\r\n\tFrom a public health perspective, reduced health literacy can lead to widespread consequences. “Low health literacy is also costly for the country because when people don't understand health information and instructions, they are more likely to have worse health outcomes and unnecessarily use emergency room services,”. Experts agree that health literacy is vital to reducing healthcare costs and improving public health. The path to improving health literacy isn’t always straightforward, however.
\r\n
\r\n\t \r\n\t“Unfortunately, up to 9 out of 10 adults can have limited health literacy, and this can be fluid,” Blue says. “It can be more challenging to be health literate when we are sick or in pain, so even someone who normally has a high level of health literacy may struggle at times to understand and process health information.”
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1. Introduction
1.1 The need for practical tools for screening in preventive settings
Circadian rhythms are omnipresent in nearly all biosignals particularly including heart rate (HR) and blood pressure [1]. Technological advances in wearables and ambulatory monitoring have made the continuous recording of real-time data highly accessible for health researchers and clinicians. Consider, 24–48 h recordings of blood pressure are frequently used in the clinical context to determine what grade of hypertension a patient has to ensure better options for treatment [2, 3]. In other areas, systematic and statistical analysis of circadian rhythms may offer adjuvant avenues such as in occupational medicine. Nonetheless, traditional approaches in this field included foremost prevention of injuries, e.g., from chemical or other environmental hazards. In the past years, the catalog of potential hazards was extended to mental health-related problems like stress and communicative problems. Moreover, the tasks in occupational medicine include now an active (occupational) health management rather than just hazard avoidance. This is mirrored by federal demands. For example, the German Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, BAuA) just recently extended the instrument for risk assessment at the workplace (“Gefährdungsbeurteilung”) [4] now covering also psychological hazards such as work stress and thus moved the field further toward the area of occupational health management. Unfortunately, these risk assessments are often based on individuals’ self-report only. This is not at least due to the fact that most objective biological methods are expensive, invasive, and/or complicated. For example, assessing a full cortisol profile (a prominent stress hormone) comprising eight saliva samples during the day is accompanied by low compliance because participants perceive the strict protocol (exact timings, no food, no coffee, no cigarettes in the first hour post-awakening) as impracticable and the reliability is being blunted by violating the measurement protocol [5]. In addition, most available biomarkers have a high disease specificity, since they originated from clinically focused applications. While in the clinical context a high disease specificity of a biomarker is a major diagnostic requirement, it precludes a broad application, for example, in the occupational prevention contexts (i.e., company-wide health screenings or health checks). For example, assessing a comprehensible health check with blood count, physical tests, and ophthalmologic and audiometric examination easily adds up to several hundred euros per examination, but the resources available for health screenings are limited. One solution is the enrollment of comprehensive health check to a limited group of persons—usually higher managers. Therefore, in the given scenario of limited resources, it appears desirable to identify biomarkers which are less disease-specific but more widely and reliably able to indicate that something is wrong even on a preclinical stage (high sensitivity) and, in this case, direct the individual to further examinations, e.g., at the company physician. In addition, in the context of prevention, this biomarker should be easy to measure at low costs and be practicable to assess in the routine of occupational health physicians [6, 7, 8].
1.2 Heart rate variability as a measure of autonomic nervous activity: a chronobiologic, unspecific index of mental and physical health
Several attempts to find a more general health index have been previously made. For example, the Allostatic Load Index (ALI) aims to measure the bodily “wear and tear” and to identify individuals before chronic health disturbances emerge [9, 10, 11]. It represents an assessment of the cumulative burden of psychosocial factors on health by exploring alterations in different biological systems but has some limitations [6, 7, 8, 11] including (A) invasive procedures, (B) cost-intensive examination, and (C) results which are relative to the investigated population and therefore not promptly available but only after the vast majority of the population has been investigated. Other screening tools encompass risk prediction of the development of (fatal) heart diseases (events) such as Framingham, PROCAM, SCORE-CVD, or SCORE-CHD risk scores but suffer from similar issues as the ALI score since they are based on a comparable set of biomarkers. One common aim of these screening tools is the detection of dysregulation, i.e., abnormal high or low values compared to a given clinical (usually age-adjusted) reference or population distribution (percentile). The vast majority of these biomarkers can be seen as an outcome of an underlying dysregulation—at least in part. The autonomic nervous system (ANS) plays a pivotal role in adaption and homeostasis, particularly the vagus nerve. This nerve is a primary, fast, and bidirectional route conveying physiological states to the brain (sensory fibers), as well as shaping and coordinating somatic responses to adapt to environmental challenges (motor fibers) [12, 13, 14, 15]. The central-peripheral brain-heart integration can be indexed noninvasively and inexpensively by cardiac autonomic activity using HR recordings, e.g., from chest belt HR monitors. From these HR recordings, beat-to-beat variability can be calculated (i.e., heart rate variability [HRV]), representing a valid and reliable measure of autonomic function [12, 15]. Thus, variability measures provide a window to the central autonomic nervous system (CAN). The working level of the CAN reflects the capacity of the body to adapt to environmental challenges [16] such as a problematic supervisor. It also corresponds to emotion regulation capacity [13]. Furthermore, decreased values of HRV predict premature mortality [17] and morbidity [12] such as higher inflammatory state [18, 19, 20], increased cardiovascular disease risk [21], and myocardial infarction risk [22] and have been implicated in fatigue [23], work stress [24], and pain regulation [25, 26, 27, 28]. Latest research demonstrates associations with common mental disorders like depression [29]. Apart from diagnosed diseases, HRV shows associations with subjective measures like self-rated health [30]. Like many other biomarkers, ANS measures express a circadian variation pattern [31].
Taken together, measures of HRV seem to represent an integrative marker for mental and somatic health. Thus, these measures characterize an ideal psychosomatic marker. Promising first studies reveal short-term measures of HRV as an index of change pre- to post-therapeutic interventions [32]. However, while short-term measures (i.e., 5-minute resting baselines) are subject to situation-specific variations, long-term measures may overcome this disadvantage and additionally provide salient information from the recorded time series inherent in a 24 h signal (i.e., diurnal variation). Furthermore, the situation-related adaptability of an individual can be visualized by long-term measurements of HRV. The latter can easily be analyzed with spectral methods, shown as a comprehensive graph, and can easily be combined with diary information from a patient, making the impact of a particular situation obvious. For example, a difficult talk with a co-worker reduces the power spectrum and can be explained to the patient. Yet, the utility of long-term measures capturing the circadian variation of HRV has not been evaluated for this purpose. Still, to be further explored, circadian variation patterns of cardiac autonomic activity may present a promising candidate as an unspecific index of both overall physical and mental health.
In the following section (Section 2), we will outline how to calculate measures of circadian variation by two different methods. In Sections 3 and 4, we will present first evidence and examples of HRV as a comprehensive health index. Particularly Section 3 describes epidemiological and other research results of circadian variation patterns of cardiac autonomic activity (normal age decrements, implications in somatic and mental health disorders). In the final section (Section 4), we will present examples of disturbed chronobiology of HRV and its application in a clinical and an occupational setting as an index for health.
2. Measuring circadian variation of the ANS
While specific measures exist that represent an index of cardiac vagal activity (such as root mean square of successive differences [RMSSD], respiratory sinus arrhythmia [RSA], percentage of the NN intervals >50 ms [PNN50]), others measure index more general cardiac autonomic activity (i.e., mixed sympathetic and parasympathetic) such as the standard deviation of normal interbeat intervals (SDNN) or total power (TP). For an excellent and detailed overview of metric and norms, see, for example, [15].
Cardiac autonomic activity exhibits a pattern of diurnal variation. The circadian timing system regulates daily modulation of synchronized physiological activity in order to conserve energy expenditure and the use of internal resources, thereby optimizing functioning at the ideal time of day (i.e., coordinate physiological functions and behavior) [1, 33]. The circadian timing system is organized hierarchically by the central pacemaker within the suprachiasmatic nucleus (SCN) [1, 2]. This master pacemaker orchestrates the rhythmicity of endogenous, or self-sustained, clocks within different central and peripheral tissues, which autoregulate through transcriptional and translational feedback loops. Genetic variations in circadian locomotor output cycles kaput (CLOCK) genes are implicated in unique phenotypes, including timing of sleep preference (evening type), metabolism, and mood regulation. More generally, endogenous molecular clocks enable organisms to anticipate environmental challenges. These endogenous pacemakers are also entrained by environmental context, including cyclical changes in season, tides, and daylight cues, which act as “zeitgebers” that anchor the internal clock [1, 34].
2.1 Analytical methods
Analytical methods for identifying and quantifying circadian rhythmicity among a time series of data (e.g., 24 h HR recording) include spectral analysis or least squares procedures [34, 35]. While the spectral analysis, in particular, allows an easy access through visual inspection of an individual 24 h ECG recording (see also Section 4), the least squares procedure allows for group aggregation and statistical comparisons/analysis due to mathematical quantification of rhythmicity, as demonstrated in Section 3. Therefore, in an individual consultation setting, a summarizing graph is of particular value, while the latter allows for scientific comparisons to detect alterations in circadian parameters, e.g., in persons reporting a high vs. low number of depressive symptoms (see Section 3).
2.1.1 Spectral analysis
Using available commercial software, the 24 h measurement is first subdivided into separate intervals (5 minutes have become standard), and within these intervals, the frequency spectrum and the height of the amplitude (= energy density) are color-coded (see left panel of Figure 1; the spectral graphs were calculated using the commercial software Cardiscope™ ANALYTICS Professional Edition Version 1.2.156, HASIBA Medical GmbH, Austria). The array of each spectrum results in a colored two-dimensional image of the color-coded energy density. These images are stacked, introducing time as a third dimension, and of across frequency when viewed from a bird’s eye perspective (see also Figure 6).
Figure 1.
Example of a color-coded power spectral segment (left panel) and its stacked representation of the 24 h time series (z-axis; right panel).
This individual graph, enhanced with diary information, can serve as a powerful tool in consultation (see Section 4).
2.1.2 Cosinor procedure
The cosinor procedure is suggested as the appropriate tool to detect circadian rhythmicity in cross-sectional studies with a single measurement [35]. In a first step, the 24 h recording is segmented into intervals, e.g., 5-minute intervals. In a 24 h recording, a total of 288 5-minute intervals are calculated. For each 5-minute interval, the HRV parameters need to be calculated.
Three individual-level cosine function parameters are estimated for each individual 24 h time series (now consisting of the 288 5-minute intervals) to quantify the circadian variation parameters of the selected HRV variables using the method of ordinary least squares regression (see Eq. (1)) [34]. Here, M is the midline-estimating statistic of rhythm (MESOR), a rhythm-adjusted mean, A is the amplitude (being the maximal distance between the oscillating signal and the MESOR), ϕ is the acrophase (defined as the clock time when A is reached), 𝜃i is the trigonometric angle, 𝑡i is the sampling rate, P is the period (duration of one cycle, in this case, supposed to be 24 h), and ei is the error term (Figure 2).
Figure 2.
Individual recording of 5-minute intervals of RMSSD (blue x on the left-hand panel) and the corresponding fitted cosine curve (orange) and LOWESS line (bluish-gray). The right-hand panel indicates the cosine measures that are calculated.
With the period P known, standard regression equations can be derived (see Eq. (2)) and analyzed using an ordinary least squares approach to minimize the residual sum of squared differences between observations and model estimation (see Eq. (3) and [34, 36, 37] for a comprehensive description).
Solving these equations provides the researcher with the three described variables per recording. In a second step, these can be easily used in further statistical analysis, as exemplified in the next section. Moreover, graphical between-group comparison including confidence intervals is possible (see examples in Section 3).
3. Examples of cosinor calculations detecting between-group differences of circadian HRV parameters
As with many other biomarkers, autonomic activity fluctuates in a pattern of diurnal variation with a frequency of an approximate solar day, with peak levels of vagal activity during nighttime in humans [21, 38, 39] and nonhuman primates [40]. Previous analyses by our group and other groups have demonstrated adverse or at least unfavorable intermediate health outcomes being associated with blunted circadian variation patterns, particularly with blunted or absent nighttime increase of vagal activity. This includes an elevated risk of cardiac events such as myocardial ischemia, myocardial infarction, malignant arrhythmias, and sudden cardiac death peaking in the early morning [41, 42, 43, 44] as well as hyperglycemic states and elevated pro-inflammatory cytokines in a working population [21]. To use this information in daily work, a clinician needs reference values which are associated with clinical and preclinical conditions such as hyperglycemia. Only if these values exist, parameters can be used as a screening tool and help to identify individuals at risk in both clinical and nonclinical populations. In preventive settings, these parameters should be associated not only to somatic complaints but also to mental health conditions such as depressive symptoms. And finally, these parameters should index change, e.g., in a clinical population pre- to post-therapy or in occupational setting pre- to post-behavioral interventions.
Yet, reference values of circadian HRV parameter are scarce and of limited usefulness. For example, existing reference values of HRV (independent of diurnal variation) are based on varying recording length [45, 46, 47, 48, 49] with no reference to circadian variation, age, or sex. Studies reporting reference values based on 24 h recording length are analyzed with other time durations [50, 51] than the recommended 5-minute interval limiting comparability across studies or have a focus on young adults [52] or are based on rather small sample sizes (<200) [39, 52].
3.1 Reference values
We recently presented values for circadian variation of cardiac autonomic modulation in 931 rigorously healthy working adults (mean age 39 ± 10; 78% males) [31]. Consecutive 5-minute intervals of RMSSD were calculated from 24 h HR recordings that were collected at four distinct study sites of the Mannheim Industrial Cohort Study (MICS) in healthy working adults. “Healthy” was defined rigorously as indicating explicitly “no” to any of the following criteria (self-report): hypertension, dyslipidemia, hyperglycemia, respiratory diseases (e.g., asthma, COPD), angina pectoris, stroke, infarction, congenital heart defect (CHD), depression, burnout, other chronic diseases, cancer, and taking beta-blockers. First, three individual-level cosine function parameters were estimated to quantify the circadian variation as described in the previous section. Second, random-effect meta-analysis was used to estimate the impact of age group (18–24/25–34/35–44/55–65), shift work (Y/N), atypical employment (Y/N), the hierarchical position (division manager/project leader/employee/skilled worker/semiskilled worker), smoking, or being physically active on the three cosine parameters MESOR, amplitude, and ϕ. Results showed that older age and being female are associated with a significantly lower amplitude. Significant age decline in MESOR could be observed. Particularly, age-related decline in MESOR and amplitude was more pronounced in the younger age groups (see Figure 3). In addition, two age groups showed phase advances compared to the youngest age group. Interestingly, current smoking was associated with reduced MESOR, while physical activity was associated with increased MESOR. Working any kind of shift work is associated with higher oscillation in amplitude. Particularly, age declined in both the overall mean (= MESOR) and the oscillation (amplitude) indicating a decrease of nocturnal parasympathetic activity.
Figure 3.
Circadian variation pattern of RMSSD by age from N=931 rigorously healthy working adults of the MICS-cohort.
3.2 Test-retest reliability of circadian variation patterns
To the best of our knowledge, no study has yet investigated the short- or long-term reproducibility of circadian variation patterns of HRV parameters. We recently demonstrated short-term reliability in 74 men (age 41 ± 7) with repeated 24 h measures and a gap of 1 day between measures [53]. The vagal activity was indicated using estimates of HRV (RMSSD, pNN50, SDNN). Between-day associations were calculated using Pearson’s correlation (PC). Short-term reliability was assessed using intra-class correlation (ICC) and Bland-Altman analysis (bias ± limits of agreement). The results demonstrate an excellent ICC (all > 0.82) and PC (all > 0.83) for the MESOR. Amplitude measures were good (ICC and PC > 0.71) for RMSSD and pNN50 but fair (ICC and PC < 0.60) for SDNN. Acrophase measures were fair (ICC and PC all < 0.60). Bland-Altman plots showed no systematic bias between measurement days for any measure. This study demonstrates high reliability for the rhythm-adjusted 24 h mean in primarily vagally mediated and mixed measures in men. As hypothesized, lower but still good reliability was demonstrated for the amplitude in vagally mediated HRV measures. This indicates a higher day-to-day variability of the vagally mediated HRV amplitude parameters and more trait-like MESOR parameters. However, future studies need to expand to female samples, collect potential (time lagged) determinates of the diurnal variation using ecological momentary assessments, and investigate the long-term test-retest reliability.
3.3 Depressive symptoms and circadian variation patterns
We also demonstrated previously a salient association between circadian variation patterns and depressive symptoms in 3030 predominantly healthy employees (mean age 41 ± 7; females 20.2%) [54]. Multivariate linear regression models revealed a negative association with MESOR and amplitude in men, but the opposite in women. This pattern of findings indicates an important moderation effect of sex in the association of circadian variation patterns with RMSSD and depressive symptoms in a healthy (preclinical) population. These findings were partly replicated by investigating associations between affective trait measures with circadian variation patterns of RMSSD [55]. Here, trait measures of positive and negative affect in N = 81 male employees (mean age 41 ± 7) were significantly associated with MESOR in multivariate linear regression models. Figure 4 exemplifies the results by showing the predicted diurnal variation of RMSSD by a median split of the negative affect scale and its corresponding MESOR line and θ around 1:30 a.m. It still needs to be explored if the decrement of circadian variation can be (partly) reversed if symptoms decrease. Two randomized controlled trials currently investigate the changes of circadian variation patterns of HRV pre- to post-therapy (DRKS00016616; NCT03080025).
Figure 4.
Patterns of circadian rhythms of vagal activity vary by trait measures of dysthymia.
3.4 Inflammatory markers and circadian variation patterns
The inflammatory reflex is a physiological mechanism through which the vagus nerve regulates immune function [56]. Here, efferent vagal activity inhibits the release of pro-inflammatory cytokines via the release of acetylcholine and has been termed the cholinergic anti-inflammatory pathway [57, 58, 59]. Moreover, the release of interleukin-6 (IL-6) and other cytokines triggers the hepatic synthesis of C-reactive protein (CRP) [60]. In addition, the vagus nerve is also known to relay information about the peripheral immune status to the brain via IL-1 receptors conveyed by paraganglia cells situated in parasympathetic ganglia [61]. Thus, both vagal efferent and afferent pathways seem to play an important role in immune regulation. We previously demonstrated that decreased vagally mediated HRV at baseline predicted increased low-grade systemic inflammation (a marker of CHD risk) after 4 years in healthy working adults [19]. The circadian variation pattern of RMSSD shows an association with systemic low-grade inflammation [62]. Data were collected at four distinct study sites of the Mannheim Industrial Cohort Study (MICS) in 3134 healthy working adults (mean age 42 ± 11; 80% males). Low-grade inflammation was measured by high-sensitive C-reactive protein (hsCRP). Participants with acute inflammation (hsCRP >10 mg/L) were excluded. CRP was categorized into the risk groups defined by the American Heart Association (AHA) as follows: low-risk group (<1 mg/L), medium-risk group (1–3 mg/L), and high-risk group (>3 mg/L). In the present study, lower MESOR and higher amplitude were associated with elevated levels of low-grade inflammation (see Figure 5).
Figure 5.
Circadian variation in groups with different systemic inflammation levels as defined by the American Heart Association (AHA).
4. Examples of 24 h HRV patterns in practical application
4.1 Clinical population
As described in the introduction, reduced HRV parameters have been shown in different risk states and diseases including depression [63]. At the same time, disturbances of circadian rhythms have been described in depression [64]. A 24 h measurement of HRV can help to detect the degree of disturbance that has already occurred. Furthermore, it supports recovery by identifying resources that can be enhanced and strengthened. Recovery from a chronobiologic point of view includes not only reduction in, e.g., depressive symptoms, but also restoration of chronobiologic rhythms. Repeated measurements can document the process of recovery and the effect of interventions.
Considering these points, a 24 h measurement of HRV could prove itself as a helpful psychophysiological tool in a psychotherapeutic setting. However, to the best of our knowledge, 24 h HRV was not yet implemented in this kind of setting. Therefore, we designed a study implementing 24 h HRV measurements into a psychosomatic consultation at the workplace (trial-ID German Clinical Trials Register DRKS00012473). The psychosomatic consultation at the workplace is a service of the Department of Psychosomatic Medicine and Psychotherapy at Ulm University Medical Center (Germany) and has been described in detail elsewhere [65]. In brief, it is open to employees who receive an early consultation by a doctor or a psychologist specialized in psychotherapy for all personnel reporting psychic (e.g., depressive symptoms, anxiety) and potentially psychosomatic complaints such as back pain, sleep problems, and exhaustion. It comprises two parts—the diagnostic phase (max. three sessions) and the immediate short-term intervention of another max. 9 sessions (if indicated). The study took place at a large center for disabled care in Germany. HRV was measured after the first sessions and the results were discussed with the patients in the second or third session. All patients that continued the sessions received a second 24 h HRV measurement at the end of the intervention (marker of change). The study also covered disturbances of the hypothalamic pituitary adrenal (HPA) axis by collecting eight saliva samples for a cortisol day profile.
Recruitment was completed in May 2019, but repeated measurements are still ongoing, so final statistical analyses will be reported later. Preliminary findings suggest that about 50% of the patients were willing to participate in the study and that all patients that were offered a second measurement (i.e., all patients receiving a short-term intervention) completed the second measurement. The vast majority of patients indicated that they gained new insights in psychophysiological interactions and most of them (90%) would highly recommend the consultation (particularly the HRV measurement with feedback) to a close friend.
Here, we want to present a case with a major depressive episode. A 50-year-old man presented with depressed mood, diminished interest in all activities, fatigue, problems to concentrate at work, and sleeping disturbances with problems falling asleep, waking up in the middle of the night and in the morning, and lying awake for a longer time. He also complained about restlessness which had become better by starting medication with olanzapine 2.5 mg per day. Twenty-four hour HRV analyses revealed a pronounced overall reduction in variability as well as a reduced night-day variation (see Figure 6). At night, vagal indices normally increase. In this patient, RMSSD and HF power were low throughout the day and the night, confirming his subjective complaints of unrestful sleep (Table 1). His chronobiologic rhythms are obviously disrupted to a greater extent on the basis of an overall reduction in variability that does not allow much variation throughout the day. Searching for resources led to one single time point at about 5 o’clock in the afternoon where power spectral analyses show for a short time signals in the VLF, LF, and HF power band. The patient reported that at this time, he sat down in his garden and could enjoy the air and the birds singing for a while.
Figure 6.
24 h HRV measurement of a patient with major depression. Displayed are heart rate and spectral analyses.
Parameter
Unit
Total
Daytime
Sleep
Duration
hh:mm
24:30
16:02
08:26
Mean HR
/min
75
80
67
SDNN
ms
99.5
72,6
76.9
rMSSD
ms
15.2
14,6
16.4
Total power-i
ms2
1643
1461
1991
VLF-i
ms2
1082
888
1454
LF-i
ms2
407
417
387
HF-i
ms2
70
66
79
Table 1.
HRV indices of a patient with major depression.
Abbreviations: HR, heart rate; SDNN, standard deviation of normal interbeat intervals; RMSSD, root mean square of successive differences; VLF, very low frequency; LF, low frequency; HF, high frequency.
-i indicates that this value is calculated as a mean of the values of all 5-min timeframes.
The symptoms aggravated in the following 2 weeks so that he was transferred to a hospital with psychiatric inpatient care.
4.2 Preventive setting
As discussed in the introduction, 24 h measurement of HRV may be a practical tool in preventive settings like occupational health. We implemented it in three large enterprises of the industrial, automotive, and metal sector into a regular manager health checkup and as an offer for any manager and employee who presents at the occupational health physician (trial-ID German Clinical Trials Register DRKS00014653). First, we want to show a healthy example with intact chronobiology and after that an example out of the mentioned study with clear disturbances.
The first example shows the measurement results of a 36-year-old woman. The medical history contained no diagnoses, no medication, normal weight, and normal blood pressure. She was working part time, about 30 h/week, living with her husband and with three children. Alcohol consumption was moderate, and she engaged in sports activities of 3–4 h/week. She complaint feeling tired in the morning and sometimes during the day but reported falling asleep easily in the evening and sleeping well. Scores for irritation and depression showed low values, while the stress scale showed intermediate values, where she was reporting work piling up.
Figure 7.
24 h HRV measurement of a healthy, 36-year-old woman. Displayed are heart rate and spectral analyses.
HRV analyses showed a pronounced and instant decrease of heart rate at night, with a distinct increase in RMSSD and HF. In spectral analyses, the nighttime is easily detected by a specific pattern inside the HF power band which represents respiratory sinus arrhythmia (RSA). In this healthy example, RSA is present almost throughout the whole night, with changing patterns in the LF power band as it is typical for sleep cycles. This is an example of well-functioning chronobiology. The daytime also shows variability with different patterns, e.g., at lunch break around 12 o’clock, during sports activity around 3 o’clock in the afternoon, and in the evening at home (see Figure 7 and Table 2).
Parameter
Unit
Total
Daytime
Sleep
Duration
hh:mm
24:41
16:44
07:57
Mean HR
/min
74
83
55
SDNN
ms
206.2
144.6
104.7
rMSSD
ms
34.8
30.3
46.0
Total power-i
ms2
5305
4794
6364
VLF-i
ms2
3105
2596
4160
LF-i
ms2
1525
1650
1266
HF-i
ms2
412
281
684
Table 2.
HRV indices of a healthy, 36-year-old woman.
Abbreviations: HR, heart rate; SDNN, standard deviation of normal interbeat intervals; RMSSD, root mean square of successive differences; VLF, very low frequency; LF, low frequency; HF, high frequency.
-i indicates that this value is calculated as a mean of the values of all 5-min timeframes.
The second example shows the results of a measurement a 50-year-old male manager working full time about 40 h/week. He also had no diagnosed diseases and reported no medication. Weight and blood pressure were unobtrusive. He reported a moderate alcohol consumption and moderate sports activity of 1–2 h/week. His complaints were only some back pain from time to time. He reported almost half of the nights waking up in the middle of the night with problems continuing sleeping and marked his sleep as “fair.” Irritation scale was low with only sometimes being irritated. No depressive or anxious symptoms were present.
In the spectral analyses (Figure 8), the typical RSA pattern at night is missing. Generally, the power seems to be “cut” with almost no spikes entering the HF power band. Though heart rate decreased at night, all HRV parameters, especially vagal values, were reduced at night, which is an inverted state. HR decreased only slowly and reached the lowest values after 4 o’clock and 5 h of sleep, respectively. Analyses of his daytime activity showed no breaks throughout the whole day and 1 h of a vigorous sports activity (ball game) from 20 to 21 o’clock with a mean HR of 130/min and a max HR of 170/min (Table 3). Heart rate did not return to baseline for 2 h, which indicates overtraining. The first hours of sleep show reduced variability in all power bands, a pattern that stands for exhaustion. Allover, chronobiologic rhythms are markedly disturbed, though HRV indices are still higher than in the example with major depression.
Figure 8.
24 h HRV measurement of a 50-year-old manager. Displayed are heart rate and spectral analyses.
Parameter
Unit
Total
Day
Sleep
Duration
hh:mm
26:27
19:44
6:43
Mean HR
/min
74
76
69
SDNN
ms
148.0
155.1
98.0
rMSSD
ms
21.4
22.7
16.5
Total power-i
ms2
3630
3980
2657
VLF-i
ms2
2086
2221
1714
LF-i
ms2
1248
1410
800
HF-i
ms2
82
95
46
Table 3.
HRV indices of a 50-year-old manager.
Abbreviations: HR, heart rate; SDNN, standard deviation of normal interbeat intervals; RMSSD, root mean square of successive differences; VLF, very low frequency; LF, low frequency; HF, high frequency.
-i indicates that this value is calculated as a mean of the values of all 5-min timeframes.
The consultation revealed a highly ambitious personality who was used to well-functioning of his body all of the time and who a mostly postpones the needs of his body in order to solve a problem on the job or to win the game at sports. The graph helped to intriguingly demonstrate to the manager the impact of what he is doing to his body and motivated him to learn to perceive when he reaches his limits as well as to hold on to his limit and not try to overachieve.
5. Conclusion
HRV as a chronobiologic, disease-unspecific biomarker holds the possibility to become a screening tool in preventive settings as well as a tool to monitor overall health status, e.g., pre- to post-therapy, and serve as an instrument to demonstrate to a patient the physiological reactions to his specific environmental cues. This could be beneficial to persons usually not so open to talk about feelings and thus pave the way into a conversation about psychosomatic interactions. Thus, its psychophysiological nature mirroring somatic as well as mental states implies HRV as a well-suited psychosomatic marker. Its usefulness in these settings should be further explored.
Acknowledgments
Parts of this work were conducted at the Leadership Personality Center in Ulm (Germany) with the support of the Karl Schlecht foundation.
MNJ positions were funded between 2016 and 2017 through the physician scientist program (Medical Faculty Heidelberg, Heidelberg University, Germany). The other studies were funded through internal funds of the Mannheim Institute of Public Health, Social and Preventive Medicine (Heidelberg University), the Institute for Medical Psychology (Center for Psychosocial Medicine, Heidelberg University), and the Clinic for Psychosomatic Medicine and Psychotherapy (University Medical Center Ulm).
JJM is awarded with a funding from the Canadian Institutes of Health Research and Fonds de Recherche du Québec-Santé that supports this work.
None of the funding entities had a role in data analysis, result report, or interpretation of this work.
Conflict of interest
EMB, MNJ and JJM declare to have no conflict of interest.
\n',keywords:"circadian variation, heart rate variability, prevention, health index, vagal activity, occupational medicine, autonomic nervous system",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/67730.pdf",chapterXML:"https://mts.intechopen.com/source/xml/67730.xml",downloadPdfUrl:"/chapter/pdf-download/67730",previewPdfUrl:"/chapter/pdf-preview/67730",totalDownloads:1103,totalViews:0,totalCrossrefCites:8,totalDimensionsCites:12,totalAltmetricsMentions:2,impactScore:4,impactScorePercentile:89,impactScoreQuartile:4,hasAltmetrics:1,dateSubmitted:"December 11th 2018",dateReviewed:"May 13th 2019",datePrePublished:"August 6th 2019",datePublished:"December 18th 2019",dateFinished:"June 19th 2019",readingETA:"0",abstract:"Circadian rhythms are omnipresent in almost any biosignal. In this chapter, we join them with the need for practical tools for screening in preventive settings and point out heart rate variability (HRV), a measure of autonomic nervous system activity, as a chronobiologic, unspecific index of mental and physical health. We discuss methods to calculate the circadian variation of HRV measures, particularly the cosinor procedure. We present reference values for circadian variation parameters of HRV and data concerning reproducibility. Furthermore, we show data giving first evidence of HRV as a comprehensive health index by showing altered circadian variation patterns of HRV depending on mental (trait dysthymia) as well as physical (inflammatory markers) health. Finally, we present examples of disturbed chronobiology of HRV in clinical and preventive settings and its practical application in medical consultation.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/67730",risUrl:"/chapter/ris/67730",book:{id:"6899",slug:"chronobiology-the-science-of-biological-time-structure"},signatures:"Marc N. Jarczok, Harald Guendel, Jennifer J. McGrath and Elisabeth M. Balint",authors:[{id:"289160",title:"Dr.",name:"Marc",middleName:"N",surname:"Jarczok",fullName:"Marc Jarczok",slug:"marc-jarczok",email:"marc.jarczok@uni-ulm.de",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"289379",title:"Dr.",name:"Elisabeth",middleName:null,surname:"Balint",fullName:"Elisabeth Balint",slug:"elisabeth-balint",email:"elisabeth.balint@uniklinik-ulm.de",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"299975",title:"Prof.",name:"Jennifer J",middleName:null,surname:"McGrath",fullName:"Jennifer J McGrath",slug:"jennifer-j-mcgrath",email:"jennifer.mcgrath@concordia.ca",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"304667",title:"Prof.",name:"Harald",middleName:null,surname:"Gündel",fullName:"Harald Gündel",slug:"harald-gundel",email:"Harald.Guendel@uniklinik-ulm.de",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1 The need for practical tools for screening in preventive settings",level:"2"},{id:"sec_2_2",title:"1.2 Heart rate variability as a measure of autonomic nervous activity: a chronobiologic, unspecific index of mental and physical health",level:"2"},{id:"sec_4",title:"2. Measuring circadian variation of the ANS",level:"1"},{id:"sec_4_2",title:"2.1 Analytical methods",level:"2"},{id:"sec_4_3",title:"2.1.1 Spectral analysis",level:"3"},{id:"sec_5_3",title:"2.1.2 Cosinor procedure",level:"3"},{id:"sec_8",title:"3. Examples of cosinor calculations detecting between-group differences of circadian HRV parameters",level:"1"},{id:"sec_8_2",title:"3.1 Reference values",level:"2"},{id:"sec_9_2",title:"3.2 Test-retest reliability of circadian variation patterns",level:"2"},{id:"sec_10_2",title:"3.3 Depressive symptoms and circadian variation patterns",level:"2"},{id:"sec_11_2",title:"3.4 Inflammatory markers and circadian variation patterns",level:"2"},{id:"sec_13",title:"4. Examples of 24 h HRV patterns in practical application",level:"1"},{id:"sec_13_2",title:"4.1 Clinical population",level:"2"},{id:"sec_14_2",title:"4.2 Preventive setting",level:"2"},{id:"sec_16",title:"5. Conclusion",level:"1"},{id:"sec_17",title:"Acknowledgments",level:"1"},{id:"sec_20",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Astiz M, Heyde I, Oster H. Mechanisms of communication in the mammalian circadian timing system. 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Available from: http://www.ncbi.nlm.nih.gov/pubmed/24626758'},{id:"B46",body:'Seppälä S, Laitinen T, Tarvainen MP, Tompuri T, Veijalainen A, Savonen K, et al. Normal values for heart rate variability parameters in children 6-8 years of age: The PANIC Study. Clinical Physiology and Functional Imaging. 2014;34(4):290-296'},{id:"B47",body:'Liao D, Crow RS, Folsom AR, Swenne CA, Schouten EG, Hannan PJ, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: The ARIC study. Atherosclerosis risk in communities. Circulation. 2000;102(11):1239-1244'},{id:"B48",body:'Baek HJ, Cho C-H, Cho J, Woo J-M. Reliability of ultra-short-term analysis as a surrogate of standard 5-min analysis of heart rate variability. Telemedicine Journal and E-Health. 2015;21(5):404-414. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25807067'},{id:"B49",body:'Jarrin DC, McGrath JJ, Poirier P, Séguin L, Tremblay RE, Montplaisir JY, et al. Short-term heart rate variability in a population-based sample of 10-year-old children. Pediatric Cardiology. 2015;36(1):41-48'},{id:"B50",body:'Bonnemeier H, Richardt G, Potratz J, Wiegand UKH, Brandes A, Kluge N, et al. Circadian profile of cardiac autonomic nervous modulation in healthy subjects: Differing effects of aging and gender on heart rate variability. Journal of Cardiovascular Electrophysiology. 2003;14(8):791-799. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12890036'},{id:"B51",body:'Umetani K, Duda CL, Singer DH. Aging effects on cycle length dependence of heart rate variability. In: Biomedical Engineering Conference 1996. Dayton, OH, USA: IEEE; 1996. pp. 361-364'},{id:"B52",body:'Nakagawa M, Iwao T, Ishida S, Yonemochi H, Fujino T, Saikawa T, et al. Circadian rhythm of the signal averaged electrocardiogram and its relation to heart rate variability in healthy subjects. Heart. 1998;79(5):493-496 Available from: http://www.ncbi.nlm.nih.gov/pubmed/9659198'},{id:"B53",body:'Jarczok MN, Koenig J, Aguilar-Raab C, Diepolder M-L, Traunmueller C, Thayer JF, et al. Test-retest reliability of parameters indexing circadian variation in vagal activity. Psychosomatic Medicine. 2017;79(4):A42'},{id:"B54",body:'Jarczok MN, Aguilar-Raab C, Koenig J, Kaess M, Borniger JC, Nelson RJ, et al. The Heart’s rhythm “n” blues: Sex differences in circadian variation patterns of vagal activity vary by depressive symptoms in predominantly healthy employees. Chronobiology International. 2018;0528:1-14. Available from: https://www.tandfonline.com/doi/full/10.1080/07420528.2018.1439499'},{id:"B55",body:'Jarczok MN, Warth M, Gabel C, Koenig J, Aguilar-Raab C, Traunmuller C, et al. Patterns of circadian rhythms of vagal activity vary by trait measures of euthymia and dysthymia. Psychosomatic Medicine. 2017;79(4):A6'},{id:"B56",body:'Pavlov VA, Tracey KJ. Neural regulation of immunity: Molecular mechanisms and clinical translation. Nature Neuroscience. 2017;20(2):156-166. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28092663'},{id:"B57",body:'Tracey KJ. Understanding immunity requires more than immunology. Nature Immunology. 2010;11(7):561-564. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20562838'},{id:"B58",body:'Matteoli G, Boeckxstaens GE. The vagal innervation of the gut and immune homeostasis. Gut. 2013;62(8):1214-1222. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3711371&tool=pmcentrez&rendertype=abstract'},{id:"B59",body:'VA P, Tracey KJ. The vagus nerve and the inflammatory reflex—Linking immunity and metabolism. Nature Reviews. Endocrinology. 2012;8(12):743-754. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23169440'},{id:"B60",body:'Casas JP, Shah T, Hingorani a D, Danesh J, Pepys MB. C-reactive protein and coronary heart disease: A critical review. Journal of Internal Medicine. 2008;264(4):295-314. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18823504'},{id:"B61",body:'Sternberg EM. Neural regulation of innate immunity: A coordinated nonspecific host response to pathogens. Nature Reviews Immunology. 2006;6(4):318-328. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1783839&tool=pmcentrez&rendertype=abstract'},{id:"B62",body:'Jarczok MN, Koenig J, Bosch JA, Fischer JE, Thayer JF. Circadian variation of cardiac autonomic modulation and low-grade inflammation in working adults. Psychosomatic Medicine. 2017;77(3). Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006842-201504000-00018'},{id:"B63",body:'Kemp AH. Major depressive disorder with melancholia displays robust alterations in resting state heart rate and its variability: Implications for future morbidity and mortality. Frontiers in Psychology, November. 2014;5:1-9'},{id:"B64",body:'Germain A, Kupfer DJ. Circadian rhythm disturbances in depression. Human Psychopharmacology. 2008;23(7):571-585'},{id:"B65",body:'Rothermund E, Kilian R, Hoelzer M, Rieger MA, Guendel H. Psychosomatic consultation in the workplace: Do we reach different users by changing the context? BMC Health Services Research. 2014;14(Suppl 2):P105'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Marc N. Jarczok",address:"marc.jarczok@gmail.com",affiliation:'
Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Germany
Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Germany
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PERFORM Centre, Montreal, Canada
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Leadership Personality Center Ulm (LPCU), Ulm University, Germany
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1. Introduction
Knowledge guarantees sustainable competitive advantage for an organization according to Grant [1] and classified as one of the most valuable and tangible resources that is acquire or replicated according to Nonaka et al. [2]. However, using knowledge as a strong competitive advantage require a unique resource which is hard to duplicate. The description of this resource matches with tacit knowledge [2]. All these arguments imply that tacit knowledge is a significant subject for discussion in recent advances in knowledge management. There is substantial evidence on the importance of knowledge management (KM) in organizational performance. Experts from a variety of fields, including management, economics, and sociology have made meaningful contributions to this subject [1, 3, 4]. Earlier studies proposed that the relevance of knowledge management necessitated a paradigm shift, given the increasing level of competiveness. This revelation led to organizations constantly embracing knowledge concepts and associated strategic models for performance and growth, meanwhile corporate executives are often confronted with the concerns of tacit knowledge sharing [5]. That is because knowledge management is seen as a necessity for efficiency in all sectors of business, whether public or private. Mårtensson [6], asserts that massive forces are shaping the business and financial sectors, resulting in significant changes to human capital and resource strategies. In addition, uncertainties in the form of natural calamities, pandemics, rapid economic and technological development, as well as shifting consumer expectations are all catalysts for knowledge requirements. Nevertheless, organizations are recognizing technological advantages to achieve long-term competitiveness through utilizing the stock of tacit knowledge and limiting the barriers to knowledge sharing within the organization.
As a result of businesses’ efforts to adapt rapidly, respond quickly to changes in their industries aggressively, steep learning curves are emerging. However, to make the competition irrelevant, businesses are concentrating their efforts on retaining experienced people, developing and using the employee potentials [7]. Knowledge application is attributed to availability raw material, labor and capital in past, today that perception has changed as the information age progresses and knowledge management advances. It is worth noting that, in modern management knowledge has superseded natural resources as the principal economic resource and a significant competitive advantage tool, and has remained a key component of all management operations.
Recent studies have highlighted several barriers to knowledge utilization, including individuals who lack the necessary educational background, training, and knowledge platforms to operate effectively in a knowledge-based environment [8]. A solution to this problem requires management to recognize and value knowledge through the development of existing human capital.
As a result, experienced personnel will be more willing to contribute to the organization’s success, sinceemployees retain approximately 90% of an organization’s knowledge, according to knowledge management literature [9]. These efforts were followed by various arguments describing the difference between knowledge and information. The essential features of knowledge management are made up of the mix of experience, values, skills contextual information and expertise that provides the framework for analyzing and absorbing new experiences and finding relevant information [10]. An individual’s knowledge is their human personal asset whereas information is just a message being communicated that is deemed unusable except understood meaningfully and used. Recent advances in knowledge management are focusing on knowledge other than natural wisdom, which researchers attribute to tacit knowledge, which is closely related to Polanyi’s claim that humans may have two forms of knowledge that may be used in different ways.
This chapter is organized according to the following sections; (i) the introduction consist of general overview of knowledge management, purpose and justification for the study (ii) section two contains the main literature review covering the main body of discussion, on tacit knowledge, objective knowledge, barriers to knowledge sharing, a proposed conceptual framework and factors affecting knowledge sharing. (iii) the third section covers the discussion of the main points relative to emerging issues and future research agenda and finally section (iv) presents a summary of the study outcome and the way forward.
2. Literature review
2.1 Objective knowledge
Several attempts to define tacit knowledge later acknowledged that it can be compared to objective knowledge, and that become one of the conversional definitions of tacit knowledge and established by many authorities in knowledge management literature [11]. In some explanations Smith [12], opined that it is the type of knowledge shared using symbolic gestures or signs between individuals and groups. The recipients of this knowledge can be as much in the known as the originator. It implies that objective knowledge may consist of two components. According to [13] the first category of objective knowledge is the ability to communicate; it is easily encoded, comprehended, written or documented and explained. The second classification is concerned with possessing objective knowledge. In the views of Lee et al. [14, 15] this type of knowledge is not peculiar to the individual possessing it or the organization. According to Inkpen and Dinur [16] this form of knowledge may be shared among a group of people. The diverse opinions of tacit knowledge and the few consensus has featured countless time in literature with the possibility of defining exactly what objective knowledge is. Irrespective of the consensus meanings of this term many scholars prefer to conceive their own terminologies that best describe objective knowledge. Hedlund [17] refers to it as articulated knowledge. Dampney et al. [18] defined it as articulable knowledge and according to Nonaka and von Krogh [19] the main attribute of objective knowledge is explicit, Fernandez and Sabherwal [20] consider it verbal while documented it as declarable in nature. These terminologies and definitions are the fundamental of knowledge management. However, these terms are often interpreted in contexts, but most importantly they tend to explain what tacit knowledge is not.
2.2 Tacit knowledge
It is relevant at this point to emphasize on the contributions of great authors like [21], when discussing the concept of knowledge management. According to [21], as humans we can know more than we can reveal. Put in another way, an individual has the potential to know much more then they can narrate or describe to others. These phases of [21] meant to describe tacit knowledge, which he identifies as almost impossible to document, interpret and encode. On the other hand, the rules and directions associated with executing it may not be known to the one possessing it. For example an experienced architect may be unaware of the some of the unique attributes a competent engineer and the individual may find it difficult to explain in detail what his main capabilities are. That goes to explain the tacitness of the knowledge we can possess. A different approach to define tacit knowledge is that, it is a kind of individualized talent or attributes. Titi Amayah [22], suggests that tacit knowledge is only discovered when certain conditions are met, since it is deeply buried in the mind. According to Sobel [23], it has cognitive dimension programed in the mind. These cognitive dimensions consist of mental models which only manifest under peculiar circumstances. Other opinions agree that, because these are embedded attributes and can go unnoticed, they are often disregarded and overlooked. Fu et al. [24], opined that tacit knowledge may be neutral due to the degree of emboddedness. These conditions describe tacit knowledge in a way that the knower may find it inexpressible. Recent scholars describe tacit knowledge as fully applied, descriptive and experimental. When one attempts to differentiate between a resource in the form of input and the process of utilizing the resource which is capability, it is more appropriate to avoid the generic term “resource” which incorporates both terms, but instead refer to capability, in the context of tacit knowledge. This is similar to Cardy and Selvarajan [25], who opined that technical knowhow is preferably used interchangeably with tacit knowledge. This assertions implies that tacit knowledge is partly constituted of technical skill with informal components difficult to account for or quantify. Above all, Martinsons et al. [26] tacit knowledge is occasional or manifest in peculiar situations and it is typically and conventionally acquired on the job through long period of application or apprenticeship. Therefore, tacit knowledge is inherently tied to activities and people.
2.3 Importance of tacit knowledge in an organization
Resource- based viewpoint examines the relationship between a firm’s performance and the value and characteristics of internal resources. This relationship is examined for the sake of measuring a firm’s competitive advantage according to Hedlund [17]. This approach indicates that every entity can be regarded as a pool of resources which are valuable, inimitable, and rare and without substitutes and that the resources are the main source of competitive advantage for the organization. The resource based view rather emphasizes more on the attributes of tacit knowledge which can be a source of sustainable competitive advantage. The value of tacit knowledge makes it irreplaceable, imprecisely transferrable and imitable because it is ingrained in the knower or the entity. It is also implicit, taken for granted and almost impossible to replicate by competitors. In Sanchez and Mahoney [27] opinion tacit knowledge is somehow shared between specific relationships or members of a group; such as colleagues of the same rank and people in the same department, it difficult for other firms to imitate. Additionally, tacit knowledge cannot be conveyed accurately or completely in a whole, like a mathematical formula or a computer language from person to person. On the other hand, this level of tacitness may not be in the known to the organization because tacitness also breeds insecurity Dalkir [5], under certain conditions an organization may overlook or undermine some of the precise actions and processes that contribute to their competitive advantage. Willem and Buelens [28], defines tacit knowledge as what is commonly termed skilled. But in a more elaborated way, it is defined it as sub element of knowhow with the opinion that a recipe is similar tacit knowledge [29]. Alternatively, tacit knowledge is referred to as procedural knowledge, undocumented informal knowledge which is a critical success factor of an entity. At the back of this argument, the term “knowledge” is instantly associated with “Scientific” and “Objectivity” This also creates a lot of anxiety and complexity of understanding the concept of tacit knowledge and by implication, knowledge is linked to tacit and tacit indicate subjectivity. Knowledge-based view of an organization require diverse and unique resources that should be hard to imitate or transferred and should be sustained longer [30]. Preserving knowledge based resources and assets may guarantee long term sustainability even in a hostile industry. Nonetheless, knowledge is termed as a belief which contributes to an organizations effective capability to execute certain positive actions. In this regard, tacit knowledge is a significant strategic asset capable of inspiring the future of an entity [31]. In any context, knowledge classified into tacit and explicit, where tacit is gained through long term practical experience and actions. As tacit knowledge is specific and pragmatic it is only absorbed, used without awareness and that makes it impossible to explain to others. This way, tacit knowledge is only shared in an interactive conversation through common experience. Old and current literature refer to tacit knowledge as personal intuition, talent and practical intelligence [32]. Despite the argument that tacit knowledge is most valuable and expensive, explicit knowledge is required to complement tacit knowledge. For example when tacit knowledge is identified, it the duty of the knowledge manager to ensure that it is transferred to those who require it through formal means such as documented information systems or in the form of communicated processes [33]. There, within an organization there are two ways identified tacit knowledge can be utilized through explicit knowledge; through organizational policies and set of laid down principles or by means of systemic procedures which are practiced on daily basis. According to Farzin, Kahreh, Hesan, and Khalouei [34] explicit knowledge is an island surrounded by tacit knowledge in an organizational setting. Tacit knowledge is required for the generation of explicit knowledge, its execution and retention such as the selection of a suitable software application, database and sequencing of operations to execute, and also for the analysis of results.
Furthermore, Pucik [35] stated that explicit, formal, or procedural knowledge may be viewed as a tool for both structure of experience and communicative involvement. Organizational tacit knowledge can be described as those unique qualities and strategies certain individuals possess which have repeatedly reproduced a pattern of positive results due the experience.When tacit knowledge is described as articulated it serves a unique purpose such as new knowledge creation and the motivation to promote internal capacity such as individual skill to meet the demand of present and future requirements [29]. In the context of strategic management protecting organizational tacit knowledge is a strategic mechanism for overcoming rivals.This level of competence enables an organization deploy the best internal capability to attain its objectives. Competence is the most appropriate term when referring to knowledge in the context of business since it incorporates various classes of qualities including; individual skills, talent, experience, value judgment and internal social networks. This is because individual competence may not be exactly duplicated, rather it is acquired through practical experience and application and it is difficult to imitate when buried in complex managerial policies and frequent procedures. In some exceptional cases business rivals may engage in comparable experience to acquire equal tacit knowledge, in long term [36]. One more significance of tacit knowledge is that, it is useful in conflict situations and hostile rivalry, competitors are unable to develop appropriate substitutes to control price and cost of resources. Finally, in the views of [37] the most important organizational resource for sustainable and renewable competiveness in tacit knowledge.
2.4 Tacit knowledge transfer
Key empirical studies have highlighted the relevance knowledge sharing and highlighted some major barriers to knowledge sharing [38]. Knowledge sharing is an activity through which; information, skills, expertise and experience is exchanged among people in an organization and it is a valuable and tangible asset for creating sustainability, performance and competitive advantage. From what is currently known, knowledge sharing activities occur generally with the support of knowledge systems designed by the board and knowledge managers [13]. Technology is one of the tools that support knowledge sharing, though other factors exist, and have been examined such as organizational culture, trust, leadership and management philosophy, incentives and internal control systems according to Sanchez and Mahoney [27]. In this study, the researchers intend to explore possible knowledge sharing opportunities and associated barriers, particularly with the board level.
Experts suggest that identifying tacit knowledge and protecting it from depleting is a challenging task for organizations. Although, knowledge sharing is now a common practice, there are major challenge in the field of management, particularly where some employees including board of directors may resist sharing their tacit knowledge. In other words people decline to share their long standing experiences, expertise and important ideas with the rest of the organization. Lee et al. [14, 15], this lowers the general efficiency, productivity and performance. In the context of sustainability this study re-emphasize the reasons why public organizations must encourage knowledge sharing at the board level to promote sustainability procurement.
Unlike tacit knowledge, explicit knowledge is available to everyone, therefore when an organization is committed to knowledge sharing, adequate procedures must be designed to document every important operational step that will help others improve and prevent existing knowledge from depleting, and from the perspective of corporate governance, it require knowledge sharing to pursue sustainability in today’s public administration.
Knowledge sharing occurs when exclusive knowledge is properly described in the information provided, and the audience are aware that the knowledge is available and accessible without difficulties [39]. Moreover, knowledge sharing can be beneficial when the body of knowledge is precisely defined and differentiated in contexts and domain of sustainability. This study is of the view that knowledge sharing can support sustainability when there is easy access to appropriate and relevant materials. Within the organization, board of directors are key components of the knowledge sharing system and are responsible for creating new knowledge to lead the organization.
According to a sample of recent findings, tacit knowledge is difficult to identify but could be influenced by developing informal social networks Willem and Buelens [28], thus daily interactions in a defined work environment. Existing knowledge platforms encourage individuals to demonstrate problem solving capability. The exchange of views and opinions lead to organizational learning. Knowledge sharing provides solutions to the challenges confronting others and in the end lowers cost and enhances efficiency. Creating thinking is also promoted using structured and unstructured experiments. Embedded knowledge is shared through routine processes and scenario planning. Arora [40], emphasized on management training and deliberate integration of people and activities to foster knowledge sharing.
2.5 Barriers to knowledge sharing
In this section, the study elaborate precisely on the barriers to knowledge from different perspectives as documented in literature. According to the founding fathers of the concept of knowledge management there has always been some key factors which have been highlighted and that include; (a) people or individual attributes, (b) organizational culture or ethics (c) emergence of technology and (d) internal organizational challenges [41], discovered that impediments to knowledge transfer begins at the individual level and then the cultural and philosophy as well as the corporate level. Loss of power, insecurity, disclosure and motivation are responsible for individual level challenges to knowledge sharing [42]. The assertion further narrate that people occupying positions and having a certain level of influence may not be willing to share their experience for the fear of losing their privileges. Also, someone possessing a certain unique talent may not pass on this knowledge to others for the purposes of job security and status in the organization. As rightly mentioned in Lindsey [43], knowledge is power and individuals may exercise fear to share their knowledge due to lose of supremacy. Additionally, individuals are motivated by their unique expertise which promote their value, couple with people feeling uncertain about their rank particularly for the fear of being replaced with young energetic and talented subordinate. In a similar comparison, it was opined that, people who lack continence and ability to estimate the impact of the knowledge may be consumed by inferiority complex. In such situations, they may either not share or avail themselves to learn. Wendling et al. [44], posit that lack or incentives may also compel certain individuals from airing their opinions irrespective of whether the platform is created for knowledge sharing or not. In a complex organizational environment inter personal conflicts, excessive bureaucracy and the consciousness of ranks within the organizational hierarchy contribute to lack of knowledge sharing. In a recent studies [45, 46], observed organizational culture contained in the leadership philosophy demonstrates managerial commitment to knowledge sharing. If the core values of an organization supports internal socials networks and encourage organizational learning, individuals would be motivated to offer constructive contributions which will break the barriers to knowledge sharing. Although [46] outline similar organizational level challenges including trust between superiors and subordinates. As people are rewarded and encouraged to transfer their experiences to others, non- availability of technology infrastructure, technology orientation or training and management overlooking the potential benefit of social media are some of the technological factors affecting knowledge sharing. In summary, although literature highlighted several factors, it appears the most dominant issues are associated with the individual, as the discussion is often centered on tacit knowledge being held by the individual. Figure 1 is a theoretical framework capturing the barriers and factors affecting knowledge sharing with the directions of hypotheses to support future empirical investigation.
Figure 1.
Conceptual framework. Source: Authors own elaboration.
Castellani et al. [47], observed that organizations with higher knowledge capital are more likely to build a strong competitive advantage in any sector and enjoy long term sustainability against their rivals. In this regard, access and locating a particular knowledge resource by the individual is key to performance and other accomplishments. As the individual is an important stakeholder and the custodian of tacit knowledge in the organization they are a great addition to the knowledge resource [48]. Therefore, whether to protect, retain or share tacit knowledge, it concerns the individual and their personal unique attributes towards willingness to share. Some empirical studies concluded that, the individual brilliance, talent are vital that is why the concept of tacit knowledge is primary centered on people as revealed that knowledge sharing have a significant impact on individual performance and generally the organizational success [49]. The study further recommended the understanding of how tacit knowledge directly affect the economic and financial performance. Subsequently, Ode and Ayavoo [50] analyzed the impact of knowledge transfer on organizational innovation and the findings suggest that, knowledge sharing has a significant relationship with individual and organismal performance, invocation leading to individual creativity. A similar comparative analysis suggest that, although sharing explicit knowledge positively contributes to organizational innovation, tacit knowledge sharing promotes the additional quality effects to the individual and organizational achievements.
2.5.2 Internal culture
This generally means the method of leadership mechanism made up of the philosophy and style the organization can be identified with. The culture of the organization could be bureaucratic, extreme rigidity, regards for high ethical standards, less concrete supervision, openness and collectivity. Whichever cultural elements are implemented by the organization, the impact on tacit knowledge could be advantageous or detrimental. Other elements of culture that may be associated with knowledge sharing as identified by Khaksar et al. [51], include interpersonal relationships and social trust, effective internal communication and information system dedicated to support knowledge transfer among people could be beneficial in this regards. Reward systems and the structure of the organization are likely determinants of knowledge flow within between people. When individuals are extremely conscious of their titles such as regard for seniority and rank, it may bread the tendency of knowledge sharing obstacles. Milne [52], studied the negative impact of imposition of strange cultures on people and the adverse impact on willingness to share knowledge. McDermott and O’dell [53] confirmed that usually a culture of intolerance is a major obstacle while culture of involvement encourages knowledge initiatives. It is risky for an organization to have knowledge sharing embedded in the culture as it could hurdle creation of new knowledge initiatives.
In other words, positive organizational cultures may promote knowledge sharing example; diversity, social behavior, informal relationships and organizational learning aimed at promoting individual creativity. Culture is aspect of organizational structure that describes people by their shared core values. A very common definition of culture is credited to Collins and Porras [54] organizational culture defines the organizational behavior, philosophy and values observed by the people, including management, employees and the board in manner that influences the conduct of individuals to pursue the objectives of the enterprise” rather than the corporate values based on the structure and hierarchy, social factors (social networks, social relationships, hierarchical relationship, trusting relationships among individuals), which impacts more on the attitude of the people to work towards the strategic objectives of the organization in relations to expectations.
2.5.3 Technology impacts
An essential requirement for any knowledge sharing initiative is designing a central database for storing and disseminating knowledge among people in an organization. Therefore technology function as the mode of communication, identification of the source of relevant knowledge and transporting this relevant knowledge to the intended persons timely. Some earlier arguments suggest that knowledge management has no connection with technology as it is entirely associated with people. However, many reasons suggest that in contemporary management science, technology facilitates effective knowledge transfer irrespective of the geographical location. According to, Willem and Buelens [28] technology has brought total reformation into corporate culture and that has influenced interactions between people such as the frequency of holding discussions and disseminating relevant information. According to Neches et al. [55], technology has enhanced knowledge accessibility, interaction and rapid responses. Technology has made available various dynamic options through which individuals and corporations can access knowledge and important information more rapidly. Irrespective of the volume of data or information required, with the use of technology mediums large amount of data and information can be shared in the matter of seconds. A major hurdle to the use of technology in KM is the lack of expertise and an organizational culture that does not support technology adoption [56]. Additionally, technology adoption could pose a major risk if management fails to initiate effective controls and protect access to important documents except authorized persons.
2.5.4 Organizational factors
Internal conflicts, structural dimensions, managerial procedures, and assessment and incentive structures that prevent knowledge sharing frequently obstruct necessary positive initiatives [57]. The uniqueness of an entity is expressed in a variety of ways, depending on its underlying values and beliefs. The organizational or corporate principles are constantly referred to as its values, concepts, and systems, which either support or obstruct knowledge creation and internal collaboration within firms [58]. It is well established that organizational culture plays a significant role in the development of a learning organization. Additionally, positive relationships among employees and a strong company culture may be beneficial. Develop their desire to offer their expertise [59]. There are several variables that promote information exchange and give motivation to adopt new technologies. Methods of communication [60, 61]. The most critical, however, are training and incentive systems. Management provisions, donation guidelines, and a designated responsible person.
3. Discussion and emerging issues
This chapter adds to the body of knowledge on knowledge management (KM) literature by identifying research gaps, articulating new arguments, and charting a new course for future research in relation to the work of Bureš [42], Ahammad et al. [62], Dalkir [5], Hafeez and Abdelmeguid [63], Lindsey [43], Mårtensson [6], Lartey et al. [8], McDermott and O’dell [53], Smith [12]. Additionally, identifying critical factors affecting knowledge transfer may assist a variety of stakeholders in academia, industry, and diverse practitioners involved in this field, thereby advancing the culture of knowledge dissemination.
The findings of this study captures the viewpoints of notable experts in the field, following a thorough review of literature on key research questions and identified the following primary areas of concern reported in past research that have generated significant debate:
Knowledge managers’ inability to catalog internal barriers to any sort of knowledge exchange between individuals is a significant barrier to the organization’s success.
The act of transforming implicit -to- explicit knowledge is referred to as “externalization,” which consists of capturing tacit knowledge by means of coding aided by initiating organizational learning, social interactions, technology infrastructure to facilitate rapid information dissemination, informal relationships between the people irrespective of ones rank and the designing knowledge program to support succession planning so as to protect the knowledge stock of the organization from depletion in the event that a key personnel retires or leave. These are the views of prominent researchers [1, 4, 34, 45, 53]. However, the main challenge facing knowledge mangers is the inability to capture and document known ideas and talents of their workers prior to their retirement. A critical argument is how tacit knowledge can be expressed openly in the same ways as explicit knowledge, taking into account the resource and competence levels of large and small enterprises, public and private entities with varying R&D programs.
In another observation Mooradian [64] associated the main disadvantage of tacit knowledge to the process of transformation which require a lot of skills and competence. In reality, if people do not exchange their tacit knowledge it may remain unknown though interpersonal communication exist it may reveal information to only one person at a time, while other group members may require time to gather tacit information. More so a significant downsides is that once tacit knowledge is lost, it may revert to tacit, and subsequently take a toll on the organization. Two research questions arise as a result of this discovery. (i) is tacit knowledge sufficient to create competitive advantage? (ii) does an organization’s intellectual capital generate tacit knowledge?
Furthermore, this study observes that as tacit knowledge is difficult to define in simple terms, the criteria and dimensions are often interpreted wrongly without taking into account distinct organizational context, industry, and sector fit elements. As cited in Nonaka and von Krogh [19] the inexpressible nature of tacit knowledge is a significant barrier to knowledge sharing despite several studies discussing tacit knowledge institutionalization through interdisciplinary approach using organizational learning, intellectual assets, social capital, human resource management and strategic management a significant research gaps still exist. This observation requires an in-depth investigation in this field of discourse to generate a more informed perspective.
The impact of information technology may be an underutilized emerging factor that could break down barriers to knowledge sharing; however, there is evidence in current literature of the use of technological solutions to facilitate the integration and exchange of new knowledge between persons; thus, the following question may be useful to investigate: how is tacit knowledge identified, stored, and codified with the aid of information technology? In conclusion, evaluating the aforementioned research problems may allow for a better understanding and broadening of the theoretical underpinnings of tacit knowledge in specific knowledge management disciplines, which is currently absent in existing literature.
4. Conclusion
This study built on prior studies and provided an overview of current research on the importance of tacit knowledge in organizations and possible barriers to knowledge sharing. By implication the chapter explored the application of knowledge management and how it is seen and executed in a variety of knowledge-based research studies that focused on tacit knowledge. The study discovered that there are numerous components to tacit knowledge inquiry, including human capital, intellectual capital, organizational learning, creativity, competitive advantage, organizational culture, social networks, and the role of technology in knowledge sharing. The study argues that these dimensions are critical for comprehending tacit knowledge. The study concludes that extensive scientific research into the foundation of tacit knowledge is necessary in order to facilitate continuous dissemination knowledge in any organizational environment. Regardless of the value of tacit knowledge, a strong combination with explicit knowledge is necessary. In summary knowledge sharing benefit organizational accomplishments because the classifications of knowledge are critical for organizational success when individuals freely exchange experiences. According to experts, discovering tacit knowledge and preventing its depletion is a difficult task for enterprises. Although knowledge sharing is now a widespread practice, there are significant challenges in the field of management, particularly since some employees, including board members, may be hesitant to share their tacit knowledge. In other words, individuals refuse to share their extensive knowledge, competence, and critical thoughts with the rest of the organization. This has a detrimental effect on overall efficiency, production, and performance. This study re-emphasizes the importance of recognizing the barriers to knowledge sharing and pursuing solutions to increase organizational learning. Unlike tacit knowledge, explicit knowledge is publicly available; therefore, when an organization is committed to knowledge sharing, sufficient protocols must be developed to document each critical operational step that will aid others in improving and preventing current knowledge from depletion.
Acknowledgments
This work has been supported by the Humanities and Social Sciences Project Funded by the Ministry of Education of China (Grant number: 21YJC630112) and National Natural Science Funding of China (Grant number: 72102090).
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From what is currently known, knowledge sharing activities occur generally with the support of knowledge systems designed by the board and knowledge managers. It is suggested that technology is one of the tools that support knowledge sharing, though other factors exist, such as organizational culture, trust, leadership and management philosophy, incentives and internal control systems. In this study, the researchers explore possible knowledge sharing opportunities and associated barriers, starting from top management to employees. The main purpose of this chapter is to look at how tacit knowledge affects organizational success. The chapter also covers ways to promote knowledge transfer in order to improve organizational performance and innovation. The discussion elaborated on the significance of tacit knowledge in a way that previous literature does not. It is emphasized that, from a resource-based view, businesses gain competitive advantage when they value and retain their existing tacit knowledge, as explicit knowledge is already known to everyone. According to the study, important variables such as corporate culture, individual employees, technology, and organizational internal factors are potential hurdles that must be examined to minimize the impact on organizational learning.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/80291",risUrl:"/chapter/ris/80291",signatures:"Peter Yao Lartey, Junguo Shi, Rupa Jaladi Santosh, Stephen Owusu Afriyie, Isaac Akolgo Gumah, Mansuur Husein and Fatoumata Binta Maci Bah",book:{id:"10993",type:"book",title:"Recent Advances in Knowledge Management",subtitle:null,fullTitle:"Recent Advances in Knowledge Management",slug:null,publishedDate:null,bookSignature:"Dr. Muhammad Mohiuddin, Dr. Mohammad Abdul Moyeen, Dr. Md. Samim Al Azad and Ms. Shammi Ahmed",coverURL:"https://cdn.intechopen.com/books/images_new/10993.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-943-6",printIsbn:"978-1-83969-942-9",pdfIsbn:"978-1-83969-944-3",isAvailableForWebshopOrdering:!0,editors:[{id:"418514",title:"Dr.",name:"Muhammad",middleName:null,surname:"Mohiuddin",slug:"muhammad-mohiuddin",fullName:"Muhammad Mohiuddin"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Literature review",level:"1"},{id:"sec_2_2",title:"2.1 Objective knowledge",level:"2"},{id:"sec_3_2",title:"2.2 Tacit knowledge",level:"2"},{id:"sec_4_2",title:"2.3 Importance of tacit knowledge in an organization",level:"2"},{id:"sec_5_2",title:"2.4 Tacit knowledge transfer",level:"2"},{id:"sec_6_2",title:"2.5 Barriers to knowledge sharing",level:"2"},{id:"sec_6_3",title:"2.5.1 Individual characteristics affecting knowledge sharing",level:"3"},{id:"sec_7_3",title:"2.5.2 Internal culture",level:"3"},{id:"sec_8_3",title:"2.5.3 Technology impacts",level:"3"},{id:"sec_9_3",title:"2.5.4 Organizational factors",level:"3"},{id:"sec_12",title:"3. Discussion and emerging issues",level:"1"},{id:"sec_13",title:"4. Conclusion",level:"1"},{id:"sec_14",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Grant RM. Toward a knowledge-based theory of the firm. 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Tacit Knowledge and Knowledge conversion: controversy and advancement in organizational knowledge creation theory. Organization Science. 2009;20(3):635-652'},{id:"B20",body:'Fernandez IB, Sabherwal R. Knowledge Management Systems and Processes. New York, NY, USA: ME Sharpe, Inc; 2010'},{id:"B21",body:'Polanyi M. Tacit knowing: Its bearing on some problems of philosophy. Reviews of Modern Physics. 1962;34(4):601-616. DOI: 10.1103/RevModPhys.34.601'},{id:"B22",body:'Titi AA. Determinants of knowledge sharing in a public sector organization. Journal of Knowledge Management. 2013;17(3):454-471. DOI: 10.1108/JKM-11-2012-0369'},{id:"B23",body:'Sobel J. Can we trust social capital? Journal of Economic Literature. 2002;40(1):139-154'},{id:"B24",body:'Fu PP, Tsui AS, Dess GG. The dynamics of guanxi in Chinese hightech firms: Implications for knowledge management and decision making. Management International Review. 2006;46(3):277-305'},{id:"B25",body:'Cardy RL, Selvarajan TT. Competencies: Alternative frameworks for competitive advantage. Business Horizons. 2006;49(3):235-245. DOI: 10.1016/j.bushor.2005.09.004'},{id:"B26",body:'Martinsons MG, Davison RM, Huang Q. Strategic knowledge management failures in small professional service firms in China. International Journal of Information Management. 2017;37(4):327-338. DOI: 10.1016/j.ijinfomgt.2017.04.003'},{id:"B27",body:'Sanchez R, Mahoney JT. Modularity, flexibility, and knowledge management in product and organization design. Strategic Management Journal. 1996;17(S2):63-76'},{id:"B28",body:'Willem A, Buelens M. Knowledge sharing in public sector organizations: The effect of organizational characteristics on interdepartmental knowledge sharing. Journal of Public Administration Research and Theory. 2007;17(4):581-606. DOI: 10.1093/jopart/mul021'},{id:"B29",body:'Denhardt RB, Denhardt JV. The new public service: Serving rather than steering. Public Administration Review. 2000;60(6):549-559. 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In our mission to support the dissemination of knowledge, we travel throughout the world to present our publications and support our Authors and Academic Editors. We attend international symposia, conferences, workshops and book fairs as well as business meetings with science, academic and publishing professionals. Take a look at the current events.
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Upcoming Events
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IntechOpen Journals Webinar - Introduction to Open Science
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IntechOpen Represented by LSR Libros Servicios y Representaciones SA de CV
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Currently, he is a professor of Orthodontics. He holds a Certificate of Advanced Study type A in Technology of Biomaterials used in Dentistry (1995); Certificate of Advanced Study type B in Dento-Facial Orthopaedics (1997) from the Faculty of Dental Surgery, University Denis Diderot-Paris VII, France; Diploma of Advanced Study (DESA) in Biocompatibility of Biomaterials from the Faculty of Medicine and Pharmacy of Casablanca (2002); Certificate of Clinical Occlusodontics from the Faculty of Dentistry of Casablanca (2004); University Diploma of Biostatistics and Perceptual Health Measurement from the Faculty of Medicine and Pharmacy of Casablanca (2011); and a University Diploma of Pedagogy of Odontological Sciences from the Faculty of Dentistry of Casablanca (2013). 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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\r\n\tThe Business and Management series topic focuses on the most pressing issues confronting organizations today and in the future. Businesses are trying to figure out how to lead in a time of global uncertainty. In emerging markets, issues such as ill-defined or unstable policies, as well as corrupt practices, can be hugely problematic. Changes in governments can result in new policy, regulations, and interest rates, all of which can be detrimental to foreign businesses and investments. A growing trend towards economic nationalism also makes the current global political landscape potentially hostile towards international businesses.
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\r\n\tThe demographic shifts are creating interesting challenges. People are living longer, resulting to an aging demographic. We have a large population of older workers and retirees who are living longer lives, combined with a declining birthrate in most parts of the world. Businesses of all types are looking at how technology is affecting their operations. Several questions arise, such as: How is technology changing what we do? How is it transforming us internally, how is it influencing our clients and our business strategy? It is about leveraging technology to improve efficiency, connect with customers more effectively, and drive innovation. The majority of innovative companies are technology-driven businesses. Realizing digital transformation is today’s top issue and will remain so for the next five years. Improving organizational agility, expanding portfolios of products and services, creating, and maintaining a culture of innovation, and developing next -generation leaders were also identified as top challenges in terms of both current and future issues.
\r\n
\r\n\tThe most sustained profitable growth occurs when a company expands its core business into an adjacent space. This has significant implications for management because innovation in business ecosystems differs from traditional, vertically integrated firms. Every organization in the ecosystem must be aware of the bigger picture. Innovation in ecosystems necessitates collaborative action to invent and appraise, efficient, cross-organizational knowledge flows, modular architectures, and good stewardship of legacy systems. It is built on multiple, interconnected platforms. Environmental factors have already had a significant impact in the West and will continue to have an impact globally. Businesses must take into account the environmental impact of their daily operations. The advantage of this market is that it is expected to grow more rapidly than the overall economy. Another significant challenge is preparing the next generation of leaders to elevate this to the number one priority within the next five years. There can be no culture of innovation unless there is diverse leadership or development of the next generation of leaders; and these diverse, next-generation leaders are the ones who will truly understand the digital strategies that will drive digital transformation.
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\r\n\tThe topic on Economics is designed to disseminate knowledge around broad global economic issues. Original submissions will be accepted in English for applied and theoretical articles, case studies and reviews about the specific challenges and opportunities faced by the economies and markets around the world. The authors are encouraged to apply rigorous economic analysis with significant policy implications for developed and developing countries. Examples of subjects of interest will include, but are not limited to globalization, economic integration, growth and development, international trade, environmental development, country specific comparative analysis, technical innovation and knowledge management, political economy analysis, and banking and financial markets.
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\r\n\tMarketing is an important aspect in the functioning of all types of organizations. The external environment is characterized by constant and dynamic changes, that pose risks to the company. It is associated with changes in macroeconomic, political, legal, and demographic, as well as new consumer trends. It is necessary to carefully plan marketing activities in order to provide the market with products that satisfy consumers' needs and desires, provide them with value, and bring satisfaction and contentment. Therefore, in this topic, we focus on overall marketing efforts, including marketing communications through traditional and social media, pricing strategies, distribution strategies, branding, innovation, and new product launches, as well as researching the current market and consumer trends. We also analyze the latest trends and tendencies in marketing, such as product placement and neuromarketing.
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