Components of efforts to eliminate the effects of structural racism among LTCF residents.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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His research interest includes Design, Devolvement, and Biological screening of Small molecules, Metal complexes, Peptides for the management of Alzheimer\\'s disease, Fragile X Syndrome, and Tuberculosis. Dr. Kumar worked on Alzheimer\\'s disease and developed CNS active small molecules such as Acetylcholine, Butyl choline, Beta-secretase 1, Matrix Metalloprotein-2 and 9 inhibitors, and NMDA receptor antagonist.\nAlong with the Drug Discovery, he is also working on the Pathophysiology of Fragile X Syndrome. His work on the Fragile X Syndrome includes identification of spine abnormality and the role of Microglia. The study of Microglia-Neuron communication in genetically modified animals is his thrust area. He is also working on the gene-editing tools using CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) technology and the development of Blood-Brain Barrier penetrating Polymers as a delivery vehicle for CRISPR molecules.",institutionString:"Dehradun Institute of Technology University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Dehradun Institute of Technology University",institutionURL:null,country:{name:"India"}}}],coeditorOne:{id:"182874",title:"Prof.",name:"Sushil Kumar",middleName:null,surname:"Singh",slug:"sushil-kumar-singh",fullName:"Sushil Kumar Singh",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSAm4QAG/Profile_Picture_2022-04-07T11:17:21.JPG",biography:"Principal Investigator, Development of bioactive molecules as therapeutic agent for Alzheimer’s disease and screening their toxicity; IIT (BHU), Varanasi.\r\nPrincipal Investigator, Design and synthesis is of Matrix Metallo Proteinase (MMP -2 & 9) inhibitors as therapeutic agents for Alzheimer’s disease; DBT, New Delhi.\r\nCo- Principal Investigator, Cestocidal activity of glands and hairs of fruits of Mallotus phillippinensis (Kampillaka Plant); ICMR, New Delhi.\r\nPrincipal Investigator, Ethno-medicinal plants as a source of new therapeutic agents against psoriasis; National medicinal Plant Board, AYUSH, New Delhi.\r\nPrincipal Investigator, Isolation of marker compounds from Withania somnifera; Natreon Inc., Kolkata.\r\nPrincipal Investigator, Isolation of marker Compounds from natural Sources; Drug Research and Development Center, Kolkata.\r\nOne of the Investigators of the Centre, Establishment of facilities for identification, chemical characterization, standardization and quality control of medicinal plants found in tribal area in central India; DST, New Delhi.",institutionString:"Banaras Hindu University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Banaras Hindu University",institutionURL:null,country:{name:"India"}}},coeditorTwo:{id:"465935",title:"Dr.",name:"Ankit",middleName:null,surname:"Ganeshpurkar",slug:"ankit-ganeshpurkar",fullName:"Ankit Ganeshpurkar",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003RKF6EQAX/Profile_Picture_2022-04-07T11:30:06.jpg",biography:null,institutionString:"Bharati Vidyapeeth Deemed University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Bharati Vidyapeeth Deemed University",institutionURL:null,country:{name:"India"}}},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"18",title:"Neuroscience",slug:"life-sciences-neuroscience"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"453623",firstName:"Silvia",lastName:"Sabo",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/453623/images/20396_n.jpg",email:"silvia@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"6628",title:"Circadian Rhythm",subtitle:"Cellular and Molecular Mechanisms",isOpenForSubmission:!1,hash:"628bbcbfaf54a56710498540efe51b87",slug:"circadian-rhythm-cellular-and-molecular-mechanisms",bookSignature:"Mohamed Ahmed El-Esawi",coverURL:"https://cdn.intechopen.com/books/images_new/6628.jpg",editedByType:"Edited by",editors:[{id:"191770",title:"Dr.",name:"Mohamed A.",surname:"El-Esawi",slug:"mohamed-a.-el-esawi",fullName:"Mohamed A. 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Currently, electrical energy is generated in centralized power plants and transported over a long‐distance transmission network to distribution networks before reaching the end consumers via communication and power flows in only one direction, i.e., from power plants to the customers, which is collectively called an electric grid. After many decades of development, it has been realized that various utilities can interconnect to achieve greater reliability of overall power system by compensating for unexpected failures as well as disconnections from power devices, i.e., transmission lines and generators.
\nIn an electric grid, generation, transmission, and distribution of power should be precisely coordinated. Figure 1 depicts various sections in today\'s electric grid, which consists of four areas that are generation, transmission, distribution, and customers [1]. Generation involves the production of electricity from energy sources such as wind and solar farms, coal plants, and hydroelectric dams. Because generators cannot be located too close to population centers for safety, legal, and financial reasons, the electric grid needs transmission lines to carry the electricity over long distances (often more than hundreds of miles). Distribution includes taking the electricity from transmission lines and delivering it to the customers. Typically, an electricity distribution system includes medium voltage power lines (below 50 kV), substations, and transformers, starting at the transmission substations and ending at the meters of customers. A substation consists of a bus to split up the power into different regions, step‐down transformers, relays, and circuit breakers, which are designed to disconnect the substation from different distribution lines or from the power grid when necessary. The same transmission substation can deliver the power at different voltages to different regions, and the power might be further stepped down in several stages to reach 7200 V. A transformer is used to reduce voltage from 7200 to 240 V at each customer site. Two wires from the transformer are used to connect to power meters at a building or house, each carrying 120 V. These two wires are 180° out of phase, resulting in 240 V, which allows customers to use both 240 and 120 V appliances.
\nTypical electric power grid [
Due to the lack of situational awareness and automated analysis, today\'s electric power grid has been aging and ill‐suited to the fast growing demand for electricity in the twenty‐first century [2]. For example, in the United States, the consumption and demand for electricity have increased by 2.5% annually over the past 20 years [3]. Besides, the global climate change and greenhouse gas emissions on the Earth caused by the electricity and transportation industries [4] put more stress on the existing power grids. Consequently, a new concept of next‐generation electric power system is urgently needed to address these challenges, which motivates the proposal of smart grid (SG).
\nThe SG can be viewed as a superposition of communication networks on the electric grids. Hence, it can improve efficiency, reliability, safety, and security of electricity supply to the customers, with a seamless integration of renewable and alternative energy sources, such as photovoltaic systems, wind energy, biomass power generation, tidal power, small hydropower plants, and plug‐in hybrid electric vehicles, through automated control and modern communications technologies [5]. In SG, various components in these four areas of the electric grid are linked together via two‐way communications and power flows to provide interoperability among them. Thus, consumers can not only draw power but also supply surplus power to the grid using smart meters that enable monitoring and measuring of these bidirectional flows. This new infrastructure could potentially produce millions of alternate micro‐energy sources and allow improved load balancing through instantaneous electricity demand information exchanges, which could help power plants match their output to demand with the help of information generated from metering, sensing, and monitoring.
\nTo realize the SG, an advanced metering infrastructure (AMI) based on smart meters is the most important key. The AMI is the system that collects and analyzes data from smart meters using two‐way communications, and giving intelligent management of various power‐related applications and services based on that data. The AMI is the deployment of a metering solution with two‐way communications to the electric meter. The implementation of AMI is widely seen as the first step in the digitalization of the electric grid control systems. Recently, AMI has gained great attraction in both industry and commerce due to the accurate improvement in online meter reading and control. The AMI is the architecture for automated two‐way communications between smart utility meters and utility companies. The AMI includes smart meters, e.g., electric, gas, and heat meters, at customer premises, access points, communication backbone network between customer and service providers, and data management systems to measure, collect, manage, and analyze the data for further processing. The smart meter can identify power consumption in much more detail than a conventional meter and periodically send the collected information back to the utility company for load monitoring and billing purposes. Besides, the data from smart meter readings are also critical for the control center to implement Demand/Response mechanism. By using smart meters, customers can control their power consumption and manage how much power they are using, particularly managing the peak load. Hence, through customer participation, the utility companies can likely provide electricity at lower and even rates for all their customers, and the consequent carbon dioxide emission will decrease. Despite the increase in the utilization of AMI, there has been very little assessment or research and development effort to identify the security needs for such systems. Hence, the aim of this chapter is to offer a comprehensive description about AMI based on smart meters in SG. In addition, the issues on security, major challenges, and solutions in AMI in SG are also proposed.
\nSmart meter is an advanced energy meter that supports two‐way communications compared with a conventional energy meter. Hence, it can measure the energy consumption data of a consumer and then transmits added information to the utility companies to support decentralized generation sources and energy storage devices, and bill the customer accordingly. Besides, smart meters can receive information about electricity price and commands from utility companies and then deliver them to consumers. In practice, smart meters can read energy consumption information of customers in real time, such as values of voltage, frequency, and phase angle, and then they securely communicate the information to control centers. By using bidirectional communication of data, smart meters can collect information regarding the electricity consumption values of customer premises. Data collected by smart meters is a combination of parameters such as a unique meter identifier, timestamp of the data, and the electricity consumption values. Based on the information, smart meters can monitor and execute control commands for all home devices and appliances at the customer\'s premises remotely as well as locally. Besides, smart meters can communicate with other meters in their reach using home area network (HAN) to collect diagnostic information about appliances at the customer as well as the distribution grid. Moreover, smart meters can be programmed such that, only power consumed from the utility grid is billed whereas the power consumed from the distributed generation sources or storage devices owned by the customers is not billed. As a result, they can limit the maximum electricity consumption, and can terminate or reconnect electricity supply to any customer remotely [6]. Figure 2 shows an architectural model of a conventional energy meter and a smart meter.
\nArchitectural model of conventional energy meter and smart meter.
A smart meter system includes various control devices and sensors to identify parameters and situations in SG and then it transfers the collected data to the control center or provides command signals to the devices in the home of customers. The collected electricity consumption data from all devices of customers on a regular basis helps the utility companies to manage electricity demand/response more efficiently and also to provide useful information to the customers about the cost‐efficient methods to use their appliances. Besides, smart meters can be programmed to maintain a schedule for operation of the home devices and control operation of other appliances accordingly, i.e., to control light, heat up water in swimming pool, air conditioning, washing machine, and other appliances [7]. In addition, by integrating smart meters in electricity grid, utility companies can detect and identify electricity theft and unauthorized consumption in view of improving the power quality and distribution efficiency [8]. Hence, smart meters would play an extremely important role in monitoring the performance and the energy usage characteristics of the load on the electricity distribution grid in the future.
\nTypically, smart meters implement two major functions, which are communication and measurement [9]. Hence, each meter is equipped with two subsystems as communication and metrology, respectively. The communication part includes security and encryption that define the suitable data transmission approach. The metrology varies depending on multiple characters such as measured phenomenon, technical requirements, region, accuracy, applications, and level of data security. Regardless of the type or quantity of their measurement, smart meters should have six basic functionalities as mentioned [10], which include the following:\n
As a result, based on smart meters, utility companies can provide highly reliable, readily accessible, flexible, and cost‐effective energy services to their consumers by combining advantages of both small distributed power generators and large centralized generators. Moreover, demand side management techniques require that these companies have to collect large quantity of data from smart meters in real time. One of key components to implement this concept is advanced metering infrastructure, which collects and analyzes data from smart meters, and gives intelligent management of various power‐related applications and services based on that data. In next section, we present AMI based on smart meters.
\nAMI is a main mechanism for the realization of other smart grid applications to deliver operational and business benefits across the utility. AMI is the system that collects and analyzes data from smart meters using two‐way communications between user domain and utility domain, and gives intelligent management of various power‐related applications and services based on that data. The implementation of AMI is widely seen as the first step in the digitalization of the electric grid control systems. AMI\'s main functionalities encompass power measurement facilities, assisting adaptive power pricing and demand side management, providing self‐healing ability, and interfaces for other systems. Recently, AMI has gained great attraction in both industry and academia due to the accurate improvement in online meter reading and control. AMI helps for financial benefits, improved services, and opportunities for consideration of environmental concerns.
\nAMI overview architecture.
The AMI includes smart meters, e.g., electric, gas, and heat meters, at customer premises, access points, communication backbone networks between customers and service providers, and data management systems to measure, collect, manage, and analyze the data for further processes. These AMI components are usually located in various networks [11] and different realms such as public and private ones [12]. In AMI systems, smart meters are regarded as the key interfaces for physical, information, and social domains of the smart grid. Figure 3\n shows AMI overview architecture that is integrated in a broader context of power generation, transmission, distribution, and customer using HAN, neighborhood area network (NAN), and wide area network (WAN).
\nFrom this figure, we can see that the smart meter is a key device for consumers because it is responsible for monitoring and recording power consumption of home appliances. HAN provides connections between home appliances, other integrated systems such as rooftop photovoltaic system, distributed sensors, plug‐in electric vehicle/plug‐in hybrid electric vehicle, in‐home display (IHD), smart thermostat, etc., and the smart meter. For communicating among these constituents, power line communications (PLCs) or wireless communications, such as ZigBee, 6LowPAN, Z‐wave, and others can be utilized. NAN provides communication links between a number of individual smart meters and a data concentrator using WiMAX or cellular technologies. A number of data concentrators are connected to a central system (it also is called an AMI headend) in the utility side through WAN. Typically, WAN consists of two interconnected networks, i.e., the core networks and backhaul networks. The core networks provide connections to the control center and commonly use fiber optics or cellular networks to guarantee high data rates and low latency. The backhaul networks handle the broadband connections to NANs and monitoring devices. Applying cognitive radio (CR) technology in backhaul networks contributes to reducing the cost for investment and enhancing the flexibility, capacity, and coverage. Typically, the AMI headend, which is located in the utility side, includes geographic information system (GIS), configuration system, meter data management system (MDMS), etc. These subsystems can utilize a local area network (LAN) for intercommunication. In the next section, we present detail in AMI communications infrastructure.
\nIn AMI, the smart meter can identify power consumption in much more detail than a conventional meter and periodically send the collected information back to the utility company for load monitoring and billing purposes. In addition, the data from smart meter readings are also critical for the control center to implement demand response mechanisms. Using smart meters, customers can control their power consumption and manage how much power they are using, particularly managing the peak load. Hence, through customer participation, the utility companies can likely provide electricity at a lower rate for all their customers, and the consequent carbon dioxide emission will be decreased. Typically, existing AMIs collect data from smart meters and sensors with intervals of 15 min, the collected data are huge and important, and it is estimated that a moderately sized city with 2 million homes could generate 22 GB of meter data every day [13], and is referred to as “Big Data,” easily overwhelming best planned data center capacity in a fairly short time. In particularly, MDMS with the analytical tools is considered the central module of the management system. Besides, MDMS has to ensure complete and accurate Big Data from customer to the management modules under possible interruptions at lower layers by performing validation, estimation and editing on the AMI data. Moreover, the distribution network automation system, which collects up to 30 samples per second per sensor for real‐time control of SG [14], third‐party systems, such as storages or distributed energy resources, connected to the grid, and asset management system responsible for communication among central command are also sources created Big Data in SG. As a result, the communication backbone networks should be reliable, secure, scalable, and cost‐effective enough to meet the requirements in terms of bandwidth and latency to communicate the data.
\nIn [15], by deploying an AMI, reliability, operational efficiency, and customer satisfaction can be achieved. This chapter also suggested several additional benefits gained in the AMI, such as managing power quality and asset management to improve service of the utility company. However, a robust communication backbone for the AMI data transmissions was not provided in the chapter. In particular, the AMI communication models include thousands of smart meters, multiple access points, and a mesh network, which is formed between smart meters for data routing purposes using industrial, scientific, and medical (ISM) frequency bands. Meanwhile, the aggregated data are routed to the utility company by access points mostly using licensed bands. The reliability and security of data communications between AMI components suffer from crowded and noisy ISM bands in urban areas. Packet losses, performance degradation, latency, and signal interferences are some of the consequences of heterogeneous spectrum characteristics of the crowded wireless communications. Moreover, the use of licensed bands to communicate the data between access points and utility companies requiring extra costs, which is another obstacle to deploy AMI in SG. Consequently, providing a robust communication backbone is sometimes hardly achievable, and it also comes with some obstacles for implementation of AMI in SG.
\nSeveral works investigated integrated communication technologies for the communication backbone of AMI. For example, mesh, Ethernet, and cellular AMI network topologies for SG have been proposed in [16–18]. In [16], the authors proposed mesh networks with a transmission architecture based on ZigBee, because the ZigBee protocol was integrated into smart meters by many AMI vendors, such as Itron, Elster, and Landis Gyr. The operation of ZigBee under an unlicensed spectrum makes it easy to implement network, being a standardized protocol based on the IEEE 802.15.4 standard. Nevertheless, ZigBee also has its own disadvantages, i.e., the transmission distance is limited, the rate of data transmission is low, and the capability to penetrate the barriers is weak due to non‐line‐of‐sight transmission. Moreover, ZigBee may cause interferences to other appliances, which operate in the identical 2.4 GHz ISM frequency band, such as IEEE 802.11 wireless local area networks (WLANs), WiFi, Bluetooth, and Microwave. Inefficiencies of AMI based on ZigBee will arise when transmission distances increase. High levels of internetwork coordination are necessary in the deployment of new mesh networks. Improved alternatives of AMI mesh networks utilize IEEE 802.11 (a, b, g, n) protocols. However, such networks only support transmission distances ranging from 50 to 200 m, which is also problematic for robust metropolitan area coverage. To increase the transmission distances in the metropolitan areas and security of data communications between AMI components, in [17], the authors discussed communication infrastructure based on Ethernet. The proposed method can support automated meter readings, customer home appliance connections, distribution automation, and substation automation. However, AMI based on Ethernet is not always affordable. In addition, the wireline systems can be challenging to rapid redeployment, particularly in emergency situations. To overcome this problem, the authors in [18] proposed a framework for Radio frequency (RF) mesh networking interfaced with high‐speed access networks such as WiMAX. In the framework, the AMI smart meters are capable of two‐way communications over a 900 MHz wireless mesh network back to a collection point at the substation. A private high‐speed access network, which typically can be fiber or an existing cellular network such as WiMAX, will be then utilized to connect the substation to the corporate network. However, the AMI network topology based on cellular network or fiber for SG brings in extra costs to the utility companies and customers. Especially, the AMI interfaces for future proprietary protocols were not proposed in the framework. Ideally, AMI interfaces should be upgraded via software without hardware modifications to save time and cost.
\nAMI security is required to protect both communication networks and power grid, because these two systems need to ensure their availability of access as well as survivability in different scenarios. However, the security of communication networks and power grid differ in several ways. In a communication network, latency needs to be limited and bandwidth needs to be guaranteed, whereas data manipulation (placement of false data), destruction of data, and unauthorized access should be prevented. On the other hand, security of a power grid needs to ensure reliability, power quality, and stability. Despite these differences, security between the two systems must be coordinated because the power grid and communication network can be used to launch attacks against each other. For instance, because the power supply in SG will be controlled by instantaneous users, information, manipulation of usage data could create a fictitious grid imbalance leading to voltage variations that can create large‐scale failures. Similarly, if the state information of the grid is poisoned, the grid could be de‐stabilized with a potential for physical damage. Physical damage could occur through overheating of transformers and relays or through voltage fluctuations in appliances. Due to the critical role of AMI in the SG, AMI security is special importance for the security of the SG. Given importance in AMI security, in [19] the authors discuss the security issue from two major aspects: maintaining the privacy of consumer\'s information and resilience of system against cyber or external attacks. Besides, the authors in [20] propose security in AMI using key management scheme for communication system. We can summarize these aspects as follows.
\nIn AMI, smart meters are capable of collecting information of customers in every 15 min. However, current technologies even allow for collecting the data with intervals of minute [21]. Hence, if attackers analyze the data, they can achieve “consumer profiling” with an alarmingly high accuracy, for example, they know how many people live in the house, type of devices, duration of occupancy, ability of security and alarming systems. The profiling allows the attackers to extract behavior of customers without the need of using computer‐aided tools or sophisticated algorithms. The authors in [21] have shown that they can identify the use of major devices in a house of customer by analyzing cumulative energy consumption data from the smart meter with a 15 min interval. Molina‐Markham et al
To discuss the importance of privacy, it is necessary to consider electrical behavior of an appliance while it is operating, which is defined as load signature (LS) because each appliance has different measurable behaviors. For example, consumption behavior of each electrical appliance is a signature, which could be measured at meter point. Typical variables are current, voltage, and power or energy. To protect the customers’ privacy, a common method is to make it impossible for unauthorized parties to differentiate between load patterns and signatures. The authors in [23] proposed “load signature moderation” technique to facilitate customers’ privacy protection by reshaping the overall pattern of data to make differentiating between load patterns and signatures impossible. This technique combines three methods, which are smoothing, hiding, and mystifying consumption, utilizing cooperation of grid and storage/battery as power source. The method is also defined as “undetectability” in [24].
\nThe AMI‐Sec Task Force, which is formed by security domain experts, industry leaders and standards bodies, developed the requirements for AMI security [25]. It provides guidance and security controls to organizations developing or implementing AMI solutions. According to the report in [25], security requirements for AMI system include confidentiality, integrity, and availability (or resilience to DoS attacks). Hence, the security for AMI system should satisfy the requirements as follows:\n
Based on the security requirements for AMI system was mentioned, security in AMI is very complex. Hence, just a single solution is insufficient for securing AMI. The authors in [22] present the threats to the security in AMI and then they propose some technologies as well as policies to improve the system\'s security.
\nA typical AMI involves smart meters, HAN, NAN, WAN, and MDMS. For secure communication between these entities, confidentiality, integrity, and authentication should be guaranteed in the first place. Meanwhile, availability is also a critical requirement that should be fulfilled due to the high availability of electrical power. Besides, the AMI system must implement intelligent applications, such as dynamic electricity pricing, demand response, and real‐time measuring/monitoring. Hence, AMI should be able to support different communication types (i.e., unicast, multicast and broadcast communications) for both customers and the utility companies to propagate information between the utility and smart meters [26]. Measured data are usually unicast communication from smart meters to the utility companies. Meanwhile, electricity pricing information is communicated multicast or broadcast from the utility to smart meters. Demand response program information is transmitted broadcast to all customers. As a result, by using the key management scheme for the AMI system, unicast, multicast, and broadcast communications should be able to securely and efficiently deliver [20].
\nTo meet the security requirements for AMI, an underlying key management scheme is needed to generate and update keys for secure message transmission and authentication. Unfortunately, existing key management schemes designed for IT systems are simply inapplicable for AMI infrastructure in SG due to the reasons as follows:\n
AMI is a complex heterogeneous system, which includes various entities with different computing ability, storage, and communication capability. In AMI, the smart meters are typical resource‐constrained appliances, which have limited computation and storage capability. Meanwhile, the MDMS has high computing ability and plenty of storage resources. Hence, AMI utilizes the key management scheme, which not only achieves the security requirements of the system, but also accommodates this imbalance in its existing resources.
Typically, AMI in SG is built based on combining IT systems with electric power system. Thus, problems of AMI are unique that are not encountered in traditional electric power system as well as IT systems. For example, electric power service demands the high availability, which is the same high availability of the security schemes in IT systems. The availability of electric power service and IT systems is considered as DoS attacks. As a result, the key management scheme must been designed with mechanisms to protect against DoS attacks. Additionally, the key management scheme has ability to support various modes of data transmission used in AMI.
Because AMI may consist of a huge number of smart meters. Hence, the key management protocol has to open with scalable ability for such a big system.
Currently, in [26, 27], the authors propose key management schemes in AMI for SG. However, these schemes cannot completely satisfy the above requirements of security. For example, the authors in [26] present a new key management scheme for AMI, but this method is vulnerable to DoS attacks and inefficient in key management for a big system. In [27], the authors propose the key management scheme using physically unclonable functions to guarantee the security requirements of the system; however, the method is designed without open protocol with scalable ability for the big size of AMI. To overcome these problems, a hybrid key management scheme for AMI is proposed in [20] by integrating public key cryptosystem with symmetric cryptosystem. In this hybrid scheme, the elliptic curve cryptosystems are utilized to achieve efficient session key generation and trusted authentication. Besides, to generate and update group keys efficiently, the authors employ a specially designed key hierarchy.
\nBased on the security requirements of AMI, the system structure, and required availability, a key security technology using trusted computing methodologies and public key infrastructure (PKI) is proposed in [28]. By combining PKI technologies with trusted computing elements, the method is the most desirable solution for SG security as well as AMI. However, the method is complex, especially in the big system. To reduce the complexity of the method, the authors propose a technology utilizing the four major technical elements, namely automated trust anchor security, PKI standards, SG PKI tools, and certificate attributes. In [29], the authors complement a novel technical element to reduce the complexity of PKI security, which is device attestation. The proposed method includes the PKI elements into the overall security architecture to achieve a cost‐effective and comprehensive solution for AMI security in SG. Besides, the trusted computing elements are utilized to guarantee that a malware cannot to access to the software processing devices. The main functionality of trusted computing is to allow any devices, which want to join a grid network, to verify that authorized code runs on that system. The adoption of strict code signing standards by SG suppliers and operators was also suggested in [28]. Mechanisms for enforcing such standards have been put forward by the Trusted Computing Group and have been also well documented and available in the literature. The works in the literature concluded that security solution in SG requires a holistic method, which combines trusted computing techniques with PKI technologies based on industry standards. In the holistic method, PKI technical elements, such as trust anchor security, attribute certificates, and certificate lifecycle management tools, are the existing technologies tailored specifically to result in an optimal solution for SG networks. To achieve the optimal solution for secure SG networks, the primary step should be taken is to propose a cohesive set of standards and requirements for AMI security.
\nThe authors in [29] articulated the security threats to transmission and distribution (T&D) automation systems. They mentioned that vulnerabilities in power T&D automation systems exist at multiple levels, including components, protocols, and networks. An attack process involves three steps: access, discovery, and control. First, the attacker gains access to the SCADA system through a connection with the corporate network or through a virtual private network (VPN). Subsequently, the attacker studies the behaviors of the system and finally launches an attack. The authors pointed out that the current security solutions are focused mainly on information technology (IT) but not on control systems, and that there are different needs for them, making IT security solutions ineffective. They suggested to decouple the controls from security in order to make it accessible for legacy systems that do not have inherent security. Their work is mainly a conjecture without clear evidence or comparison with other approaches.
\nSuch a complex system undoubtedly presents many challenges. In this section, the challenges and solutions in AMI are identified in two domains including security and communications between networks.
\nIn AMI security, the primary challenge stems from the high‐level dependence between grid components, such that seemingly independent random events can aggregated to yield large‐scale catastrophic failures in the grid. High complexity in AMI increases the probability of flaws, and unintended access points increase the possibility of attacks induced failure, especially in an adversary model, in which attacks are readily replicated, thus propagating the failures. In addition, new entities, such as electric vehicles and DER, are expected to be incorporated in the grids. However, researches on security raised up by the incorporations have received very limited attention. Hence, it is very difficult to identify and address the new failure modes in such systems before they become large‐scale problems.
\nWe understand the threats to the communication networks of AMI and power grids, and we understand to some extent how the threats associated with the SG communication infrastructure impact on the power grid. However, it is unclear how the threats in the power grids can affect the communication networks of AMI.
\nThe most serious challenge comes from the ubiquitous connectivity in the equipment, software, and controls in AMI. Network‐based threats may propagate quickly to overwhelm the whole network of AMI. In addition, the universal connectivity and multiple access points make AMI more vulnerable to attacks (such as DoS). We need to rely on automated detection schemes to respond to network‐based threats.
\nTypically, DoS is one of the most dangerous attacks against AMI. If such attack cannot be detected and quarantined early enough, it will risk the failure of the functionality in most critical infrastructure and threaten AMI. Hence, we need new methods for risk assessment based on prior knowledge in order not to introduce further delays in the overall system. Besides, in case that an attack cannot be identified and prevented, appropriate intrusion recovery techniques must be implemented to remedy the consequences of the attack on the critical infrastructure of AMI.
\nToday, the majority of key management schemes were proposed only for secure communications within the SG, to address the issues on key establishment for the communicating entities within SCADA systems to protect critical messages, such as near‐real‐time information, pricing signals, and feedback data regarding energy consumption of customers. In fact, very few studies have been carried out on key management schemes for the AMI. Hence, in the future, researchers should focus on the proposal of novel key management techniques specifically designed for the AMI.
\nIt is important to develop a risk/security analysis process that can autonomously detect faults to limit the damages to communications of AM. In addition to the analysis of causes and effects of different threats on the electric grid, we need to establish comprehensive failure scenarios that include the impacts of multiple threats simultaneously. The risks include those associated with interactions among cyberspace and physical systems. It will not be possible to consider all possible combinations of threats. Consequently, an automated test system of taking into account different failures (attacks) in both cyberspace and physical systems will be an important additional source for mapping all of the threats and studying their behaviors. Contingency analysis is already performed for analyzing the stability of AMI. However, that will need to be expanded to incorporate the risks due to threats coming from various communication networks in AMI. More precise detection techniques that use multiple factors for accurately predicting threats will need to be devised to reduce false‐alarm probability. Based on the previous risk analysis, the algorithms can autonomously detect the faults in AMI to limit the damages caused by degraded security performance.
\nOn the other hand, international security standards and legislations are also needed for communications in AMI. Currently, there are numerous independent efforts to develop security standards and legislations. Security standards being developed need to be future‐proof, considering futuristic applications, operations, and energy markets. Standard test scenarios need to be developed for the researchers developing the algorithms, as well as for equipment manufacturers for detecting security attacks and failure scenarios at the interfaces between power grid and communication networks of AMI. Moreover, we should establish standardized testing requirements for the security in all applications and protocols of AMI. It is also essential to create auditing requirements to ensure compliance with security legislations for utilities, equipment manufacturers, and generators for local, national, and regional regulatory bodies.
\nThe use of quantum key distribution (QKD) can help improve the security of communications in an AMI. Quantum communication is an emerging technology with potential applications to the power grids. QKD has been proposed as an approach to improve the security of communications between the power grids, and it could be implemented over existing fiber‐optic channels and free‐space optical communication links, within generation systems and power distribution networks. Quantum communication employs a fundamentally different technique from most of traditional communicationtechnologies, and it works based on the physics of entangled quantum states as a fundamental resource. The classical cyber security techniques depend on physical protection of communication channels, and they need complex computational techniques to encrypt transmitted data and protect its confidentiality. The observation of quantum communication measurements fundamentally disturbs the system, alerting the receiver for the changes in the channel. QKD has rapidly matured and is now providing commercial applications by several companies around the world. Researchers are exploring its applications in more challenging and interesting scenarios, including AMI. One potential usage in AMI is quantum location verification. Because today\'s power system components tend to be stationary, quantum communication techniques could potentially be used to improve the security with regard to the identification of the location of a smart meter. This adds another level of security by ensuring that a smart meter placed at a fixed location in the power grid is truly at that location and is not being spoofed. There are potentially many other applications of quantum communication techniques that might become useful to ensure the security in AMI [1].
\nCross‐layer design for attacks detection in communications of AMI based on CR technology is another new research topic. To realize a secure communications of AMI based on CR, security should prevail every other aspects of the whole system design, and be integrated into every system component. AMI security includes the protection of both communication networks and power grids to ensure availability and survivability. The detection techniques based on higher layer introduce an overhead in the network, which could potentially affect timely delivery of critical messages in the SG, resulting in instabilities. Thus, our earlier work proposed a cross‐layer design for primary user emulation attacks detection without burdening the networks with extra overhead [30]. In this work, to completely identify primary user emulation attacks and primary users (PU) at PHY layer over multipath Rayleigh fading channels in mobile CR networks, cross‐layer intelligent learning capability of secondary user (SU) was exploited to establish radio‐frequency fingerprint (i.e., channel‐tap power) databases by combining the accuracy and capability of higher layer authentication [31] with a quick detection algorithm on PHY layer [32].
\nDepending on the characteristics of HAN, NAN, and WAN, different communication technologies are utilized efficiently. For example, in a small area as customers’ home, HANs use ZigBee, Bluetooth, or PLC to communicate data between devices. Besides, WiMAX, or WiFi is utilized to build NAN based on wireless mesh topology, and fiber optics or broadband cellular networks are adopted for WANs. However, these traditional communication methods bear the high costs for investment, operation, and maintenance, which are incapable of meeting the requirements and challenges in SG. It has been recognized that CR is a promising technology to construct a more advanced communication infrastructure for SG. By using dynamic spectrum access technique, CR networks solve the problem of scarce spectrum and poor allocation of traditional spectrum policies, and support increasing demand for applications based on wireless communications in SG [33]. In [34], the authors propose the use of CR technology to address the communication requirements, standardization, and security problems of SG communications. There are many benefits brought in by introducing CR into SG. In [35], by using CR technology, it can support energy‐ and spectrum‐efficient designs, as well as avoiding interference and adapting the data throughput, i.e., CR communication over license‐free bands is employed in the HANs to coordinate heterogeneous wireless technologies, whereas CR communications over licensed bands is employed in the NANs and WAN to dynamically access unoccupied spectrum opportunities [36].
\nMoreover, to address aforementioned problems in AMI communications infrastructure (Section 3.2), CR technology can be suitable for AMI communication system. In [37], the authors proposed to enhance a routing protocol for low power and lossy networks (RPL) for CR‐enabled AMI networks, i.e., CORPL [38]. This protocol provides novel modifications to RPL to address the routing challenges in CR environments, such as reliable and low latency data delivery, along with protecting the PUs and meeting the requirements of secondary networks. Results show that CORPL improves the reliability of the network while reducing harmful interferences to PUs by up to 50%, as well as reducing the deadline violation probability for delay sensitive traffic. The authors in [39] proposed to use a cloud computing data center as a central communication and optimization infrastructure supporting a CR network of AMI smart meters that is called netbook advance metering infrastructure (Net‐AMI). The proposed system is extensible and can easily handle thousands of variations in power systems, communication protocols, control, and energy optimization protocols. By placing new CR antennas on existing cellular antenna towers, vast geographical coverage can be achieved. Moreover, remote software upgrades allow modifications of existing networks components, AMI interfaces, and Net‐AMI smart meters in a flexible and amorphous manner using CR technology. In [40], the authors modeled the AMI as a SU in CR‐based SG systems based on the IEEE802.22 wireless regional area network (WRAN) [41], which supports the unlicensed operation of SUs with spectrum sensing technologies in VHF/UHF TV broadcast bands from 54 to 862 MHz. The authors also investigated a beam‐forming method based on minimum mean squared error (MMSE) to suppress self‐interferences in smart meter channels. In [42], the authors proposed a CR‐based SG using wireless access communication of line and substation monitoring system addressing the system implementation issues, such as communication efficiency and energy supply in AMI.
\nAs part of the end‐user facilities, AMIs can also be efficiently realized with the help of CR technology. For example, by using CR technology, AMI can self‐configure and deploy in coexisting wireless networks at various customer premises easily. Based on the spectrum‐aware capability of CR, smart meters and equipment in AMI can be easily deployed at the remote sides to achieve reliable and seamless communications between AMIs and the control center of utility company. The cognitive sensor network (CSN) nodes designed with consideration of energy and price limitations in remote monitoring can be the main components for efficient realization of wireless AMI.
\nHowever, when we apply CR technology in communications of AMI, we have to face some challenges.
\nThe challenges to implement communications between CR‐based HANs and NANs can be identified as follows.\n
The challenges to implement communications between cognitive NANs and WANs are identified in the sequel.\n
In order to facilitate the communications between cognitive HANs and NANs, we suggest to use the following techniques.\n
To ensure reliable and scalable communications between cognitive NANs and WANs, we identify the approaches as listed in the sequel.\n
AMI based on smart meters in SG has been identified, and their state‐of‐the‐art research activities were reviewed. In addition, the issues on security of AMI in SG have also been discussed. Future SG should comprise intelligent monitoring systems to keep a track of all electricity flows and a huge amount of collected data from smart devices as well. Hence, it must be flexible and resilient to accommodate new requirements in an economical manner. To achieve these goals, communications in AMI based on CR will certainly play an important role for infrastructures of the SG. Moreover, by using AMI, SG can support real‐time traffic delivery with stringent the quality of service requirements of real‐time applications. The major challenges on evolutional path toward SG and solutions are also identified in this chapter. With AMI, SG should preserve its interoperable and secured communications within a hybrid system where both new and legacy grids coexist. Therefore, AMI in SG should be built up on open protocols with a common notion of security and standard. Besides, advanced research topics, such as artificial neuron network and Fuzzy theory, can also apply to the intelligent monitoring systems to improve the ability of AMI. Moreover, accurate state estimation methods need to propose in the future to detect blind false data injection attacks because accurate state estimation is of paramount importance to maintain normal operations of AMI. Typically, a bad data detection system is used to ensure the integrity of state estimation and to filter faulty measurements introduced by device malfunctions or malicious attacks. However, in [44], we prove that blind false data injection attacks using the principal component analysis approximation method without the knowledge of Jacobian matrix and the assumption regarding the distribution of state variables can bypass the bad data detection system to inject fault data in the system. In the future, the architecture of AMI not only aims at seamless integration of various existing smart metering products, but also other software systems used by power utilities (i.e., outage, energy and distribution management systems, etc.). Hence, new solutions aim at enabling flexible integration of metering devices and their grouping in form of
Structural racism affects individuals and communities across the life course. For older Americans, inequities in health access, quality, and outcomes caused by racism and systemic barriers in the United States can be exacerbated in later life in a variety of domains including physical and cognitive health, mortality rates, and quality of care. Systems for care in later life include long-term care facilities (LTCFs) such as nursing homes and assisted living/residential care communities. Paired with the demographic trend of increasing proportions of older adults from historically minority racial and ethnic groups [1] is a growing utilization of LTCFs by people of color [2]. Unfortunately, older adults of color in the United States experience disparities in access to quality nursing homes; access to care in assisted living communities; quality of care and quality of life in LTCFs; health outcomes as LTCF residents; and social engagement within LTCFs. These disparities are associated with a variety of structural factors (e.g., federal and state policy related to LTCF funding and oversight, housing policies that have created racially segregated communities, and workforce practices that lead to income and wealth disparities). The growing number of people of color in LTCFs and persistent disparities within them creates an urgency to address racial and ethnic inequities in quality of care and quality of life for older adults of color living in LTCFs.
Older adults who experience chronic limitations in physical and cognitive functioning may need long-term services and supports. Long-term care encompasses a range of services and supports that assists individuals in completing activities such as dressing, preparing meals, medication management, and housework [3]. Most long-term care is provided at home by family caregivers [4]; however, long-term care is also available in long-term care facilities (LTCFs). The need for long-term services and supports increases as individuals age, as does the likelihood of not having the assistance of a spouse who can provide informal care. For this reason, and due to the aging of the population in the United States, a growing number of older adults are utilizing LTCFs [3, 5].
In the United States, the majority of the funding for long-term services and supports comes from public sources, but many people privately pay or use private long-term care insurance [6, 7]. Medicaid, a means-tested program, is the primary funder of care in LTCFs. The federal and state governments jointly fund Medicaid, but it is administered by the states. Each state sets its own eligibility requirements for Medicaid, which include income and resource limits. In contrast, Medicare is administered at the federal level, and eligibility requirements are tied to eligibility for Social Security or Railroad Retirement benefits [8].
Nursing homes are residential communities that provide a higher level of care than can often be provided at home or through other community-based services. Nursing homes may also provide health care services such as physical or occupational therapy to help patients recover from illnesses or injuries. The median monthly U.S. nursing home cost in 2020 was $8,821 for a private room and $7,756 for a semi-private room [9]. Most nursing home residents pay for long-term nursing home care with Medicaid, with Medicare paying for more short-term post-acute nursing care in skilled nursing facilities [10].
Private nursing homes became common in the United States beginning in the late 1930s, after the Social Security Act of 1935 prohibited older adults who lived in public alms houses from receiving Old Age Assistance [11]. Wealthier White older adults were able to afford private nursing home care; however, this option was financially inaccessible for poorer White people and poorer people of color [12]. Public funding for nursing home care was not available until the 1950s [13]. These policy decisions created financial barriers for people of color, particularly African Americans, to access nursing home care.
In contrast to the past, today older adults of color are overrepresented in the nursing home population, representing approximately 25% of nursing home residents [2, 10]. The trend for increasing portions of residents of color in nursing homes seems to be driven in part by White older adults disproportionately accessing more appealing alternatives to nursing homes that are funded by Medicaid waivers for Home and Community-Based Services [2] and privately paying for care in assisted living communities [14]. At the same time that an increasing percentage of people of color are using nursing homes, there have been increased closures of nursing homes across the country, with closures concentrated in disadvantaged communities of color [2].
Nursing homes tend to be quite segregated by race and ethnicity [15], a phenomenon related to past structural racism. Policies such as the 1946 Hill-Burton Act (which funded construction of “separate but equal” nursing homes) and southern Jim Crow laws combined with discriminatory practices in hospital discharge planning and nursing home admissions to create and maintain segregated nursing home systems [12, 16, 17]. In the 1960s, the Johnson administration failed to use provisions of the Civil Rights Act to desegregate nursing homes and prohibit discrimination in nursing home practices [12, 17, 18]. Housing policies such as redlining created and perpetuated racial segregation of neighborhoods which in turn supported racial segregation of nursing homes, as nursing home residents tend to come from their surrounding communities [15].
Assisted living or similar residential care communities are another type of LTCF. They serve older adults who cannot live alone safely, but do not need the level of care provided at nursing homes. They offer personal care and household assistance to residents in a homelike environment. Assisted living and residential care communities can range from small homes with a few residents to large communities of private apartments in large residential settings, which tend to be chain-affiliated and owned by for-profit companies. These communities generally provide communal meals and opportunities for socialization and physical activities in addition to personal care services. Assisted living communities tend to be in urban/suburban areas and communities characterized by high levels of education, income, and financial resources [2]. Licensing of assisted living/residential care communities is at the state level, with variations across the states.
Many Americans have a more favorable impression of assisted living than of nursing homes, and it the fastest growing model of residential long-term care [19]. The 2020 median monthly cost of assisted living care was $4,300 – substantially less than care in a nursing home [9] – but prohibitive for many to pay out of pocket. Medicaid only covers assisted living in states that have Medicaid waivers for Home and Community-Based Services that fund assisted living [20]. Although most states have these waivers, the coverage is low, and smaller and poorer states are less likely to adopt Medicaid waivers [21]. Furthermore, Medicaid eligibility, benefits, cost sharing requirements, and reimbursement rates vary by state [22], and evidence suggests that racial bias within a state is related to lower levels of Medicaid spending [23]. A few states do not provide any Medicaid funding for assisted living/residential care and in others, Medicaid covers personal care, but not room and board. In states that do fund assisted living with Medicaid, low reimbursement rates and the costs of administering Medicaid deter many assisted living providers from becoming Medicaid certified [24]. Indeed, less than half of the assisted living/residential care communities in the United States accept Medicaid [10]. As might be suggested by these systemic barriers, older adults of color are underrepresented in assisted living communities [10, 25].
The almost half-million older adults of color who currently live in U.S. LTCFs [3] face disparities along a variety of dimensions including health outcomes, quality of care, quality of life, and social integration compared to non-Hispanic White residents. Much of the evidence of racial and ethnic disparities in long-term care comes from nursing homes, which are federally mandated to provide detailed health outcome and demographic data for their residents. This evidence points to racial and ethnic disparities in health and quality of life outcomes, engagement with health services, and access to quality care.
In nursing homes, health outcome disparities are evidenced by findings that Black residents have a higher risk for developing pressure ulcers [26, 27] which can lead to serious medical complications, and are less likely to recover from pressure ulcers present when they are admitted [28]. There are ample examples of racial and ethnic disparities in engagement with health services and health care quality within LTCFs. Black residents have received less pain management [29], have been subject to more use of physical restraints [30], and are less likely to receive a flu vaccine [31] compared to White residents. Black residents and those categorized on medical records as coming from “other” racial groups (e.g., American Indian/Alaska Native; Native Hawaiian/Pacific Islander) were found to be less likely to have toileting plans for incontinence than White residents [29]. Depressive symptoms – which can have severe mental health consequences if depression is left untreated – seem to be underreported for Black, Latinx, and Asian nursing home residents [32].
Racial and ethnic disparities in quality of life outcomes such as cultural fit and social engagement have also been reported. For example, higher proportions of minority residents in nursing homes are associated with more quality of life deficiencies reported in the facility [33]. Chinese residents have reported a lack of culturally appropriate food, which related not only to their feelings of belonging and being valued, but also to receiving enough nutrition [34]. Compared to White residents, Black, Latinx, and other nursing home residents of color have scored lower on social engagement measures that include interacting with others, accepting invitations to group activities, being at ease in group/structured activities, and establishing their own social goals [35]. Indeed, nursing home residents of color have reported lower quality of life indicators than White residents across multiple domains, including personal attention, food, engagement within the facility and with staff, and mood [36].
Data regarding complaints received by the U.S. Long-Term Care Ombudsman Program extends our understanding of racial and ethnic disparities in LTCFs to include assisted living communities. The Long-Term Care Ombudsman Program is a federally mandated program administered at the state level that advocates for LTCF residents in both nursing homes and assisted living communities. Local ombudsmen conduct site visits, make referrals as needed, provide resident and public education, engage in policy advocacy, and receive and resolve complaints on behalf of residents. In their role as resident advocate, state Ombudsman Programs are well positioned to enhance our understanding of racial and ethnic disparities among LTCF residents. However, State Ombudsman Programs are not required to collect and report data about the race and ethnicity of the residents for whom they receive complaints; they are only required to report aggregate-level race and ethnicity data for the facilities under their purview.
A recent study of ombudsman complaints in the Dallas, TX, area collected race/ethnicity data associated with resident complaints in an examination of racial and ethnic differences in complaint types and resolution rates [37]. Residents of color were more likely than White residents to file complaints related to residents’ rights (i.e., abuse, access to information, autonomy, financial rights). Interestingly, complaints more likely to be resolved in nursing homes and assisted living communities with higher percentages of minority residents; however, this finding was related to the resolution of complaints from or on behalf of White residents living in those communities [37]. In focus groups, ombudsmen noted they had witnessed residents of color who refrained from making complaints about care compared to complaints about rights for fears of retaliation or being branded as a problem in the community. The ombudsmen also described ways in which LTCFs did not provide culturally appropriate environments for all residents (e.g., staff who could not communicate with residents in their language). Finally, the ombudsmen provided additional information about staffing ratios at Medicaid-certified facilities noting at times that only one aid would be available to care for a dozen residents needing aid.
As described earlier in this chapter, LTCFs tended to be racially segregated which relates to disparities in access to quality LTCF care. Many of the racial and ethnic disparities LTCF residents experience arise from differences between LTCFs that serve higher percentages of residents of color, particularly Black residents, and those that serve lower percentages [27, 33, 36]. LTCFs that serve higher percentages of residents of color tend to have fewer financial and community resources and insufficient staffing, with a correspondingly high number of care deficiencies, inadequate direct care, and low quality of care ratings [33, 38, 39, 40]. Economic factors play a major role in these differences. In general, LTCFs with higher concentrations of residents of color rely more on Medicaid funding than LTCFs serving predominantly White residents and are therefore more constrained by Medicaid’s lower reimbursement rates [33, 38, 39]. Indeed, the more Medicaid-reliant a nursing home is, the fewer resources it has to devote to resident-directed care and activities, improving the home environment, and other quality of life and quality of care related pursuits [41].
Although facility-level differences account for many of the racial and ethnic disparities among nursing home residents, disparities still exist within individual facilities such as in vaccination rates and quality of care [31, 42]. This can be attributed in part to an unconscious provider bias, which can lead to health care providers limiting the amount of information they share with residents of color and result in less patient-centered communication [43]. It can also be related to the fact that people of color tend to be admitted to nursing homes with worse health and greater care needs [44].
The COVID-19 pandemic ushered in a heightened awareness of structural racism and discrimination related to the provision of health care to older adults. Communities of color were disproportionately affected by COVID-19 infections, severe illness, and deaths [45]. The Centers for Disease Control and Prevention [46] reported that approximately 22% of the COVID-19 deaths in the United States in 2020 occurred in LTCFs. Prior to the pandemic about 63 percent of nursing homes had infection-control deficiencies [47]. Because older people of color were overrepresented in nursing home populations in general – and specifically more likely to reside in lower-quality nursing homes – this put them at an increased risk for contracting infectious diseases like COVID-19. Indeed, facility-level disparities quickly became apparent. In the early months of the pandemic in the United States,
To understand and address the effects of structural racism for LTCF residents, this chapter proposes a conceptual framework with elements from critical race theory, social determinants of health, and life course perspectives of inequity. Figure 1 presents a graphical image of this conceptual model for understanding the role of structural racism in racial and ethnic disparities among LTCF residents. In this framework, structural racism directly contributes to increased racial and ethnic inequities among LTCF residents through LTCF-related policies and practices. It is also the root cause of economic and health disparities, which in turn cause racial and ethnic disparities among LTCF residents.
Conceptual framework for understanding and addressing racial and ethnic inequities among long-term care facility residents.
The first tenet in our conceptual framework is that structural racism – the reinforcement of a racial hierarchy privileging “whiteness” and disadvantaging “color” through policy, systems, and institutional practices – is a direct cause of racial and ethnic inequities among LTCF residents. It is important to recognize that racism is so deeply embedded in the very fabric of U.S. society that the nation has, in a sense, become desensitized to it. Critical race theory responds to this need by shining a light on the role of race and structural racism in contemporary inequities [50].
To understand racial and ethnic disparities among LTCF residents, it is necessary to identify how structural racism directly affects their experiences. For example, the societal decisions to restrict public financing of LTCFs to Medicaid and to provide low levels of Medicaid reimbursement have created racial and ethnic disparities in access to quality LTCF care. Black, Latinx, American Indian/Alaska Native, and multiracial people are more likely to have Medicaid coverage or be dual eligible for Medicare and Medicaid [51]. As a result, LTCFs that rely on Medicaid funding tend to have higher portions of residents of color [52]. These more Medicaid-dependent LTCFs tend to provide poorer quality of care than those with more generous funding streams [27, 33, 36]. Policy decisions restricting Medicaid reimbursement rates are not color blind; low rates of Medicaid reimbursement are correlated with higher levels of racism within a state [23]. Another example of structural factors associated with inequities in health services engagement and health outcomes for LTCF residents is federal regulations that fail to specify racial equity in their oversight of residents’ quality of care and quality of life [53], in essence whitewashing the unique experiences and challenges of residents of color.
The second component of our conceptual framework relies on the Social Determinants of Health Framework. This framework recognizes that health is a social phenomenon across the life course, determined in part by social contexts and stratification [54]. When new residents are admitted into nursing homes, those from historically minority ethnic and racial groups tend to be younger, in poorer physical health with greater physical dependency, and have higher levels of cognitive impairment and care needs than newly admitted White residents [44]. These racial and ethnic disparities in health outcomes influence the level of care needs residents have once admitted and the quality of life they can experience.
Experiencing racism at the individual or personal level leads to worse physical and mental health outcomes for people of color [55]. However, the influence of racism systemically in the United States also leads to poorer health though its impact on economic stability, education, health care systems, and social and neighborhood environments [56]. The Social Determinants of Health Framework acknowledges that structural forces such as social policies, education and public health systems, social safety nets, politics, and societal values all affect health outcomes and health equity. Intermediary social determinants of health such as housing and neighborhood physical environment, financial resources, psychosocial stressors, and behavioral factors are caused by these structural factors.
There are abundant and interrelated examples of structural factors associated with the social determinants of health and racial and ethnic health disparities [56]. Access to quality health care in the United States requires insurance coverage or the financial means to pay for services. However, discriminatory hiring practices have disproportionately excluded people of color from higher paying jobs and jobs that provide health insurance. Furthermore, a confluence of policies and discriminatory practices from Jim Crow laws to the intentional exclusion of Black Americans from Social Security coverage in passage of the Social Security Act of 1935, as well as discriminatory hiring practices have resulted in economic inequities that span decades of unjust outcomes affecting generations of families [11, 56, 57]. Discriminatory practices in the criminal justice system and the War on Drugs have disproportionately targeted and incarcerated Black men [56], removing them from the paid workforce and economic opportunity. Income and wealth are important social determinants of health on their own and as factors associated with access to health care and healthy environments. Historical policies such as redlining and current discriminatory practices in rental and housing markets combined with economic disparities lead to racially segregated neighborhoods with communities of color being more likely to be placed near environmental health hazards or contain substandard housing [56, 58]. This also reduces opportunities for people of color to generate wealth through real estate [56]. The placement of health care services in predominantly White communities has made geographic access to health care difficult for people of color. Within health care systems, people of color experience both interpersonal and institutional racism resulting in worse care and disparities in engagement with health services [56].
The original model of Social Determinants of Health took pains to distinguish the social causes of health from unjust societal factors [54]. More recently, scholars have acknowledged the prominent role of structural racism in health outcomes [12, 56, 57]. Yearby [12] has reconfigured the original model to remove this distinction and place structural racism as a prominent root cause of racial health disparities [12]. In her reconfiguration, structural discrimination is the force that shapes aspects of social policy and systems of public health, neighborhood environments, education, and the economy. Our model for understanding and addressing racial and ethnic inequities among LTCF residents incorporates this perspective placing structural racism as an indirect effect on disparities in LTCFs by creating the conditions that result in poorer health for LTCF residents.
The third feature of our conceptual model relates to the economic inequities experienced by people of color across the life course [59, 60]. It has long been acknowledged that nursing homes that serve higher proportions of Medicaid-paying residents are more likely to serve Black residents and have poorer staffing ratios and more care deficiencies [38]. This is relevant to racial and ethnic disparities because, as discussed in Section 3.2, due to economic disparities in the United States, Black and Latinx residents are more likely than White residents to have limited financial means [59, 60]. Inequality in wealth and income makes people of color more likely to rely on Medicaid for LTCF funding. This inequality is caused by systemic barriers to higher paying jobs, professional networks, educational opportunities and ownership of valuable real estate. Economic inequities can also explain why White LTCF residents compared to residents of color are disproportionately opting out of care in nursing homes in favor of receiving care in assisting living [14]. Although the homelike setting of assisted living makes it appealing [61], the cost of assisted living and the need for private pay in many assisted living communities exclude people of color with limited savings.
The vast majority of LTCF residents are older adults. In nursing homes, most residents are age 75 or older and in assisted living/residential care communities, over half are at least 85 years old [10]. These older residents carry with them a lifetime of experiences, opportunities, and injustices. American-born residents who are 85 years old today grew up in the United States when racial discrimination was legal and codified in many state laws. Lynchings by White people targeted Black citizens in the south and Mexican nationals along the Texas-Mexico border [62]. Many older LTCF residents were in their 20s and 30s when the Civil Rights Act of 1964 was passed. Unequal opportunities and oppression of people of color continued throughout their lifetimes and persist today.
Taking a life course perspective on the accumulated effects of inequities adds perspective to disparities among LTCF residents. The Matthew effect explains that inequalities, once they occur, become a perpetual cycle, and in the absence of advocacy, widen the gap between the advantaged and disadvantaged [63]. The Matthew effect framework closely aligns with the theory of cumulative (dis) advantage/disadvantage [64], which has been used to examine inequities in a variety of domains including health, well-being, and aging [65, 66]. One approach to distinguishing the two frameworks is to consider the Matthew effect (or
Individuals who have experienced an accumulation of advantages early in life may find the concept of Matthew effects unsettling [63]. These very people may be overrepresented in positions of power such as policy-makers and LTCF chief executive officers as a result of their early advantages. In spite of this, it is necessary for individuals in the position to make meaningful change in LTCF disparities to recognize the accumulating effects of structural racism across the life course. Without policies or interventions in place to address the vicious cycle of compounding advantage and disadvantage, social inequities will widen [63].
There are myriad federal, state, and local policies that affect racial equity in LTCFs because the long-term care system is integrally connected to systems of – and structural racism within – housing, economic opportunity, and health care. In this section, we present federal and state policies directly related to LTCFs. Federal policy applies across all states and territories and is the prevailing law in terms of citizen rights when there are discrepancies between federal and state law. State laws can vary widely, and while state law can provide additional rights and protections to citizens beyond what is provided by federal law, it cannot reduce those rights.
There are broad prohibitions against racial discrimination within federal law and regulations. Regulations of the U.S. Department of Health and Human Services (DHHS) prohibit health care providers who receive federal funding from discriminating against people of color [67]. The federal Fair Housing Act prohibits discrimination based on race, color, or national origin in assisted living/residential care communities [68].
Federal policy also works to eliminate health disparities. The Patient Protection and Affordable Care Act of 2010 mandates and funds efforts to redress racial and ethnic health disparities. The Office of Minority Health reports directly to the Secretary of Health and Human Services and works to improve the health and quality of care of people from racial and ethnic minority groups and eliminate racial and ethnic health disparities [69]. There are also separate Offices of Minority Health within six DHHS agencies and the National Institute on Minority Health and Health Disparities within the National Institutes of Health that seek to eliminate health disparities.
Because approximately 72% of the funding for long-term care in the United States comes from federally funded programs [10], the Centers for Medicare & Medicaid Services is a major regulator of LTCFs. This includes regulations and guidance for Medicare- and Medicaid-participating LTCFs [70] and assisted living/residential care communities that receive funding through Medicaid waivers for Home and Community-Based Services [71]. It is important to note, however, that over 14,000 assisted living/residential care communities in the United States do not accept Medicaid funding and are therefore not subject to any regulations by the Centers for Medicare & Medicaid Services [10].
Many of the Centers for Medicare & Medicaid Services regulations specifically for LTCF operations pertain to the quality of care and quality of life of residents [53]. Overall, these regulations do not mention race and ethnicity (apart from including “insults based on race” in the definition of abuse). Rather, they speak more broadly to concerns such as residents’ rights to “a dignified existence” and freedom from discrimination in exercising rights [53]. In fact, in crafting the 2014 regulations for Medicaid waivers for Home and Community-Based Services, the Centers for Medicare & Medicaid Services noted they had received several public comments recommending specific non-discrimination protections in the policy but chose not to include them because more general provisions existed elsewhere in Medicaid policy [71]. Additionally, although the Centers for Medicare & Medicaid Services provides detailed guidelines for state surveyors of Medicare- and Medicaid-certified nursing homes and training for nursing home staff, the regulations do not specify assessments or training related to racial and ethnic disparities in LTCFs [53].
As described in Section 2, the federally mandated mission of the Long-Term Care Ombudsman Program is to advocate for LTCF residents. The federal government provides detailed regulations for state Long-Term Care Ombudsman Programs and their local-level designees, including the types of policies they must have, required qualifications for staff, and the need to submit a publicly available annual report of their activities to the U.S. Administration on Aging and their state’s government [53]. Like the provisions of the Centers for Medicare & Medicaid Services, the regulations of the Long-Term Care Ombudsman Program do not identify racial and ethnic equity as an explicit concern in their guidelines. For example, the required qualifications for Ombudsman Program staff do not include any skills or knowledge of racial health equity [53]. Another omission is in the reporting requirements which do not mandate disaggregation of complaint data by race and ethnicity which would allow the program, public, and lawmakers to evaluate racial and ethnic disparities related to residents’ complaints [53].
States can create policies to license, inspect, and regulate LTCFs. In fact, they are responsible for the bulk of oversight of assisted living/residential care communities. States cannot create regulations for nursing homes that are less stringent than federal policy, but for assisted living, each state has the latitude to set its own standards. These vary widely across domains of building and occupancy requirements, training, staffing requirements, and resident assessments [72]. States differ in the ways they distinguish and treat board-and-care homes for older adults – which tend to serve older adults of color – and assisted living communities [73]. The variation of state regulations for assisted living is related to the liberal/conservative leaning of state legislatures, the states’ bureaucratic capacities (e.g., capacity of the state Long-Term Care Ombudsman Program), and even the salaries of the legislators [68]. The lack of consistency in LTCF oversight and commitment to addressing racial health disparities across the states (see for example [74]) highlights the importance of a federal response to address inequities among LTCF residents.
The root causes of inequities among LTCF residents lie in structural racism and ultimately need to be addressed across multiple domains of economic opportunity, housing, and health care systems. Nonetheless, there are responses at the LTCF-level that demonstrate promise to reduce the consequences of structural racism. This section presents efforts with the potential to address structural racism and reduce inequities among LTCF residents.
Across the globe, some high-income countries like the United States provide universal access to LTCF benefits through social long-term care insurance (i.e., Germany, Japan, Luxembourg, the Netherlands, and South Korea) or taxpayer funded long-term care (i.e., Denmark, Finland, Norway, and Sweden) [75]. By making coverage universal, these countries avoid the inequities that arise from relegating long-term care coverage to means-tested programs such as Medicaid in the United States. Universal long-term care helps ensure that all citizens have access to long-term care regardless of their financial circumstances and removes potential stigma associated with receiving public assistance. The countries with universal long-term care coverage do not have the unique social circumstances related to race and structural racism as the United States. However, it is reasonable to expect that the equalizing effects of universal long-term care exhibited elsewhere would include reducing racial and ethnic disparities among U.S. LTCF residents.
Within the United States, the State of Washington is implementing universal social insurance for long-term care within its borders [76]. In 2019, the state legislature passed the Washington Long-Term Services and Supports Act, which funds the Washington Cares Fund. Beginning January 1, 2022, Washington employers will be required to collect 0.58% of an employee’s wages as premiums for long-term care insurance. Beneficiaries of the fund can receive up to $36,500 for a variety of long-term care services and supports including care in assisted living/residential care communities and nursing homes [76]. This program is the first of its kind in the United States and can serve as an example for other states or ultimately for a federal program of universal long-term care benefits.
Because older adults of color are more likely to live in LTCFs that are funded predominantly through Medicaid, the states have an opportunity to address racial and ethnic LTCF disparities through their Medicaid programs. Limited Medicaid funding results in residents of color disproportionately living in LTCFs that are under resourced and poorly staffed. However, some states’ Medicaid policies have improved the quality of care or life for residents of color. One solution is as straightforward as increasing Medicaid’s per diem reimbursement rates LTCFs. In a longitudinal study of nursing home citations for care deficiencies from 2006 to 2011, Li et al. [77] found evidence that increased reimbursement rates reduce disparities between nursing homes with high- and low-percentages of minority residents. In another example, Hernandez [24] found in 2012 that the state of Oregon provided Medicaid reimbursement for apartment-style assisted living. Compared to states like Florida which, at the time, reimbursed for assisted living units with as many as two to four roommates in a room, the practice in Oregon could provide better quality of life for assisted living residents. A state-by-state comparison of policies for state funding for assisted living/residential care (see, for example, compilations like [78]) can provide additional insights into how state policy can affect older adults in LTCFs.
Within the private sector there are also examples of initiatives aimed at awareness, education, and elimination of racial and ethnic disparities in LTCFs. In Canada, the Ontario Centres for Learning, Research & Innovation in Long-Term Care have created resources for LTCFs including a toolkit for embracing diversity; a diversity and inclusion calendar; diversity, equity, and inclusion (DEI) posters for use within LTCFs; and publications, reports, and toolkits related to indigenous culture and care for indigenous residents [79]. The toolkit for embracing diversity includes an instrument LTCFs can use to assess their LTCF and plan DEI efforts [80]. It contains detailed assessment items for DEI in seven domains: planning and policy, organizational culture, education and training, human resources, community capacity building, resident and family engagement, and service provision. It also provides a template for LTCFs to create SMART goals (i.e., specific, measurable, assignable, realistic, and time-bound) related to DEI in their homes. In the United States, the Oregon Health Care Association, the largest long-term care trade association in the state of Oregon, helps connect its member LTCFs to resources related to race and racism, including information on cultural trauma; Black, Indigenous, and other People of Color (BIPOC) mental health; bystander intervention, and racial justice [81]. While these efforts may not dismantle structural racism itself, they can affect change in individual LTCFs or LTCF chains resulting in reduced disparities for residents of color.
The process of eliminating the effects of structural racism among LTCF residents is seemingly impossible without first acknowledging the history and plight of persons of color in the United States. Inequities in access to quality LTCFs have existed since the rise of private nursing homes in the late 1930s. In the U.S. society, systems of economic opportunity, education, housing, health care, and retirement financing have created and perpetuated racial disparities in health outcomes, engagement in health care services, and quality of care. The effects of structural racism accumulate over the life course, resulting in heightened disparities by the time older adults enter LTCFs. Immediate action at the LTCF policy- and practice-level is needed to reduce the inequities to which thousands of LTCF residents of color are subjected. This section focuses on actionable policy and practice recommendations geared toward the residents and systems directly connected to LTCFs, However, as our conceptual model for understanding and addressing racial and ethnic disparities among LTCF residents suggests, structural racism is a force across the life course. To ensure future cohorts of older adults experience racial equity and justice in LTCF-settings and systems, we must conquer structural racism and its resulting health and economic disparities across the life span.
The process of effectively eliminating structural racism can seem like a daunting task. However, the examples in the preceding section demonstrate the potential for tangible results that improve the LTCF experience for residents. Because structural racism is directly and indirectly associated with racial and ethnic disparities experienced by LTCF residents, policymakers and practitioners need to employ a critical lens to understand and rectify its effects for LTCF residents. This critical approach includes four domains: awareness, acceptance, advocacy, and action related to structural racism and its effects. Table 1 presents these domains with LTCF-related examples. In terms of
Domain | Examples |
---|---|
Awareness | Make staff and shareholders aware of the existence structural racism and its impact on residents of color through diversity training and other educational activities |
Acceptance | Collect and analyze data related to racial and ethnic disparities within LTCFs and across LTCFs Internal and external dissemination of statistical reports that include statements of how historical, social, and economic factors contribute to the perpetuation of discriminatory practices |
Advocacy | Advocate with and for residents of color experiencing inequitable care or quality of life Testify at state legislative hearings about the need for increased Medicaid reimbursement rates for long-term care facilities Lobby Department of Health and Human Services Officials to include requirements that state surveyors and LTCFs assess and address racial disparities |
Action | Facilitate focused efforts that result in tangible outcomes including:
|
Components of efforts to eliminate the effects of structural racism among LTCF residents.
This chapter concludes with policy and practice recommendations. With diligent advocacy and action, change aimed at equity and racial justice for all LTCF residents is possible.
Several policy changes have the potential to reduce racial and ethnic disparities among LTCF residents. This section focuses on the action of implementing these policies. However, as described above, awareness, acceptance, and advocacy are preliminary and important steps for enacting these recommendations.
An ambitious but powerful tool for reversing structural racism in long-term care funding is implementing a universal social insurance for long-term care. In 2018, 70% of Americans over the age of 40 supported this proposal [82]. Although universal long-term care coverage would not eliminate the root causes of current racial and ethnic disparities in LTCFs, it would increase access to care in LTCFs and reduce reliance on Medicaid and its low reimbursement rates for disadvantaged older adults, including many people of color.
Increased Medicaid reimbursement rates for LTCFs are another way to reduce racial and ethnic disparities among LTCF residents [77]. The percentage of Medicaid funding that was spent on long-term care dropped from almost 50% in 1985 to only 30% in 2015 [83], during a time when the percentage of older adults in the United States was increasing. This trend could be reversed and funding priorities could reflect a greater emphasis on supporting LTCFs. To overcome fiscal objections to increasing Medicaid reimbursements for LTCFs, Chisolm et al. [39] suggest increased reimbursement rates could be targeted to LCTFs with high percentages of residents paying for care with Medicaid. Both approaches merit serious consideration, particularly when backed with federal funding as opposed to state funding, which would help LTCFs in states with low levels of income and resources.
Reforms such as a new social insurance program or increased federal funding from Medicaid would require legislative action, but many other policy changes could be made within the executive branches of government (e.g., within the U.S. Department of Health and Human Services). Because the Centers for Medicare & Medicare Services regulates Medicare- and Medicaid-certified nursing homes (as well as some aspects of Medicaid-certified assisted living/residential care communities), it has the ability to transform LTCF practices. For example, regulations could add training in racial and ethnic disparities in LTCFs to the mandatory staff training requirements staff. Similarly, The Centers for Medicare & Medicare Services should add to their current guidance for state surveyors of nursing homes to include information about identifying and reducing racial and ethnic disparities. At the state level, state health departments could bolster regulations for state inspectors of LTCFs to include considerations of racial and ethnic disparities in assessments and reporting.
The Long-Term Care Ombudsman Program has long advocated for LTCF residents [84]. However, reporting practices vary by state and some state programs do not collect and report race and ethnicity data related to the complaints they receive and resolve [53]. The Patient Protection and Affordable Care Act of 2010 requires programs that receive federal funding to collect and analyze data related to their participants’ race and ethnicity. We recommend extending the spirit of the Affordable Care Act to regulations for the Long-Term Care Ombudsman Program’s reporting responsibilities. If the ombudsman programs were mandated to collect, analyze, and report race and ethnicity data related to the individual complaints they receive, it would facilitate tracking, understanding, and addressing potential racial and ethnic disparities in LTCFs, including assisted living communities, across the United States.
Organizations and individuals should take steps to increase awareness, acceptance, advocacy, and action related to structural racism and racial and ethnic disparities among LTCF residents. Organizations such as local Long-Term Care Ombudsman Programs, LTCF trade organizations, and LTCF companies can help increase awareness of staff, residents, and the public by including racial justice in their mission statements. They can not only hire staff from more diverse backgrounds or bilingual staff members, but also ensure their staff receive diversity training, including training on the disparities across and within LTCFs and the systemic factor associated with the disparities. As part of acceptance of disparities, LTCF administrators can ensure their organizations analyze and report data related to racial and ethnic disparities among their own residents. Organizations and individuals can advocate for policy reform to their state and federal legislators, officials at their state department of human services, or the U.S. Department of Health and Human Services. It is also potentially empowering for teams across organizations and agencies to form partnerships to address racial and ethnic disparities within LTCF systems. For example, LTCF social workers and Long-Term Care Ombudsman staff and volunteers could work together to reduce disparities and bring cultural inclusiveness to LTCF residents and staff [53]. Finally, within individual LTCFs or LTCF chains, administrators can ensure that their services and group activities are appealing to and affirming of minority residents, that food options and building design are culturally appropriate; and that minority residents are empowered to raise concerns about their care and quality of life [85]. Some of these recommended efforts at the LTCF-level will require careful interrogation of assumptions of what is considered normative in LTCFs (e.g., book collections with only White authors) and could be supported by diversity, equity, and inclusion equity tools such as the toolkit from the Ontario Centres for Learning, Research & Innovation in Long-Term Care [79].
The authors declare no conflict of interest.
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\n\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
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\n\n3.2. CORRIGENDUM
\n\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n4. FINAL REMARKS
\n\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
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He was an ENT registrar at the Royal Infirmary, Middlesbrough, UK, in 1993, and a JW Fulbright scholar, University of Pittsburgh, USA, in 1997. During his Fulbright experience, he also worked at the Hospital of the University of Pennsylvania (HUP), Philadelphia, USA, and St. Joseph’s Hospital, Chicago, USA, with a sub-specialty interest in rhinology and aesthetic nasal surgery. Dr. Gendeh retired after thirty-eight years of government service as a consultant ENT surgeon at the National University of Malaysia Medical Centre (UKMMC) in 2014. Currently, he is a visiting professor at the Department of Otorhinolaryngology-Head and Neck Surgery, UKMMC, and a resident ENT consultant at Pantai Hospital Kuala Lumpur. He is an executive member of numerous national and international bodies including board chairman of the Malaysian American Commission on Educational Exchange (MACEE). 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K. Aremu",authors:[{id:"106996",title:"Dr.",name:"Shuaib",middleName:"Kayode",surname:"Aremu",slug:"shuaib-aremu",fullName:"Shuaib Aremu"}]},{id:"70727",doi:"10.5772/intechopen.90768",title:"Neuro-Olfactory Regulation and Salivary Actions: A Coordinated Event for Successful Blood-Feeding Behavior of Mosquitoes",slug:"neuro-olfactory-regulation-and-salivary-actions-a-coordinated-event-for-successful-blood-feeding-beh",totalDownloads:751,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"The synergistic actions of the nongenetic and genetic factors are crucial to shape mosquitoes’ feeding behavior. Unlike males, adult female mosquitoes are evolved with unique ability to take blood meals from a vertebrate host for reproductive success which eventually makes them a potential vector. Processing and integration of chemical information in the neuro-olfactory system followed by salivary actions facilitate blood meal uptake process. Thus, deciphering the underlying molecular mechanism of odor sensing through the detection machinery (olfactory system), odor processing and decision-making by decision machinery (brain), and regulation of saliva secretion by the action machinery (salivary gland) is likely to reveal molecular pathways which can be targeted to disrupt mosquitoes’ feeding behavior. Here we summarize how smart actions of highly specialized neurosensory systems guide and manage feeding behavior associated complex events of (i) successful navigation to find a suitable host, (ii) making food choice decisions, and (iii) regulation of the salivary gland actions in mosquitoes.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Tanwee Das De and Rajnikant Dixit",authors:[{id:"309585",title:"Dr.",name:"Tanwee",middleName:null,surname:"Das De",slug:"tanwee-das-de",fullName:"Tanwee Das De"}]}],mostDownloadedChaptersLast30Days:[{id:"70060",title:"Maxillofacial and Oral Aspects of Dysphagia",slug:"maxillofacial-and-oral-aspects-of-dysphagia",totalDownloads:971,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Oral cavity/mouth is first recipient of food. Food is broken down and prepared for initial phases of digestion. The oral preparatory phase is voluntary. In this phase, food is manipulated by the tongue and teeth. A bolus which is ready to swallow is prepared. Any disruption of oral cavity functions commonly due to oral infections, space infections, facial trauma, congenital-cleft lip and palate, temporo-mandibular joint disorders, salivary gland pathology, oral cancers, radiation therapy, etc., can cause dysphagia. In this chapter, we would explain the maxillofacial and oral aspects of dysphagia along with diagnosis and treatment aspects.",book:{id:"7844",slug:"voice-and-swallowing-disorders",title:"Voice and Swallowing Disorders",fullTitle:"Voice and Swallowing Disorders"},signatures:"Mohammed Basha",authors:null},{id:"70716",title:"Imaging in Sinonasal Disorders",slug:"imaging-in-sinonasal-disorders",totalDownloads:858,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Computed tomography (CT) is the “working horse” in sinonasal imaging and should always be the first choice. Magnetic resonance imaging (MRI) is complementary to CT when complications to rhinosinusitis or neoplasm are suspected. Imaging of the paranasal sinuses is common due to stuffy nose. In order to correct interpretation, proper imaging technique as well as knowledge of bony anatomy and variants and mucosal incidental findings are of outmost importance. Acute rhinosinusitis is very common and does not need imaging unless complications are suspected. In chronic rhinosinusitis, a CT examination is needed to find the cause and site of the mucociliary obstruction and to rule out other causes as odontogenic and fungal sinusitis and neoplasms.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Heidi Beate Eggesbø",authors:[{id:"65505",title:"Dr.",name:"Heidi Beate",middleName:null,surname:"Eggesbø",slug:"heidi-beate-eggesbo",fullName:"Heidi Beate Eggesbø"}]},{id:"70261",title:"Sinusitis, Asthma and Headache",slug:"sinusitis-asthma-and-headache",totalDownloads:627,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Sinusitis is the infection of sinuses. Sinuses are four hollow cavities in face which are connected to nasal pathways to help moisten, warm and filter the air which we breathe in. Sinuses get irritated due to bacteria, virus and allergens. It is often associated with asthma and headache. Pressure in the sinuses is built by over production of mucous and leads to sinus headache. Asthma gets severe with the sinusitis as both are related to sino-nasal pathway. Treatment includes steroids, nasal decongestants, antibiotics and to avoid allergens which not only reduce the symptoms of asthma but also sinusitis. Acute sinusitis may turn into chronic sinusitis including narrowing of nasal passages, deviated septum and lumps in the nose (polyp). It can be treated with surgical procedures. The only way to prevent sinusitis is by precaution and medication. Post nasal drip may also associate with asthma causing bronchial constriction.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Fozia Masood",authors:[{id:"302764",title:"Dr.",name:"Fozia",middleName:null,surname:"Masood",slug:"fozia-masood",fullName:"Fozia Masood"}]},{id:"71245",title:"Septoplasty: Endoscopic and Open Techniques",slug:"septoplasty-endoscopic-and-open-techniques",totalDownloads:955,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Septoplasty is one of the most commonly performed procedures by rhinologists. This article will provide a brief review of the surgical anatomy and the operative techniques of this procedure. Both endoscopic and open septoplasty procedures will be addressed. However, more than 15% of patients undergoing septoplasty fail to achieve symptomatic relief. Incomplete separation of the bony-cartilaginous junction and inadequate correction of the caudal septal deviation are the main reasons for persistent septal deviation after primary septoplasty. In revised septoplasty, correction of the caudal septal deviation can be done by proper correction of the cartilaginous curvature and strengthening of the structure using a batten graft.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Yi-Tsen Lin",authors:[{id:"311313",title:"Dr.",name:"Yi-Tsen",middleName:null,surname:"Lin",slug:"yi-tsen-lin",fullName:"Yi-Tsen Lin"}]},{id:"70540",title:"Swallowing Disorders in Cervical Facial Tumors",slug:"swallowing-disorders-in-cervical-facial-tumors",totalDownloads:722,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"We review current state of the art protocols on swallowing disorders associated to cervical facial tumors. The clinician needs to translate physiology notions to bedside diagnosis. Facing such a case the ENT surgeon must follow several key steps: thorough history taking, barium transit, endoscopy evaluation of swallowing, high resolution diagnosis imaging. Afterwards surgical treatment plan should take into consideration the need to careful dissection of vascular and nervous structures. Dysphagia may present from initial diagnosis or after surgical resection of the tumor or during radiation and chemotherapy. We discuss the use of various staging scales or questionnaires for assessing quality of life. We illustrate the importance of swallowing disorders management with various cases of tumors at the level of skull base, pharynx, salivary glands, larynx, esophagus, etc. There are various solutions for dysphagia ranging from nasogastric feeding tube placement to percutaneous endoscopic gastrostomy to specially designed exercises. Sometimes the surgeon neglects these disorders and focuses on airway management. However, the rule should be to encourage swallowing as soon as possible after surgery. A good nutritional status is necessary for a positive prognosis in swallowing disorders. Team effort in tertiary oncology units is the key in supporting such complex cases.",book:{id:"7844",slug:"voice-and-swallowing-disorders",title:"Voice and Swallowing Disorders",fullTitle:"Voice and Swallowing Disorders"},signatures:"Daniela Vrinceanu and Mihai Dumitru",authors:null}],onlineFirstChaptersFilter:{topicId:"1098",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Buchholz",profilePictureURL:"https://mts.intechopen.com/storage/users/89438/images/6463_n.jpg",institutionString:null,institution:{name:"Loma Linda University",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Plant Physiology",value:13,count:1},{group:"subseries",caption:"Human Physiology",value:12,count:2},{group:"subseries",caption:"Cell Physiology",value:11,count:8}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:1},{group:"publicationYear",caption:"2020",value:2020,count:4},{group:"publicationYear",caption:"2019",value:2019,count:5},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:302,paginationItems:[{id:"198499",title:"Dr.",name:"Daniel",middleName:null,surname:"Glossman-Mitnik",slug:"daniel-glossman-mitnik",fullName:"Daniel Glossman-Mitnik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/198499/images/system/198499.jpeg",biography:"Dr. Daniel Glossman-Mitnik is currently a Titular Researcher at the Centro de Investigación en Materiales Avanzados (CIMAV), Chihuahua, Mexico, as well as a National Researcher of Level III at the Consejo Nacional de Ciencia y Tecnología, Mexico. His research interest focuses on computational chemistry and molecular modeling of diverse systems of pharmacological, food, and alternative energy interests by resorting to DFT and Conceptual DFT. He has authored a coauthored more than 255 peer-reviewed papers, 32 book chapters, and 2 edited books. He has delivered speeches at many international and domestic conferences. He serves as a reviewer for more than eighty international journals, books, and research proposals as well as an editor for special issues of renowned scientific journals.",institutionString:"Centro de Investigación en Materiales Avanzados",institution:{name:"Centro de Investigación en Materiales Avanzados",country:{name:"Mexico"}}},{id:"76477",title:"Prof.",name:"Mirza",middleName:null,surname:"Hasanuzzaman",slug:"mirza-hasanuzzaman",fullName:"Mirza Hasanuzzaman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/76477/images/system/76477.png",biography:"Dr. Mirza Hasanuzzaman is a Professor of Agronomy at Sher-e-Bangla Agricultural University, Bangladesh. He received his Ph.D. in Plant Stress Physiology and Antioxidant Metabolism from Ehime University, Japan, with a scholarship from the Japanese Government (MEXT). Later, he completed his postdoctoral research at the Center of Molecular Biosciences, University of the Ryukyus, Japan, as a recipient of the Japan Society for the Promotion of Science (JSPS) postdoctoral fellowship. He was also the recipient of the Australian Government Endeavour Research Fellowship for postdoctoral research as an adjunct senior researcher at the University of Tasmania, Australia. Dr. Hasanuzzaman’s current work is focused on the physiological and molecular mechanisms of environmental stress tolerance. Dr. Hasanuzzaman has published more than 150 articles in peer-reviewed journals. He has edited ten books and written more than forty book chapters on important aspects of plant physiology, plant stress tolerance, and crop production. According to Scopus, Dr. Hasanuzzaman’s publications have received more than 10,500 citations with an h-index of 53. He has been named a Highly Cited Researcher by Clarivate. He is an editor and reviewer for more than fifty peer-reviewed international journals and was a recipient of the “Publons Peer Review Award” in 2017, 2018, and 2019. He has been honored by different authorities for his outstanding performance in various fields like research and education, and he has received the World Academy of Science Young Scientist Award (2014) and the University Grants Commission (UGC) Award 2018. He is a fellow of the Bangladesh Academy of Sciences (BAS) and the Royal Society of Biology.",institutionString:"Sher-e-Bangla Agricultural University",institution:{name:"Sher-e-Bangla Agricultural University",country:{name:"Bangladesh"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",biography:"Kusal K. Das is a Distinguished Chair Professor of Physiology, Shri B. M. Patil Medical College and Director, Centre for Advanced Medical Research (CAMR), BLDE (Deemed to be University), Vijayapur, Karnataka, India. Dr. Das did his M.S. and Ph.D. in Human Physiology from the University of Calcutta, Kolkata. His area of research is focused on understanding of molecular mechanisms of heavy metal activated low oxygen sensing pathways in vascular pathophysiology. He has invented a new method of estimation of serum vitamin E. His expertise in critical experimental protocols on vascular functions in experimental animals was well documented by his quality of publications. He was a Visiting Professor of Medicine at University of Leeds, United Kingdom (2014-2016) and Tulane University, New Orleans, USA (2017). For his immense contribution in medical research Ministry of Science and Technology, Government of India conferred him 'G.P. Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. degree in chemistry in 2000 and Ph.D. degree in physical chemistry in 2007 from the University of Khartoum, Sudan. He moved to School of Chemistry, Faculty of Science, University of Sydney, Australia in 2009 and joined Dr. Ron Clarke as a postdoctoral fellow where he worked on the interaction of ATP with the phosphoenzyme of the Na+/K+-ATPase and dual mechanisms of allosteric acceleration of the Na+/K+-ATPase by ATP; then he went back to Department of Chemistry, University of Khartoum as an assistant professor, and in 2014 he was promoted as an associate professor. In 2011, he joined the staff of Department of Chemistry at Taif University, Saudi Arabia, where he is currently an assistant professor. His research interests include the following: P-Type ATPase enzyme kinetics and mechanisms, kinetics and mechanisms of redox reactions, autocatalytic reactions, computational enzyme kinetics, allosteric acceleration of P-type ATPases by ATP, exploring of allosteric sites of ATPases, and interaction of ATP with ATPases located in cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from the Area.\n\nInternationally, Dr Mesraoua is an active and elected member of the Commission on Eastern Mediterranean Region (EMR ) , a regional branch of the International League Against Epilepsy (ILAE), where he represents the Middle East and North Africa(MENA ) and where he holds the position of chief of the Epilepsy Epidemiology Section; Dr Mesraoua is a member of the American Academy of Neurology, the Europeen Academy of Neurology and the American Epilepsy Society.\n\nDr Mesraoua's main objectives are to encourage frequent gathering of the epileptologists/neurologists from the MENA region and the rest of the world, promote Epilepsy Teaching in the MENA Region, and encourage multicenter studies involving neurologists and epileptologists in the MENA region, particularly epilepsy epidemiological studies. \n\nDr. Mesraoua is the recipient of two research Grants, as the Lead Principal Investigator (750.000 USD and 250.000 USD) from the Qatar National Research Fund (QNRF) and the Hamad Hospital Internal Research Grant (IRGC), on the following topics : “Continuous EEG Monitoring in the ICU “ and on “Alpha-lactoalbumin , proof of concept in the treatment of epilepsy” .Dr Mesraoua is a reviewer for the journal \"seizures\" (Europeen Epilepsy Journal ) as well as dove journals ; Dr Mesraoua is the author and co-author of many peer reviewed publications and four book chapters in the field of Epilepsy and Clinical Neurology",institutionString:"Weill Cornell Medical College in Qatar",institution:{name:"Weill Cornell Medical College in Qatar",country:{name:"Qatar"}}},{id:"282429",title:"Prof.",name:"Covanis",middleName:null,surname:"Athanasios",slug:"covanis-athanasios",fullName:"Covanis Athanasios",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/282429/images/system/282429.jpg",biography:null,institutionString:"Neurology-Neurophysiology Department of the Children Hospital Agia Sophia",institution:null},{id:"190980",title:"Prof.",name:"Marwa",middleName:null,surname:"Mahmoud Saleh",slug:"marwa-mahmoud-saleh",fullName:"Marwa Mahmoud Saleh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/190980/images/system/190980.jpg",biography:"Professor Marwa Mahmoud Saleh is a doctor of medicine and currently works in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. She got her doctoral degree in 1991 and her doctoral thesis was accomplished in the University of Iowa, United States. Her publications covered a multitude of topics as videokymography, cochlear implants, stuttering, and dysphagia. She has lectured Egyptian phonology for many years. Her recent research interest is joint attention in autism.",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259190/images/system/259190.png",biography:"Dr. Naqvi is a radioanalytical chemist and is working as an associate professor of analytical chemistry in the Department of Chemistry, Government College University, Faisalabad, Pakistan. Advance separation techniques, nuclear analytical techniques and radiopharmaceutical analysis are the main courses that he is teaching to graduate and post-graduate students. In the research area, he is focusing on the development of organic- and biomolecule-based radiopharmaceuticals for diagnosis and therapy of infectious and cancerous diseases. Under the supervision of Dr. Naqvi, three students have completed their Ph.D. degrees and 41 students have completed their MS degrees. He has completed three research projects and is currently working on 2 projects entitled “Radiolabeling of fluoroquinolone derivatives for the diagnosis of deep-seated bacterial infections” and “Radiolabeled minigastrin peptides for diagnosis and therapy of NETs”. He has published about 100 research articles in international reputed journals and 7 book chapters. Pakistan Institute of Nuclear Science & Technology (PINSTECH) Islamabad, Punjab Institute of Nuclear Medicine (PINM), Faisalabad and Institute of Nuclear Medicine and Radiology (INOR) Abbottabad are the main collaborating institutes.",institutionString:"Government College University",institution:{name:"Government College University, Faisalabad",country:{name:"Pakistan"}}},{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",country:{name:"Hungary"}}},{id:"277367",title:"M.Sc.",name:"Daniel",middleName:"Martin",surname:"Márquez López",slug:"daniel-marquez-lopez",fullName:"Daniel Márquez López",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/277367/images/7909_n.jpg",biography:"Msc Daniel Martin Márquez López has a bachelor degree in Industrial Chemical Engineering, a Master of science degree in the same área and he is a PhD candidate for the Instituto Politécnico Nacional. His Works are realted to the Green chemistry field, biolubricants, biodiesel, transesterification reactions for biodiesel production and the manipulation of oils for therapeutic purposes.",institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},subseries:[{id:"14",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",annualVolume:11411,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. Thus all studies on metabolism will be considered for publication.",annualVolume:11413,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",fullName:"Anca Pantea Stoian",profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"203824",title:"Dr.",name:"Attilio",middleName:null,surname:"Rigotti",fullName:"Attilio Rigotti",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"300470",title:"Dr.",name:"Yanfei (Jacob)",middleName:null,surname:"Qi",fullName:"Yanfei (Jacob) Qi",profilePictureURL:"https://mts.intechopen.com/storage/users/300470/images/system/300470.jpg",institutionString:null,institution:{name:"Centenary Institute of Cancer Medicine and Cell Biology",institutionURL:null,country:{name:"Australia"}}}]},{id:"18",title:"Proteomics",keywords:"Mono- and Two-Dimensional Gel Electrophoresis (1-and 2-DE), Liquid Chromatography (LC), Mass Spectrometry/Tandem Mass Spectrometry (MS; MS/MS), Proteins",scope:"With the recognition that the human genome cannot provide answers to the etiology of a disorder, changes in the proteins expressed by a genome became a focus in research. Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",annualVolume:11414,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null,editorialBoard:[{id:"72288",title:"Dr.",name:"Arli Aditya",middleName:null,surname:"Parikesit",fullName:"Arli Aditya Parikesit",profilePictureURL:"https://mts.intechopen.com/storage/users/72288/images/system/72288.jpg",institutionString:null,institution:{name:"Indonesia International Institute for Life Sciences",institutionURL:null,country:{name:"Indonesia"}}},{id:"40928",title:"Dr.",name:"Cesar",middleName:null,surname:"Lopez-Camarillo",fullName:"Cesar Lopez-Camarillo",profilePictureURL:"https://mts.intechopen.com/storage/users/40928/images/3884_n.png",institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}},{id:"81926",title:"Dr.",name:"Shymaa",middleName:null,surname:"Enany",fullName:"Shymaa Enany",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRqB9QAK/Profile_Picture_1626163237970",institutionString:null,institution:{name:"Suez Canal University",institutionURL:null,country:{name:"Egypt"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/453590",hash:"",query:{},params:{id:"453590"},fullPath:"/profiles/453590",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)}()