\r\n\t2) Human sexual disorders in males and females.
\r\n\t3) Psychological aspects of the human sexual response cycle and its disorders.
\r\n\t4) The therapeutic aspects.
\r\n\r\n\tThe human sexual response cycle and human sexual behavior are interrelated. How this inter-relationship and its association to normal sexual health need to be delineated. In a world torn between sex and sexually transmitted disease, clear-cut scientific information in the form of a monograph is required to educate.
\r\n\r\n\tHuman sexuality, gender identity, and sexuo-erotic orientation play great roles in human health and disease. Sex education is the need of the hour and a reflection will be timely.
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1. Introduction
\n
Cotton is one of the most important fiber crops in the world. It is cultivated in more than 100 countries contributing about 40% of the global market. About 350 million people are directly or indirectly linked with cotton production and industry. Cotton has major share in global agriculture economy; however, its production and yield are compromised due to various biotic, abiotic, and climatic factors. To meet the global need, innovative research has been carried out to enhance the cotton production. Starting from the conventional breeding strategies to the modern technologies, there is a long history of cotton research. In this chapter, the milestones of cotton research have been reviewed with recent and innovative results. The chapter briefly deals with cotton biotechnology, cotton cytogenetics, cotton genetics and genomics, genetic modification of cotton, genome editing, genome sequencing, etc. It contains the latest information in the field of cotton research.
\n
Cotton is major economic crop in the world. However, its production is restricted by various biotic and abiotic factors. Its growth and efficiency are rigorously influenced by the stresses such as high temperature, salinity, less water availability, diseases, insects, etc. The chapter discusses the recent trends in cotton research to combat these biotic and abiotic stresses in crop plants.
\n
\n\n
2. Abiotic stress tolerance in cotton
\n
Drought is a major abiotic stress which limits plant growth and fiber quality. Yield is badly affected under less water conditions. It is widely spread in many countries and is expected to increase further [1] due to sudden climate changes. Plant growth is decreased due to drought stress as photosynthetic rate and nutrient availability in soil are reduced. Similarly, salinity causes physiological dryness. High temperature can also cause stress [2], which is cause of reduced yield. A lot of research efforts have been done with a statement that the better understanding of these mechanisms would result in crop production under stress conditions. Desiccation stress results in the changing expression pattern of genes in plants, usually arbitrated with abscisic acid (ABA) [3] and physiology of plant is badly affected by the drought stress [4].
\n
When a plant is under stress, the genes are turned on or off. Some proteins are regulatory in nature and regulate signal transduction and regulate expression of stress-responsive genes. Transcription factors also regulate gene expression and are grouped into large families, like WRKY, bZIP, AP2/ERF, Cys2His2, MYC, zinc finger, MYB, and NAC [5]. The DREB subfamily of proteins belongs to the CBF (C repeat binding factor) proteins. ERF subfamily also has crucial role in plant gene expression under abiotic stress response and therefore received considerable attention in the recent past [6]. Drought causes significant damage to plants [7, 8, 9]. Plants have their self-defense mechanisms which respond to abiotic stresses at molecular, biochemical, and physiological levels [10, 11, 12, 13, 14]. Some genes are known to have role in the drought stress response at transcription level [8, 13, 15]. Few drought-tolerant genes have also been studied, which code for regulatory proteins, involved in further regulation of stress-responsive gene expression [14, 15].
\n
Cotton expressing AtNHX1 was grown in the presence of salt, which produced more fiber and biomass. Cotton plants overexpressing the AtNHX1 gene resulted in the movement of salt (Na+) into the vacuole, which leads to high concentration of salt in the vacuole, which leads to high salt tolerance in cotton. AVP1 gene from Arabidopsis introduced into the cotton resulted in enhanced salt tolerance and more fiber production [16]. CMO gene is a major catalyst in the production of glycine betaine and transgenic cotton expressing AhCMO was more tolerant to high salt concentration then non-transgenic cotton. Thus, it is clear that the salt tolerance in the cotton can be enhanced by the genetic engineering [17]. Cotton plants expressing GhDof1 gene resulted in an increased tolerance to cold and salt stress. GhSOD, GhMYB, and GhP5CS are the stress-responsive genes [18].
\n
\n\n
3. Biotic stress tolerance in cotton
\n
GhWRKY3 is a gene which is expressed under biotic stress. Cotton seeds were analyzed with three fungi known as Fusarium oxysporum, Rhizoctonia solani, and Colletotrichum gossypii to understand the response of GhWRKY3. The level of GhWRKY3 protein was increased after infection with these three fungi clearly indicated that GhWRKY3 has an important role in fungal pathogenesis [19]. Increased pathogen tolerance can be achieved by the transgenic management of the expression of the GhLac1 gene in cotton (Gossypium hirsutum). Elevated tolerance to the fungal pathogen, Verticillium dahliae, and cotton aphid (Aphis gossypii) resulted in response to the up-regulation of GhLac1.
\n
GhWRKY39 present in the nucleus and few cis-acting elements related to stress response were studied. GhWRKY39 gene was expressed by the fungal and bacterial attack and this gene resulted in the enhanced activity of the SOD, POD, and CAT antioxidants after pathogen attack. Thus, GhWRKY39 was found to be involved in the plant protection against pathogen attack. GhWRKY39 directs the reactive oxygen species (ROS) system, which positively results in regulation of plant protection against pathogens [20].
\n
\n\n
4. Cell and tissue culture technology
\n
Cotton is included in the list of commercial plants because it can be generated from undifferentiated tissues. Tissue can be taken from plant which can be cultured on an appropriate media. By using tissue culture technology, cotton plants have been screened for disease resistance and embryonic plants produced from the callus young plants produced by suspension cultures from callus. Shoot tips were also used to regenerate whole cotton plants [21]. Cotton has successfully been regenerated from the shoot apex. Problem related to regeneration of plant from callus has been sorted out by using shoot apex as explant [21, 22, 23]. Cotton was regenerated by the use of shoot apex which was less expensive and required less labor to regenerate cotton plant.
\n
\n\n
5. Genetically modified cotton
\n
Lots of efforts have been made to genetically modify cotton for insect tolerance. Bt cotton is the success story in this regard. It is being grown in more than 20 countries for the last more than two decades. Extensive studies on Bt cotton have been done in different countries like India [24], Mexico [25], China [26], and Argentina [27]. Bt cotton verities have good impact on environment and human health. Bt cotton has been produced by the transfer of genes from the bacterium known as Bacillus thuringiensis which produce the insecticidal proteins. Bt cotton also resulted in the production of high level of useful insects [28].
\n
Naturally, 15% oleic acids are present in the cotton seeds. So, transgenic cotton was developed to contain high levels of oleic acids. By the subcloning of mutant allele of the Fad2 gene from the phaseolin (seed specific promoter), the level of Fad2 gene in cotton was decreased. Gas chromatography was used to analyze the fatty acids profile of seed lipids from the transgenic cotton varieties. About 21–31% oleic acids were seen in the transgenic lines. Progeny of some transformants showed high levels of oleic acid (47%). So, genetically modified cotton can be developed to produce high level of oleic acid [29].
\n
\n\n
6. CRISPR/cas9 system in cotton
\n
Genome editing can be used for the functional studies and crop improvements. CRISPR/cas9 system has a sgRNA, which directs the break of double-stranded DNA but all sgRNAs are not equally good. So, in cotton it is necessary to decrease the use of less-efficient sgRNA which can be used in the production of genetically transformed plants without the preferred CRISPR/cas9-induced mutations. The transient expression system was used to improve the functions of sgRNA in cotton. This method was used to check the target sites for the genes known as GhEF1, GhPDS, and GhCLA1 and to analyze the nature of mutation induced by CRISPR/cas9 system. Most frequent mutations observed were deletions. So, it was confirmed that CRISPR/cas9 can generate the mutations in the cotton genes, which are very important for the allotetraploid plant. It was also shown that targeting of gene can be achieved by the expression of many sgRNAs. CRISPR/cas9 was used to generate the deletions in the GhPDS locus. Genetically modified cotton having gene editing mutations in GhCLA1 gene was produced by the CRISPR/cas9 system. Intense albino phenotype was produced by the mutation in the GhCLA1 gene [30].
\n
Cotton is a significant crop for the production of fiber, oil and bio-fuel. Usually, Agrobacterium tumefaciens-mediated transformation into cotton takes 8–10 months to generate the T0 plants. Scientists used the transient expression system to validate the CRISPR/cas9 cassettes in cotton. Efficient CRISPR/Cas9 cassettes can be selected to get the better mutagenesis rate by the use of GhU6 promoter instead of Arabidopsis ATU6–29 promoter and GhU6 promoter. When CRISPR/cas9 expressed the sgRNA under the GhU6 promoter, CRISPR/cas9 mutagenesis rate was increased four to six times and expression level of sgRNA was increased from six to seven times, which was a great achievement in the targeted mutagenesis of cotton by the CRISPR/cas9 system [31]. CRISPR/cas9 system has been used to generate multiple sites in Gossypium hirsutum. Two genes GhCLA1 and DsRed2 were selected as targets. Plants containing edited DsRed2 gene reverted its character to wild type in T0 generation. Gene editing efficiency was 66–100% [32].
\n
\n\n
7. Cotton computational analysis
\n
Genomic, genetic, and breeding data are available on the Cottongen (http://www.cottongen.org), which has information related to markers, gene maps, expressed sequence tags, whole genome sequence, and genetic map. Analysis tools like BLAST are also available on the Cottongen [33]. Drought-tolerant cDNA libraries have been made by suppressive subtractive hybridization (SSH) technique and many genes were characterized and expression level of the genes under drought stress was studied [34]. DREB gene was identified in cotton (Gossypium arboreum), which was cloned and sequenced. Further, it was characterized in silico to study its interactions with other genes. It was found to interact with MYB, NAC, ABRE, and AREB, which are involved in the drought stress tolerance pathways [35].
\n
\nAcknowledgments
\n
This work was supported by funds from Higher Education Commission of Pakistan.
\n
\n
Author contributions
\n
PZ, RS, and HMA did the research work and wrote the first draft of manuscript. MR and MI designed and wrote the paper and BR and SAK assisted in writing the paper. All the authors read the manuscript and approved it for publication.
\n
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Introduction",level:"1"},{id:"sec_2",title:"2. Abiotic stress tolerance in cotton",level:"1"},{id:"sec_3",title:"3. Biotic stress tolerance in cotton",level:"1"},{id:"sec_4",title:"4. Cell and tissue culture technology",level:"1"},{id:"sec_5",title:"5. Genetically modified cotton",level:"1"},{id:"sec_6",title:"6. CRISPR/cas9 system in cotton",level:"1"},{id:"sec_7",title:"7. Cotton computational analysis",level:"1"},{id:"sec_8",title:"Acknowledgments",level:"1"},{id:"sec_8",title:"Author contributions",level:"1"}],chapterReferences:[{id:"B1",body:'[\nBurke EJ, Brown SJ, Christidis N, Burke EJ, Brown SJ, Christidis N. Modeling the recent evolution of global drought and projections for the twenty-first century with the Hadley centre climate model. Journal of Hydrometeorology. 2006;7(5):1113-1125. DOI: 10.1175/JHM544.1\n]'},{id:"B2",body:'[\nChinnusamy V, Schumaker K, Zhu J. Molecular genetic perspectives on cross-talk and specificity in abiotic stress signalling in plants. 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DNA-binding specificity of the ERF/AP2 domain of arabidopsis DREBs, transcription factors involved in dehydration- and cold-inducible gene expression. Biochemical and Biophysical Research Communications. 2002;290(3):998-1009. DOI: 10.1006/bbrc.2001.6299\n]'},{id:"B7",body:'[\nBoyer JS. Plant productivity and environment. Science. 1982;218(4571):443-448. DOI: 10.1126/science.218.4571.443\n]'},{id:"B8",body:'[\nIngram J, Bartels D. The molecular basis of dehydration tolerance in plants. Annual Review of Plant Physiology and Plant Molecular Biology. 1996;47(1):377-403. DOI: 10.1146/annurev.arplant.47.1.377\n]'},{id:"B9",body:'[\nJakab G, Ton J, Flors V, Zimmerli L, Métraux J-P, Mauch-Mani B. Enhancing arabidopsis salt and drought stress tolerance by chemical priming for its abscisic acid responses. Plant Physiology. 2005;139(1):267-274. DOI: 10.1104/pp.105.065698\n]'},{id:"B10",body:'[\nSchroeder JI, Kwak JM, Allen GJ. Guard cell abscisic acid signalling and engineering drought hardiness in plants. Nature. 2001;410(6826):327-330. DOI: 10.1038/35066500\n]'},{id:"B11",body:'[\nShinozaki K, Yamaguchi-Shinozaki K. Gene expression and signal transduction in water-stress response. Plant Physiology. 1997;115(2):327-334. DOI: 10.1104/pp.115.2.327\n]'},{id:"B12",body:'[\nXiong L, Schumaker KS, Zhu J-K. Cell signaling during cold, drought, and salt stress. The Plant Cell. 2002;14(Suppl. 1):S165-S183. DOI: 10.1105\n]'},{id:"B13",body:'[\nZhu J-K. Salt and drought stress signal transduction in plants. Annual Review of Plant Biology. 2002;53(1):247-273. DOI: 10.1146/annurev.arplant.53.091401.143329\n]'},{id:"B14",body:'[\nShinozaki K, Yamaguchi-Shinozaki K. Gene networks involved in drought stress response and tolerance. Journal of Experimental Botany. 2007;58(2):221-227. DOI: 10.1093/jxb/erl164\n]'},{id:"B15",body:'[\nShinozaki K, Yamaguchi-Shinozaki K, Seki M. Regulatory network of gene expression in the drought and cold stress responses. Current Opinion in Plant Biology. 2003;6(5):410-417. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12972040\n\n]'},{id:"B16",body:'[\nPasapula V, Shen G, Kuppu S, et al. Expression of an arabidopsis vacuolar H+-pyrophosphatase gene (AVP1) in cotton improves drought- and salt tolerance and increases fibre yield in the field conditions. Plant Biotechnology Journal. 2011;9(1):88-99. DOI: 10.1111/j.1467-7652.2010.00535.x\n]'},{id:"B17",body:'[\nMa X, Dong H, Li W. Genetic improvement of cotton tolerance to salinity stress. African Journal of Agricultural Research. 2011;6(33):6798-6803. DOI: 10.5897/AJARX11.052\n]'},{id:"B18",body:'[\nSu Y, Liang W, Liu Z, et al. Overexpression of GhDof1 improved salt and cold tolerance and seed oil content in Gossypium hirsutum. Journal of Plant Physiology. 2017;218:222-234. DOI: 10.1016/j.jplph.2017.07.017\n]'},{id:"B19",body:'[\nGuo R, Yu F, Gao Z, An H, Cao X, Guo X. GhWRKY3, a novel cotton (Gossypium hirsutum L.) WRKY gene, is involved in diverse stress responses. Molecular Biology Reports. 2011;38(1):49-58. DOI: 10.1007/s11033-010-0076-4\n]'},{id:"B20",body:'[\nShi W, Liu D, Hao L, Wu C, Guo X, Li H. GhWRKY39, a member of the WRKY transcription factor family in cotton, has a positive role in disease resistance and salt stress tolerance. Plant Cell, Tissue and Organ Culture. 2014;118(1):17-32. DOI: 10.1007/s11240-014-0458-8\n]'},{id:"B21",body:'[\nMcCabe DE, Martinell BJ. Transformation of elite cotton cultivars via particle bombardment of meristems. Nature Biotechnology. 1993;11(5):596-598. DOI: 10.1038/nbt0593-596\n]'},{id:"B22",body:'[\nGould J, Banister S, Hasegawa O, Fahima M, Smith R. Regeneration of Gossypium hirsutum and G. barbadense from shoot apex tissues for transformation. Plant Cell Reports. 1991;10(1):12-16. DOI: 10.1007/BF00233024\n]'},{id:"B23",body:'[\nSaeed NA, Zafar Y, Malik KA. 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Available from: https://ideas.repec.org/p/ags/aaea02/19710.html [Accessed: 23 July 2019]\n]'},{id:"B28",body:'[\nFitt GP, Mares CL, Llewellyn DJ. Field evaluation and potential ecological impact of transgenic cottons (Gossypium hirsutum) in Australia. Biocontrol Science and Technology. 1994;4(4):535-548. DOI: 10.1080/09583159409355367\n]'},{id:"B29",body:'[\nChapman KD, Austin-Brown S, Sparace SA, et al. Transgenic cotton plants with increased seed oleic acid content. Journal of the American Oil Chemists\' Society. 2001;78(9):941-947. DOI: 10.1007/s11746-001-0368-y\n]'},{id:"B30",body:'[\nGao W, Long L, Tian X, et al. Genome editing in cotton with the CRISPR/Cas9 system. Frontiers in Plant Science. 2017;8:1364. DOI: 10.3389/fpls.2017.01364\n]'},{id:"B31",body:'[\nLong L, Guo D-D, Gao W, et al. Optimization of CRISPR/Cas9 genome editing in cotton by improved sgRNA expression. Plant Methods. 2018;14(1):85. DOI: 10.1186/s13007-018-0353-0\n]'},{id:"B32",body:'[\nWang P, Zhang J, Sun L, et al. High efficient multisites genome editing in allotetraploid cotton (Gossypium hirsutum) using CRISPR/Cas9 system. Plant Biotechnology Journal. 2018;16(1):137-150\n]'},{id:"B33",body:'[\nYu J, Jung S, Cheng C-H, et al. CottonGen: A genomics, genetics and breeding database for cotton research. Nucleic Acids Research. 2014;42(D1):D1229-D1236. DOI: 10.1093/nar/gkt1064\n]'},{id:"B34",body:'[\nZhang L, Li F-G, Liu C-L, Zhang C-J, Zhang X-Y. Construction and analysis of cotton (Gossypium arboreum L.) drought-related cDNA library. BMC Research Notes. 2009;2:120. DOI: 10.1186/1756-0500-2-120\n]'},{id:"B35",body:'[\nShaheen T, Fazal Abbas M, Zaib P, Ullah I, Tahir ul Qamar M, Arif A. Identification, characterization, homology modeling and protein-protein interactions of cotton (Gossypium arboreum L.) DREB gene. 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Introduction
It is worldwide recognized the impact of kidney disease in economy and society. In developed countries, the costs associated with dialysis treatment and transplantation consume 2 to 3% of the health budget. On the other hand, in middle and low-income countries the accessibility to kidney function replacement treatments is low [1].
Chronic kidney disease (CKD) is considered a public health problem and has a significant weight in the context of chronic diseases. This disease affects around 850 million people worldwide, with one in ten adults having chronic kidney disease [2].
All stages of the disease - 1 to 5 -, are associated with increased risk of cardiovascular morbidity, premature mortality and quality of life decrease [3].
Considering the weight of hypertension, cardiovascular disease and diabetes mellitus in the increase of CKD, it is crucial to be concerned with its management.
2. Chronic kidney disease and hypertension
There is a complex association between CKD and hypertension due to a cause-effect relationship, in which both hypertension and CKD have a risk factor sharing relationship, being that one may be the cause or consequence of the other. Every year the number of people diagnosed with CKD due to hypertension increases by 10%.
The literature states that 5% of CKD are due to hypertension. It is highlighted that hypertension is more common in glomerular diseases, but the incidence of this clinical condition differs according to the histological characteristics of the disease. Membranoproliferative glomerulonephritis and segmental and focal glomerulosclerosis forms have a higher incidence of hypertension than membranous forms and IgA glomerulopathy. Table 1 shows the prevalence of hypertension in different chronic renal diseases [4].
Chronic kidney disease | % of hypertension patients |
---|
Glomerular diseases Segmental and focal glomerulosclerosis Membranoproliferative glomerulonephritis Diabetic nephropathy Membranous nephropathy Mesangial proliferative glomerulonephritis IgA nephropathy Minimal change disease | 75–80 65–70 65–70 40–50 35–40 30 20–30 |
Polycystic kidney disease | 60 |
Chronic interstitial nephritis | 35 |
Table 1.
Hypertension prevalence in CKD patients.
The evidence supports that the prevalence of hypertension increases as kidney function deteriorates in CRD, with a progressive decrease in the glomerular filtration rate [5].
Several studies have shown that hypertension is an independent risk factor for end-stage renal disease (ESRD), contributing to the disease itself and its progression [6, 7].
Cardiovascular disease is the leading cause of death in CKD, which in turn, increases the risk of long-term cardiovascular events [8].
When compared to the general population, the prevalence of hypertension is higher in people with CKD, constituting the factor with the greatest impact on the progression and outcome of kidney disease [9].
It is not yet known the exact mechanism that causes hypertension in CKD, nor has been isolated any factor responsible for its establishment. It is theorized that there are several mechanisms that, acting together, contribute to increased blood pressure, such as the progressive loss of sodium excretion with the consequent volume overload, the excessive activity of the renin-angiotensin system, the disproportionate increase in sympathetic activity, secondary hyperparathyroidism, the reduction of nitric oxide synthesis and the high endothelin levels, among others [10, 11].
Observational studies report an increased risk of development and rapid progression of CKD in cases of uncontrolled blood pressure [12].
Failure to treat hypertension is associated with harmful effects such as left ventricular hypertrophy, dilated cardiomyopathy and accelerated deterioration of renal function, among other causes [10].
According to Kidney Disease Improving Global Outcomes (KDIGO), international organizations (such as National Kidney Foundation Kidney Disease Outcomes Quality Initiative - NKF KDODQI; Eighth Joint National Committee published - JNC 8) committed to the prevention and treatment of hypertension recommend non-pharmacological measures along with pharmacological measures in the prevention and treatment of this disease [13, 14].
According to these organizations, health professionals are responsible for early detection of the disease and monitoring of risk factors.
The disease can progress slowly due to the gradual loss of the nephrons, and in its initial stages it goes unnoticed, only being identified when symptoms appear.
The purpose of screening and monitoring the disease in the early stages is to delay its progression to ESRD, a condition that leads to the need for renal replacement therapy.
Only a minority of patients with hypertension have blood pressure within the accepted target values (systolic blood pressure less than 140 mmHg, diastolic blood pressure less than 90 mmHg). The main causes for the lack of blood pressure control are related to low knowledge of the problem and lack of screening for hypertension in the population [15].
In the context of non-pharmacological measures, European Society of Cardiology makes clear the urgent need to promote preventive actions, mentioning that blood pressure measurement is a simple, non-invasive and low-cost technique, especially if considering the costs of treating hypertension and associated complications.
Regarding hypertension and kidney disease, there is no consensus among the authors about what the reference values should be. This is an issue that remains in debate despite recent recommendations and the publication of the clinical trials SPRINT, ACCORD, among others [16, 17].
The European Society of Hypertension and the European Society of Cardiology (ESH/ESC) recommend target blood pressure values below 140/90 mmHg for blood pressure measurements in a clinical setting. However, in the presence of proteinuria, these values drop to 130/80 mmHg as a reference. Similar recommendations are indicated by the JNC-8, suggesting target blood pressure values below 140/90 mmHg for the general population, disregarding the recommendations of SPRINT study, which suggests blood pressure values below 130/80 mmHg for patients at increased risk of cardiovascular events, including patients with CKD [18].
Target blood pressure values have changed over time. The literature shows that the target blood pressure value acceptable for patients with CKD is 130/80 mmHg [19]. The latest guidelines of the European Society of Hypertension and the European Society of Cardiology published in 2018 recommend a target SBP (Systolic Blood Pressure) value of 130–139 mmHg and DBP (Diastolic Blood Pressure) of 70–79 mmHg for patients with CKD. But there is not a unanimous view among scientific community on this issue [20, 21].
Vital for the success of the blood pressure prevention and control programs is the participation of the patient/family.
Health care, as integrating element of praxis, which takes place during the course of the chronic disease, calls for the participation of all stakeholders in the care process and for the investment in patients’ education, enabling them to understand their health needs and become co-responsible for their health and well-being [22].
Everybody should to be part of an active citizenship stance based on education and training. Care must focus on the needs of the patient, it is important to know their level of mastery in response to the needs considered significant at any stage of the disease pathway [23].
3. Home blood pressure measurement
Blood pressure self-monitoring has been proposed as a strategy to improve hypertension control. Although the results of previous clinical trials on blood pressure measurement in the adjustment of hypertensive therapy and in the control of hypertension are inconsistent, the results of TASMINH4 demonstrated that 90% of eligible participants revealed that they wanted to take an active role in self-monitoring of blood pressure [24].
However, the importance of new studies in this area is highlighted, mainly studies involving risk groups, including patients with CKD in the advanced stage of the disease [25].
Hypertension is common in CKD patients, with a prevalence of around 60% to 90%, depending on the stage and cause of the disease, and is responsible for high cardiovascular morbidity and mortality. In this context, blood pressure control is a key measure [10].
HBPM is easier than ambulatory blood pressure measurement and, therefore, can be an important tool for blood pressure control in combination with other measures.
In this regard, Sanghavi, & Vassalotti emphasize that measuring blood pressure at home is a mean of reducing the burden of medication in individuals with “white coat hypertension”, that is defined as the increase in blood pressure in the clinical context and maintenance of normal values at home. And, therefore, a means of improving the therapeutic compliance of hypertensive patients [26].
The authors also add that HBPM offers the patient a means to monitor the effectiveness of the medication and acts as a positive reinforcement, as shown by a study carried out in Spain. Of the 250 participants, 92% of the individuals in the experimental group (home blood pressure measurement) adhered to the antihypertensive regime, against 74% in the control group.
They concluded that HBPM is simple and not expensive. Besides, it offers more information to the practitioner, allowing more informed clinical decisions. It also promotes the involvement of the patient and the commitment of the health team, including nurses.
The evidence that shows the benefits of HBPM compared to measuring blood pressure in the clinical setting. Namely in improving blood pressure control, in reducing “white coat hypertension” events and in cardiovascular risk prediction [27, 28, 29].
The diagnosis of “white coat hypertension” is important because one of the consequences of this situation is overtreatment [30].
CKD patients with “white coat hypertension” have a lower cumulative risk of progressing to ESRD, so home blood pressure monitoring is essential. On the other side, renal patients have a high prevalence of masked hypertension, defined as normal blood pressure values in the clinical setting and high blood pressure values at home or ambulatory. This situation puts them at risk of organ damage, cardiovascular events and tends to evolve to ESRD [31].
HBPM allows a complementary assessment of daytime blood pressure variation, commonly seen in chronic kidney patients [32, 33].
Self-measurement of blood pressure at home is therefore an alternative for measuring blood pressure. Besides providing a more accurate assessment of blood pressure, it offers the possibility of having regular measurements in conditions closer to the patients’ daily lives [34].
It is recognized by the scientific community that the measurement of blood pressure in the clinical context does not accurately reflect the blood pressure of each individual (due to changes in circadian rhythm and in the environment). It is thus necessary to create alternative methods whose main goal is to enable a closer assessment of the patient’s values, because it takes place in a natural context, in the patient’s natural environment [35].
Therefore, the self-monitoring of blood pressure at home becomes a tool to be incorporated into the self-care of CKD patients, through which the person has control over the process. This action makes the patient co-responsible for their health. This is a simple and important measure in preventing progression to ESRD, but it is nevertheless a complement to blood pressure measurement in the clinical context [36].
The negative individual, social, and economic consequences of not controlling blood pressure are evident. But these effects can be positive when enhanced by the self-management of hypertension.
The main negative effects resulting from the lack of blood pressure control in CKD patients call for the development of self-care interventions that result in behavior modification and optimization of hypertension control.
This issue is evident in the study by Humpherys et al., which, through a multifaceted intervention approach, optimized blood pressure values in proteinuric CKD patients and unproteinuric CKD patients. For that, the authors run 4 projects, which occurred in different practices, established chronologically in different periods of time. The percentage of patients with self-care behaviors for blood pressure management within the recommended target values increased from 34% to 74% in project 1, from 60% to 83% in project 2, from 68% to 71% in project 3 and 63% to 76% in project 4. Both groups (proteinuric and unproteinuric CKD patients) were able to reach the recommended target blood pressure values. The group of unproteinuric patients achieved blood pressure values below 140/90 mmHg and the group of proteinuric patients reached values of blood pressure below 130/80 mmHg. In this context, the authors concluded that this type of intervention proves to be an asset in reducing long-term complications resulting from suboptimization of blood pressure control [22].
The analysis of the systematic literature review carried out by Gallagher, et al. shows us the positive effects of educational interventions in reducing high blood pressure. The benefits of health education interventions in lowering blood pressure in chronic kidney patients were confirmed. As well as their potential in reducing cardiovascular events and delaying the progression of the disease [37].
Given that nurses have a pivotal role in promoting self-care behaviors in all aspects of care, including (1) problem identification, (2) diagnosis, (3) intervention, (4) evaluation and (5) follow-up, it is essential to highlight the interventions developed in the context of high blood pressure control in chronic kidney patients.
According to the literature, the possible causes of blood pressure control in this target group are associated with a reduction in self-care behaviors in relation to the consumption of salt, the practice of physical exercise and the adherence to medication. The overlook of these behaviors leads to hypertension. In this context, non-pharmacological interventions are relevant, along with pharmacological measures [38].
4. The role of nursing education in promoting patient’s kidney self-care capacities
Health education, as a field for knowledge production, assumes a privileged relationship with active citizenship, providing patient/family with the possibility of making informed decisions and acting in collaboration with the health team.
Assuming the empowerment speech as a key element of the care action, which is shaped at the border between the biomedical model and the model of care centred on the patient, Orem’s theory of self-care fits in this context. Especially when it is intended to establish partnerships and promote self-care behaviors in the prevention and control of hypertension in patients with CKD through an educational intervention.
According to Orem, the individual is an active subject, but in a situation of illness, his capacity for self-care can be reduced due to his inefficiency in relation to the condition that affects him [39].
In 2013, the World Health Organization (WHO) defined self-care as the ability of individuals, families and the community to promote health, prevent disease and stay healthy. The partnership with healthcare professionals to deal with the disease and disabilities arises when individuals are unable to meet some or all of the needs for self-care, due to a lack of knowledge, disability or perception of their diminished health status.
Nurses act as a resource for the patient, developing helping methods in order to overcome or compensate health-related limitations, leading the patient to undertake actions to regulate their own functioning and development. The intervention is carried out according to a diagnostic and intervention process. It starts with needs assessment, identification of motivation to learn and, in partnership with the patient and/or family, establishment of the goals to be achieved. In this process the nurse can direct, guide, provide support and teach [39].
CKD patients need to undertake a range of complex activities, such as monitoring blood pressure, blood glucose, introducing changes in diet, adhering to therapy, avoiding nephrotoxic substances and practicing physical exercise [40].
It is internationally recognized that disease self-management is now an essential aspect of the health system. The implementation of a disease self-management plan based on negotiated complementary actions, allows the process participants to rediscover the conditions (knowledge and skills) to satisfy their needs. With the aging of population, families assume an increasing importance in the daily management of the disease. Therefore, families and patients are the clients of health professionals and the expression of their interests must be taken into account [41].
There are many difficulties for active participation of individuals in the management of their disease due to lack of knowledge and skills to deal with the disease. Therefore, between unawareness and fears, people’s behavior can take two directions: control or ignore the problem. In either cases, nurses have a predominant support role in making people aware of their potential, leading them to develop and put that potential at the service of the disease.
Health education is a strategy to be followed, as it constitutes a teaching, instruction and training tool in order to guide the patient and their families to face a new situation in the management and prevention of the disease.
It is true that CKD patients have the same characteristics as the general population in terms of self-care behaviors in controlling blood pressure, following a healthy diet and regular physical exercise. However, it is no less true that CKD disease, due to its complexity and need for intervention in all of the stages, requires specific intervention and monitoring actions along the path of the disease.
As CKD is an asymptomatic disease, especially in the early stages, it means that patients with CKD, because they are unaware of their situation, do not seek information. It is also a fact that the low perception of susceptibility is associated with low levels of literacy and, consequently, with a reduced perception of the risk of developing the disease [40].
This discouraging picture highlights important gaps regarding the patient’s monitoring plan. In this context, innovative and complementary practices are needed to implement an individualized monitoring program based on the patient’s real problems, both in hospitals and in primary health care. As a reference, we identify health education projects developed in specialized hospital consultations, or even in the wards, based on information, instruction and training techniques aimed at this population.
The question that arises is: what directions can be pursued to achieve these goals?
Firstly, it is essential to identify and accurately assess self-care behaviors, regarding blood pressure monitoring at home and levels of activation in disease management in its various stages. Secondly, the implementation of an intervention that promotes knowledge, skills and patient activation in the disease management. That is, providing the means to enable patients to make informed decisions, make a self-monitoring and self-assessment of their condition and implement strategies to solve some problems that arise [42].
Indeed, in the context of CKD research, self-management interventions are on the top of the agenda when it comes to preventing disease progression [43]. For example, Havas et al. indicates that chronic kidney patients reported the need to learn how self-manage their disease and to integrate self-management behaviors into their daily lives [44].
In this context, the education process is a fundamental tool. For it to be successful it is important to take into account the motivation, the literacy level, the patient activation in disease management and the patient/health professional relationship [45].
Activation is an interactive process and consists of the patient’s ability to actively participate in disease management, to assume an active behavior in favor of a passive attitude. Several factors take action in this process, such as the patient’s motivation, beliefs, knowledge and abilities/skills to perform [46].
Activated patients have higher scores for participation in disease self-management, namely blood pressure monitoring, healthy eating habits, physical exercise, smoking cessation, etc., when compared to those who are not [47].
Activation exists in a continuum in which the patient moves between four levels, depending on state of health, self-confidence, motivation to get involved and circumstances of life.
The four levels are:
Beliefs: activated patients believe they have a fundamental role in disease self-management and health status maintenance, collaborating with health professionals.
Trust and knowledge to take action: activated patients have knowledge and confidence in disease self-management.
Take action: activated patients have the skills to manage their health condition.
Maintaining action: activated patients maintain their functionality even if exposed to high levels of stress [48].
Along with the concept of patient activation, the concept of perceived efficacy gains relevance in the disease self-management. To the previous ones, demographic characteristics (age, gender, education) and clinical characteristics (cognitive and physical capacity) are added.
Perceived self-efficacy refers to the person’s perception of their own ability to perform a certain activity in order to achieve a goal or result. According to Bandura, it is important for people to believe that they are able to successfully develop a certain action, because that will be the guarantee of getting involved and adopting goals for that purpose [49].
Bandura also defines how much effort a person will need and how long it will last when faced with difficulties and negative experiences. There is a tendency to avoid situations that may exceed the limit of the person’s capabilities and to deal with those that the person thinks are solvable. The person tends to distance from situations with high levels of demand, offering the most varied justifications [50].
In this way, different scores for perception of self-efficacy can increase or decrease the motivation for action, with higher self-efficacy scores corresponding to better health. Previous research has shown this relationship, in addition to showing that high self-efficacy was associated with positive changes in health behaviors [49].
Several studies in nephrology field have found an association between high levels of perceived self-efficacy and health gains in groups of hemodialysis patients, regarding weight control improvement between dialysis sessions, reducing hospitalizations, amputations and improving quality of life [51].
Taking into account the international scenario, hypertension represents a burden for global disease context. Thus, standardized blood pressure measurement is essential for diagnosis and blood pressure management [36].
Lopez-vargas et al. showed that patients with CKD in the most advanced stages have low levels of knowledge about the associated risk factors, including hypertension and its management. The authors found that 54% of the patients received information on blood pressure monitoring, adherence to therapy and food preparation. They also identified that nurses had the main role of educators in 73% of the necessary studies. The results indicated that of the 54% of the patients involved in disease self-management, 31% had their blood pressure controlled [52].
The interventions that most contributed to the effectiveness of the process were: teaching practical skills, workshops, follow-up patient on a regular basis and negotiating goals to achieve.
Patients involved in blood pressure monitoring at home learn to understand the connection between measuring and controlling blood pressure and more easily adhere to strategies that contribute to controlling blood pressure, specifically diet, exercise and adherence to therapy. This attitude towards the disease shows improvements in health status [53].
For Wanchai & Armer nurses can help the patient to improve their self-care skills [54]. The question is: how to do it?
Returning to Orem’s theory, the authors mention that there are three classifications of nursing systems to meet the self-care requisites of the patient: wholly compensatory system, partially compensatory system and the supportive-educative system. Regarding the first system, nurses need to completely replace the individual due to the inability to self-care. In the second system, a patient can meet some self-care requisites but needs a nurse to help meet other needs. In the supportive-educative system, a patient can meet self-care requisites but needs assistance with decision making, behavior control, or knowledge acquisition skills, so nurses teach, train and support the patient for self-care. Often the patient is unable to perform his activities because he does not have the necessary knowledge to perform them. According to Orem, in some situations, the patient needs the nurse’s guidance to carry out the self-care action and in other situations he needs to learn the techniques to be able to perform them.
The authors mention other methods of training the patient for self-care, promoted by nurses, such as coaching, stimulating the patient’s participation and establishing of therapeutic relationship.
The authors add the motivational interview as a strategy to motivate the patient to change specific behaviors. They also report that review studies have shown the effectiveness of this method in changing behaviors for healthy lifestyles. Other authors have stated that this type of approach is useful in situations where the patient is less motivated to assume self-care or in situations where the patient not yet prepared to take charge of his illness condition.
In the context of health education, giving educational materials can help the patient in the learning process. However, it is necessary to pay attention to the patient’s abilities in terms of reading and comprehension to avoid bad decisions about self-care. The demonstration and training blood pressure measurement in different methods involving the technique of blood pressure measurement at home should be promoted. Additional resources such as videos, access to websites dedicated to this subject or leaflets demonstrating the technique, may be useful in demonstrating blood pressure monitoring at home.
Nurses play an important role in this process, helping the patients to select and understand the best method for themselves [55].
Nurses should inform the patient about the recommended schedule for blood pressure monitoring at home. According to the European Hypertension Society Working Group, blood pressure should be taken twice in the morning and twice in the afternoon [56].
In some experts’ opinion, blood pressure self-monitoring over a long period may allow a more accurate assessment of blood pressure stability and increase the patient’s commitment to treatment.
Nurses should discuss with patients the importance of blood pressure self-management. Therefore, an important element in this whole process is the communication established between the health professional and the patient. Feedback should be maintained even when the professional is not on duty. The patient should be able to communicate with the healthcare professional via telephone, fax and e-mail. There are also other ways of data communication, namely through stored data in devices, mobile phone applications (smartphone applications) and internet.
Nurses can help the patient to obtain health gains through adequate training in blood pressure measuring methodology and interpreting the values obtained in blood pressure monitoring at home.
To this purpose, nurses should explain and demonstrate the technique to the patient and inform about the recommended devices [57]. The Table 2 shows the Society of Cardiology and the European Society of Hypertension recommendations regarding blood pressure measurement at home.
Environment | Comfortable environment temperature Quiet and noiseless environment |
---|
Patient | Training in blood pressure measurement technique is required Measurement conditions and procedures:
Patients should be relaxed, in a seating position with their backs supported and uncrossed legs; Wait for 5 minutes at rest before beginning BP measurements. Patients should remain alone where the blood pressure is measured; The bladder must be empty; Do not eat or smoke within 30 minutes of BP measuring; Do not exercise in the 60 minutes before BP measurement; Do not speak before and during the BP measurement. Arm Position and support Arm selection
Blood pressure should be, preferably, measured on the right arm; The left arm should be used if BP values are higher than in the right arm or due to an abnormality or some circumstance that indicates against its use. In the case CKD patients, it is essential to check for arteriovenous fistulas (AVFs) or arteriovenous grafts (AVGs). Do not assess the blood pressure in the access arm; Record blood pressure assessment arm is also required.
|
Blood pressure measurement devices | Blood pressure cuff size
Before using the BP measuring device ensure that the cuff dimensions are adequate; In relation to the length, the bladder inside the cuff should encircle 80 to 100% of the arm; the bladder width should be 40 to 50% of arm circumference. Blood pressure cuff position
It should be 2–3 cm above the cubital fossa, at the level of the heart; At each BP measurement the cuff should be wrapped around the arm with the central area placed over the brachial artery. Time and frequency for BP measurement
Three consecutive readings in the morning (in fasting and before taking the medication) in the afternoon and evening; Repeat the measurement with 1–2 minutes interval between; Record the values obtained.
|
Table 2.
Recommendations for HBPM.
Regarding device selection, literature indicates that the recommended devices for HBPM are the automatic oscillometric arm devices. This kind of equipment is more user-friendly and requires less skills when compared to manual devices.
Electronic arm devices for BP measurement, especially those that allow the storage, transmission or printing measuring data, should be preferred for HBPM. It is also crucial that patients make sure that the devices they acquire have been validated according to recommended criteria. The European Society for Hypertension Working Group on Blood Pressure Monitoring has developed a protocol applicable to most BP measuring devices available on the market. The European Society of Hypertension supported the creation of a website where updated lists of validated BP measurement devices are published (www.dableeducational). The British Hypertension Society (www.bhsoc.org) also publishes information on device validation.
In Herber, et al., it is essential that the patient and family have coping strategies to deal with the disease and complications. The authors highlight the role of regular home visits in establishing a therapeutic relationship. In these visits, nurses can support and teach the patient and family to manage the therapeutic regimen, increase levels of knowledge about the disease and self-care behaviors, as well as guide the resources available in the community [58].
For Coates et al., the management of the disease is challenging, both for the patient and his relatives, as well as for health professionals, as it requires a change in the philosophy of care. The paradigm change demands the active involvement of the patient in decisions and problem solving. In this context, new strategies are required to make the patient responsible for the management of his health [59].
Negotiation is, thus, an important strategy to prevent the patient from adopting a passive attitude and, at the same time, to equip the patient with the necessary skills and abilities for disease management [60].
Advice and support in changing daily routines are essential for the control of HTA [61].
Blood pressure self-monitoring makes patients more aware of their pressure values and leads them to commit themselves more actively in their therapeutic plan.
In summary, self-care is an essential component for chronic disease management and, in the case of CKD, is certainly a sine qua non condition. The evolutionary path of CKD brings with it a growing number of daily self-care activities for the individual, such as deciding what to do, undertaking self-care activities related to disease monitoring and putting a strong increase in the investment of healthy behaviors, including blood pressure control, diet and exercise, among others.
The health gains for the patient consist of increased quality of life, empowerment, success in lifestyle changes due to active role and involvement in disease management. The change in perception of hypertension can encourage the patient to comply with therapy and make the necessary lifestyle changes [62].
5. Conclusion
The main objective of HBPM is to prevent and delay morbidity, mortality and organ damage. To achieve this goal, it is essential to implement pharmacological and non-pharmacological measures, including: regular blood pressure measuring throughout life at home. This self-care behavior results in gains for the patient as it has been shown in CKD patients. Adequate blood pressure control reduces the rate of decline in kidney function and cardiovascular morbidity and. In this context, HBPM is important for the effective management of hypertension in this group with compromised kidney function [27, 63].
Nurses play an important role in patient empowerment by accompanying, teaching, training and informing about hypertension and the additional measures needed to achieve the expected result: blood pressure control and quality of life. The establishment and maintenance of a model of care based on cooperation between health professionals and the patient is the key to success.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"home blood pressure, self-management, nurse interventions, chronic kidney disease, health gains",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75662.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75662.xml",downloadPdfUrl:"/chapter/pdf-download/75662",previewPdfUrl:"/chapter/pdf-preview/75662",totalDownloads:171,totalViews:0,totalCrossrefCites:0,dateSubmitted:"January 28th 2021",dateReviewed:"February 4th 2021",datePrePublished:"March 11th 2021",datePublished:"February 9th 2022",dateFinished:"March 11th 2021",readingETA:"0",abstract:"One of the advantages of HBPM (Home Blood Pressure Measurement) compared to office measurement is being a strong predictor of cardiovascular morbidity and mortality in hypertensive patients, including those with chronic kidney disease (CKD). However, studies with renal patients not dependent on dialysis are scarce. HBPM is an important tool in the regular monitoring of blood pressure (BP) and in patient’s involvement in its long-term self-management. Nurses have an important role here and their involvement in the process is essential. Nurses must be aware of the latest recommendations as well as they should teach, train, guide and supervise patients. This chapter summarizes information about CKD and hypertension, the importance of measuring blood pressure at home in CKD and describes nursing interventions in this field. Nurses have a role in enabling patients to optimize their self-management skills. Nurse-delivered interventions have been shown to contribute to improved patient outcomes. Nurses can educate patients about proper blood pressure monitoring techniques at home, and also interpreting and evaluating the results and managing the therapeutic regimen. Evidence shows the effects of interventions performed by nurses in improving and controlling BP, such as teaching, training, counseling, motivational interview, coaching, nurse–patient relationship, communication, negotiation, and support.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75662",risUrl:"/chapter/ris/75662",signatures:"Dilar Costa and Filipa Aguiar",book:{id:"9811",type:"book",title:"Ultimate Guide to Outpatient Care",subtitle:null,fullTitle:"Ultimate Guide to Outpatient Care",slug:"ultimate-guide-to-outpatient-care",publishedDate:"February 9th 2022",bookSignature:"Gaffar Sarwar Zaman",coverURL:"https://cdn.intechopen.com/books/images_new/9811.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83968-763-1",printIsbn:"978-1-83968-762-4",pdfIsbn:"978-1-83968-764-8",isAvailableForWebshopOrdering:!0,editors:[{id:"203015",title:"Dr.",name:"Gaffar",middleName:"Sarwar",surname:"Zaman",slug:"gaffar-zaman",fullName:"Gaffar Zaman"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"332843",title:"Ph.D.",name:"Dilar",middleName:null,surname:"Costa",fullName:"Dilar Costa",slug:"dilar-costa",email:"dilarcosta@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"332845",title:"MSc.",name:"Filipa",middleName:null,surname:"Aguiar",fullName:"Filipa Aguiar",slug:"filipa-aguiar",email:"FILIPAGUIAR@HOTMAIL.COM",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Chronic kidney disease and hypertension",level:"1"},{id:"sec_3",title:"3. Home blood pressure measurement",level:"1"},{id:"sec_4",title:"4. The role of nursing education in promoting patient’s kidney self-care capacities",level:"1"},{id:"sec_5",title:"5. Conclusion",level:"1"},{id:"sec_9",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'[Macário, F. Some reflections on renal care. Port J Nephrol Hypert. 2019; 33 (4): 209-211. DOI: 10.32932/pjnh.2020.01.043]'},{id:"B2",body:'[Carney, E.F. The impact of chronic kidney disease on global health. Nat Rev Nephrol. 2020; 16: 251. DOI: 10.1038/s41581-020-0268-7]'},{id:"B3",body:'[Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS One [Internet]. 2016 [cited 2020 Nov 27]; 11 (7):1-18. 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ASD is associated with deficiencies in communication and social interaction, as well as restricted and repetitive behavioural patterns, according to the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5). By using the ISI Web of Knowledge as the reference data basis, we perform a bibliometric study of the use of VR as an educational tool for high-functioning ASD children. By this study we can quantify, on the one hand, the up to day importance of the different types of VR applied to this field: immersive or non-immersive, as well as the use of human or agent avatars. On the other hand, we can also differentiate amongst those interventions that work on emotional and social competences. The analysis of periods of research scarce, research abundance and research trends provides a dynamic view of the strategies used in this field in the last 20 years and suggests future lines of research.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Jorge Fernández-Herrero, Gonzalo Lorenzo-Lledó and Asunción\nLledó Carreres",authors:[{id:"187920",title:"Prof.",name:"Gonzalo",middleName:null,surname:"Lorenzo",slug:"gonzalo-lorenzo",fullName:"Gonzalo Lorenzo"},{id:"189580",title:"Prof.",name:"Asunción",middleName:null,surname:"Lledó",slug:"asuncion-lledo",fullName:"Asunción Lledó"},{id:"213024",title:"Mr.",name:"Jorge",middleName:null,surname:"Fernandez-Herrero",slug:"jorge-fernandez-herrero",fullName:"Jorge Fernandez-Herrero"}]},{id:"57269",doi:"10.5772/intechopen.71265",title:"Enhancing Young Children’s Access to Early Childhood Education and Care in Tanzania",slug:"enhancing-young-children-s-access-to-early-childhood-education-and-care-in-tanzania",totalDownloads:1473,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"This chapter draws on the current situation of limited access of young children to early childhood education and care (ECEC) settings in Tanzania. It offers information and evidence on early childhood education and care (ECEC) from an international perspective to those who are, directly or indirectly, involved with young children and their families. Basically, early childhood education and care in Tanzania is still unsatisfactory. Many children have no access to early childhood settings for various reasons including: lack of parents’ awareness on the importance of early investment in education, lack of support from the government, low socio-economic status of parents, gender discrimination, and traditional norms and cultural values. To improve the situation, there is need for a forging of partnership between the government, parents, and the community. Government policy-makers have to set clear policies regarding how quality early childhood education and care can be equitably funded and conducted throughout the country.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Ignasia Mligo",authors:[{id:"212055",title:"Dr.",name:"Ignasia",middleName:null,surname:"Mligo",slug:"ignasia-mligo",fullName:"Ignasia Mligo"}]},{id:"57391",doi:"10.5772/intechopen.71287",title:"Influence of Parental Divorce on Anxiety Level of Adolescents",slug:"influence-of-parental-divorce-on-anxiety-level-of-adolescents",totalDownloads:1854,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Family divorce might have an effect on some aspects of child development. Adolescence as a transitional stage is marked by process of seeking identity, the need for intimate relationship, as well as the struggle for psychological independence from family. Anxiety is defined as a state of extreme worry, fear, and uncertainty which results from the expectation of a threatening event or situation. The aims of study are: to explore the differences in anxiety levels among adolescents from divorced and intact families; to explore the level of anxiety of adolescents from divorced and intact families with respect to their genders. A demographic questionnaire was created and The Beck Anxiety Inventory was applied to measure anxiety. The scale was applied with 162 participants who were chosen randomly from 5 different high schools in Istanbul province. The study found out that there are statistically significant differences in anxiety level of adolescents between children from divorced and intact families. Descriptive measures are in range as follows: (17.67 ± 9.645). The adolescents from divorced families had a higher level of anxiety (t = 17.322; p < .05). The result related to the second study aim shows that there are no statistically significant differences in anxiety between male and female adolescents from divorced and intact families (p > .05).",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Senija Tahirović and Gokce Demir",authors:[{id:"214445",title:"Dr.",name:"Senija",middleName:null,surname:"Tahirovic",slug:"senija-tahirovic",fullName:"Senija Tahirovic"},{id:"214465",title:"MSc.",name:"Gokce",middleName:null,surname:"Demir",slug:"gokce-demir",fullName:"Gokce Demir"}]},{id:"57686",doi:"10.5772/intechopen.71672",title:"Children and Young People’s Vulnerabilities to Grooming",slug:"children-and-young-people-s-vulnerabilities-to-grooming",totalDownloads:2210,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Child abuse is evolving, pervasive and complex and children are vulnerable to its widespread reach in many aspects of their lives, from face-to-face interactions to those they have online. This chapter aims to review contemporary literature which outlines the vulnerabilities of children to face-to-face and online grooming as part of a process leading to child abuse and exploitation. The chapter will undertake a review of literature on two aspects of grooming: child sexual exploitation (CSE) and radicalisation. It will draw on contemporary case examples to illustrate grooming drawn from UK Serious Case Reviews (SCR) on CSE and, on radicalisation, the case of the three girls from Bethnal Green who were groomed for travel to Syria. It will then reflect on the push and pull factors of grooming to highlight the similarities between CSE and radicalisation. Moving on, the chapter will then consider how and if interactive social media simulations, linked to an innovative, preventative educational approach and designed with reference to Vygotsky’s social construction theory, have the potential to educate young people to help protect them from being groomed. The chapter will then make reference to the findings of a small pilot study which evaluated the use of this approach with young people.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Jane Reeves, Emma Soutar, Sally Green and Tracy Crowther",authors:[{id:"211328",title:"Prof.",name:"Jane",middleName:null,surname:"Reeves",slug:"jane-reeves",fullName:"Jane Reeves"},{id:"211838",title:"Dr.",name:"Tracy",middleName:null,surname:"Crowther",slug:"tracy-crowther",fullName:"Tracy Crowther"},{id:"211839",title:"Mrs.",name:"Emma",middleName:null,surname:"Soutar",slug:"emma-soutar",fullName:"Emma Soutar"},{id:"211840",title:"Mrs.",name:"Sally",middleName:null,surname:"Green",slug:"sally-green",fullName:"Sally Green"}]},{id:"57167",doi:"10.5772/intechopen.70998",title:"The Early Childhood Educators’ Attitudes Towards Innovative Instructional Applications about Digital Learning Activities for Young Children",slug:"the-early-childhood-educators-attitudes-towards-innovative-instructional-applications-about-digital-",totalDownloads:1175,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The innovative value and practices of digital learning activities assist early childhood educators in employing effective instruction to improve young children’s performance as well as advance their own professional autonomy to implement digital learning activities for young children. This study examined the factors and relationships about early childhood educators’ attitudes towards the integration and behavioral intention of digital learning tools into young children’s innovative pedagogical activities using a questionnaire survey. The questionnaire consisted of five factors, including digital innovative value (DIV), digital innovative practices (DIP), perception of instructional use (PIU), instructional professional autonomy (IPA), and behavioral intention to use (BIU). The researcher used structural equation modeling to analyze the survey data. The results showed that early childhood educators’ perceptions about innovative value and applications of digital learning activities play a key role in the success of young children’s performance and competence in preschool. The early childhood educators with positive attitudes towards the innovative consideration and practical instructional applications of digital learning activities had more behavioral intention to plan and design instructional activities with innovative applications of digital learning tools.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Ru-Si Chen",authors:[{id:"211677",title:"Prof.",name:"Ru-Si",middleName:null,surname:"Chen",slug:"ru-si-chen",fullName:"Ru-Si Chen"}]}],mostDownloadedChaptersLast30Days:[{id:"57686",title:"Children and Young People’s Vulnerabilities to Grooming",slug:"children-and-young-people-s-vulnerabilities-to-grooming",totalDownloads:2205,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Child abuse is evolving, pervasive and complex and children are vulnerable to its widespread reach in many aspects of their lives, from face-to-face interactions to those they have online. This chapter aims to review contemporary literature which outlines the vulnerabilities of children to face-to-face and online grooming as part of a process leading to child abuse and exploitation. The chapter will undertake a review of literature on two aspects of grooming: child sexual exploitation (CSE) and radicalisation. It will draw on contemporary case examples to illustrate grooming drawn from UK Serious Case Reviews (SCR) on CSE and, on radicalisation, the case of the three girls from Bethnal Green who were groomed for travel to Syria. It will then reflect on the push and pull factors of grooming to highlight the similarities between CSE and radicalisation. Moving on, the chapter will then consider how and if interactive social media simulations, linked to an innovative, preventative educational approach and designed with reference to Vygotsky’s social construction theory, have the potential to educate young people to help protect them from being groomed. The chapter will then make reference to the findings of a small pilot study which evaluated the use of this approach with young people.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Jane Reeves, Emma Soutar, Sally Green and Tracy Crowther",authors:[{id:"211328",title:"Prof.",name:"Jane",middleName:null,surname:"Reeves",slug:"jane-reeves",fullName:"Jane Reeves"},{id:"211838",title:"Dr.",name:"Tracy",middleName:null,surname:"Crowther",slug:"tracy-crowther",fullName:"Tracy Crowther"},{id:"211839",title:"Mrs.",name:"Emma",middleName:null,surname:"Soutar",slug:"emma-soutar",fullName:"Emma Soutar"},{id:"211840",title:"Mrs.",name:"Sally",middleName:null,surname:"Green",slug:"sally-green",fullName:"Sally Green"}]},{id:"57391",title:"Influence of Parental Divorce on Anxiety Level of Adolescents",slug:"influence-of-parental-divorce-on-anxiety-level-of-adolescents",totalDownloads:1852,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Family divorce might have an effect on some aspects of child development. Adolescence as a transitional stage is marked by process of seeking identity, the need for intimate relationship, as well as the struggle for psychological independence from family. Anxiety is defined as a state of extreme worry, fear, and uncertainty which results from the expectation of a threatening event or situation. The aims of study are: to explore the differences in anxiety levels among adolescents from divorced and intact families; to explore the level of anxiety of adolescents from divorced and intact families with respect to their genders. A demographic questionnaire was created and The Beck Anxiety Inventory was applied to measure anxiety. The scale was applied with 162 participants who were chosen randomly from 5 different high schools in Istanbul province. The study found out that there are statistically significant differences in anxiety level of adolescents between children from divorced and intact families. Descriptive measures are in range as follows: (17.67 ± 9.645). The adolescents from divorced families had a higher level of anxiety (t = 17.322; p < .05). The result related to the second study aim shows that there are no statistically significant differences in anxiety between male and female adolescents from divorced and intact families (p > .05).",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Senija Tahirović and Gokce Demir",authors:[{id:"214445",title:"Dr.",name:"Senija",middleName:null,surname:"Tahirovic",slug:"senija-tahirovic",fullName:"Senija Tahirovic"},{id:"214465",title:"MSc.",name:"Gokce",middleName:null,surname:"Demir",slug:"gokce-demir",fullName:"Gokce Demir"}]},{id:"57167",title:"The Early Childhood Educators’ Attitudes Towards Innovative Instructional Applications about Digital Learning Activities for Young Children",slug:"the-early-childhood-educators-attitudes-towards-innovative-instructional-applications-about-digital-",totalDownloads:1175,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The innovative value and practices of digital learning activities assist early childhood educators in employing effective instruction to improve young children’s performance as well as advance their own professional autonomy to implement digital learning activities for young children. This study examined the factors and relationships about early childhood educators’ attitudes towards the integration and behavioral intention of digital learning tools into young children’s innovative pedagogical activities using a questionnaire survey. The questionnaire consisted of five factors, including digital innovative value (DIV), digital innovative practices (DIP), perception of instructional use (PIU), instructional professional autonomy (IPA), and behavioral intention to use (BIU). The researcher used structural equation modeling to analyze the survey data. The results showed that early childhood educators’ perceptions about innovative value and applications of digital learning activities play a key role in the success of young children’s performance and competence in preschool. The early childhood educators with positive attitudes towards the innovative consideration and practical instructional applications of digital learning activities had more behavioral intention to plan and design instructional activities with innovative applications of digital learning tools.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Ru-Si Chen",authors:[{id:"211677",title:"Prof.",name:"Ru-Si",middleName:null,surname:"Chen",slug:"ru-si-chen",fullName:"Ru-Si Chen"}]},{id:"57680",title:"Thinking and Learning Demands in Contemporary Childhood",slug:"thinking-and-learning-demands-in-contemporary-childhood",totalDownloads:1451,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Is today’s childhood is the same as the past’s? Frankly speaking, we cannot answer this question as a clear yes. It is obvious that children today are more into tablet computers, social networks and online games than traditional child games. Besides, our communication styles have been changed significantly for the past years. We, no longer need to meet others face to face to ask for help or to chat. Artificial intelligence, machine learning and robots are another story of the contemporary world. Robots capable of perceiving their surroundings and making decisions have started to deprive many people of their jobs. But what kind of jobs will human beings perform? The increasing emphasis on innovation, cooperation, critical thinking, being creative, problem solving, communication skills and project management is an indicator of what kind of a business world will today’s children meet in the future. This on-going trend also includes clues about how should children be educated. This study is focusing on thinking and learning demands expected contemporary children to meet. Throughout the chapter, the changing world was depicted briefly and then demands of the contemporary age on critical thinking, creative thinking, problem solving and learning were explored respectively.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Cenk Akbiyik",authors:[{id:"212205",title:"Associate Prof.",name:"Cenk",middleName:null,surname:"Akbiyik",slug:"cenk-akbiyik",fullName:"Cenk Akbiyik"}]},{id:"57269",title:"Enhancing Young Children’s Access to Early Childhood Education and Care in Tanzania",slug:"enhancing-young-children-s-access-to-early-childhood-education-and-care-in-tanzania",totalDownloads:1471,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"This chapter draws on the current situation of limited access of young children to early childhood education and care (ECEC) settings in Tanzania. It offers information and evidence on early childhood education and care (ECEC) from an international perspective to those who are, directly or indirectly, involved with young children and their families. Basically, early childhood education and care in Tanzania is still unsatisfactory. Many children have no access to early childhood settings for various reasons including: lack of parents’ awareness on the importance of early investment in education, lack of support from the government, low socio-economic status of parents, gender discrimination, and traditional norms and cultural values. To improve the situation, there is need for a forging of partnership between the government, parents, and the community. Government policy-makers have to set clear policies regarding how quality early childhood education and care can be equitably funded and conducted throughout the country.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Ignasia Mligo",authors:[{id:"212055",title:"Dr.",name:"Ignasia",middleName:null,surname:"Mligo",slug:"ignasia-mligo",fullName:"Ignasia Mligo"}]}],onlineFirstChaptersFilter:{topicId:"1391",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:86,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:96,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:283,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:138,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:128,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:100,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science and Technology from the Department of Chemistry, National University of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013. She relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the National Institute of Fundamental Studies from April 2013 to October 2016. She was a senior lecturer on a temporary basis at the Department of Food Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is currently Deputy Principal of the Australian College of Business and Technology – Kandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI) Ambassador to Sri Lanka.",institutionString:"Australian College of Business & Technology",institution:null}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. She has more than fifteen years of teaching and research experience. She has published more than 550 scientific publications/communications, including 15 books, 50 book chapters, 100 original research papers, 380 research communications in national and international conferences, and 12 patents. She is a member of the editorial board of five journals and acts as a reviewer for several national and international journals. 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Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment"},{id:"5",title:"Parasitic Infectious Diseases",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology"},{id:"6",title:"Viral Infectious Diseases",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Infectious Diseases",id:"6"},selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/83264",hash:"",query:{},params:{id:"83264"},fullPath:"/profiles/83264",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()