Summary of perceptions of leadership support for teleworkers during the COVID-19 pandemic (n = 7608).
\r\n\tThis book will consist of chapters that are an elegant mix of reviews and current developments on the subject that will be useful both to an expert on the subject as well as a newcomer to this area of research.
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Before the pandemic, with the advancement of technologies, telework was already being discussed and adopted as a strategy considered advantageous by some public and private organizations [1, 3]. However, with the social distancing protocols to face the pandemic, some discussions about telework gained prominence in the surveys. One of them focuses on the studies of workers’ physical and mental health, with isolation and lack of social contact being factors that can affect workers’ health and well-being. Leadership support in this context can improve relationship levels and increase the chances of teleworkers staying healthy [4]. Therefore, the COVID-19 pandemic, compulsory teleworking reached workers in several countries, raising concern about managerial support. Before the pandemic, studies on teleworking already showed a need for more significant support from the leadership for this type of work.
Thus, the pandemic context instigated the discussion of electronic leadership, which promotes the adaptability of companies and workers. A set of challenges about telework and e-leadership started to be studied. Telework is often seen as an opportunity, with gains for the productivity of companies and for people who work remotely [1, 5]. However, a good part of telework results depends on leadership performance, which cannot be conventional. On the one hand, organizational structures need to be less hierarchical. On the other hand, leadership must establish a solid and trustworthy relationship with its employees, maintaining a genuine concern for their well-being [1, 3, 6].
Research indicates that in uncertain contexts, such as the pandemic, support for workers oriented toward management practices can increase employee engagement and reduce worker burnout [7]. In this pandemic context, interactions between management and the team become remote, requiring a set of coping strategies from workers [2, 8]. Leaders had to review the distribution and execution of goals and deadlines and establish shared goals. Leaders also had to monitor resource consumption and anticipate potential problems and track the progress of work by each member of their team [9].
Thus, the role of leaders in this challenging context gained even greater centrality [6] since the stressful situations experienced by workers [10] required more outstanding organizational and supervisory support. Positive results in the teleworking method require mechanisms that favor establishing a trust relationship [9]. Leadership encouragement was already considered decisive for the professional development of their subordinates [11], but in times of pandemic, the role of leadership became even more evident [6, 8, 9, 10]. However, excessive control by managers—with constant verification of employees or their performance—signals a feeling of distrust that affects the psychological safety of workers and the bond they establish with the organization [8].
Faced with mandatory work on the pandemic, leaders must be able to (i) improve communication processes in the team; (ii) ensure employee access to technology; (iii) prioritize the emotional stability of employees; (iv) maintain attention to the organization’s goals and financial health; and (v) promote organizational resilience [6]. This supportive action by leaders is associated with the theory of organizational support discussed in this chapter.
So, the present study aims to propose an e-leadership theoretical model based on lessons learned from the coronavirus pandemic. To that end, we describe and discuss a survey on the perceptions of support received from managers during the initial 3 months of the pandemic. In other words, we propose to present a theoretical model of e-leadership, based on a broad study of how teleworkers perceived the support that received from their leaders during the compulsory telework carried out in the COVID-19 pandemic.
In addition to this broad empirical study, we also consider important lessons learned about leadership from the recent literature on the subject to consider e-leadership based on the lessons learned from the pandemic. Thus, after the section on the empirical study, we complement it with other studies in the literature, culminating with the proposition of the e-leadership theoretical model.
The perception of organizational support stems from a view that employees have the organization’s support. This perception is formed from the treatment that the employee receives in the organization. Thus, if the leader takes care of social welfare and values subordinates’ contributions, they tend to perceive organizational support positively. This positive perception can affect work motivation, employees’ effort to perform well, and their intention to remain in the organization [12, 13]. This is a chain process. Furthermore, the way leaders are treated also affects the organizational support perceived by subordinates since leaders who feel supported by the organization tend to treat their associates well [14].
The organizational support theory is based on the social exchange theory [15], whose central principle is that the interaction between individuals relates to attempts to maximize rewards and reduce costs. This social psychology perspective establishes that people maintain interactions because they perceive some benefit/reward in material or nonmaterial terms.
In the organizational support theory, employees’ beliefs about the support that they receive from the organization are evaluated [13]. Perceived support would be positive when they present a consistent assessment that organizational actions demonstrate concern for their well-being. This theory is based on the theory of social reciprocity. The norm of reciprocity is taught as a moral obligation and describes the development of exchange mechanisms for what is seen as mutually beneficial [16]. Thus, organizational support theory indicates a social exchange and reciprocity—employees’ commitment to the organization increases as they perceive the organization’s commitment to them.
According to this theory, social support from coworkers and leadership is perceived as social support. Leadership plays a significant role in coaching, providing care, and feedback to subordinates regarding their work tasks [9, 17]. This leadership support plays a vital role in workers’ psychological safety and commitment [18]. As discussed in organizational support theory, treating employees well makes a difference in workers’ returns to the organization [13].
In teleworking, the support of managers becomes even more relevant, whether due to the moment of crisis in the pandemic scenario or due to the difficulty of self-management of performance by workers, with processes of learning new skills and renegotiating work goals [2, 10]. Managers in such a context had to be dynamic, reorganizing work routines and adapting to the unique demands of workers and the organization [6]. The exchange of resources between leaders and subordinates in the context of the COVID-19 pandemic included several elements, such as tasks, information, open communication, shared goals, flexibility, feedback, and sharing of ideas and decisions [8]. Positive interactions and exchanges based on reciprocal relationships are associated with more favorable perceptions of psychological security at work [8].
Leaders have a relevant role in the development of their subordinates and in supporting them so that they can adequately perform their activities at work [11]. In this sense, we understand that the role of leadership needs to act on two simultaneous fronts—focus on results and focus on people. Therefore, bosses need to provide the necessary support to their subordinates in terms of return on performance and showing concern with the fulfillment of work tasks and, at the same time, act to promote the well-being of associates [19].
During the COVID-19 pandemic, a study with teleworkers showed that social support, autonomy, monitoring, and work overload are directly related to well-being at work performed in the home environment [20]. The results show that the workers’ social support and autonomy acted as a work resource that contributes to telework management. However, monitoring and work overload served as demands that negatively affected the teleworker’s well-being.
These results show the importance of leadership support, as leaders are directly responsible for the degree of autonomy assigned to workers and monitoring the fulfillment of tasks and goals [9, 19]. It is also up to the leaders to define the goals that may or may not generate overload [9]. This set of studies presented here shows a need to think about a different role on the part of leaders in the telework scenario. In this sense, the term e-leadership has been used, discussed in the next section.
The digital revolution has led to an intensification of telework that has become more prominent from the experiences of millions of workers during home-based work in pandemic. This expressive expansion of telework brought about the need to discuss the role of leaders in this new work context. Thus, the discussion of e-leadership became relevant, as it is a different form of management.
E-leadership or electronic leadership involves management carried out through information and communication technologies. Given the challenges faced in teleworking during the COVID-19 pandemic crisis, some researchers have carried out studies to discuss the concepts and characteristics of this e-leadership. Although researching different contexts and countries, these authors have some points in common. One of them is the understanding that the demands and competencies to meet these demands are different in traditional and electronic leadership. Some of the points raised in this e-leadership discussion are summarized below.
Based on an exploratory case study, [21] proposed an operational definition based on six factors for e-leadership, also called e-competencies for leaders. According to these authors, these six skills are e-communication, e-social skills, e-team building skills, e-change management, e-technological skills, and e-trustworthiness.
According to [21], e-communications skills involve three specific skills—communication clarity, lack of miscommunication, and management of communication flow. E-social skills, in turn, refer to good leader support, that is, ensuring that all teleworkers are provided with customized communication from time to time, with robust interaction methods. E-team building skill comprises three specific skills of virtual team leaders—team motivation, team accountability, and team and team member recognition. E-change management skill contemplates change management techniques by preplanning transitions, monitoring implementation, and refining technology practice with experience. E-technological skills are related to four elements—currency with relevant ICTs, blending traditional and virtual methods, basic technological savvy, and technical security. Finally, e-trustworthiness contemplates three central aspects—trustworthiness in a virtual environment, work-life balance, and diversity management [21].
In a similar vein, [22] surveyed education industry leaders and highlighted three of the best leadership practices for dealing with adaptive challenges as presented by the COVID-19 pandemic. A first point would be, considering the type of servant leadership, to emphasize the empowerment, involvement, and collaboration of leaders, putting the interests of others above their own. A second point would be for leaders to distribute leadership responsibilities to a network of teams across the organization, to improve the quality of decisions and crisis resolution. Finally, the third point would be for leaders to communicate clearly and frequently with all stakeholders by using various communication channels. In summary, the study by [22] suggests a leadership style called “allostatic leader,” which would describe leaders with flexibility and adaptability to learn and evolve in crisis management, to respond more effectively and with less effort to future challenges.
Another study, of an exploratory and qualitative nature, was carried out by [23], who investigated electronic leadership in the context of the Lithuanian public sector. The authors highlight four central roles of e-leadership—instructing employees to use electronic tools, collecting, and sharing information, monitoring and reviewing the division of roles and tasks. The authors compared e-leadership with the leadership that they had before the COVID-19 pandemic crisis, considering three criteria—(i) communication mode, channels, and tools, (ii) time management, and (iii) delivering tasks [23].
According to [23], in the first criterion, communication mode, channels, and tools, there would be a demand that e-leadership act with multilateral communication dominates, main communication channels (audio, video, written mode) and main ICT tools (phone, Zoom, Email, Facebook groups, “Hive,” teams). In the time management criterion, the main demands for e-leadership to manage would be—flexible work schedule, short-term and irregular on-demand meetings, the number of sessions sharply increases, reduced meeting time to avoid “redundant” talks, lunch break at the same time in all public sector organizations, and using ICT tools (Google calendar, Zoom, or Teams calendars). Finally, the delivering tasks criterion comprises challenges for e-leadership, such as explicit attention given to the clarity of the requestor of the tasks via email to assure the quality of their performance, and explicit norms of urgent responses, for example, establishing a maximum deadline for reply.
The study by [24] also discusses the need for an effective e-leadership to promote companies’ adaptability, so telework can be understood as an advantageous opportunity for the productivity of companies, the environment, and people who work remotely. For the authors, the prosperity of telework depends on an e-leadership model that makes the structure of companies less hierarchical and simultaneously develops skills to establish a solid and trustworthy relationship with employees. Thus, a central role of e-leadership would be to consolidate the performance of virtual teams so that they can have an effective implementation and be capable of meeting organizational goals. But [24] consider that electronic or e-leadership is not just an extension of traditional leadership; it requires a crucial change in how leaders and their virtual teams report within the organizations and with stakeholders. Moreover, e-leadership implies the development of specific skills, as discussed by [21, 22, 23].
Although e-leadership can benefit from previous models on leadership, some adaptations are necessary for the leaders to act electronically. In addition, virtual teams have different demands from face-to-face groups, requiring work redesign [25]. In this sense, authors such as [26] suggest the construction of a new theory and the conduct of more empirical research that support organizations to design, structure and manage more effectively virtual work teams. The following section presents the empirical and exploratory study on the perception of leadership support to teleworkers during the pandemic. This empirical study, together with several other studies revisited and briefly presented here, served as inspiration for the proposition of the theoretical model shown at the end of this chapter.
Assessing leadership support for teleworking in pandemic times is relevant, as this reconciliation between productivity and workers’ mental health depends on leaders. Furthermore, even after the pandemic, it is expected that many of the remote practices will be continued and expanded [2, 6].
Considering what was previously exposed, the present study proposes an e-leadership model based on lessons learned from the coronavirus pandemic. To that end, we describe and discuss a survey on the perceptions of support received from managers during the initial 3 months of the pandemic. We propose to present a theoretical model of e-leadership, based on a broad study of how teleworkers perceived the support received from their leaders during the compulsory telework carried out in the COVID-19 pandemic. In addition to this comprehensive study, we also consider important lessons learned about leadership from the recent literature on the subject to consider e-leadership based on the lessons learned from the pandemic.
The research carried out had a quantitative approach, with an online questionnaire to an extensive sample of workers from Brazilian public institutions who were teleworking. One of the differentials of this work was that data collection was carried out from April to June 2020, that is, in the first months of the pandemic that began in Brazil in mid-March 2020. Therefore, this study was exploratory but allowed the construction of an overview of how teleworkers realized the support received from their leaders to carry out compulsory telework during the COVID-19 pandemic.
A total of 7608 public servants in Brazil, spread over 22 states, took part in this study, but with a greater concentration in the capital Brasília. Participation in the research was previously authorized by the 95 public organizations to which these participants are linked. Most of these organizations already worked telework before the pandemic, but they expanded this type of work due to social distancing protocols.
The sample was mainly composed of female participants (59.3%), aged between 38 and 47 years (34.2%) and between 28 and 37 years (29.8%), and married/in a stable relationship (63.5%). Almost the entire sample (93.4%) had completed higher education, and 60.5% had graduate degrees. However, only 6.6% of the sample were workers with high school education. Regarding the previous experience with telework, most participants (58.1%) had no prior experience with this type of work. Of that 41.9% who had previous experience with telework, 93.7% rated that the incidents had been positive, and 6.3% negatively evaluated their previous experience with telework.
The items were built from the literature analysis on challenges, difficulties, demands, benefits, and barriers associated with teleworking at home and on the supportive role of leadership at that time. This work resulted in the construction of six items, and for each of them, the theoretical and empirical framework that supported it was analyzed. The central concepts considered for the construction of the items were—feedback, goal (attribution and monitoring), support, guidance, well-being, and infrastructure.
After choosing the items, an analysis of the judges was performed. Human resources professionals from two public institutions with previous experience in telework participated in this stage, as well as masters and doctors in psychology, linked to three postgraduate courses in Brazil. The judges assessed that the items adequately represented the main aspects of leadership support for telework performed from home.
The items included in the survey were—(i) I receive constructive feedback from my manager about my performance in remote activities, indicating opportunities for improvement; (ii) the remote work goals assigned to me by my manager are compatible with the workload from my sector; (iii) I receive support from my manager when I ask for directions to perform tasks remotely; (iv) my manager monitors the achievement of my work goals; (v) my manager is concerned about the adequacy of my infrastructure to work remotely (computer, internet, and furniture); and (vi) my manager demonstrates that he cares about my health and well-being. All these items were answered on a Likert scale of agreement, ranging from 1 (I totally disagree) to 5 (I totally agree). In addition, in the instructions for answering the questionnaire, participants were asked to answer the items considering their experiences during the pandemic period, linked to telework performed from home.
Data collection took place online, from links generated by researchers and forwarded by organizations to their teleworkers. The release of the questionnaire was subject to acceptance, by the participants, of an informed consent form. This form presented the research objectives and the responsible researchers and ensured the confidentiality of individual responses and the freedom to interrupt their participation in any research phase.
For data analysis, we used the Statistical Package for Social Sciences (SPSS) software, version 25. We performed descriptive and inferential analyses to identify differences between the average scores of perceptions of leadership support. The tests used were the Student’s
The survey included some fundamental concepts for e-leadership, including feedback from leaders to their subordinates. Feedback can be understood as information about the difference between the actual and desired levels of performance, which allows the implementation of corrective actions capable of eliminating this difference [27]. Feedback is even more prominent regarding telework, especially that carried out compulsorily in the pandemic period [9, 25, 28]. Leaders need to establish exchanges with subordinates in the COVID-19 pandemic—feedback, the sharing of ideas and decisions [8].
The survey results showed that most teleworkers (69.8%) received constructive feedback on their performance in remote activities, indicating opportunities for improvement. However, those who did not realize that their leaders were giving constructive feedback in the telework period in the COVID-19 pandemic totaled 11.7%. In addition, there were also 18.5% who had difficulty in giving their opinion about receiving constructive feedback from leaders about their performance in remote activities.
About goals, they gained greater relevance with the goal orientation theory, which goes beyond the content of what people are trying to achieve (goals, specific standards). The theoretical emphasis here is on why and how people try to achieve goals, thus referring to broader goals of achievement behavior [29]. This theory comprises both the process of assigning goals and monitoring them.
The lack of monitoring or improper monitoring of the subordinates’ performance and goals are configured as forms of destructive leadership. In the study of [30], researchers tested 658 team members out of 149 teams to compare abusive supervision and laissez-faire leadership effects from a Bayesian multilevel analysis. Abusive supervision lowered team trust and subsequent organizational citizenship behavior at the individual and team level, whereas laissez-faire was not related to team trust on the team level. The results indicated that laissez-faire was more harmful to organizational citizenship than abusive supervision on both groups.
In the context of telework, leaders must review the distribution and execution of goals, considering the workers’ conditions to avoid overload [9] and organizational needs [6, 24]. In this sense, it is sometimes necessary to renegotiate deadlines and establish shared goals [2, 9, 10]. In addition, a careful process of monitoring tasks and goals must be carried out by leaders to monitor the progress of each member of their team, reassessing the degree of autonomy attributed to each worker [9, 19].
In the survey with teleworkers, we observed a positive perception of the establishment of compatible goals by the leadership. For example, we observed that 85% agreed with the statement, “The remote work goals assigned to me by my manager are compatible with the workload from my sector.” In a complementary way, 90.5% agreed with the sentence “My manager monitors the achievement of my work goals.” In this sense, the positive performance of e-leadership in the Brazilian public service during teleworking in the COVID-19 pandemic was evident. These results are consistent with several studies that pointed out the importance of having feasible and agreed goals in telework and monitoring the leader concerning these goals.
In addition to feedback and goals, it is also necessary to consider as an essential attribution of e-leadership the support and guidance given by leaders to their subordinates. Such support and guidance are theoretically linked to the supervisor’s support, which concerns contributions and guidelines from the head and those influencing behaviors in the work context [13, 17]. But excessive guidance and monitoring by managers characterize micromanagement, which causes psychological insecurity in the worker [31].
During the COVID-19 pandemic, e-leadership needed to be aware of the workers’ new demands for learning and the guidelines and guidelines they needed to receive. Compulsory telework added to pre-existing learning demands, a set of new directions, and leaders’ care in observing and surveying such needs [25]. Supporting the performance of teleworkers is directly related to this survey of conditions and the availability of opportunities for new learning, in addition to the leader’s ability to direct the performance of their virtual team.
In the survey conducted with teleworkers, we observed that few (3%) disagreed that they receive support from their leadership when they request directions to perform their remote tasks. On the other hand, most respondents (91.1%) rated satisfactorily the support that they received from their leaders when they asked for guidance. Several authors associate this ability to provide advice and support to subordinates as a central element of e-leadership [9, 25, 30].
Another aspect investigated in the survey with teleworkers was the infrastructure they must work remotely from their homes. These structural elements relate to the physical working conditions present in the production locus that characterize the physical environment, instruments, equipment, raw material, and institutional support. For example, for a home office to be ergonomically efficient, healthy, and safe, there must be a workspace and designated tools, including a computer, desk, chair, telephone, and internet connection [32].
With the tendency of teleworking to remain in many organizations after the end of the COVID-19 pandemic, e-leadership must actively seek to promote adequate infrastructure conditions for the work of its virtual team. In this new context of home-based work, workers need to have furniture, a computer, internet access, and easier access to the organizations’ work platforms.
It is worth noting that home-based work can affect the physical health of workers for several reasons. One is the configuration of home workstations that are not ergonomically designed and can result in poor posture and musculoskeletal disorders [33]. A study by [34] showed that 41.2% of participants experienced low back pain, and 23.5% experienced neck pain and other pain while teleworking in the pandemic. These percentages increased over time and reduced levels of job satisfaction.
In this sense, [25] consider that e-leadership needs to dialog about the ergonomic and technological conditions of the home office, additionally preventing stress and injuries. The authors argue that leaders should seek to provide multi-functionality tools (synchronous and asynchronous collaborative work, video calls, and repository of documents). The use of asynchronous work tools (wikis, database shared on the cloud, messaging tools, and work management) and synchronous work tools (technology-mediated virtual meetings) are crucial to coordinate the interdependence of tasks with demands, goals, and work schedules and conditions in home-based work [25].
In the survey carried out with teleworkers, we observed that providing adequate ergonomic conditions for teleworking was the item with the worst evaluation. Only 21.3% of teleworkers fully agree that their leaders are concerned about the adequacy of the infrastructure for the remote work of virtual teams. The percentage of teleworkers who agreed or totally agreed with the statement “My manager is concerned about the adequacy of my infrastructure to work remotely (computer, internet, furniture)” was 55.4%. However, it is worrying that 44.6% of teleworkers do not realize that their leaders are concerned about their physical working conditions.
Finally, the last item in the survey referred to how much teleworkers realized, during the COVID-19 pandemic, that their leaders were concerned about their health and well-being. Well-being at work, in turn, can be understood as a multidimensional psychological construct, integrated by positive affective bonds with work and with the organization [4] and with a clear association with the health of the worker.
Studies on telework have investigated how remote work can be related to the worker’s well-being, which can be considered a source of stress due to possible role conflicts between work and personal life tasks. In this sense, an e-leadership can contribute to the realization of telework to be effective and reduce the risks of this modality of telework, such as social isolation and increased work–family conflict [24].
The e-leadership needs to prevent work from invading the times and spaces of family life, resulting in a breach of the psychological contract, which can be harmful to both teleworkers and organizations. The work-family and family–work conflict are among the principal risks of telework [24, 35] and, therefore, should deserve attention from the e-leadership in managing their virtual teams. Research on the JD-R theory during the pandemic found a mediating effect of job stress between the breach of psychological contract and the well-being of those who are only working at home [36].
In the empirical study carried out with teleworkers in the public sector in Brazil, we observed that 74% of respondents agreed with the statement, “My manager demonstrates that he cares about my health and well-being.” This result indicates that most e-leadership manifested behavior of attention to the health and well-being of their workers. However, it is worrisome that, amid a pandemic such as that of COVID-19, one in four workers did not realize that their leaders showed concern for taking care of the health and well-being of their team members. Therefore, it needs to be reinforced with those who will act with electronic leadership.
Taken together, the results of this empirical study show that leaders also need to develop to act in the context of telework (Figure 1). However, in the view of the surveyed teleworkers, most leaders are already able to meet central aspects of e-leadership, such as providing feedback, setting, or renegotiating goals, monitoring goals, providing support/orientation, provision of infrastructure for teleworking, and demonstrating care for the health and well-being of members of their virtual teams.
Perception of e-leadership support during teleworking in the COVID-19 pandemic.
The results indicate that two of the most favorable e-leadership performances aim to provide support to their team when they request guidelines for the performance of their tasks in the remote context and monitor the achievement of members’ work goals of your team. Furthermore, these items had higher means in their scores (4.4 and 4.3, respectively) and were the only ones whose most frequent value (mode) was 5.0, that is, the highest point of the scale. At the same time, these items were also the ones with the lowest coefficient of variation, signaling a greater homogeneity in the assessment that the 7608 teleworkers made of their leaders.
At the opposite extreme, there is the item related to the demonstration of concern with the adequacy of the infrastructure for remote work and the item associated with receiving constructive feedback from leaders about performance in remote activities. In both cases, the mean scores (3.5 and 3.8, respectively) were lower than those of the other items. Furthermore, these items have the highest coefficient of variation, which indicates greater heterogeneity in the responses. Thus, while some respondents positively assess the support received from their leaders in terms of concern with providing physical conditions for remote work and constructive feedback for the virtual team, other respondents negatively assess their leaders in these two aspects. Table 1 summarizes the perceptions of leadership support for teleworkers during the COVID-19 pandemic. It is possible to verify that the evaluation tended to be positive in all items, although the average scores varied.
Leadership support items for teleworkers during the Pandemic | Mean | Mode | Standard deviation | Coef. of variation (%) |
---|---|---|---|---|
I receive support from my manager when I ask for directions to perform tasks remotely | 4.4 | 5.0 | 0.76 | 17.4 |
My manager monitors the achievement of my work goals | 4.3 | 5.0 | 0.75 | 17.4 |
The remote work goals assigned to me by my manager are compatible with the workload from my sector | 4.1 | 4.0 | 0.82 | 20.1 |
My manager demonstrates that he cares about my health and well-being | 4.0 | 4.0 | 1.03 | 26.0 |
I receive constructive feedback from my manager about my performance in remote activities, indicating opportunities for | 3.8 | 4.0 | 1.04 | 27.4 |
My manager is concerned about the adequacy of my infrastructure to work remotely (computer, internet, furniture) | 3.5 | 4.0 | 1.13 | 32.0 |
Summary of perceptions of leadership support for teleworkers during the COVID-19 pandemic (n = 7608).
Student’s
As for the results of Spearman’s correlation to identify a possible relationship between the age groups of the participants and the scores of items supporting leadership for teleworkers, the results did not indicate significant relationships. The only significant correlation (
Finally, the Pearson’s correlation matrix analysis showed that the items correlated significantly with each other (
Leadership support items for teleworkers during the Pandemic | (1) | (2) | (3) | (4) | (5) | (6) |
---|---|---|---|---|---|---|
(1) I receive constructive feedback from my manager about my performance in remote activities, indicating opportunities for improvement | — | 0.46 | 0.55 | 0.56 | 0.55 | 0.56 |
(2) The remote work goals assigned to me by my manager are compatible with the workload from my sector | — | 0.50 | 0.47 | 0.40 | 0.42 | |
(3) I receive support from my manager when I ask for directions to perform tasks remotely | — | 0.66 | 0.48 | 0.54 | ||
(4) My manager monitors the achievement of my work goals | — | 0.50 | 0.50 | |||
(5) My manager is concerned about the adequacy of my infrastructure to work remotely (computer, internet, furniture) | — | 0.67 | ||||
(6) My manager demonstrates that he cares about my health and well-being | — |
Correlations of perceptions of leadership support to teleworkers during the COVID-19 Pandemic (n = 7608).
Despite the benefits of teleworking, this modality also presents risks for workers, such as reduced interpersonal contact and increased sense of social isolation and distance from the organizational culture [21, 24]. The role of leaders is fundamental in providing social support and reducing risks related to the well-being of teleworkers. It is also up to them to think of strategies to promote the professional development of their subordinates [11]. As we have seen in the revised literature, the attributions of e-leadership are diverse, such as (i) the transfer of goals, objectives, and expectations of the organization, (ii) delegation of responsibilities, (iii) maintenance of fluid and frequent communication with team members and encouragement of communication between team members, and (iv) monitoring of appropriate work behaviors and conflict reduction [9, 21, 25].
Self-discipline is also indicated in the literature as a critical competence for working virtually, with the potential to affect work motivation, effective performance, and the well-being of teleworkers [20]. In this sense, e-leadership must encourage self-discipline and autonomy so that teleworkers can simultaneously achieve better results in their work and greater well-being at work.
It is also worth considering that studies by [20] indicate that monitoring and control had less resistance from teleworkers in the context of a pandemic, as these mechanisms helped to deal effectively with procrastination and work demands in the home environment [20]. In this sense, many workers tended to positively evaluate the actions of e-leadership in terms of monitoring and control.
Another important point highlighted in the literature is that workers without experience with telework before the pandemic expressed more negative opinions about telework than experienced workers. For those who were experiencing telework for the first time during the COVID-19 pandemic, there were reports of adverse experiences. They complain about the lack of face-to-face interaction with the leader, the difficulty of accessing work-related information, the lack of feedback, the distractions caused by others in the home environment, the inability of leaders to estimate the workload, the concern about the possibility of information loss, the delay in decision-making processes, and the expense of asynchronous communications [28]. All these points point to the importance of e-leadership having an effective action with teleworkers, especially in times of crisis.
In the discussion about the role of e-leadership, it is also necessary to consider the results of several studies that show that telework has produced benefits to personal life (decrease in time spent commuting from home to work, organization of free time, the balance between work and family, improvement in social life,) and professional life (reduction of interference from colleagues, increased flexibility of timetables, greater autonomy to organize and plan the performance of tasks, greater job satisfaction, and reduced stress). In this sense, an e-leadership can contribute to the realization of teleworking to be effective and to reduce the risks of this modality of telework, such as social isolation, increased work-family conflict, and reduced social learning with coworkers [24].
Thus, an effective e-leadership should be able to contribute to minimizing the risks for teleworkers. In addition, e-leadership would also be expected to generate positive impacts for organizations. In the study of [25], the authors present an extensive set of competencies for e-leadership and consider that telework requires a redesign of work. In this sense, electronic leadership should be able to (i) negotiate achievable goals and monitor them through indicators; (ii) dialog about the ergonomic and technological conditions of the home office, preventing additional stress and conflicts; (iii) provide multi-functionality tools (synchronous and asynchronous collaborative work, video calls, repository of documents) to coordinate the interdependence of tasks with demands, goals, and work schedules and conditions in remote work at home; (iv) schedule virtual meetings to times suitable for workers engaged in activities; (v) learn new ways to manage time, and to balance work-family; (vi) develop new skills to provide emotional support to coworkers; (vii) develop new skills of social support; and (viii) provide constructive feedback [25].
It is essential to understand that teleworking during the Covid-19 pandemic period occurred in a specific context that involved compulsory telework, amid a pandemic crisis that led to isolation and lack of social contact [9, 24, 26, 28]. Furthermore, there was a lack of experience with telework on the part of many workers and leading leaders. In addition to the specific issues of the pandemic, the telework experience occurred in a context marked by a changing and uncertain environment, advancement of digital technologies, and in a context of more congested cities [2, 24, 26, 28, 34].
The results of these experiences with telework also depend on procedures adopted by organizations, covering different types of resources (material, financial, procedural, technological, resources, and human resources) [5, 20, 21, 26, 33, 34]. In addition to organizational inputs, several studies show that much of the success of telework experiences depends on an e-leadership’s supportive activities and skills. The importance of e-leadership support was highlighted in the study reported in this chapter and is also widely explored in telework literature, before or during the pandemic [2, 3, 5, 6, 7, 8, 20, 21, 22, 23, 24, 25, 26, 28, 36]. These e-leadership skills can turn to hard skills (more focused on technological and tool aspects) and soft skills. The soft one involves skills to provide emotional support to coworkers, in addition to other factors related to dialog, constructive feedback guidance, team confidence, and time management [25, 28, 33].
The results of telework can be very positive, including a reduction in travel time, increased work autonomy and well-being, reduced worker burnout risks, and improved workers’ sense of psychological security. Other positive results from remote work are solid and trustworthy relationships with employees, higher effort employees make to perform well, and intention to remain in the organization [2, 7, 20, 22, 23, 24, 25, 28, 33, 34]. Likewise, telecommuting can also bring many positive results for organizations. These outcomes include talent retention, increased organizational citizenship behavior, higher productivity levels, infrastructure cost diminution, abusive supervision reduction, and continuous 24/7 productivity by using different time zones [6, 8, 20, 24, 25, 26].
Given so much research on e-leadership that gained greater prominence during the COVID-19 pandemic, we present below a model of e-leadership based on lessons learned during the academic period. The model shown in Figure 2 is supported by the empirical study presented here and in the revised literature, as presented above. It does not intend to replace theoretical leadership models but to present specificities that characterize e-leadership and its performance in virtual teams.
E-leadership theoretical model.
Millions of professionals worked remotely during the pandemic, mediated by technologies, modifying traditional communication, monitoring, and managing teams. It is the e-leadership’s role to identify the activities that require adjustments in telework, including surveying the resource demands of each subordinate. Thus, telework success depends on leaders mapping out which support routines need to be developed for remote work [9]. The present study aims to propose an e-leadership theoretical model based on lessons learned from the coronavirus pandemic. To that end, we describe and discuss a survey on the perceptions of support received from managers during the initial 3 months of the pandemic. For this purpose, we collected data with 7608 workers distributed to 95 public service organizations in Brazil.
Therefore, this paper presents a theoretical research and intervention model on the effectiveness of e-leadership, which assumes relationships between context variables, inputs, processes, and outcomes. The model includes context variables (changing and uncertain environment, advances of digital technologies, more congested cities, lack of experience with telework), which have led organizations to adopt telework in its most varied forms. For example, full-time or part-time telework, in fixed locations (work from home or in satellite offices) or different spaces (mobile work, work anywhere and anytime), for a fixed or indefinite period with or without flexible working hours. Furthermore, the health crisis generated by the COVID-19 pandemic added to these situations, social distancing, the lack of face-to-face social contacts, and the sudden change in the design of the work to the compulsory remote modality in a fixed location (at home). This situation highlighted the importance of leadership support to teleworkers, previously evidenced by telework literature.
In addition to these context variables, the model includes inputs or resources (material, financial, technological, and human), which need to be considered in studies on the effectiveness of e-leadership since they are antecedents of the leader’s supportive behaviors for the teleworkers. The e-leadership actions comprise e-hard and e-soft skills, which characterize the effective conduct of leadership, associated with valuable outcomes for employees and organizations. In summary, the theoretical model proposed in this work can be used to plan and conduct research on relationships between antecedent variables (context, inputs), e-leadership processes, and their effects on essential criterion variables (outcomes for teleworkers and organizations).
The leadership theoretical model also contributes to the improvement of telework management, indicating variables that need to be considered by organizations to enable leadership support actions for teleworkers. These actions increase the chances of achieving positive results for teleworkers and organizations. Before implementing telework, the organization, according to the proposed model, should analyze the following resources—technological support (management and monitoring systems for deliveries, digital information, and communication technologies); material and financial support for the acquisition and maintenance of equipment, internet access necessary for teleworking; characteristics of work processes eligible for telework (description of activities, measurement of work volume and flow, the interdependence of tasks between members of the same team and between different groups and organizational units, optimization of work processes) and the characteristics of human resources with motivation and good profile for telework (professional experience, autonomy, and self-discipline).
It is essential to point out that despite the many positive results presented in the e-leadership model, telework also poses many risks for workers and organizations [4, 5, 21, 24, 25, 26]. Without the proper performance of e-leadership, especially in terms of support for teleworkers, the demands (overload, difficulty in reconciling work and nonwork, feelings of loneliness, and social isolation) are likely to increase the risk of exhaustion, stress, and burnout. Likewise, without a compelling performance of e-leadership, telework can also be harmful to organizational results. From these preliminary analyses, organizations need to provide the resources necessary to exercise effective leadership and provide training and e-leadership skills development programs. In addition, we recommended defining in advance the expected results (outcomes) for teleworkers and the organization, aiming to choose teleworking arrangements compatible with the organization’s work, people, and culture. After the implementation of teleworking, we suggested monitoring and evaluating resources, e-leadership processes (considering hard and soft skills), and their effects on the behavior (outcomes) of teleworkers and the organization to achieve adjustments and improvements in each component of the model.
An important warning—the e-leadership theoretical model does not intend to replace all leadership models but to present specificities that characterize e-leadership and its performance in virtual teams. Thus, even though it is based on empirical studies found in the literature and on reviews about telework, the e-leadership model presented in this chapter lacks further testing. But it can be helpful for organizations that intend to maintain telecommuting or a hybrid system with face-to-face workers and remote workers. We also hope that the model can contribute to those already involved in e-leadership or who intend to move to this new management format.
It is worth considering the generalization of the results to the Brazilian context and other countries. Despite the convenience sample, its breadth and the heterogeneity of respondents encourage more extensive use of the findings. However, although comprising 95 organizations, the sample was aimed at public servants, and there may be differences for workers from private organizations. As for the model’s generalization to other countries, we consider it possible and indicate empirical tests since it is a theoretical model. What leads us to believe in more global use of this model is that it was based not only on the extensive research carried out in Brazil but also on an expressive set of studies carried out in different countries during the pandemic.
Regarding this generalization to other countries, it is worth mentioning that the e-leadership theoretical model is in tune with the practical guide prepared by the International Labor Organization [37]. This guide indicates that teleworking policies can be planned as part of a continuity plan to keep operational organizations and people safe in their homes in contexts of unforeseen events, such as extreme weather conditions, natural disasters, terrorist actions, and pandemics. The analysis presented is that the experience arising from the measures of social distancing necessary to contain the COVID-19 pandemic marked the beginning of a new era of telework, which tends to be a labor modality adopted by some organizations even in “normal time.”
But to ensure the well-being and maintenance of productivity in telecommuting, whether in “new normal” or contingency periods (such as pandemics and other unexpected events), attention is needed in some aspects. Thus, with illustrations of situations or legislation from different countries, eight focuses are listed to ensure well-being and productivity in telework, these are—focus on time and work organization, focus on performance management, focus on digitization, focus on communication, focus on safety and health at work, focus on legal and contractual implications, focus on training, and focus on reconciling professional and personal life. In addition to these eight focal points, the ILO’s practical guide also presents reflections in two other directions—gender equity and trust and organizational culture. Thus, it is considered that teleworking should not become a setback to previous achievements in terms of equality between men and women, nor should it hinder the efforts of diversity and inclusion by companies. Finally, there are also recommendations to strengthen trust as a value and a practice in the organizational culture. Therefore, we recommend avoiding, for example, the use of tools and software for control and surveillance of employees, which in addition to ethical issues can impact the relationship between the worker and the employing organization, leading to negative attitudes and counterproductive behavior [37].
Considering the set of these recommendations for the future of teleworking after the pandemic, we observe that the e-leadership theoretical model can be applied in contingency periods and in new normal or “normal time.” Moreover, the scope of this theoretical model shows that the lessons learned from the coronavirus pandemic made it possible to advance on reflections on telework and propose strategies that simultaneously ensure organizational productivity and workers’ well-being. About expectations for the future of teleworking after the pandemic, one of the basic premises is that teleworking should result from a voluntary agreement between employers and workers, establishing working hours or hours worked, communication tools, tasks to be performed, supervision procedures, systematic recording of tasks performed, and workplace which can be at the workers’ homes or elsewhere [37].
The expectation is that after the pandemic we have a new era of telework, with many lessons learned during this period [2, 20, 24, 25, 37]. Unlike the pandemic phase, there are predictions that hybrid models of telework will be adopted, with variability in terms of full-time or part-time, fixed or flexible hours, workplaces [at home, satellite offices or mobile, and ubiquitous work (anytime and from anywhere)]. A study that projected the potential of telecommuting in Brazil and worldwide confirms a growing relationship between the proportion of jobs that can be performed at home. The level of economic development among 86 countries, Brazil occupied the 45th position, with 25.7% of teleworking. Considering the 12 Latin American countries that made up the study, Brazil occupies the third position, approaching Chile (25.8%) and Uruguay (27.3%). Directors, managers, and professionals in science and intellectuals had a high percentage of occupations subject to telework (between 61% and 65%) [38].
The large sample of the research reported in this study, made up of professionals with a high level of education, suggests that the results are generalizable to developing countries and may be helpful for organizations and workers in developed countries. Moreover, the usefulness of this survey and others carried out during the pandemic period is even greater if we consider that the potential for telecommuting was little explored globally, as only 2.9% of workers worked from home before the COVID-19 pandemic [39].
Additional evidence is reported by the International Labor Organization, signaling those workers from developed countries are more likely to work from home. They also add that many workers from developing countries carry out activities that do not allow for adopting the modality, such as civil construction, or work informally. Suppose the structure of labor occupations and available technologies are considered. In that case, the estimated difference between developed and developing countries reaches 15%, and there may be regional differences in each country [38]. Depending on the level of social inequality, it is possible to find realities similar to those in Brazil, even in developed countries, which increases the generalization of the results.
The authors wish to thank the Brazilian National Council for Scientific and Technological Development (CNPq) Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State (FAPERJ) for their support. We would also like to thank the Aprimora—Nucleus for Studies in Trajectory and Professional Development members and the E-Work Group—Research Group on Telework in the Public Service.
Episiotomy is a surgical cut in the tissue between the vagina and the anus (called the perineum) made just before delivery. It is one of the most commonly practiced obstetric procedures done to enlarge the diameter of the vulval outlet to facilitate the passage for the fetal head and prevent an uncontrolled tear of the perineal tissues in the second stage of labor [1, 2, 3]. The procedure was introduced into obstetric practice without any sound scientific evidence corroborating any possible benefits [4]. It was promoted in the twentieth century by renowned interventionists, obstetricians such as Gabe and De Lee [5]. Their perception was that the female body was essentially defective and dependent on medical interventions to enable childbirth [5]. In 1970s, there was disagreement in the practice especially because of pressure from the women’s movements demanding changes in the obstetric model [4].
In 1983, Thacker and Banta gave a full account of the lack of scientific data supporting the use of episiotomy and the potential danger associated with the procedure [3]. Historical indications such as a prolonged second stage, macrosomia, non-reassuring fetal heart rate, instrumental delivery, occiput posterior position, and shoulder dystocia have been questioned [6].
Routine episiotomy is now considered to be obstetrics violence when a woman is automatically transformed into a patient and when routine medical procedures are carried out without giving the woman the right to make her own decisions concerning her own body [7].
The most commonly practiced and accepted type of episiotomy is the mediolateral, owing to its protective roles in preventing obstetric anal sphincter injury (OASI) [8]. Median/midline episiotomy, although has a bigger risk of causing OASI, is praised for causing less pain/bleeding, ease in repair, and healing more easily [9]. A clear illustration and description of the type of episiotomy can be seen in Figure 1 and Table 1. Other reported episiotomy types in literature are lateral episiotomy, which was condemned, and also a J-shaped episiotomy incision that is not commonly practiced.
Illustration of episiotomy types.
Type of episiotomy | |
---|---|
Definition | Way of execution |
Median | The incision starts at the posterior fourchette and runs along the midline through the center of the perineal body. The incision should run for approximately half of the length of the perineum (2–3 cm) without affecting the anal muscle |
Mediolateral | An incision is performed downward and outward from the midpoint of the fourchette, either to the right or left toward the ischial tuberosity with 3–4 cm length, beginning in the midline and directed laterally, and downward away from the rectum. It affects the skin, subcutaneous tissue, bulbospongiosus muscle, superficial transverse perineal muscle, and the levator |
Lateral | The incision starts from about 1 cm (0.4 in) away from the center of the fourchette and extends laterally. Possible complications comprise injury to the Bartholin’s duct, which is why lateral incisions are deemed inadvisable by most specialists and rarely mentioned in the obstetric literature |
J-shaped episiotomy | It entails a midline incision, curved laterally away from the anus. Curved scissors are used starting in the midline of the vagina until the incision is 2·5° cm from the anus, then directing the incision toward the ischial tuberosity away from the anal sphincter |
Radical lateral (Schuchardt incision) | Generally considered a non-obstetrical incision, it is a fully extended episiotomy, deep into one vaginal sulcus and is curved downward and laterally partway around the rectum. It may be carried out at the beginning of radical vaginal hysterectomy or trachelectomy to allow easy access to the parametrium, to enable extraction of a neglected vaginal pessary, or quite rarely, to facilitate childbirth if complications arise (fetal macrosomia, difficult breech, or shoulder dystocia) |
Episiotomy incision is generally repaired after delivery of placenta to achieve hemostasis and approximate lacerated tissues. The aseptic procedure is carried out in a well-lit room with adequate exposure and appropriate instruments and anesthesia. Since most if not all repairs are done in laboring wards, adequate local or regional analgesia is used. Extension to a third- or fourth-degree perineal tear may necessitate examination under anesthesia and requires regional or general anesthesia that is done in an operating theater.
A suture is placed approximately a centimeter proximal to the apex of the incision within the vagina and secured with a knot, vaginal mucosa, and sub-mucosa are sutured up to the hymeneal ring, perineal muscles are then approximated followed by the closure of perineal skin using a continuous subcutaneous suturing technique [11]. Continuous stitching technique is preferred to interrupted as it is associated with less pain, easily performed by the inexperienced operator, and economical [12].
Episiotomy is practiced in varied ways with differing prevalence ranging from as low as less than 1/3 to as high as 86% [13] depending on whether it is used routinely or in a restricted way.
World Health Organization (WHO) Guideline Developing Groups emphasized the need for health systems to adopt a policy of restrictive rate of not more than 10% rather than routine use of episiotomy to reduce its potential complications and the use of additional resources for its treatment [14] as restrictive episiotomy has shown benefits [15]. Restrictive other than routine episiotomy protocol has been supported by FIGO [16], a mediolateral episiotomy type is the one recommended, and this should be performed under adequate analgesia, whether anesthesia is already in place for labor, such as epidural, or by administering a local infiltration [16].
Despite the controversy regarding the validity of episiotomy’s routine use in obstetrics and the fact that liberal use of the procedure has been discouraged, this is still one of the most commonly performed obstetric procedures worldwide [17, 18]. Although this restrictive episiotomy practice has shown many benefits, especially regarding the reduction of injuries to the posterior perineum, the strictest definition of restrictive use was to avoid episiotomy unless indicated for fetal well-being. Other definitions of restrictive episiotomy are to “avoid the procedure,” use only when “medically necessary,” or not perform an episiotomy to avoid a laceration [19]. The balance between risk and benefit for episiotomy is therefore not entirely straightforward. An episiotomy may be unavoidable if the baby needs to be delivered quickly.
The lack of evidence supporting episiotomy benefits has caused a significant decline in the practice in most countries. In France, a decline from 15.5% in 2013 to 9.3% in 2017 has been realized [20], and for operative vaginal births, there had been a varied decrease in episiotomy rates from as low as 25% to as high as 75% in some geographical location in France [21].
Historical indications for episiotomy included: abnormal progress of labor, non-reassuring fetal status, prematurity, assisted vaginal delivery, shoulder dystocia. It was also believed to hasten the second stage of labor, decrease pelvic floor disorder and sexual dysfunction, reduce urinary and fecal incontinence [15]. Several guidelines recommend the use of mediolateral episiotomy for the prevention of obstetric anal sphincter injuries (OASI) [8]. Episiotomy plays the main role during assisted vaginal birth as this is related to the increased incidence of OASI. The procedure can be indicated when there is a high likelihood of third-degree or fourth-degree perineal tear, soft tissue dystocia, a requirement to accelerate delivery of a compromised fetus, and need to facilitate operative vaginal delivery or a history of female genital mutilation [22].
Varied risk and protective factors are influencing the practice of episiotomy in obstetrics. The risk factors include primiparity [23, 24], absence of prior vaginal birth, assisted vaginal delivery are among the predictive factors influencing episiotomy practice. In some settings, episiotomy operations were being performed to allow midwifery and medical students the opportunity to learn and practice the procedure [24]. Being an adolescent and having other medical conditions while pregnant is associated with the procedure [25].
Factors that are protective against episiotomy include perineal massage. This procedure can be done especially in the second stage of labor [26, 27, 28]. The procedure is an effective approach to increasing the chance of delivery with intact perineum especially for women with a first vaginal birth [29]. In other literature, massage can be started as early as 34 weeks of gestation, and it is done with oil for 5–10 min every day to increase flexibility and elasticity [30]. In addition to massage, perineal support and warm compresses during the second stage are protective for episiotomy and anal sphincter injury [30].
Another important innovative tool to reduce the risk of episiotomy is an Epi-No device, developed in early 2000, to facilitate a natural birth and reduce the risk of perineal injury including needs for episiotomy. The Epi-No device is promising, with potentially positive effects on a natural birth without major complications [31].
OASI are injuries that involve the anal sphincter. It is dreaded complication after a vaginal delivery that has significant maternal morbidity such as perineal pain, dyspareunia, flatulence, and anal incontinence [33].
OASI either involves third or fourth-degree perineal tears. A third-degree perineal tear is defined as a partial or complete disruption of the anal sphincter muscles, a fourth-degree involves the rectal mucosa [34] as seen in Table 2 and Figure 2.
Third-degree tear | Injury to the perineum involving the anal sphincter complex |
---|---|
3A | Less than 50% of EAS thickness torn |
3B | More than 50% of EAS thickness torn |
3C | Both EAS and IAS torn |
Fourth-degree tear | Injury to perineum involving the anal sphincter complex (both EAS and IAS) and anal epithelium |
Buttonhole tear | External anal sphincter intact but anal or rectal mucosa with or without internal anal sphincter tear |
Description of OASI.
Adopted from [35].
Key: IAS, internal anal sphincter; EAS, external anal sphincter.
OASI; (a) third-degree perineal tear, (b) fourth-degree perineal tear. Adopted from [
The risk of getting OASI can be done by relieving pressure on the central posterior perineum by an episiotomy and/or controlled delivery of the head. An episiotomy aimed at 60° from the midline has been seen to be protective for OASI [36]; hence, the introduction of episiotomy scissors specially designed to achieve a cutting angle of 60°, EPISCISSORS-60® [37]. Vacuum-assisted delivery and bigger babies were seen to be an important independent factor in one cohort study [38].
A repair can be done primarily if OASI is diagnosed following vaginal delivery, and this represents the mainstay of treatment. A delay of up to 12 h is allowable if resources for repair are not available. A secondary repair can be done later when tissue edema has subsided for cases diagnosed later or if injuries have been unrepaired for more than 12 h, and this is referred to as secondary repair [39].
The aim of sphincter repair (either primary or secondary) is to restore a functioning anal canal by reconstruction of a muscular cylinder that is at least 2 cm thick and 3 cm long [39].
Meticulous hemostasis and anatomic approximation with a multilayer closure of all disrupted tissue layers are the key principles for preventing complications and restoring fecal continence and two recognized methods for the repair of OASI: end-to-end (approximation) and overlap repair [39] are important depending on the extent of the injuries as illustrated in Figure 3.
Episiotomy repair technique. Adopted from [
An overlap is more superior to an end-to-end method in terms of reduction in perineal pain, dyspareunia, flatus incontinence, and fecal incontinence [39, 40].
Although the repair techniques have been well documented, the confidence in detecting OASI and competence in the repair of OASI does not correlate with knowledge of anatomy and risk factors of OASI in a survey among obstetricians [41].
The suitability of routine use of episiotomy has been questioned by specialists and scientific societies, and several professional medical associations and patient and women’s rights advocates have been associating it with obstetric violence [9]. Episiotomy has been associated with the risk of repeat episiotomy in the subsequent birth due to tighter perineum and weaker scar [42]. Post episiotomy pain is common after delivery, and this may end up in pain at first intercourse especially if it occurs in the first 3 months after delivery [43]. The risk is higher if intercourse occurs within the first 6 weeks after delivery and in some cases, women present with gaping episiotomy wounds following intercourse [44]. The incision substantially increases maternal blood loss, the average depth of posterior perineal injury, risk of anal sphincter damage, improper wound healing, increased amount of pain in the first several postpartum days, and infection [45]. Episiotomy at the first vaginal birth significantly and independently increases the risk of repeated episiotomy and spontaneous tears in subsequent delivery [42, 46].
Episiotomy-related morbidity can be measured using the Redness, Ecchymosis, Edema, Discharge, and Apposition scale (REEDA scale) [47]. Higher REEDA scores denote poor healing process or severe trauma to the perineal tissue as shown in one of our studies in Mulago Hospital in Uganda [48]. The rate of the gaping wound is particularly higher among those done episiotomy compared with spontaneous perineal tear [48], and this can be attributed to the fact that spontaneous perineal tear occurs normally along the natural tissue planes, and it’s easier to repair compared with episiotomy. A similar study in Mulago relates episiotomy to increased risk of infection and the need for secondary re-suturing [49].
Episiotomy-related pain has been shown to persist for more than 14 days after delivery [48] supporting claims that cutting across tissue planes is associated with more pain compared with spontaneous tear that normally follows the natural tissue planes as reported by [3, 50, 51] and that episiotomy is a painful policy [2]. A meta-analysis done by [52] found out that episiotomy is associated with increased incidence and severity of postpartum perineal pain.
An episiotomy is, therefore, a traumatic procedure that should be practiced restrictively. World Health Organization (WHO) Guideline Developing Groups and FIGO emphasized the need for health systems to adopt a policy of restrictive rate of not more than 10%, and mediolateral episiotomy type is the one recommended, and this should be performed under adequate analgesia, whether anesthesia is already in place for labor, such as epidural, or by administering a local infiltration.
The authors declare no conflict of interest.
"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges".
\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.
",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\\n\\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\\n\\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
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\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
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\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
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\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
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The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
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\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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Cells encode “receptors” containing Ub-/Ubl-binding domains that interpret and translate each modification into appropriate cellular responses. Among the different Ubls, NEDD8, which is the ubiquitin’s closest relative, retains many of the structural determinants that enable ubiquitin the ability to target proteins to degradation. Nevertheless, the direct involvement of NEDD8 conjugation to proteasome recruitment has been proved only in a few cases. To date, well-defined major NEDD8 substrates are primarily members of the cullin family, and cullin neddylation does not appear to mark these proteins for degradation. Various studies have demonstrated that selectivity between ubiquitin and NEDD8 is guaranteed by small but substantial differences. Nevertheless, several issues still need to be addressed, mainly concerning which interaction surfaces mediate NEDD8 function and what domains recognize them. Recently, two novel domains identified in KHNYN and N4BP1 proteins have shed new light on this research area. Here, I discuss some recent reports that contributed to shed light on the mechanisms underlining the discrimination between ubiquitin and NEDD8. Understanding the details of these molecular mechanisms represents a prominent facet for the identification of new therapeutic targets.",book:{id:"8301",slug:"ubiquitin-proteasome-system-current-insights-into-mechanism-cellular-regulation-and-disease",title:"Ubiquitin Proteasome System",fullTitle:"Ubiquitin Proteasome System - Current Insights into Mechanism Cellular Regulation and Disease"},signatures:"Elena Santonico",authors:[{id:"271923",title:"Dr.",name:"Elena",middleName:null,surname:"Santonico",slug:"elena-santonico",fullName:"Elena Santonico"}]},{id:"65025",doi:"10.5772/intechopen.82883",title:"E3 Ubiquitin Ligases in Cancer and Their Pharmacological Targeting",slug:"e3-ubiquitin-ligases-in-cancer-and-their-pharmacological-targeting",totalDownloads:1681,totalCrossrefCites:2,totalDimensionsCites:8,abstract:"Ubiquitination plays many critical roles in protein function and regulation. Consequently, mutation and aberrant expression of E3 ubiquitin ligases can drive cancer progression. Identifying key ligase-substrate relationships is crucial to understanding the molecular basis and pathways behind cancer and toward identifying novel targets for cancer therapeutics. Here, we review the importance of E3 ligases in the regulating the hallmarks of cancer, discuss some of the key and novel E3 ubiquitin ligases that drive tumor formation and angiogenesis, and review the clinical development of inhibitors that antagonize their function. We conclude with perspectives on the field and future directions toward understanding ubiquitination and cancer progression.",book:{id:"8301",slug:"ubiquitin-proteasome-system-current-insights-into-mechanism-cellular-regulation-and-disease",title:"Ubiquitin Proteasome System",fullTitle:"Ubiquitin Proteasome System - Current Insights into Mechanism Cellular Regulation and Disease"},signatures:"Joseph Y. Ong and Jorge Z. Torres",authors:[{id:"186645",title:"Dr.",name:"Jorge",middleName:null,surname:"Torres",slug:"jorge-torres",fullName:"Jorge Torres"},{id:"264944",title:"Mr.",name:"Joseph",middleName:null,surname:"Ong",slug:"joseph-ong",fullName:"Joseph Ong"}]},{id:"28199",doi:"10.5772/31082",title:"F0F1 ATP Synthase: A Fascinating Challenge for Proteomics",slug:"f0f1-atp-synthase-a-fascinating-challenge-for-proteomics",totalDownloads:5557,totalCrossrefCites:2,totalDimensionsCites:8,abstract:null,book:{id:"780",slug:"proteomics-human-diseases-and-protein-functions",title:"Proteomics",fullTitle:"Proteomics - Human Diseases and Protein Functions"},signatures:"Federica Dabbeni-Sala, Amit Kumar Rai and Giovanna Lippe",authors:[{id:"85523",title:"Prof.",name:"Giovanna",middleName:null,surname:"Lippe",slug:"giovanna-lippe",fullName:"Giovanna Lippe"},{id:"149272",title:"Dr.",name:"Federica",middleName:null,surname:"Dabbeni-Sala",slug:"federica-dabbeni-sala",fullName:"Federica Dabbeni-Sala"},{id:"149273",title:"Dr.",name:"Amit",middleName:null,surname:"Kumar Rai",slug:"amit-kumar-rai",fullName:"Amit Kumar Rai"}]},{id:"28201",doi:"10.5772/31113",title:"Identification of the Novel Plasminogen Receptor, Plg-RKT",slug:"identification-of-the-novel-plasminogen-receptor-plg-rkt",totalDownloads:2435,totalCrossrefCites:2,totalDimensionsCites:5,abstract:null,book:{id:"780",slug:"proteomics-human-diseases-and-protein-functions",title:"Proteomics",fullTitle:"Proteomics - Human Diseases and Protein Functions"},signatures:"Lindsey A. Miles, Nicholas M. Andronicos, Emily I. Chen, Nagyung Baik, Hongdong Bai, Caitlin M. Parmer, Shahrzad Lighvani, Samir Nangia, William B. Kiosses, Mark P. Kamps, John R. Yates III and Robert J. Parmer",authors:[{id:"85634",title:"Dr.",name:"Lindsey A.",middleName:null,surname:"Miles",slug:"lindsey-a.-miles",fullName:"Lindsey A. Miles"},{id:"85772",title:"Dr.",name:"Nicholas M.",middleName:null,surname:"Andronicos",slug:"nicholas-m.-andronicos",fullName:"Nicholas M. Andronicos"},{id:"85773",title:"Dr.",name:"Emily I.",middleName:null,surname:"Chen",slug:"emily-i.-chen",fullName:"Emily I. Chen"},{id:"85775",title:"MSc.",name:"Nagyung",middleName:null,surname:"Baik",slug:"nagyung-baik",fullName:"Nagyung Baik"},{id:"85776",title:"Dr.",name:"Hongdong",middleName:null,surname:"Bai",slug:"hongdong-bai",fullName:"Hongdong Bai"},{id:"85777",title:"Ms.",name:"Caitlin M.",middleName:null,surname:"Parmer",slug:"caitlin-m.-parmer",fullName:"Caitlin M. Parmer"},{id:"85778",title:"Dr.",name:"William B.",middleName:null,surname:"Kiosses",slug:"william-b.-kiosses",fullName:"William B. Kiosses"},{id:"85780",title:"Dr.",name:"John R.",middleName:null,surname:"Yates, III",slug:"john-r.-yates-iii",fullName:"John R. Yates, III"},{id:"85781",title:"Dr.",name:"Robert J.",middleName:null,surname:"Parmer",slug:"robert-j.-parmer",fullName:"Robert J. 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This chapter will present an evolution of the techniques used to identify the proteoforms and the importance of this identification for understanding of biological processes. This chapter highlights the fundamental concepts in the field of top-down mass spectrometry (TDMS), and provides numerous examples for the use of knowledge obtained from the identification of proteoforms. The identification of mutant proteins is one of the emerging areas of proteogenomics and has the potential to recognize novel disease biomarkers and may point to useful targets for identification of therapeutic approaches.",book:{id:"9352",slug:"proteoforms-concept-and-applications-in-medical-sciences",title:"Proteoforms",fullTitle:"Proteoforms - Concept and Applications in Medical Sciences"},signatures:"Jucélia da Silva Araújo and Olga Lima Tavares Machado",authors:[{id:"30130",title:"Dr.",name:"Olga Lima Tavares",middleName:null,surname:"Machado",slug:"olga-lima-tavares-machado",fullName:"Olga Lima Tavares Machado"},{id:"310148",title:"Dr.",name:"Jucelia",middleName:null,surname:"Da Silva Araujo",slug:"jucelia-da-silva-araujo",fullName:"Jucelia Da Silva Araujo"}]},{id:"65025",title:"E3 Ubiquitin Ligases in Cancer and Their Pharmacological Targeting",slug:"e3-ubiquitin-ligases-in-cancer-and-their-pharmacological-targeting",totalDownloads:1681,totalCrossrefCites:2,totalDimensionsCites:8,abstract:"Ubiquitination plays many critical roles in protein function and regulation. Consequently, mutation and aberrant expression of E3 ubiquitin ligases can drive cancer progression. Identifying key ligase-substrate relationships is crucial to understanding the molecular basis and pathways behind cancer and toward identifying novel targets for cancer therapeutics. Here, we review the importance of E3 ligases in the regulating the hallmarks of cancer, discuss some of the key and novel E3 ubiquitin ligases that drive tumor formation and angiogenesis, and review the clinical development of inhibitors that antagonize their function. We conclude with perspectives on the field and future directions toward understanding ubiquitination and cancer progression.",book:{id:"8301",slug:"ubiquitin-proteasome-system-current-insights-into-mechanism-cellular-regulation-and-disease",title:"Ubiquitin Proteasome System",fullTitle:"Ubiquitin Proteasome System - Current Insights into Mechanism Cellular Regulation and Disease"},signatures:"Joseph Y. Ong and Jorge Z. Torres",authors:[{id:"186645",title:"Dr.",name:"Jorge",middleName:null,surname:"Torres",slug:"jorge-torres",fullName:"Jorge Torres"},{id:"264944",title:"Mr.",name:"Joseph",middleName:null,surname:"Ong",slug:"joseph-ong",fullName:"Joseph Ong"}]},{id:"65109",title:"Ubiquitin Signaling in Regulation of the Start of the Cell Cycle",slug:"ubiquitin-signaling-in-regulation-of-the-start-of-the-cell-cycle",totalDownloads:1579,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"The small protein ubiquitin plays a vital role in virtually all aspects of cellular life. Among the diverse signaling outcomes associated with ubiquitination, the most well-established is the targeted degradation of substrates via the proteasome. During cell growth and proliferation, ubiquitin plays an outsized role in promoting progression through the cell cycle. In particular, ubiquitin-mediated degradation is critically important at transition points where it provides directionality and irreversibility to the cell cycle, which is essential for maintaining genome integrity. Specifically, the boundary between G1 and S-phase is tightly regulated by the ubiquitin proteasome system. Notably, the G1/S boundary represents a major barrier to cell proliferation and is universally dysfunctional in cancer cells, allowing for the unbridled proliferation observed in malignancy. Numerous E3 ubiquitin ligases, which facilitate the ubiquitination of specific substrates, have been shown to control G1/S. In this chapter, we will discuss components in the ubiquitin proteasome system that are implicated in G1/S control, how these enzymes are interconnected, gaps in our current knowledge, and the potential role of these pathways in the cancer cycle and disease proliferation.",book:{id:"8301",slug:"ubiquitin-proteasome-system-current-insights-into-mechanism-cellular-regulation-and-disease",title:"Ubiquitin Proteasome System",fullTitle:"Ubiquitin Proteasome System - Current Insights into Mechanism Cellular Regulation and Disease"},signatures:"Michael James Emanuele and Taylor Paige Enrico",authors:[{id:"264977",title:"Dr.",name:"Michael",middleName:null,surname:"Emanuele",slug:"michael-emanuele",fullName:"Michael Emanuele"},{id:"282200",title:"Ms.",name:"Taylor",middleName:null,surname:"Enrico",slug:"taylor-enrico",fullName:"Taylor Enrico"}]},{id:"60432",title:"Protein-Based Detection Methods for Genetically Modified Crops",slug:"protein-based-detection-methods-for-genetically-modified-crops",totalDownloads:1432,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"The generation of genetically modified (GM) crops is rapidly expanding each and every year around the world. The well-being and quality assessment of these harvests are vital issues with respect to buyers’ interests. This drove the administrative specialists to execute an arrangement of extremely strict strategies for the endorsement to develop and use GMOs and to produce an interest in scientific techniques equipped for identifying GM crops. The GM crops have been added to the effective fuse of various attributes by presenting transgenes, for example, Bacillus thuringiensis (Bt) insecticidal qualities, in various crop species. GM crops give critical financial, natural, well-being and social advantages to both small and large agriculturists. The detection strategies incorporate either DNA-based or protein-based measures. Different immunoassays or catalyst connected immunosorbent tests are delicate and more affordable; however, they need experienced technicians. A very simple method, that is, immunochromatographic (ICS) test, is set up in the world, which is modest, compact and simple to utilize. The ICS is a semiquantitative method for indicative screening and semi-measurement of new remote proteins presented through hereditary change of plants. The strip is the easiest method for the assessment of several Bt crop plants for insecticidal quality.",book:{id:"6635",slug:"protein-protein-interaction-assays",title:"Protein-Protein Interaction Assays",fullTitle:"Protein-Protein Interaction Assays"},signatures:"Kausar Malik, Haleema Sadia and Muhammad Hamza Basit",authors:[{id:"238750",title:"Prof.",name:"Kausar",middleName:null,surname:"Malik",slug:"kausar-malik",fullName:"Kausar Malik"},{id:"243713",title:"Dr.",name:"Haleema",middleName:null,surname:"Sadia",slug:"haleema-sadia",fullName:"Haleema Sadia"},{id:"243714",title:"Mr.",name:"Muhammad Hamza",middleName:null,surname:"Basit",slug:"muhammad-hamza-basit",fullName:"Muhammad Hamza Basit"}]},{id:"60064",title:"Rapid Endosomal Recycling",slug:"rapid-endosomal-recycling",totalDownloads:1342,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Peripheral membrane proteins are endocytosed by constitutive processes of membrane invaginations, followed by internalization driven by diverse endocytic machinery available at the cell surface. It is believed that after endocytic uptake, cargo proteins proceed either through the endosomal recycling circuit of the cell or travel toward late endosomes for degradation. In this chapter, we analyzed trafficking of seven cargo molecules (transferrin receptor, fully conformed MHC-I, non-conformed MHC-I, cholera-toxin B subunit, CD44, ICAM1, and G-protein-coupled receptor Rae-1) known to use the distinct endocytic route. For that purpose, we developed the software for multicompartment analysis of intracellular trafficking. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. 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Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). 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Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"111683",title:"Prof.",name:"Elmer P.",middleName:"P.",surname:"Dadios",slug:"elmer-p.-dadios",fullName:"Elmer P. 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She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. 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