:
\\n\\n
\\n\\t
European Commission
\\n\\t
Bill and Melinda Gates Foundation
\\n\\t
Wellcome Trust
\\n\\t
National Institute of Health (NIH)
\\n\\t
National Science Foundation (NSF)
\\n\\t
National Institute of Standards and Technology (NIST)
We are currently in the process of collecting sponsorship. If you have any ideas or would like to help sponsor this ambitious program, we’d love to hear from you. Contact Dr. Anke Beck at anke@intechopen.com.
\n\n
All of our IntechOpen sponsors are in good company! The research in past IntechOpen books and chapters have been funded by:
\n\n
\n\t
European Commission
\n\t
Bill and Melinda Gates Foundation
\n\t
Wellcome Trust
\n\t
National Institute of Health (NIH)
\n\t
National Science Foundation (NSF)
\n\t
National Institute of Standards and Technology (NIST)
\n\t
Research Councils United Kingdom (RCUK)
\n\t
Foundation for Science and Technology (FCT)
\n\t
Chinese Academy of Sciences
\n\t
Natural Science Foundation of China (NSFC)
\n\t
German Research Foundation (DFG)
\n\t
Max Planck Institute
\n\t
Austrian Science Fund (FWF)
\n\t
Australian Research Council (ARC)
\n
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. Hashim",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/6700/images/1864_n.jpg",biography:"Currently I am carrying out research in several areas of interest, mainly covering work on chemical and bio-sensors, semiconductor thin film device fabrication and characterisation.\nAt the moment I have very strong interest in radiation environmental pollution and bacteriology treatment. The teams of researchers are working very hard to bring novel results in this field. I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:null},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/55578/images/4574_n.png",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. His current research interests include the areas of mobile communication systems and channel modeling in addition to atmospheric optical communications, adaptive optics and statistics",institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:5319},{group:"region",caption:"Middle and South America",value:2,count:4828},{group:"region",caption:"Africa",value:3,count:1471},{group:"region",caption:"Asia",value:4,count:9370},{group:"region",caption:"Australia and Oceania",value:5,count:837},{group:"region",caption:"Europe",value:6,count:14788}],offset:12,limit:12,total:108345},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{topicId:"8"},books:[{type:"book",id:"7434",title:"Molecular Biotechnology",subtitle:null,isOpenForSubmission:!0,hash:"eceede809920e1ec7ecadd4691ede2ec",slug:null,bookSignature:"Ph.D. Sergey Sedykh",coverURL:"https://cdn.intechopen.com/books/images_new/7434.jpg",editedByType:null,editors:[{id:"178316",title:"Ph.D.",name:"Sergey",surname:"Sedykh",slug:"sergey-sedykh",fullName:"Sergey Sedykh"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7702",title:"Electrolysis of Water",subtitle:null,isOpenForSubmission:!0,hash:"7532579d8c6881554d1812b55d0e8d4d",slug:null,bookSignature:"Prof. Fumio Okada",coverURL:"https://cdn.intechopen.com/books/images_new/7702.jpg",editedByType:null,editors:[{id:"147954",title:"Prof.",name:"Fumio",surname:"Okada",slug:"fumio-okada",fullName:"Fumio Okada"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8085",title:"Photochemistry and Photophysics - Recent Advances",subtitle:null,isOpenForSubmission:!0,hash:"d12a01a39921705f78e98baf99705b4e",slug:null,bookSignature:"Dr. Satyen Saha and Dr. Ravi Kumar Kanaparthi",coverURL:"https://cdn.intechopen.com/books/images_new/8085.jpg",editedByType:null,editors:[{id:"226917",title:"Dr.",name:"Satyen",surname:"Saha",slug:"satyen-saha",fullName:"Satyen Saha"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8199",title:"Hydroxyapatite - Properties and Functions",subtitle:null,isOpenForSubmission:!0,hash:"6a3c2d529bd0b7fb6d259f00b4562d77",slug:null,bookSignature:"Dr. Claudia Manuela da Cunha Ferreira Botelho",coverURL:"https://cdn.intechopen.com/books/images_new/8199.jpg",editedByType:null,editors:[{id:"258963",title:"Dr.",name:"Claudia Manuela",surname:"da Cunha Ferreira Botelho",slug:"claudia-manuela-da-cunha-ferreira-botelho",fullName:"Claudia Manuela da Cunha Ferreira Botelho"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8486",title:"Toxicity in Food",subtitle:null,isOpenForSubmission:!0,hash:"6d7b03f7f7bc6bda7523eeca2dbc3ba6",slug:null,bookSignature:"Prof. Mohammed Muzibur Rahman, Dr. Inamuddin Inamuddin, Dr. Anish Khan and Dr. Abdullah M. Asiri",coverURL:"https://cdn.intechopen.com/books/images_new/8486.jpg",editedByType:null,editors:[{id:"24438",title:"Prof.",name:"Mohammed",surname:"Rahman",slug:"mohammed-rahman",fullName:"Mohammed Rahman"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8492",title:"Ammonia - Properties and Use",subtitle:null,isOpenForSubmission:!0,hash:"60ee20d7f06bb9fc8b6a4dff9182f1f1",slug:null,bookSignature:"Dr. Kafa Khalaf",coverURL:"https://cdn.intechopen.com/books/images_new/8492.jpg",editedByType:null,editors:[{id:"209244",title:"Dr.",name:"Kafa",surname:"Khalaf",slug:"kafa-khalaf",fullName:"Kafa Khalaf"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8497",title:"Metalloproteins",subtitle:null,isOpenForSubmission:!0,hash:"1a8a35c5fe647362c031ee6da23b5a27",slug:null,bookSignature:"Dr. Takashiro Akitsu",coverURL:"https://cdn.intechopen.com/books/images_new/8497.jpg",editedByType:null,editors:[{id:"147861",title:"Dr.",name:"Takashiro",surname:"Akitsu",slug:"takashiro-akitsu",fullName:"Takashiro Akitsu"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8764",title:"Methanol Chemistry",subtitle:null,isOpenForSubmission:!0,hash:"87db86b0b044f975cb3fc7e0e6af01a2",slug:null,bookSignature:"Associate Prof. Kasibhatta Siva Kumar and Dr. Sreenivasulu Karlapudi",coverURL:"https://cdn.intechopen.com/books/images_new/8764.jpg",editedByType:null,editors:[{id:"293276",title:"Associate Prof.",name:"Kasibhatta",surname:"Siva Kumar",slug:"kasibhatta-siva-kumar",fullName:"Kasibhatta Siva Kumar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9183",title:"Nematic Liquid Crystals",subtitle:null,isOpenForSubmission:!0,hash:"c9adbbaa21f66dbafc6074bb74a893a3",slug:null,bookSignature:"Prof. Irina Carlescu",coverURL:"https://cdn.intechopen.com/books/images_new/9183.jpg",editedByType:null,editors:[{id:"258032",title:"Prof.",name:"Irina",surname:"Carlescu",slug:"irina-carlescu",fullName:"Irina Carlescu"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9187",title:"Spiro Compounds/Spiranes",subtitle:null,isOpenForSubmission:!0,hash:"fa002b6b35caf5b7eca35ab6e1387909",slug:null,bookSignature:"Dr. Nguyen Xuan Nhiem",coverURL:"https://cdn.intechopen.com/books/images_new/9187.jpg",editedByType:null,editors:[{id:"66831",title:"Dr.",name:"Nguyen Xuan",surname:"Nhiem",slug:"nguyen-xuan-nhiem",fullName:"Nguyen Xuan Nhiem"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9198",title:"Chemistry of Indoles",subtitle:null,isOpenForSubmission:!0,hash:"fa213f54dd56cefc6bfb783edf4de62d",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/9198.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9452",title:"Hydrazones",subtitle:null,isOpenForSubmission:!0,hash:"a0096875b03aeb5da7c7da8a7620de4b",slug:null,bookSignature:"Dr. Ranjan Kumar Kumar Mohapatra",coverURL:"https://cdn.intechopen.com/books/images_new/9452.jpg",editedByType:null,editors:[{id:"91752",title:"Dr.",name:"Ranjan Kumar",surname:"Mohapatra",slug:"ranjan-kumar-mohapatra",fullName:"Ranjan Kumar Mohapatra"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:34},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:33},{group:"topic",caption:"Business, Management and Economics",value:7,count:10},{group:"topic",caption:"Chemistry",value:8,count:30},{group:"topic",caption:"Computer and Information Science",value:9,count:25},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:15},{group:"topic",caption:"Engineering",value:11,count:70},{group:"topic",caption:"Environmental Sciences",value:12,count:13},{group:"topic",caption:"Immunology and Microbiology",value:13,count:4},{group:"topic",caption:"Materials Science",value:14,count:38},{group:"topic",caption:"Mathematics",value:15,count:14},{group:"topic",caption:"Medicine",value:16,count:136},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:6},{group:"topic",caption:"Neuroscience",value:18,count:6},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:8},{group:"topic",caption:"Physics",value:20,count:20},{group:"topic",caption:"Psychology",value:21,count:2},{group:"topic",caption:"Robotics",value:22,count:6},{group:"topic",caption:"Social Sciences",value:23,count:14},{group:"topic",caption:"Technology",value:24,count:9},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:3},{group:"topic",caption:"Genesiology",value:300,count:1},{group:"topic",caption:"Machine Learning and Data Mining",value:521,count:1},{group:"topic",caption:"Intelligent System",value:535,count:1}],offset:12,limit:12,total:47},popularBooks:{featuredBooks:[{type:"book",id:"7878",title:"Advances in Extracorporeal Membrane Oxygenation",subtitle:"Volume 3",isOpenForSubmission:!1,hash:"f95bf990273d08098a00f9a1c2403cbe",slug:"advances-in-extracorporeal-membrane-oxygenation-volume-3",bookSignature:"Michael S. Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/7878.jpg",editors:[{id:"64343",title:null,name:"Michael S.",middleName:"S",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8299",title:"Timber Buildings and Sustainability",subtitle:null,isOpenForSubmission:!1,hash:"bccf2891cec38ed041724131aa34c25a",slug:"timber-buildings-and-sustainability",bookSignature:"Giovanna Concu",coverURL:"https://cdn.intechopen.com/books/images_new/8299.jpg",editors:[{id:"108709",title:"Dr.",name:"Giovanna",middleName:null,surname:"Concu",slug:"giovanna-concu",fullName:"Giovanna Concu"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7614",title:"Fourier Transforms",subtitle:"Century of Digitalization and Increasing Expectations",isOpenForSubmission:!1,hash:"ff3501657ae983a3b42fef1f7058ac91",slug:"fourier-transforms-century-of-digitalization-and-increasing-expectations",bookSignature:"Goran S. Nikoli? and Dragana Z. Markovi?-Nikoli?",coverURL:"https://cdn.intechopen.com/books/images_new/7614.jpg",editors:[{id:"23261",title:"Prof.",name:"Goran",middleName:"S.",surname:"Nikolic",slug:"goran-nikolic",fullName:"Goran Nikolic"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7062",title:"Rhinosinusitis",subtitle:null,isOpenForSubmission:!1,hash:"14ed95e155b1e57a61827ca30b579d09",slug:"rhinosinusitis",bookSignature:"Balwant Singh Gendeh and Mirjana Turkalj",coverURL:"https://cdn.intechopen.com/books/images_new/7062.jpg",editors:[{id:"67669",title:"Prof.",name:"Balwant Singh",middleName:null,surname:"Gendeh",slug:"balwant-singh-gendeh",fullName:"Balwant Singh Gendeh"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7087",title:"Tendons",subtitle:null,isOpenForSubmission:!1,hash:"786abac0445c102d1399a1e727a2db7f",slug:"tendons",bookSignature:"Hasan Sözen",coverURL:"https://cdn.intechopen.com/books/images_new/7087.jpg",editors:[{id:"161402",title:"Dr.",name:"Hasan",middleName:null,surname:"Sözen",slug:"hasan-sozen",fullName:"Hasan Sözen"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7955",title:"Advances in Hematologic Malignancies",subtitle:null,isOpenForSubmission:!1,hash:"59ca1b09447fab4717a93e099f646d28",slug:"advances-in-hematologic-malignancies",bookSignature:"Gamal Abdul Hamid",coverURL:"https://cdn.intechopen.com/books/images_new/7955.jpg",editors:[{id:"36487",title:"Prof.",name:"Gamal",middleName:null,surname:"Abdul Hamid",slug:"gamal-abdul-hamid",fullName:"Gamal Abdul Hamid"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7701",title:"Assistive and Rehabilitation Engineering",subtitle:null,isOpenForSubmission:!1,hash:"4191b744b8af3b17d9a80026dcb0617f",slug:"assistive-and-rehabilitation-engineering",bookSignature:"Yves Rybarczyk",coverURL:"https://cdn.intechopen.com/books/images_new/7701.jpg",editors:[{id:"72920",title:"Prof.",name:"Yves",middleName:"Philippe",surname:"Rybarczyk",slug:"yves-rybarczyk",fullName:"Yves Rybarczyk"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7837",title:"Geriatric Medicine and Gerontology",subtitle:null,isOpenForSubmission:!1,hash:"e277d005b23536bcd9f8550046101979",slug:"geriatric-medicine-and-gerontology",bookSignature:"Edward T. Zawada Jr.",coverURL:"https://cdn.intechopen.com/books/images_new/7837.jpg",editors:[{id:"16344",title:"Dr.",name:"Edward T.",middleName:null,surname:"Zawada Jr.",slug:"edward-t.-zawada-jr.",fullName:"Edward T. Zawada Jr."}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,isOpenForSubmission:!1,hash:"61c627da05b2ace83056d11357bdf361",slug:"current-topics-in-neglected-tropical-diseases",bookSignature:"Alfonso J. Rodriguez-Morales",coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",editors:[{id:"131400",title:"Dr.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7610",title:"Renewable and Sustainable Composites",subtitle:null,isOpenForSubmission:!1,hash:"c2de26c3d329c54f093dc3f05417500a",slug:"renewable-and-sustainable-composites",bookSignature:"António B. Pereira and Fábio A. O. Fernandes",coverURL:"https://cdn.intechopen.com/books/images_new/7610.jpg",editors:[{id:"211131",title:"Prof.",name:"António",middleName:"Bastos",surname:"Pereira",slug:"antonio-pereira",fullName:"António Pereira"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8416",title:"Non-Equilibrium Particle Dynamics",subtitle:null,isOpenForSubmission:!1,hash:"2c3add7639dcd1cb442cb4313ea64e3a",slug:"non-equilibrium-particle-dynamics",bookSignature:"Albert S. Kim",coverURL:"https://cdn.intechopen.com/books/images_new/8416.jpg",editors:[{id:"21045",title:"Prof.",name:"Albert S.",middleName:null,surname:"Kim",slug:"albert-s.-kim",fullName:"Albert S. Kim"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8008",title:"Antioxidants",subtitle:null,isOpenForSubmission:!1,hash:"76361b4061e830906267933c1c670027",slug:"antioxidants",bookSignature:"Emad Shalaby",coverURL:"https://cdn.intechopen.com/books/images_new/8008.jpg",editors:[{id:"63600",title:"Prof.",name:"Emad",middleName:null,surname:"Shalaby",slug:"emad-shalaby",fullName:"Emad Shalaby"}],productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:4398},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"7878",title:"Advances in Extracorporeal Membrane Oxygenation",subtitle:"Volume 3",isOpenForSubmission:!1,hash:"f95bf990273d08098a00f9a1c2403cbe",slug:"advances-in-extracorporeal-membrane-oxygenation-volume-3",bookSignature:"Michael S. Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/7878.jpg",editors:[{id:"64343",title:null,name:"Michael S.",middleName:"S",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8299",title:"Timber Buildings and Sustainability",subtitle:null,isOpenForSubmission:!1,hash:"bccf2891cec38ed041724131aa34c25a",slug:"timber-buildings-and-sustainability",bookSignature:"Giovanna Concu",coverURL:"https://cdn.intechopen.com/books/images_new/8299.jpg",editors:[{id:"108709",title:"Dr.",name:"Giovanna",middleName:null,surname:"Concu",slug:"giovanna-concu",fullName:"Giovanna Concu"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7614",title:"Fourier Transforms",subtitle:"Century of Digitalization and Increasing Expectations",isOpenForSubmission:!1,hash:"ff3501657ae983a3b42fef1f7058ac91",slug:"fourier-transforms-century-of-digitalization-and-increasing-expectations",bookSignature:"Goran S. Nikoli? and Dragana Z. Markovi?-Nikoli?",coverURL:"https://cdn.intechopen.com/books/images_new/7614.jpg",editors:[{id:"23261",title:"Prof.",name:"Goran",middleName:"S.",surname:"Nikolic",slug:"goran-nikolic",fullName:"Goran Nikolic"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7062",title:"Rhinosinusitis",subtitle:null,isOpenForSubmission:!1,hash:"14ed95e155b1e57a61827ca30b579d09",slug:"rhinosinusitis",bookSignature:"Balwant Singh Gendeh and Mirjana Turkalj",coverURL:"https://cdn.intechopen.com/books/images_new/7062.jpg",editors:[{id:"67669",title:"Prof.",name:"Balwant Singh",middleName:null,surname:"Gendeh",slug:"balwant-singh-gendeh",fullName:"Balwant Singh Gendeh"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7087",title:"Tendons",subtitle:null,isOpenForSubmission:!1,hash:"786abac0445c102d1399a1e727a2db7f",slug:"tendons",bookSignature:"Hasan Sözen",coverURL:"https://cdn.intechopen.com/books/images_new/7087.jpg",editors:[{id:"161402",title:"Dr.",name:"Hasan",middleName:null,surname:"Sözen",slug:"hasan-sozen",fullName:"Hasan Sözen"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7955",title:"Advances in Hematologic Malignancies",subtitle:null,isOpenForSubmission:!1,hash:"59ca1b09447fab4717a93e099f646d28",slug:"advances-in-hematologic-malignancies",bookSignature:"Gamal Abdul Hamid",coverURL:"https://cdn.intechopen.com/books/images_new/7955.jpg",editors:[{id:"36487",title:"Prof.",name:"Gamal",middleName:null,surname:"Abdul Hamid",slug:"gamal-abdul-hamid",fullName:"Gamal Abdul Hamid"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7701",title:"Assistive and Rehabilitation Engineering",subtitle:null,isOpenForSubmission:!1,hash:"4191b744b8af3b17d9a80026dcb0617f",slug:"assistive-and-rehabilitation-engineering",bookSignature:"Yves Rybarczyk",coverURL:"https://cdn.intechopen.com/books/images_new/7701.jpg",editors:[{id:"72920",title:"Prof.",name:"Yves",middleName:"Philippe",surname:"Rybarczyk",slug:"yves-rybarczyk",fullName:"Yves Rybarczyk"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7837",title:"Geriatric Medicine and Gerontology",subtitle:null,isOpenForSubmission:!1,hash:"e277d005b23536bcd9f8550046101979",slug:"geriatric-medicine-and-gerontology",bookSignature:"Edward T. Zawada Jr.",coverURL:"https://cdn.intechopen.com/books/images_new/7837.jpg",editors:[{id:"16344",title:"Dr.",name:"Edward T.",middleName:null,surname:"Zawada Jr.",slug:"edward-t.-zawada-jr.",fullName:"Edward T. Zawada Jr."}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,isOpenForSubmission:!1,hash:"61c627da05b2ace83056d11357bdf361",slug:"current-topics-in-neglected-tropical-diseases",bookSignature:"Alfonso J. Rodriguez-Morales",coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",editors:[{id:"131400",title:"Dr.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7610",title:"Renewable and Sustainable Composites",subtitle:null,isOpenForSubmission:!1,hash:"c2de26c3d329c54f093dc3f05417500a",slug:"renewable-and-sustainable-composites",bookSignature:"António B. Pereira and Fábio A. O. Fernandes",coverURL:"https://cdn.intechopen.com/books/images_new/7610.jpg",editors:[{id:"211131",title:"Prof.",name:"António",middleName:"Bastos",surname:"Pereira",slug:"antonio-pereira",fullName:"António Pereira"}],productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"7698",title:"Educational Psychology",subtitle:"Between Certitudes and Uncertainties",isOpenForSubmission:!1,hash:"740943e2d029253e777150e98ebe2f0d",slug:"educational-psychology-between-certitudes-and-uncertainties",bookSignature:"Victori?a Trif",coverURL:"https://cdn.intechopen.com/books/images_new/7698.jpg",editedByType:"Edited by",editors:[{id:"201656",title:"Ph.D.",name:"Victorița",middleName:null,surname:"Trif",slug:"victorita-trif",fullName:"Victorița Trif"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8747",title:"Asphalt and Asphalt Mixtures",subtitle:null,isOpenForSubmission:!1,hash:"6083f7c9881029f1e033a1e512af7e20",slug:"asphalt-and-asphalt-mixtures",bookSignature:"Haitao Zhang",coverURL:"https://cdn.intechopen.com/books/images_new/8747.jpg",editedByType:"Edited by",editors:[{id:"260604",title:"Prof.",name:"Haitao",middleName:null,surname:"Zhang",slug:"haitao-zhang",fullName:"Haitao Zhang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8516",title:"Metacognition in Learning",subtitle:null,isOpenForSubmission:!1,hash:"5fa6eaad7b509b8b7ec5124d79e5f605",slug:"metacognition-in-learning",bookSignature:"Nosisi Feza",coverURL:"https://cdn.intechopen.com/books/images_new/8516.jpg",editedByType:"Edited by",editors:[{id:"261665",title:"Prof.",name:"Nosisi",middleName:"N.",surname:"Feza",slug:"nosisi-feza",fullName:"Nosisi Feza"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7000",title:"Legume Crops",subtitle:"Characterization and Breeding for Improved Food Security",isOpenForSubmission:!1,hash:"4d0f73bf883bbb984cc2feef1259a9a7",slug:"legume-crops-characterization-and-breeding-for-improved-food-security",bookSignature:"Mohamed Ahmed El-Esawi",coverURL:"https://cdn.intechopen.com/books/images_new/7000.jpg",editedByType:"Edited by",editors:[{id:"191770",title:"Dr.",name:"Mohamed A.",middleName:null,surname:"El-Esawi",slug:"mohamed-a.-el-esawi",fullName:"Mohamed A. El-Esawi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8292",title:"Oral Health by Using Probiotic Products",subtitle:null,isOpenForSubmission:!1,hash:"327e750e83634800ace02fe62607c21e",slug:"oral-health-by-using-probiotic-products",bookSignature:"Razzagh Mahmoudi",coverURL:"https://cdn.intechopen.com/books/images_new/8292.jpg",editedByType:"Edited by",editors:[{id:"245925",title:"Dr.",name:"Razzagh",middleName:null,surname:"Mahmoudi",slug:"razzagh-mahmoudi",fullName:"Razzagh Mahmoudi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8323",title:"Traditional and Complementary Medicine",subtitle:null,isOpenForSubmission:!1,hash:"60eadb1783d9bba245687adf284d4871",slug:"traditional-and-complementary-medicine",bookSignature:"Cengiz Mordeniz",coverURL:"https://cdn.intechopen.com/books/images_new/8323.jpg",editedByType:"Edited by",editors:[{id:"214664",title:"Associate Prof.",name:"Cengiz",middleName:null,surname:"Mordeniz",slug:"cengiz-mordeniz",fullName:"Cengiz Mordeniz"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8347",title:"Computer Architecture in Industrial, Biomechanical and Biomedical Engineering",subtitle:null,isOpenForSubmission:!1,hash:"3d7024a8d7d8afed093c9c79ec31f15a",slug:"computer-architecture-in-industrial-biomechanical-and-biomedical-engineering",bookSignature:"Lulu Wang and Liandong Yu",coverURL:"https://cdn.intechopen.com/books/images_new/8347.jpg",editedByType:"Edited by",editors:[{id:"257388",title:"Dr.",name:"Lulu",middleName:null,surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7583",title:"Advanced Computational Fluid Dynamics for Emerging Engineering Processes",subtitle:"Eulerian vs. Lagrangian",isOpenForSubmission:!1,hash:"896509fa2e7e659811bffd0f9779ca9d",slug:"advanced-computational-fluid-dynamics-for-emerging-engineering-processes-eulerian-vs-lagrangian",bookSignature:"Albert S. Kim",coverURL:"https://cdn.intechopen.com/books/images_new/7583.jpg",editedByType:"Edited by",editors:[{id:"21045",title:"Prof.",name:"Albert S.",middleName:null,surname:"Kim",slug:"albert-s.-kim",fullName:"Albert S. Kim"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7839",title:"Malaria",subtitle:null,isOpenForSubmission:!1,hash:"91cde4582ead884cb0f355a19b67cd56",slug:"malaria",bookSignature:"Fyson H. Kasenga",coverURL:"https://cdn.intechopen.com/books/images_new/7839.jpg",editedByType:"Edited by",editors:[{id:"86725",title:"Dr.",name:"Fyson",middleName:"Hanania",surname:"Kasenga",slug:"fyson-kasenga",fullName:"Fyson Kasenga"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7093",title:"Pneumothorax",subtitle:null,isOpenForSubmission:!1,hash:"0b1fdb8bb0448f48c2f234753898f3f8",slug:"pneumothorax",bookSignature:"Khalid Amer",coverURL:"https://cdn.intechopen.com/books/images_new/7093.jpg",editedByType:"Edited by",editors:[{id:"63412",title:"Dr.",name:"Khalid",middleName:null,surname:"Amer",slug:"khalid-amer",fullName:"Khalid Amer"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"973",title:"Probability",slug:"probability",parent:{title:"Applied Mathematics",slug:"applied-mathematics"},numberOfBooks:1,numberOfAuthorsAndEditors:1,numberOfWosCitations:16,numberOfCrossrefCitations:4,numberOfDimensionsCitations:17,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicSlug:"probability",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"3750",title:"Bayesian Network",subtitle:null,isOpenForSubmission:!1,hash:"e13716028dd76e0c381db287f7410d92",slug:"bayesian-network",bookSignature:"Ahmed Rebai",coverURL:"https://cdn.intechopen.com/books/images_new/3750.jpg",editedByType:"Edited by",editors:[{id:"11939",title:"Prof.",name:"Ahmed",middleName:null,surname:"Rebai",slug:"ahmed-rebai",fullName:"Ahmed Rebai"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:1,mostCitedChapters:[{id:"11961",doi:"10.5772/10060",title:"Probabilistic Modelling and Recursive Bayesian Estimation of Trust in Wireless Sensor Networks",slug:"probabilistic-modelling-and-recursive-bayesian-estimation-of-trust-in-wireless-sensor-networks",totalDownloads:1984,totalCrossrefCites:0,totalDimensionsCites:4,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Mohammad Momani and Subhash Challa",authors:null},{id:"11951",doi:"10.5772/10068",title:"Monitoring of Complex Processes with Bayesian Networks",slug:"monitoring-of-complex-processes-with-bayesian-networks",totalDownloads:2290,totalCrossrefCites:3,totalDimensionsCites:4,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Sylvain Verron, Teodor Tiplica and Abdessamad Kobi",authors:null},{id:"11958",doi:"10.5772/10062",title:"Accommodating Uncertainty in Rangeland Condition Assessment Using Bayesian Belief Networks",slug:"accommodating-uncertainty-in-rangeland-condition-assessment-using-bayesian-belief-networks",totalDownloads:1334,totalCrossrefCites:0,totalDimensionsCites:2,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Hossein Bashari and Carl Smith",authors:null}],mostDownloadedChaptersLast30Days:[{id:"11962",title:"Time-Frequency analysis using Bayesian Regularized Neural Network Model",slug:"time-frequency-analysis-using-bayesian-regularized-neural-network-model",totalDownloads:2463,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Imran Shafi, Jamil Ahmad, Syed Ismail Shah and Ataul Aziz Ikram",authors:null},{id:"11952",title:"Bayesian Networks for Network Intrusion Detection",slug:"bayesian-networks-for-network-intrusion-detection",totalDownloads:3507,totalCrossrefCites:0,totalDimensionsCites:1,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Pablo Garcia Bringas and Igor Santos Grueiro",authors:null},{id:"11947",title:"Dynamic Data Feed to Bayesian Network Model and SMILE Web Application",slug:"dynamic-data-feed-to-bayesian-network-model-and-smile-web-based-interface",totalDownloads:2135,totalCrossrefCites:0,totalDimensionsCites:1,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Nipat Jongsawat, Anunucha Tungkasthan and Wichian Premchaiswadi",authors:null},{id:"11939",title:"Learning Structure and Parameters in Bayesian Networks Using an Implicit Framework",slug:"learning-structure-and-parameters-in-bayesian-networks-using-an-implicit-framework",totalDownloads:2594,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Hanen BenHassen, Lobna Bouchaala, Afif Masmoudi and Ahmed Rebai",authors:null},{id:"11949",title:"MiniTUBA: a Web-Based Dynamic Bayesian Network Analysis System",slug:"minituba-a-web-based-dynamic-bayesian-network-analysis-system-",totalDownloads:2003,totalCrossrefCites:0,totalDimensionsCites:1,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Yongqun He and Zuoshuang Xiang",authors:null},{id:"11951",title:"Monitoring of Complex Processes with Bayesian Networks",slug:"monitoring-of-complex-processes-with-bayesian-networks",totalDownloads:2290,totalCrossrefCites:3,totalDimensionsCites:4,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Sylvain Verron, Teodor Tiplica and Abdessamad Kobi",authors:null},{id:"11956",title:"Causal Modelling Based on Bayesian Networks for Preliminary Design of Buildings",slug:"causal-modelling-based-on-bayesian-networks-for-preliminary-design-of-buildings",totalDownloads:1887,totalCrossrefCites:0,totalDimensionsCites:1,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Berardo Naticchia and Alessandro Carbonari",authors:null},{id:"11958",title:"Accommodating Uncertainty in Rangeland Condition Assessment Using Bayesian Belief Networks",slug:"accommodating-uncertainty-in-rangeland-condition-assessment-using-bayesian-belief-networks",totalDownloads:1334,totalCrossrefCites:0,totalDimensionsCites:2,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Hossein Bashari and Carl Smith",authors:null},{id:"11961",title:"Probabilistic Modelling and Recursive Bayesian Estimation of Trust in Wireless Sensor Networks",slug:"probabilistic-modelling-and-recursive-bayesian-estimation-of-trust-in-wireless-sensor-networks",totalDownloads:1984,totalCrossrefCites:0,totalDimensionsCites:4,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"Mohammad Momani and Subhash Challa",authors:null},{id:"11945",title:"Guiding Complex Design Optimisation Using Bayesian Networks",slug:"guiding-complex-design-optimisation-using-bayesian-networks",totalDownloads:1578,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"bayesian-network",title:"Bayesian Network",fullTitle:"Bayesian Network"},signatures:"John Leaney and Artem Parakhine",authors:null}],onlineFirstChaptersFilter:{topicSlug:"probability",limit:3,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[{type:"book",id:"10080",title:"Vortex Dynamics",subtitle:null,isOpenForSubmission:!0,hash:"ea97962e99b3e0ebc9b46b48ba5bea14",slug:null,bookSignature:"Dr. Zambri Harun",coverURL:"https://cdn.intechopen.com/books/images_new/10080.jpg",editedByType:null,editors:[{id:"243152",title:"Dr.",name:"Zambri",middleName:null,surname:"Harun",slug:"zambri-harun",fullName:"Zambri Harun"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8903",title:"Carbon Based Material for Environmental Protection and Remediation",subtitle:null,isOpenForSubmission:!0,hash:"19da699b370f320eca63ef2ba02f745d",slug:null,bookSignature:"Dr. Mattia Bartoli and Dr. Marco Frediani",coverURL:"https://cdn.intechopen.com/books/images_new/8903.jpg",editedByType:null,editors:[{id:"188999",title:"Dr.",name:"Mattia",middleName:null,surname:"Bartoli",slug:"mattia-bartoli",fullName:"Mattia Bartoli"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8771",title:"Raman Scattering",subtitle:null,isOpenForSubmission:!0,hash:"1354b3097eaa5b27d9d4bd29d3150b27",slug:null,bookSignature:"Dr. Samir Kumar and Dr. Prabhat Kumar",coverURL:"https://cdn.intechopen.com/books/images_new/8771.jpg",editedByType:null,editors:[{id:"296661",title:"Dr.",name:"Samir",middleName:null,surname:"Kumar",slug:"samir-kumar",fullName:"Samir Kumar"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10073",title:"Recent Advances in Nanophotonics-Fundamentals and Applications",subtitle:null,isOpenForSubmission:!0,hash:"aceca7dfc807140870a89d42c5537d7c",slug:null,bookSignature:"Dr. Mojtaba Kahrizi and Ms. Parsoua Abedini Sohi",coverURL:"https://cdn.intechopen.com/books/images_new/10073.jpg",editedByType:null,editors:[{id:"113045",title:"Dr.",name:"Mojtaba",middleName:null,surname:"Kahrizi",slug:"mojtaba-kahrizi",fullName:"Mojtaba Kahrizi"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10132",title:"Applied Computational Near-surface Geophysics - From Integral and Derivative Formulas to MATLAB Codes",subtitle:null,isOpenForSubmission:!0,hash:"38cdbbb671df620b36ee96af1d9a3a90",slug:null,bookSignature:"Dr. Afshin Aghayan",coverURL:"https://cdn.intechopen.com/books/images_new/10132.jpg",editedByType:null,editors:[{id:"311030",title:"Dr.",name:"Afshin",middleName:null,surname:"Aghayan",slug:"afshin-aghayan",fullName:"Afshin Aghayan"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10110",title:"Advances and Technologies in Building Construction and Structural Analysis",subtitle:null,isOpenForSubmission:!0,hash:"df2ad14bc5588577e8bf0b7ebcdafd9d",slug:null,bookSignature:"Dr. Ali Kaboli and Dr. Sara Shirowzhan",coverURL:"https://cdn.intechopen.com/books/images_new/10110.jpg",editedByType:null,editors:[{id:"309192",title:"Dr.",name:"Ali",middleName:null,surname:"Kaboli",slug:"ali-kaboli",fullName:"Ali Kaboli"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10175",title:"Ethics in Emerging Technologies",subtitle:null,isOpenForSubmission:!0,hash:"9c92da249676e35e2f7476182aa94e84",slug:null,bookSignature:"Prof. Ali Hessami",coverURL:"https://cdn.intechopen.com/books/images_new/10175.jpg",editedByType:null,editors:[{id:"108303",title:"Prof.",name:"Ali",middleName:null,surname:"Hessami",slug:"ali-hessami",fullName:"Ali Hessami"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9284",title:"Computational Aeroacoustics",subtitle:null,isOpenForSubmission:!0,hash:"7019c5e5985faef7dc384c87dca5c8ef",slug:null,bookSignature:"Prof. Ramesh K. Agarwal",coverURL:"https://cdn.intechopen.com/books/images_new/9284.jpg",editedByType:null,editors:[{id:"38519",title:"Prof.",name:"Ramesh K.",middleName:null,surname:"Agarwal",slug:"ramesh-k.-agarwal",fullName:"Ramesh K. Agarwal"}],productType:{id:"1",chapterContentType:"chapter"}}],offset:8,limit:8,total:16},humansInSpaceProgram:{},teamHumansInSpaceProgram:{},route:{name:"profile.detail",path:"/profiles/44823/sung-wook-kim",hash:"",query:{},params:{id:"44823",slug:"sung-wook-kim"},fullPath:"/profiles/44823/sung-wook-kim",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()