“Organizational Health Literacy Self-Assessment Tool for Primary Care” (OHL self-AsseT).
\r\n\tThis book will aim to survey the most recent diagnostic techniques as well as the most promising therapeutic options we can count on to deal with optic nerve disorders. The audience of the book is quite wide and it aims at being the main entry to this fascinating topic for students, clinicians, and researchers.
",isbn:"978-1-80356-774-7",printIsbn:"978-1-80356-773-0",pdfIsbn:"978-1-80356-775-4",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"e3d02512ccae0638a73c5c2839e50015",bookSignature:"Prof. Felicia M. Ferreri",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11704.jpg",keywords:"Toxic Neuropathy, Ethambutol, Methanol, Leber Neuropathy, Congenital Anomalies, Coloboma, Optic Disc Excavation, Systemic Anomalies, Optic Disc Swelling, Anterior ION, Posterior ION, ION Variants",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 25th 2022",dateEndSecondStepPublish:"June 2nd 2022",dateEndThirdStepPublish:"August 1st 2022",dateEndFourthStepPublish:"October 20th 2022",dateEndFifthStepPublish:"December 19th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Prof. Felicia M. Ferreri graduated summa cum laude from the University of Messina, Italy in 1998. She served as co-investigator for many national and international clinical trials. Since 2002, she is an Assistant Professor in Ophthalmology at the University of Messina",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"32442",title:"Prof.",name:"Felicia M.",middleName:null,surname:"Ferreri",slug:"felicia-m.-ferreri",fullName:"Felicia M. Ferreri",profilePictureURL:"https://mts.intechopen.com/storage/users/32442/images/system/32442.png",biography:"Felicia M. Ferreri graduated summa cum laude from the University of Messina, Italy, in 1998 and completed her ophthalmology residency at the Policlinico Universitario, Messina, in 2002. She interned at the Corneal Section of San Raffaele Hospital in Milan and at the Pediatric Ophthalmology Diseases Section of Hospital Careggi in Florence. She spent research periods at Virginio del Rocio hospital in Seville, San Carlos hospital in Madrid, the Royal Bolton Hospital in Manchester, and Universidade Fluminense in Rio de Janeiro. She served as co-investigator of many national and international clinical trials. Since 2002, she is an Assistant Professor in Ophthalmology at the University of Messina. Her research interests are in the areas of glaucoma, neuro-ophthalmology, pediatric ophthalmology, and cataract. 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21 techniques and individual modifications are used on face and in body areas, even where open surgical techniques cannot be directly applied. Serdev Sutures® are scarless and uncomplicated in the post-operative period. These techniques use curved semi-blunt semi-elastic needles and smooth surgical sutures to elevate and fixate mobile fascial tissue. Polycon surgical sutures are preferred for these techniques. They are characterized by short elasticity to prevent mobilized tissue from rupture and are characterized by delayed resorption (in 2-3 years, after the fibrosis is finalized). This enables stable fibrotic fixation before suture degradation.
Fixed mobile facial tissue using Serdev Sutures® is SMAS in all face areas: upper facial SMAS (galea aponeurotica), zygomatic SMAS extension, cheek SMAS, platysma and others. It is fixed by suture to stable, immobile tissues, such as periosteum, temporal fascia, zygoma, coli fascia, mastoid, occipital bone etc.
In addition to the possibility of lifting, Serdev Sutures
The structuring and positioning of different face elements is not limited to facial ptosis and elderly cases. Unaesthetic face angles, volumes and proportions are responsible for lack of beauty in young patients as well. Beautification is most important in youth and rejuvenation incl. beautification in elderly. Changing SMAS position by sutures can restore aesthetic angles, shape, volume and proportions as a basis for beautification and rejuvenation, imparting a happy, youthful appearance and a smiling expression.
Scarless closed approach Serdev Suture® lifts present skeletal fixation using skin punctures, without incisions and excisions, as a first alternative to classic excision lifts. Sutures are the same as in open surgery, but with much more variations and even in areas not reachable in open surgery. The anatomy study, instrument creation and surgical suture selection commenced in 1990 and the entire understanding of local topographic anatomy, instrumentarium and technique of this new method was ready in 1993. Needle preparation and selection of surgical sutures was experimental. For sutures stretch, elasticity and cut through tests were performed. The long term absorption of the sutures is crucial in the author’s method. In 1994, at the Second annual meeting of the National Bulgarian Society of Aesthetic Surgery and Aesthetic Medicine, most of the scarless suture techniques for correction of early ptosis and flabbiness in areas of face and body were presented, as well as the initial results with 54 patients, operated during the period from 1993 to 1994. The author’s contribution is that the transcutaneous closed approach suture techniques lift the SMAS and the facial skin attached to it, without traditional incisions. Operations were ambulatory with excellent results, reported by the patients. The trauma is minimal and the follow-up period is no longer than 3 days with fast and mostly immediate return to work and social life. There are no visible scars and the needle perforations on the skin are no longer visible after days.
Operations are ambulatory, without hospital stay. Trauma is minimal. The techniques consist of passing closed sutures, by needle perforations only, to lift mobile fascias supporting the skin and fix them to immobile skeletal structures (such as periosteum) in several facial and body areas.
The author has invented and performs the following scarless transcutaneous closed approach
The suture methods became possible after creating specific curved, semi-elastic, semi-blunt needles. Best results were obtained with the Bulgarian polycaproamide sutures Polycon, which ensure semi-elastic fixation of mobile to immobile tissue (unlike other available non elastic and non-absorbable surgical sutures). The author has experimentally evaluated that they do not cut through the tissues.
Preferred
Polycon surgical sutures (3/0, 0, 2, 4, 6, 8) are semi-elastic (short elasticity), braided polycaproamide sutures of different thickness and have anti-microbial qualities.
USP depends on application.
Polycon surgical sutures are absorbed in the human body within 2-3 years, i.e. after the final fibrosis. According to the author, these are the best surgical sutures for lifting methods, because they permit semi-elastic movement of the sutured tissues.
Serdev Suture
A new method for closed approach face and body liftings – a new alternative to classic excision lifts;
Scarless lifting, using skin punctures only (no incisions or excisions);
Mini-invasive, no downtime procedures;
Beautification and rejuvenation methods;
Volumizing method without implants and transplants. When needed, tissue augmentation is performed using patient’s own tissue – a new alternative without implants;
Can be used in cosmetic, aesthetic and plastic-reconstructive surgery;
Downtime is shortened from weeks into some days;
No danger of hematoma formation, no nerve damage, no scars.
Elastic curve (the curve cannot be deformed when applying pressure in patients tissue);
Smooth surface (does not cut periosteum);
Conical semi-blunt tip (trauma is minimized);
Thickness depends on length (from 50 mm to 250 mm) and application - http://medicaldevices-bg.com/MDI/Serdev_Needles.html.
Mini Mini 50 - for ear and nose: tip and alar base
Mini Mini 50 (bended) - for fine chin subperiosteal fixations
Mini 60 - for brow, chin, temporal, mid-face, cheekbone etc. lifts
Mini 60 (bended) - for fine mid-face subperiosteal fixations
Serdev® needles (from left to right): Mini Mini 50 mm (bended), Mini Mini 50 mm, Mini 60 mm, Small 100 mm, Medium 140 mm, Long 170 mm, Super Long 210 & 230, and Super Super Long 250 mm (mostly used in Latin America).
Small 80 - for neck lifts
Small 100 - for facial, inner thigh, abdomen lifts
Medium 140 - for mid-face, breast, abdomen lifts
Long 170 - for buttock and breast lifts
Super Long 210 - for buttock lifts *
Super Long 230 - for buttock lifts *
Super Super Long 250 - for buttock lifts *
*The choice of length depends on patient’s physical characteristics
The needles are similar in shape to the currently used surgical needles with a handle to ease manipulation, with an eye at the needle tip (example Reverdin needles). However, Serdev® Needles are different in surface, elasticity, shape, size, thickness and have a curved elastic section (that retains structural curve memory regardless of the applied pressure). The elasticity and smooth polished surface allows the needles to safeguard bone-periosteal structures against cutting, regardless of the length and change of direction of the moving needle. The semi-blunt tip and elastic needle characteristics combine to avoid tissue trauma. The needle curve is specifically designed to provide ease of skin ingress, fluid movement through different soft tissue levels and periosteum, and the capture of fascial tissue. The semi-blunt tip exhibits variable penetrative qualities adapting to the application of the respective methods. The handle is flat and has a concavity mark for secure handling and display of needle tip position in the tissue.
Scarless Serdev Suture® liftings use closed approach fixation of specific mobile fascial tissue to immobile skeleton periosteum without incisions. In Brazil they are known as “fio elastico” or “fio bulgaro”. The Serdev Suture® techniques are used to correct early ptosis and flaccidity in areas of face and body, without traditional incisions. They are used also for tissue augmentation.
Observing Dr. Serdev’s videos without proper training and understanding of anatomy led to “modified” techniques using non-original or straight needles, performing superficial barbed threads that are neither sutured, nor fixed, free floating in subdermal fat tissue or fixed only superiorly. Superficial threads and sutures fixed solely to the trabecular system in the subdermal fat cannot guarantee outcome longevity. Using straight needles is an over simplification that fails to secure deep fixation of mobile to immobile tissues that is essential for stable fixation. These are easy procedures for non-surgeons and this is the reason that this oversimplification became popular. However, outcomes are insecure. As little as a 1 or 2 mm change is enough to miss the topography of the important anatomical fixations such as bony rim, level of fascias and tendons. Therefore it is essential that doctors have a critical perception about the differences between suture lifts of mobile to immobile stable tissues and superficial thread lifts in subdermal fat.
Multiple invasive techniques have been described for fixation of the scalp and upper face. However, these methods do not allow the direct positioning of the brow as in the suture method described by the author. Within the past decade the demand for minimally invasive surgery, fast recovery and immediate beautification outcomes have revised the trend toward extensive surgical procedures and radically changed surgery in face-forehead beautification and rejuvenation. Even minimal incision approaches to brow lifting, using endoscopic methods or excisions of supra-brow skin, are associated with longer down time and have become undesirable options for beautification in younger patients. Improved understanding of eyebrow anatomy, pathophysiology of the aging face and advances in small - and non-incision surgery, have contributed to the new approach in correction of the eyebrow position for beautification and rejuvenation. The Serdev Suture® method with needle skin perforations between the eyebrow hairs has been reported and introduced internationally since 1994. The concept is to capture mobile but stable tissue (the orbito-supercilliar fascia, discovered by the author) and attach it to firm, immobile upper temporal line bone and periosteum.
The eye-eyebrow is the most influential region in determining facial expressions. There is only a narrow range of eyebrow positions that are perceived as attractive. Artistic location of the eyebrow is a guide line for eyebrow repositioning. The author has reviewed the young position of the eyebrow in models and also the artistic experience and aesthetic criteria for ideal female eyebrow height and shape in both international fashion models and movie stars. The preferred distance from the upper orbital rim to the eyebrow tail is on average 1.5 cm. Eyebrow shape should have a lateral apex slant. In male patients a lesser rise of the eyebrow tail has to be considered. The importance of aesthetic anatomy, aеsthetic assessment and treatment planning in evaluation of the face must take into account considerations of patient selection, indications, and contraindications.
The author performs brow lift by suture in cases of ptosis, asymmetry, or in patients who desire a non-scarring and non-invasive procedure. Indications are beautification, rejuvenation, correction of proportions and angles.
The brow lift suture is done by needle punctures only between the eyebrow hairs to prevent scaring. It presents a stable fixation of the orbito-supercilliar fascia to the periosteum of the rim of the upper temporal line, 1.5 cm above the orbital rim or at the hair line. The subperiosteal bite line (1.5 cm above the orbital rim) defines the eybrow design. An important instrument that facilitates performing this technique is the curved, semielastic, semiblunt mini-mini Serdev® needle with length of 50 mm that can be turned down and up in order to enter through the skin, capture periosteum or fascias and exit through another skin perforation point (Fig. 5). It is most important that we have at our disposal the 0 polycaproamide surgical sutures with marked elasticity that are biodegradable in the longer term (in 2-3 years), antimicrobial and braided (Fig. 1, 4). The semielastic, braided, USP 0 suture permits movements of face and muscles, fixation under elastic tension and does not traumatise or cut the sutured tissue. The extended period of resorption quality allows time for a stable fibrosis formation and does not leave foreign bodies in the tissue after the fibrotic fixation formation process and suture absorption is complete.
Curved, elastic, semi-blunt 50 mm or 60 mm Serdev® needle.
Semi-elastic, absorbable, braided, anti-microbial, polycaprocamide surgical sutures USP 0 are preferable and give best results.
To perform and accomplish the brow lift suture, the author uses 2 perforation points between the hairs of the brow, using the tip of a No. 11 scalpel blade. The perforation points are located on both sides of the intersection of the lateral canthus line and the eyebrow (Fig. 5A, B). The lateral canthus line is very important as the upper temporal line rim is located along this line, above the upper orbital rim. To position the eyebrow for artistic fixation, the forehead skin is pulled with a thumb placed 1 cm higher than the eyebrow, at the lateral canthus line. The maximum pull positions the eyebrow tail at the desired level of 1.5 cm over the upper orbital rim, without exeption.
Additionally, through a 3-mm medial brow incision, glabellar muscles can be excised or ligated.
Rarely, the author performs eyebrow fixation to the upper temporal line at the hair line (Fig.5B) – Video: http://www.youtube.com/watch?v=71n9oveGapc.
It is more traumatic and the author uses it only if higher lifting of the eyebrows is requested and only if the particular face permits aesthetic proportions with higher eyebrow position.
This technique consists on: Subdermal suture pass A-B (just below the line of the eyebrow), in order to attach the mobile Serdev orbito-superciliar fascia; two Connecting subdermal passes – A-A1 and B-B1; and Subperiosteal pass A1-B1: immobile subperiosteal attachment to the upper temporal line
Eyebrow lift enhances appearance of the eyes.
Lifted eyebrows solve the problem with proportions in high fronts and baldness.
Total face beautification in the above 22 years young female obtained by a combination of operations: Brow lift + Nasal tip and allar base narrowing by suture + Chin enhancement + Cheekbone lift – all done by sutures + nasal hump removal. Result 4 days after surgery.
Beautification is mostly obtained by a combination of multiple operations – in this case: Brow lift + Chin enhancement + Chin dimple – all done by suture +secondary Rhinoplasty + Lip wy-plasty augmentation – immediate result
Beautification and rejuvenation obtained by a combination of operations: Brow + Temporal + Lower SMAS lifts by sutures + Rhinoplasty – Immediate and late result.
Total face beautification in a young male: Brow lift + Chin enhancement by sutures + Rhinoplasty. Brow lift in male patients has to be a bit lower than in female patients.
During the period from 1994 to 2012, brow elevations using sutures were carried out in 982 patients. The follow up period varies from one month to 15 years. 96% of the patients reported excellent results, while 4% experienced good results. 68 % of the patients were followed during the first 5 years after surgery with very good rates of satisfaction. Only one 59 years old patient experienced aesthetic lack of satisfaction due to differences in appreciation of aesthetic proportions and angles in her age group. Complications were minimal – only 2 cases of infection in the lateral skin punctures which were treated by wound cleaning and disinfection for 2-3 days.
There were no instances of scarring, skin problems, or hair loss. The post operative period is characterized by a small percentage of swelling, no bleeding or bruising, no nerve injury, no scars, near to zero complications, immediate return to social life, preservation of facial expressive function.
In the patients with more than one year of follow up, the author has observed stable results and no ptosis was discovered with the years during follow up.
Two complications, infection in the lateral perforation point, 2 and 3 weeks after surgery, were treated by wound cleaning and disinfection and healed in 2 to 3 days. There were no cases of suture removal. No nerve damage has been noted in any patient.
The purpose of this section is to present new trends in brow lifting philosophy and techniques.
There are a lot of procedures for brow lift that can have some negative effects for patients in modern society life: scars on the face that are only partially acceptable or non acceptable, asymmetries, increased tension across the healing wound, tension-related trophic skin changes, alopecia, paresis, ptosis etc. We can devide the proposed methods into invasive and mini-invasive surgeries. This chapter aims to describe an innovation in scarless brow lifting without any incision, without undermining but through suturing in situ the brow subdermal fibrous tissue and the orbito-supercilliar fascia higher to stable periosteum, using special needles and skin punctures only between the hairs of the brow. The method was introduced in 1994, with protocol description and was presented around the world as a part of author’s “fashion art” face beautification in young patients and for correction of ptotic eyebrow and rejuvenation. In his hands it has the following advantages compared to incision and excision metods: short intervention time (about 5 minutes per side), no visible scars, minimal trauma, immediate result, a short and easy post-operative period with immediate return to social life. The suture absorbs over the longer term – in 2-3 years, so that it remains until the fibrosis is finally completed in 6 to 18 month after surgery and disappears later. The results are long lasting and pleasing.
The brow lift by suture without scars is an effective and safe technique for beautification of the eye region and rejuvenation of the upper face, producing a natural result with minimal complications and high level of longevity. It is a beautification method, ambulatory, under local anesthesia and i.v. sedation, with immediate results and near to 0 complications. It is done without visible scars, preserves the expression, the movement of the brow, and also preserves the natural look. A combination of local anesthesia and intravenous sedation provides excellent patient tolerance and comfort, both intraoperatively and postoperatively. Postoperative recovery is uneventful. Complications are very rarely encountered.
The eye-eyebrow region is the center for facial expression. The position of the eyebrows expresses emotion and even a minor change in brow position can be important for the understanding and contact between individuals. Lifting the eyebrows can change the expression into a more pleasant, young and natural one. We believe that this technique provides a more permanent and stable result. This brow lift method can be one of the most beneficial surgical procedures in cosmetic surgery. This very simple procedure allows lifting in any degree and elevation of any brow point. It supports the upper lid with lateral face improvement. It may be utilized for eyebrow ptosis alone or for fashion beauty, whether unilateral or bilateral; in conjunction with other suture techniques for equalizing asymmetrical eyebrows and for further support of markedly ptotic upper lids. It has been used by the author in instances of facial paresis or paralysis in conjunction with other procedures in the face to accomplish better symmetry. The stable duration of results with this procedure depends on the tissue quality and healing, the non-traumatic surgical technique, care given to the area during healing by the patient, amount of frowning and vigorous facial muscle use by the patient, and aging. It is a useful adjunct, especially when used with temporal SMAS lift, other suture methods on the face, beautification rhinoplasty etc. to adjust proportions, volumes and angles for beautification and rejuvenation of the individual’s face.
The author’s experience indicates that this specific method of scarless brow lift by suture adds a great deal to appearance and satisfaction. The procedure has taken its place as an integral part of facial beautification and rejuvenation.
Since Mitz and Peyronie described the superficial muscle-aponeurotic system, or SMAS, in 1976, the SMAS facelift has become common and has risen into an operation to which others are compared. The author’s concept to lift the whole SMAS in temporal direction is realised using the scarless Serdev Suture® method for changing the “mask of tragedy” into the “mask of comedy” in cases of beautification, soft tissue laxity, early facial ptosis and revision facelifts.
The temporal SMAS lift by suture was started in 1990 using traditional surgical instrumentarium. The author’s needles and semi-elastic surgical sutures were introduced in 1993. In 1994 the author firstly reported his concept of a scarless ambulatory temporal SMAS lift by sutures, as lifting of the suprazygomatic SMAS with effect on the infrazygomatic SMAS, i.e. the whole SMAS. It became a routine ambulatory procedure for beautification and rejuvenation, presented and demonstrated around the world.
Since soft tissue and skin are attached to the SMAS in the temporal region, the lifting of the SMAS in temporal direction reflects in lifting of the face and its most important elements in the same direction (Fig. 18). It affects the lower face as well.
Anatomic landmarks for this method are: 1. The upper temporal line; and 2. The crosspoint (intersection) of the upper temporal line and the coronal line.
The aim of this method is to obtain beautification in patients of any age and rejuvenation in elderly, using minimally invasive cosmetic surgery procedures. It is performed in the ambulatory setting under local anesthesia with i.v. sedation. It is scarless with immediate results and near to 0% complications.
Mechanism of temporal SMAS lift – lifting of facial fascial mask (upper SMAS). Effect on facial structures. Transforming the old appearance into a young one. In ancient theater these masks are known as “Mask of tragedy” and “Mask of comedy”.
Same idea of a temporal lift is easily created in any lady’s mind, beautiful or not (Fig.19).
Ladies with no exception are thinking about temporal lift of the face.
With age, cranium volume shrinks and ptosis is reflected in the SMAS, which we can name Loose SMAS, and skin laxity changes expression into a sad and tired one. On the other hand, re-positioning of face elements could be used without restriction in face ptosis of the elderly. Aesthetically wrong face angles make young people look sad. Fixing the SMAS in a higher position allows repositioning of other soft tissue facial structures, fixed to SMAS. In young patients, the aim of the temporal SMAS lift is beautification, based on facial aesthetics.
Before and after surgery. Temporal SMAS lift changes hanging eyebrow tail, lateral canthus angle of the eye and oral commissure. After: Better expression of cheek-bone prominence, due to the lifting of the skin and the fat pad. Additional rhinoplasty is made to correct the “golden section rule” of facial proportions in 3 equal parts; Lip augmentation to equalize lip and eye volume; Chin augmentation to obtain the “beauty triangle” and the straight line of the profile. Embellishment of the face is obtained and “smiling” expression is present (“mask of comedy” = fresh and young look).
The SMAS is spread from the vertex to the platysma. It lies superficially to facial nerves. The SMAS acts as a suspension for the overlying facial skin and distributes forces of facial expression.
The Galea aponeurotica, as the upper part of the SMAS, is a muscle-aponeurotic tissue and extends from the vertex to the brow and the zygoma. It is named “superficial temporal fascia” as well, but it does not cover the temporal area solely. The temporal region, or “temporal pocket”, is located over the temporal muscle, bordered by the superior temporal line above, by the lateral orbital rim in front, and by the zygomatic arch below. The layer, covering the temporalis muscle, is a bright and thick aponeurosis, the Temporalis Fascia, named also (wrongly) “deep temporal fascia”. Both galea and temporal fascia are described with different names that causes confusion. At the level of the superior orbital rim, the temporal fascia (or “deep temporal fascia”) splits in two layers: Superficial and Deep layer of the temporalis fascia (or /wrongly/ “deep temporal fascia”). These two fascial layers: Superficial and Deep layer of the temporalis fascia enclose intermediate fat, including nerve and vessels. An important landmark in the temporal region is the superficial temporal artery that can be easily palpated along the hairline. The vein follows the same pattern. The frontal branch of the facial nerve, which innervates the frontalis muscle, the orbicularis oculi and corrugator supercilii lies in the intermediate fat interposed between the deep and the superficial layer of the temporalis fascia (or /wrongly/ “deep temporalis fascia”). It is considered to travel along a line connecting the base of the tragus to a point 1.5cm above the eyebrow.
The concept of the scarless closed approach transcutaneous temporal face lift by sutures is to lift loose mobile galea and to fix it to stable immobile upper temporalis line periosteum and temporalis fascia. Skin fixed to the galea follows this repositioning in temporal direction that reflects in face lifting. To obtain such lifting, special curved semi-blunt, semi-elastic Serdev® needles with different lengths of 50 mm, 60 mm and 100 mm are used to introduce long-term absorbable, semi-elastic, braided, antimicrobial Bulgarian polycaproamide (Polycon) surgical sutures USP 2 or 4. Other surgical sutures could be used, but the short elasticity quallity of the Bulgarian suture reduces trauma to the fixated mobilised tissues. Rigid thin USP 2/0 threads work as a scalpels to mobile tissue, when under tension.
Curved semi-blunt and semi-elastic needles 50 mm, 60 mm and 100 mm
Two lines A-B and A1-B1 are marked as parts of a rhombus inside the temporal area (Fig. 22 A). Line A-B represents the subperiosteal (upper temporal line) and subtemporal pass of the suture. Point A is located above the intersection point of the upper temporal line and the coronal line and point B is marked about 3-4 cm below at the coronal line. Starting from A, a line A-A1 is marked in 45 degrees angle to the line A-B in direction to the eyebrow tail. Point A1 is located at the end of that line in a distance from A, depending on the laxity, usually at 3-5 cm away from A. Line A1-B1 is the line of supragaleal fixation of SMAS. Lines A-A1 and B-B1 are subgaleal passes of the suture, connecting the two fixation lines. They mark the direction of movement of the galea to temporalis fascia. In cases of a very loose SMAS, mostly in elderly, it is advisable to perform a second suture, lower than the first one, to lift the medial and lower facial SMAS and soft tissue.
The wide spread temporal fixation (to temporal fascia) is not advisable, because temporalis fascia fibers are perpendicular and cannot hold a suture fixation with tension in distal direction. The suture will slide down and the lift will lose on longevity (Fig. 23).
A second line of galea fixation A2-B2 (below A1-B1) is marked (Fig. 22B) and a second suture is performed. in cases when laxity in the lower face is still presented after the first suture, mostly in elderly. The needle and surgical suture are introduced as follows: A-B – subperiosteally/subtemporally at the upper temporal line; A2-B2 – supragaleally; A-A2 and B-B2 – subgaleally.
Temporal fascia fibers
After local anesthesia, a No. 11 scalpel blade is used to make skin perforations at points A, B, A1 and B1. The order of needle entries should be convenient to right or left handed surgeons and could be as follows: the needle is introduced supragaleally in line A1-B1, just under the skin (between skin and galea, where a thin layer of subdermal fat allows to pass without any resistance). After threading the needle, the surgical suture is introduced in the A1-B1 supragaleal plane. The next subgaleal passes are directed from A to A1 and from B to B1 to take the suture ends. The final A-B pass is through the bone of the upper temporal line, subperiosteally and subtemporally. So, we have 3 levels of needle passes i.e. 3 levels of positioning of the surgical suture in the tissue: A1-B1 is supragaleal/subdermal (mobile fixation), A-A1 and B-B1 are subgaleal, and A-B – subperiosteal and subtemporal (immobile fixation). The location of the needle in each level has its characteristics. In the subdermal plane, the needle is not fixed by stable tissue – it is movable laterally and is covered only by a thin layer of skin. In the subgaleal plane, the needle is introduced deeper (in the tunnel of the lifted skin and galea, fixed together), and is mobile laterally again (Galea is mobile), and is covered by a thicker layer that includes skin, subdermal fat and galea. As galea is fixed to skin in that region, pulling of skin like a tunnel pulls galea as well and subgaleal entry in that tunnel is made easy. In this plane, one has to avoid taking temporalis fascia that is located below the needle. If temporalis fascia is captured with the needle, movement of the needle is impossible without movement of the entire head. Such fixation is incorrect and the needle has to be repositioned.
In the very beginning, the author was using a 3 cm temporal incision in the coronal line A-B, which, working under visual control, is more comfortable for beginners to perform the subperiosteal and subtemporal fixation. In this technique we start with anesthesia and make a 2-3 cm long A-B incision along the coronal line. The skin and subdermal fat are opened and the red vascularised galea below becomes visible. After the galea is opened with a mosquito instrument, the white shiny temporal fascia is presented (Fig. 24).
A blunt subgaleal dissection follows till the hairline. It should be very easy because there is no stable fixation between these two fascias – galea and temporal fascia. Further, the same surgical technique is done as described above. Lines A-A1 and B-B1 are subgaleal passes of the suture, done under visual control, A1-B1 is a supragaleal i.e. subdermal pass, and A-B is a subperiosteal and subtemporal pass under visual control as well. A very important part of the technique is prevention of hair insertion with the suture loop into the subdermal plane that will lead to granuloma formation and local infection. Deep biting of the temporal muscle instead of a subfascial pass should be avoided to prevent pain, which is described by patients as headache. The galea, presenting the SMAS, is pulled up and fixed higher to the upper temporal line with one or two sutures on each side, under elastic tension. Thus, the whole SMAS is pulled up in temporo-occipital direction. Following this, the skin is closed with single stitches and no dressing is necessary. A hair wash is recommended on the next day to remove any residual blood. Wound stitches are removed after 7 days.
1427 patients were followed up for more than 3 years, operated from 1993 to 2001, using the Temporal lift suture method, firstly with a minimal incision in the coronal line and later with needle perforations only. Patients’ age ranges from 19 to 68 years. The operation was performed in ambulatory settings. After washing and styling the hair, patients could return to their social life next day, if necessary on the same day.
The temporal SMAS lift has effects on the suprazygomatic area: it reduces the lateral and forehead wrinkles; raises the eyebrow tails and the lateral canthus of the eyes; reduces the crows-foot wrinkles, raises the cheekbone prominence and tightens the skin. The effects on the lower face are collateral. The SMAS elevates the lateral canthus of the eyes, and the oral commissure. It improves the skin texture, reducing cheek flaccidity; gives a clearer outline of the jaw. Generally, the method gives excellent results in younger and middle aged patients whose lower face flacidity is minimal to medium. The facial tissues are repositioned to the desired higher youthful location. The temporal hair is preserved. There are no visible scars, no signs of operative intervention, and no "operated-on" appearance. A moderate feeling of tension in the face could be present for hours or days. The feeling is mostly pleasing. Only 7 patients described the tension as uncomfortable for one or two days. During the first week 12 patients reported headache. Lower eyelid swelling could appear on day 3 after surgery due to gravity and should be prevented by resting in supine position during the first two days. Five patients had lower lid bruising on the 3rd day on one side and four other patients – on both sides. Seven patients reported a crust formation with liquid under the crust. The reason was subdermal position of hair by the suture sling. After hair removal, the wounds healed in approximately two to four days. One patient had the same problem in another country and the surgeon removed the suture. Due to the fibrosis formation, no ptosis appeared after removal of the suture. No other infections, no hematomas or damage on the facial nerve were observed. Some palpable bulging in the temporal area could be present for some weeks. Most important in face lifting is its longevity. Numerous factors act against face stability, such as gravity and facial movements. The longevity of the result is improved due to the SMAS fixation to periosteum. This is best seen years after surgery in cases of a unilateral temporal SMAS lift in facial paralysis, post traumatic and postoperative canthal abnormalities etc. (Fig. 30). Two patients could not see the difference, despite the photograph demonstrations, contesting the aesthetic result. The effect of lifting angles was not satisfactory with 5 patients. With 3 of them the operation was repeated after 3 to 5 years.
Currently, there are plenty of techniques used for face-lifts: conventional rhytidectomy, composite face-lifting, deep layer rhytidectomy, sub-SMAS, extended face-lifting, subcutaneous temporofacial lift combined with SMAS suspension, medial SMAS lift with aggressive temporal skin removal, temporal lift via blepharoplasty approach. Stretching the skin solely is obsolete. New techniques were proposed, such as endoscopic, subperiosteal, extended face lifts etc. There is no general agreement and no definitive answer as to which operative technique is most effective or preferable for each specific case. This is due to the subjective nature of aesthetics, aspirations and to the variability of skills and anatomy.
In the last years, an increasing number of patients ask for non-invasive or minimally invasive surgery for beautification or rejuvenation with minimal trauma and short recovery downtime, corresponding to the modern lifestyle. The suture method for temporal SMAS lift is the most preferred option by author’s patients as an optimal solution for upper (and total) face beautification and rejuvenation, which preserves the natural look.
The temporal SMAS lift is a nice, weekend ambulatory procedure that gives a pleasing rejuvenation and beautification of the skin, eyes, brows, cheekbones, and most importantly - changes the expression. Complications rate is very low and the methods to solve the complications are easily performed. In young ladies, only one suture per side is usually enough to lift the lateral canthus of the eye, the eyebrow and to pull the ptotic malar fat into place, which restores and forms a nice malar eminence. It is also possible to combine the temporal lift by suture with other suture procedures: the author uses additional suture methods for brow, mid-face, cheekbone, and lower SMAS lift, simultaneous rhinoplasty, chin and lip augmentation, fat reduction and/or augmentation, skin resurfacing or blepharoplasty to obtain facial beautification and or rejuvenation. The closed approach Serdev Suture® method for temporal SMAS lift provides a safe and effective beautification, as well as rejuvenation in early laxity and face ptosis, and in some revision facelifts.
Supra-temporal lift presents fixation of the mobile galea aponeurotica at the hairline to the upper temporal line periosteum.
Suture lines A-B, B-C and A-C to ligate glabella muscles
20 patients were followed up to 3 years after operation with the suture ligation method to block glabella muscles. 3 years results show 80-95% relaxation of the glabella muscle function that is permanent.
Serdev Sutures® glabella muscle ligation provides a minimally invasive, scarless glabella muscle ligation, necrosis and relaxation with no downtime and near to zero complications. Longevity is very satisfactory. Aesthetic results often exceed patient expectations.
There are 2 methods for lateral canthus lifting:
Lateral canthus repositioning is performed mostly in reconstructive surgery. Serdev Suture® lift permits beautification as well. Another possibility for lateral canthus lifting is the Serdev Suture® brow lift, which also reflects in a lateral canthus lifting.
Health literacy (HL) is an issue of increasing importance in the health sector due to its ability to use existing health services effectively and efficiently. It allows the acquisition of better outcomes from the services provided thus, reducing health expenditure. Study findings indicate that a significant number of successful results from health services are closely associated with the health literacy of individuals [1, 2, 3]. Its importance was better understood during the COVID-19 pandemic, because of the dependent relationship between individuals and the health care organizations.
The health literacy concept, which has been initially used to mean individuals’ ability to read drug prospectuses, health-related brochures, and understand health-related information, has changed and expanded over time. Today, health literacy is defined as “people’s knowledge, motivation, and competencies to access, understand, appraise, and apply health information to make judgments and take decisions in everyday life concerning healthcare, disease prevention, and health promotion to maintain or improve quality of life during the life course.” [4], in essence, a lifelong learning activity that needs continuous improvement for individuals.
Over time, it has been understood that health literacy issue is not solely an individual burden, the health system and health organizations have an important role as well, so the “Organizational Health Literacy” (OHL) concept has been launched. OHL is defined as the ability of health organizations to provide information and services that are easy to find, understand and use, to assist people in decision making, and to remove existing barriers to all individuals who are seeking services. Health literate health care organizations are organizations that provide the needed information and services to the people in an easier way of access, understanding, and use [5].
Literacy is not a genetic or an ordinary characteristic of the people. It is a phenomenon that emerges and develops under the influence of several variables. It is the product of a kind of interaction and that means there is a mutual and reciprocal action. For such action there must be at least two sides, a receiver and a sender or influencer. Additionally, it always occurs in an environment that has physical, social, and psychological characteristics. So, all of these variables regarding receiver, sender, and environment should be considered to understand the concept. That means health literacy is a product of an interaction between health-seeking individuals and the health care providers within the environment of health care organizations [6, 7].
Because measurement and evaluation methods of a feature is closely linked to its conceptualization, the concepts of HL and OHL should be clarified before discussing the measurement methods.
The first use of the term health literacy was in the 1970s, during the times when health education was seen as a component of social policy, [8] and evolved in recent years. HL is expressed as the knowledge of individuals throughout their life course, which will guide behaviors and decisions related to themselves and public health, their knowledge of basic health information and services, their access to this information, their understanding of the information accessed, and then their use of this information for the development of health for the maintenance or improvement of quality of life. It is the degree to which individuals have the capacity to access, understand and interpret the basic health information, and services they need to make appropriate decisions associated with their health [4, 6].
Studies have reported that there is an association between low health literacy and various negative health behaviors as well as poor health-related outcomes, such as difficulties to interpret health messages and labels, poor medication adherence, high rates of hospitalization [9], frequent emergency room use, less frequent mammography rates [10], lower participation in preventive activities [11], inappropriate drug use, poor self-management of chronic conditions [12], high mortality rates [13], and increased health care costs [1, 14, 15].
Several definitions of health literacy [4, 16], as well as health literacy measures, were reported in different studies [15]. It is seen that more than 150 health literacy instruments were developed and used in the first decade of the 21st century according to various publications [17, 18].
Presence of different health literacy definitions and use of different measurement tools may be considered normal since they focus on different aspects of the concept and are complementary to each other. Here, the important thing to remember is that methods needed to measure health literacy are usually developed according to our understanding and definition of health literacy. In their study, Urstad et al. [15] have concluded that there will be a risk of missing information when the used measurement tools of health literacy are not consistent with the definition and concept of health literacy.
On the other hand, current health care systems have a complex nature and they are in rapid change and evolution. They usually are not designed according to the abilities of at least some of their service users and this characteristic makes it difficult for some patients to access and use the correct health information they needed. So, such systems should also be literate to help and increase the low literacy level of all patients.
The term OHL is relatively a new concept that emerged a few decades ago to address the challenges faced by individuals with predominantly limited HL. Because the service relationship in healthcare institutions and organizations is a mutual interaction, the literacy of institutions has become an important issue in recent years.
Features of the health organizations, such as a respectful approach to patients, easy access to services, easy information to understand, helpful navigation and signage systems, and correct answers given to every kind of question are important factors. These features are helpful to individuals for the correct use of the services, and they are as effective as the literacy of the individuals [5, 19, 20].
There are numerous studies showing that the development of OHL leads to positive effects on the health of patients and increases patient satisfaction [21, 22, 23, 24]. Although there are various studies and ways on how an institution can become a health literate organization, agreed-upon methods to measure, and evaluate the level of OHL are still lacking. The existing methods are generally highly scoped, but their reliability and criterion validity are generally unknown since they are not used in interventional research.
OHL standards and measurement methods have become an increasingly important topic in the last decade. Although there is a strong interest in OHL, majority of the studies are theoretical, and methodological studies are limited. Presence of measurement methods with different characteristics causes confusion over OHL.
A recent review showed that at least 17 different measures were used to assess OHL. According to the findings of this scoping review, six major categories of OHL have been defined and the most prevalent topic is referred to as “communication with service users.”
The following categories were, “easy access and navigation,” “integration and prioritization of OHL,” “assessments and organizational development,” “engagement support of service users,” and “information and qualification of staff” [25]. However, it was stated that no consensus has been reached on criteria that can describe a health care organization as a health literate organization.
Some criteria are focused on specific health facilities [26] or different aspects of OHL [26, 27] and/or interventions [26, 28], their evaluation [29] and implementation [30].
Another scoping review regarding OHL implementation has found that important factors that can be helpful for creating health literate organizations are ordered as, supportive leadership, a culture of change and innovation, awareness and participation of the staff, and engagement of service users [31]. However, different studies have also commented that still there is not a sufficient amount of evidence to assess the effects of OHL interventions on improved health outcomes or cost-effectiveness, and further studies are needed [26, 28].
As it was stated by Kaper et al. [31], interventional studies regarding the improvement of OHL have several weaknesses and the main limitations of the studies were lack of an experimental design and lack of instruments measuring OHL outcomes with known reliability and validity. Studies were usually conducted on small sample groups and without a control group or based on baseline cross-sectional measurements. Nevertheless, it is concluded that the instruments used in these studies may be useful to observe and monitor the change over time and make comparisons between the organizations [31].
Following are the most frequently referred studies regarding the conceptualization, implementation, and measures of the OHL.
The idea of a
The comprehensive study, prepared by Brach et al. in 2012 [5], is a milestone in OHL. In this study, detailed recommendations on what health literate organizations should and should not be are clearly stated and Ten Attributes of Health Literate Health Care Organizations are defined.
Ten attributes of Health Literate Health Care Organizations are as follows [5]:
Has leadership that makes health literacy integral to its mission, structure, and operations.
Health literacy is an organizational value for a health literate organization, and strategies of health literacy are internalized at every management level. They are perceived as part of the business and integral to its mission, structure, and operations. Leadership is the key to the success and sustainability of such an implementation.
Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement.
Health literacy is integrated into the strategic and operational plans of a health literate organization. It is seen as an inseparable part of patient safety and quality improvement activities and is evaluated regularly.
Prepares the workforce to be health literate and monitors progress.
Every professional in the organization must be health literate and understand the meaning of being a health literate organization. So, they must be trained and educated by appropriate adult education methods for the establishment of a health literate organizational culture. Training and education activities must be continuous and monitored regularly. They must be organized under the responsibility of a training team and include every staff member.
Includes populations served in the design, implementation, and evaluation of health information and services.
Community participation and decision sharing are essential for the success of all health care activities including health literacy. Health literate organizations include representatives of the local people in the design, implementation, and evaluation of services. Especially hearing the voices of individuals with low health literacy is important for designing user-friendly services.
Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
Health literate organizations use communication methods that are as simple as possible. Written, visual or digital communication is not sufficient since some individuals may have difficulties. So, alternatives such as oral communication and escort guiding are useful methods. These methods must be available for and offered to every service user to reduce the low literacy-related stigma. This is particularly important for individuals who have limited health literacy.
Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
Health literate organizations create an environment that has linguistic and cultural competency to support health literacy strategies. Such an environment aims to provide clear communication during all interactions and for every kind of service including clinical, administrative, and financial services.
Provides easy access to health information and services and navigation assistance.
Health literate organizations design their facilities to help people to access information and services easily. They use a simple and easy-to-understand style of symbols, language, and signage.
Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
Health literate organizations design all printed materials, such as education documents, diagnosis and treatment guides, laboratory test results, insurance policies, bills, and various written directives in an understandable style and with easy-to-understand language. The same approach is true for the design and distribution of audiovisual and social media content.
Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
“First, do no harm” is the number one principle of medicine since Hippocrates. However, due to the nature of the health services, there are several high-risk situations that cannot be eradicated in health facilities. Complications following surgical operations, adverse drug reactions, and absence of radical therapies are some examples of these situations. Health literate health care organizations identify such situations and inform patients appropriately.
Communicates clearly what health plans cover and what individuals will have to pay for services.
Health literate organizations communicate openly, clearly, and on time regarding financial issues such as coverage of the patient’s health plans, and how much they will have to pay for which services. They answer all relevant questions of the service users in an understandable language.
The ten attributes are related to health organizations, health care professionals, and various types of healthcare facilities that have direct responsibility for the provision of health services. All kinds of hospitals, clinics, group practices, private physician offices, community health centers, pharmacies, health insurance companies, accreditation agencies, information technology and health education professionals, and administrative staff needed to have these attributes to become health literate. In other words, almost all components of the supply side of a health system must have these ten attributes.
“Ten attributes of health literate healthcare organization” has been used by many researchers in the following years.
In a study conducted by Kowalski et al. [33] a ten items survey tool “Health Literate Health Care Organization Ten Item Questionnaire” (HLHO-10) to represent the ten attributes was developed. It was applied as part of a larger study and cross-sectional data was collected from a key informant survey in 51 German hospitals, and found to be reliable and valid [33]. It was concluded to be a useful tool to assess the level of OHL that is which organizations are helpful to their users to access, find, understand, and use the correct information they needed as well as the services.
Later HLHO-10 has been used during a survey to assess the OHL of a group of hospitals in Turkey and investigate the relationships between OHL, patient satisfaction, and individual health literacy by Hayran and Ozer [21].
Bonaccorsi et al., have used the Italian version of the HLHO-10 scale in healthcare organizations in Tuscany. They have found that accredited hospitals have higher HLHO-10 scores and perceived quality increases with the increase in HLHO-10 scores, which is interpreted as OHL an integral element for the quality of care [34].
HLHO-10 scale was also adapted to measure and use the OHL level of the facilities established for individuals with various disabilities [35].
Ten attributes provided intellectual foundation to other action frameworks. At least two other concepts and tools were based on the principles of the ten attributes. These are, “Vienna Concept of Health Literate Hospitals and Healthcare Organizations” (V-HLO) [36] and “the Organizational Health Literacy Responsiveness self-assessment tool” (Org-HLR) [37].
V-HLO is designed as a self-assessment questionnaire that includes 9 standards, 22 sub-standards, and 160 items [36]. It was tested by Pelikan and Dietscher in Austria and found to be successful [38].
This tool builds upon the “Ten Attributes of Health Literate Health Care Organizations.” However, the V-HLO expands the concept by introducing specific aspects tested in Health Promoting Hospitals (HPH) that were created by an international working group within the ‘International Network of Health Promoting Hospitals. It includes five standards published by WHO-EURO [39], 18 strategies of the HPH [40], and with reference to quality management concepts.
V-HLO considers the significance of organizational support for health literacy as a necessary precondition for sustainable implementation. This support is necessary for the implementation of interventions in relation to four action areas of the concept. These action areas are health literacy that is needed to gain adequate
These action areas are applied to three stakeholder groups, namely, patients, staff, and population.
Nine standards of V-HLO are as follows [38]:
Establishment of management policy and organizational structures for health literacy (includes 2 sub-standards)
Development of materials and services in participation with stakeholders (includes 2 sub-standards)
Qualification of staff for health-literate communication with service users (includes 2 sub-standards)
Provision of a supportive environment with health-literate navigation and access (includes 5 sub-standards)
Application of health literacy principles in routine communication with patients (includes 4 sub-standards)
Improvement of the health literacy of patients and their entourage (includes 2 sub-standards)
Improvement of the health literacy of the staff (includes 2 sub-standards)
Contribution to the health literacy in the region (includes 2 sub-standards)
Sharing experiences and being a role model (includes 1 sub-standard)
In the following years, the French version of V-HLO has been prepared and tested in three hospitals in Belgium. It was concluded to be an appropriate tool for hospitals that have the intention to raise their level of health literacy, create awareness and formulate strategies and actions [41].
The rationale underlying this Project was the need for a specific tool to assess and enhance OHL in primary health care settings. As the authors have stated, most approaches to OHL have usually focused on inpatient care, and outpatient and/or primary health care services have rarely been included. However, especially the level of OHL in primary care settings is of great importance, because they are the first contact points of the well-designed health systems.
The tool has been developed and evaluated with the participation of various practice partners including general practitioners and community health care organizations as well as expert opinions. The aim of this tool is to make the needs assessment, identify the improvement areas, and implement the actions necessary for OHL.
The tool consists of three modules and six dimensions:
A user manual containing instructions
A checklist for self-assessment of the community health services
A handbook to measure the improvement of the check-list items
Six dimensions of the tool were based on the ten attributes of a health literate health care organization [5], the nine standards of the V-HLO [38], and six dimensions of a health literate organization as used in the Tasmanian toolkit [HelloTAS] [43] and finalized after discussions with the representatives of primary care professionals the community health care organizations.
Six dimensions of the tool included the main content of the checklist. Then it was divided into 15 sub-dimensions including a total of 43 criteria (Table 1).
Dimensions | Sub-dimensions (number of criteria) |
---|---|
1. Provision of easy access to primary care services and facilitated navigation | 1.1 Contact (5) 1.2 Navigation within the primary care service (2) |
2. Communication in plain and easy to understand language | 2.1 Oral communication (8) 2.2 Written communication (5) |
3. Promotion of health literacy for service users | 3.1 Empowering service users to use health information (1) 3.2 Promotion of an active role and self-management of service users (2) |
4. Promotion of health literacy of staff members | 4.1 Know-how and professional competence (1) 4.2 Personnel development (3) 4.3 Staff members’ health (1) |
5. Incorporation of health literacy into management and organizational structure | 5.1 Health literacy as an organizational responsibility (2) 5.2 Health literacy as a development goal (2) 5.3 Organizational culture (2) 5.4 User involvement – feedback (2) |
6. Promotion of health literacy at care interfaces, networks, and further activities of the organization | 6.1 Care interfaces (4) 6.2 Networking and further activities (3) |
“Organizational Health Literacy Self-Assessment Tool for Primary Care” (OHL self-AsseT).
Adapted from De Ganni et al. [42].
Authors have concluded that this tool may be helpful for a successful implementation of OHL in primary care settings because it was developed with the participation of various practice partners and shaped by expert opinions.
In their study, Trezona et al. [37] developed the Organizational Health Literacy Responsiveness self-assessment tool (Org-HLR) and conducted an assessment process for supporting the health organizations with the application of the tool.
OHL responsiveness is the synonym term for OHL. It means the provision of health information and services in an equitable manner in terms of access and participation, taking into consideration the literacy needs and preferences of all service users, and supporting community participation during decision-making processes for health and well-being [37].
The self-rating Org-HLR tool and process were derived through co-design processes with a wide range of professionals working in the health and social services sectors, It has seven dimensions for assessment and they are divided into 24 sub-dimensions with 135 performance indicators.
Seven assessment dimensions are:
External policy and funding environment
Leadership and culture
Systems, processes, and policies
Access to services and programs
Community engagement and partnerships
Communication practices and standards
Workforce
A scale to assess the OHL status of different types of secondary and tertiary care hospitals has been developed by Dundar Ege and Hayran [44]. Forty-three 7-point Likert-type scale items were prepared by a comprehensive literature review and shaped by expert opinions. It was tested by the management staff of a sample group of 47 hospitals in İstanbul, including State hospitals, Private Hospitals, University Hospitals, Non-Profit Foundation Hospitals, and Accredited and Non-accredited Hospitals.
Five dimensions of OHL-Hosp were identified following the exploratory and confirmatory factor analyses. Internal consistency of the items of each dimension has been found significantly high and statistically significant (Table 2).
Dimensions (number of items) | Eigenvalues | Variance (%) | Cronbach’s alpha |
---|---|---|---|
1. Leadership and Regulations (16) | 20.996 | 48.828 | 0.987 |
2. Communication (14) | 5.014 | 11.661 | 0.946 |
3. Operational Access (6) | 3.320 | 7.722 | 0.954 |
4. Indoor Access (4) | 2.973 | 6.914 | 0.948 |
5. Outdoor Access (3) | 1.638 | 3.810 | 0.841 |
Dimensions and factor analysis findings of the OHL-Hosp scale.
The scale consisting of 43 items and five dimensions is concluded to be a valid and reliable instrument to determine OHL levels of secondary and tertiary care institutions.
This tool is the updated version of the “Health Literacy Environment of Hospitals and Health Centers” by Rudd and Andersen [45]. It was developed by Harvard University and published in 2019 [7]. Its original form has been widely used in the USA. It was also adapted to use in different countries including Australia, New Zealand and European countries.
It is helpful to identify and rate the factors that are related to the literacy of health organizations for improving health literacy and monitoring change over time.
The HLE2 tool is organized into five sections, 10 parts, and 135 criteria as it is presented in Table 3. Content of all sections is addressed through the lens of health literacy. Each section has a rating scale. Following data collection, a total score and a percentage score is computed for each section. An overall score tally of the HLE2 has not been recommended. Instead, actions to consider for the % score of each section are described.
Sections | Parts (number of criteria) |
---|---|
1. Organizational Policies |
|
2. Organizational Practices |
|
3. Navigation |
|
4. Culture and Language | (10) |
5. Communication |
|
The study is based on visitor observations and standards to be applied by officials and it is organized as a list of things to do for OHL. The list can be applied in the form of brainstorming sessions with active members of healthcare institutions.
In a scoping review [25] which was held in 2021, sixty studies on OHL are examined in-depth and common six main categories, 25 subcategories of attributes, and 494 criteria of OHL were identified.
The main categories were ordered as:
Communication with service users
Easy access and navigation
Integration and prioritization
Assessments and organizational development
Engagement and support of service users
Information and qualification of staff
Among the reviewed articles published between 2006 and 2020, the majority were related to toolkits. This was followed by discussions, case studies, feasibility studies, surveys, workshop summaries, or evaluation studies.
“Ten Attributes of Health Literate Health Care Organizations” by Brach et al. [5] was the most frequently referred publication for the concepts used.
Reviewed studies have used 17 different assessment tools and instruments for the assessment of OHL. The HLHO-10 [33] and the HLE2 [7, 45] were the most frequently referenced tools among them.
The tools were usually designed as questionnaires and used during surveys. Some studies have used them in their original form while others have used a subset of items. Some studies have used the translated tools in a different language while others have adopted the measures for a different type of method.
Design of the assessment methods has also varied. Some studies have used standardized questionnaires and semi-structured interviews while others have collected the data by observations, checklists, and material assessments.
However, the authors have stated that the majority of the tools and instruments were not tested for validity and feasibility.
The goal of the study was to develop a valuable set of measures to inform OHL-related quality improvement activities. The study [46] was based on patient feedback and presented the standards that increase quality in healthcare organizations.
These are organizational structure, policy and leadership, communication, navigation, and patient participation. The results are similar to other studies.
Communication has been deeply examined as the main standard of OHL in this study in 2021 [47]. A sensitive communication approach was assessed from the perspective of the patients’ health in complex care structures.
As an important finding of the study, better processing of the organization is perceived by patients that was related to significantly higher health literacy scores. On the other hand, better health literacy scores were related to more patient-reported social support provided by physicians and nurses as well as fewer unmet information needs.
It was concluded that investing in good processing of the organization can improve the communication that is sensitive to health literacy. This has the potential to encourage service user–provider relationships and it might reduce the unmet information needs of the service users.
In this meta-narrative review, Farmanova et al. have identified 20 health literacy guides with various contexts and scopes [27]. Most guides have been prepared for general healthcare organizations. Six of them were specific for primary care besides hospitals and pharmacies. One was specific to health literacy of nursing practices.
Most included dimensions of OHL in guides were verbal and written communication, and access and navigation. All guides have included these dimensions. Access and navigation referred to the physical environment as well as the provided services by the organization.
Thirteen key barriers under 3 broad themes were identified during the use of health literacy guides: barriers related to the leadership and cultural environment of the organization; barriers related to the design and planning of interventions needed for the improvement; and barriers referred to the health workforce.
Especially recent guides provided best practices and recommendations that are evidence-based to support OHL actions. However, it was found that most of the guides have not been tested and their applicability was unknown in organizational practices, and this finding raises questions regarding their effectiveness [27].
Authors have concluded that OHL seems to be a heterogeneous phenomenon and it can be theorized from many different perspectives and implemented in different ways.
There is a similarity among the criteria identified in the conceptualization of the OHL in various studies. However, despite the conceptual similarities and presence of many different techniques and scales to assess OHL, there is still confusion about conceptualization and operationalization [25].
“Ten Attributes of Health Literate Organizations” by Brach et al. [5], is the most detailed and broad-ranged study in terms of conceptualization of OHL and has been an intellectual foundation for several other studies. Many of the assessment tools and instruments were based on the principles described as ten attributes. Most frequently used examples are, HLHO-10 [33], V-HLO [36], and the Org-HLR [37].
HLHO-10 is designed as a questionnaire that rates each of the ten attributes on a Likert scale.
The V-HLO aims at the sustainability of OHL and expands the concept by introducing specific aspects tested in Health Promoting Hospitals (HPH) [39, 40]. It approaches OHL from the stakeholders’ view considering their impact zone.
The Org-HLR uses health literacy responsiveness as a system-level action. It aims to coordinate and integrate all health care services, and system navigation by intersectoral collaboration [37].
Another important instrument HLE2 Assessment Tool [7] has a long history and wider use and includes palpable criteria mostly based on observations regarding implementation details. It offers ‘to-do lists’, observation forms, and process management details that can also be used during brainstorming meetings in organizations.
Among the several criteria to describe OHL, “communication” seems to be the major and most common component in all studies. Possible benefit effects of HL-sensitive communication were examined in several studies [47] including specific groups such as cancer patients [48], culturally diverse patient groups [49], and concluded to be an important dimension of OHL.
“Ease of access and navigation” is another significant criterion to describe OHL that has been investigated in many studies. Zanobi et al. [26] and Bremer et al. [25] have identified many different interventions for easy access and navigation in their scoping reviews. Use of pathways with different color codes, directions prepared with a plain and standardized language, support from volunteer escorts, directions posted in commonly used languages, and navigation apps are some examples. However, no studies have been found to evaluate their effects.
In some studies, quality is considered the main aspect [46] and OHL is examined as an instrument to raise the quality of healthcare.
It is known that patient satisfaction and responsiveness are high in organizations with high OHL [21]; however, it is not possible to say the opposite and it is important not to confuse OHL with patient satisfaction or health care responsiveness.
According to a study conducted during the COVID-19 pandemic, OHL principles and guidelines may be helpful to promote human-centered health care and services even in times of crisis [50].
OHL has been examined in various countries, in different settings, and from different aspects by many researchers. Among the limited number of scales that have been presented in some studies, none of them was tested for validity and reliability [51].
Additionally, many patient health outcomes have been investigated, but it is seen that almost all of them were related to supportive interventions for patients. No study was found reporting the patient health outcomes that are related to staff.
The effects of environmental support on health care staff have been rarely studied. Only a few studies have reported outcomes related to the satisfaction and helpfulness perception of the staff [26].
Comprehensive work done by Brach et al. on the conceptualization of the OHL is a milestone as we have mentioned above [5]. It serves as an intellectual base for other studies. In studies, regarding the implementation and assessment of OHL, checklists based on on-site observation and interview forms based on general questions for qualitative evaluation purposes are used. Furthermore, in some studies, it is observed that checklists for self-evaluation and guidelines to assess the healthcare organizations including primary healthcare institutions are also used.
In a comprehensive systematic review, it was found that the practices, measurement, and evaluation criteria in the field of OHL are very diverse and differ from each other [52]. According to the results of the screening, there were 8 main measurement-evaluation tools used for OHL measurement-evaluation, among which HLHO-10 (Health Literate Health Organization-10) [33] and V-HLO (Vienna Health Literate Organization) [36, 38] were used more frequently.
No definitive list of actions for implementation was found as well as assessment and measurement of the OHL. As a matter of fact, the rapid change in health care systems, institutions, types of services, technologies, and even professions naturally will affect and change the ways of our understanding of OHL.
So, aims for the implementation, operationalization, and improvement of the OHL must be addressed in a systematic and flexible manner. This issue is particularly significant for the communication of health care organizations with service users.
As the last word, some recommended steps to facilitate organizational change when promoting OHL practices can be summarized as encouragement of leadership, presence of clear and effectively communicated change vision, and provision of staff training and education to promote OHL practices [53]. These are the most important steps during the journey to facilitate organizational change toward OHL.
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from R&D to Final Solutions"},signatures:"Mohamed Khodja, Malika Khodja-Saber, Jean Paul Canselier, Nathalie Cohaut and Faïza Bergaya",authors:null},{id:"35523",doi:"10.5772/38092",title:"New Opportunities for the Tourism Market: Senior Tourism and Accessible Tourism",slug:"new-opportunities-for-the-tourism-market-senior-tourism-and-accessible-tourism",totalDownloads:16642,totalCrossrefCites:19,totalDimensionsCites:47,abstract:null,book:{id:"1852",slug:"visions-for-global-tourism-industry-creating-and-sustaining-competitive-strategies",title:"Visions for Global Tourism Industry",fullTitle:"Visions for Global Tourism Industry - Creating and Sustaining Competitive Strategies"},signatures:"Elisa Alén, Trinidad Domínguez and Nieves Losada",authors:[{id:"115524",title:"Dr.",name:"Elisa",middleName:null,surname:"Alen",slug:"elisa-alen",fullName:"Elisa Alen"},{id:"118677",title:"Dr.",name:"Trinidad",middleName:null,surname:"Dominguez",slug:"trinidad-dominguez",fullName:"Trinidad Dominguez"},{id:"118678",title:"MSc.",name:"Nieves",middleName:null,surname:"Losada",slug:"nieves-losada",fullName:"Nieves Losada"}]},{id:"17370",doi:"10.5772/16376",title:"Mental Fatigue Measurement Using EEG",slug:"mental-fatigue-measurement-using-eeg",totalDownloads:6084,totalCrossrefCites:24,totalDimensionsCites:39,abstract:null,book:{id:"146",slug:"risk-management-trends",title:"Risk Management Trends",fullTitle:"Risk Management Trends"},signatures:"Shyh-Yueh Cheng and Hong-Te Hsu",authors:[{id:"24884",title:"Dr.",name:"Shyh-Yueh",middleName:null,surname:"Cheng",slug:"shyh-yueh-cheng",fullName:"Shyh-Yueh Cheng"},{id:"24893",title:"Dr.",name:"Hong-Te",middleName:null,surname:"Hsu",slug:"hong-te-hsu",fullName:"Hong-Te Hsu"}]}],mostDownloadedChaptersLast30Days:[{id:"55499",title:"Human Resources Management in Nonprofit Organizations: A Case Study of Istanbul Foundation for Culture and Arts",slug:"human-resources-management-in-nonprofit-organizations-a-case-study-of-istanbul-foundation-for-cultur",totalDownloads:2401,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The aim of this study is to investigate the efficiency and importance of human resources management in nonprofit organizations. The understanding was included to the literature as personnel management at the beginning of the twentieth century and it turned into an approach as human resources management in the 1980s. It could be observed that many organizations, which deem the human as the most critical stakeholder, adopt a traditional way of personnel management in operating human resources. The employees play a key role in the success of an organization. For this reason, subjects such as recruitment, training, development, career management, performance appraisal, occupational health, and safety are the fundamental functions of human resources management. The study examines to what extent these roles are evaluated through a case study. The subject matter of the study is the most powerful culture and art foundation in Turkey. Compared to many other nonprofit organizations, the foundation actively performs a variety of services within a year worldwide. The fact that the total number of employees might rise up to 800, including the field personnel, indicates the need of a good functioning human resources management. The human resources practices of the foundation are examined and evaluated within that scope.",book:{id:"5826",slug:"issues-of-human-resource-management",title:"Issues of Human Resource Management",fullTitle:"Issues of Human Resource Management"},signatures:"Beste Gökçe Parsehyan",authors:[{id:"189113",title:"Dr.",name:"Beste",middleName:null,surname:"Gokce Parsehyan",slug:"beste-gokce-parsehyan",fullName:"Beste Gokce Parsehyan"}]},{id:"70045",title:"Islamic Leadership: Comparisons and Qualities",slug:"islamic-leadership-comparisons-and-qualities",totalDownloads:3023,totalCrossrefCites:5,totalDimensionsCites:6,abstract:"This chapter explores the concept and principles Islamic leadership which generate qualities. These qualities differentiate the Islamic leadership with other leadership concepts. The fundamental sources of Islamic leadership and guidance for the Muslim leaders are Al-Qur’an and Hadith. The sub-topics related to the Islamic leadership elaborate all attributes (traits, skills, power, authority) needed by the leaders. This content analysis method is based on a review of literature and other secondary data. The information in this chapter expectedly will give understanding on the importance of the Islamic leadership concept and can be useful or as a reference for further studies.",book:{id:"7799",slug:"digital-leadership-a-new-leadership-style-for-the-21st-century",title:"Digital Leadership",fullTitle:"Digital Leadership - A New Leadership Style for the 21st Century"},signatures:"Ahmad Rafiki",authors:[{id:"307090",title:"Ph.D.",name:"Ahmad",middleName:null,surname:"Rafiki",slug:"ahmad-rafiki",fullName:"Ahmad Rafiki"}]},{id:"63695",title:"The Role of National Cultures in Shaping the Corporate Management Cultures: A Three-Country Theoretical Analysis",slug:"the-role-of-national-cultures-in-shaping-the-corporate-management-cultures-a-three-country-theoretic",totalDownloads:5070,totalCrossrefCites:8,totalDimensionsCites:9,abstract:"This chapter explores answers to the question that how national cultures influence the management cultures of organizations. In this case, therefore, differences and similarities among the national cultures of Pakistan, Mexico, and the USA are under investigation in order to analyze the impacts of such differences and similarities on the management cultures of organizations located in these countries. The outcomes of the analysis based on the existing literature suggest that differences in national cultures greatly influence the way organizations are managed in these countries. These findings present cross-cultural management challenges for organizations working in these countries, especially when they want to build trilateral or bilateral business partnerships. This is in addition to the fact that the USA and Mexico are geographically far from Pakistan.",book:{id:"7251",slug:"organizational-culture",title:"Organizational Culture",fullTitle:"Organizational Culture"},signatures:"Mohammad Ayub Khan and Laurie Smith Law",authors:[{id:"247709",title:"Prof.",name:"Mohammad",middleName:null,surname:"Khan",slug:"mohammad-khan",fullName:"Mohammad Khan"},{id:"247712",title:"Prof.",name:"Laurie Smith",middleName:null,surname:"Law",slug:"laurie-smith-law",fullName:"Laurie Smith Law"}]},{id:"60433",title:"The Role of Leadership in the Professional Development of Subordinates",slug:"the-role-of-leadership-in-the-professional-development-of-subordinates",totalDownloads:2668,totalCrossrefCites:4,totalDimensionsCites:7,abstract:"Professional development is relevant for the workers themselves, for the organizations, and, in a more macro view, also for the countries. In this sense, this chapter aims to discuss the influence of leadership in the professional development of subordinates, pointing out the importance of leadership performance. To achieve this goal, research results are presented on the relationship between leadership and professional development of subordinates. Research in the field shows that professional development is directly related to the day-to-day activities of workers and should be part of a broader process of continuous learning, which results both from formal and informal learning actions. The debate proposed for this chapter considers that professional development is more directly related to the combination of cognitive, affective, and behavioral processes that involve learning than the specific results of certain formal or informal learning actions. Thus, we discuss how the relations established with the leadership in the work environment can influence the professional development of the subordinates besides the type of learning provided to the workers. This discussion can shift the focus of research—currently centered on learning modes—to a focus on leadership practices for skills development and the consequent career progression of subordinates.",book:{id:"6781",slug:"leadership",title:"Leadership",fullTitle:"Leadership"},signatures:"Luciana Mourão",authors:[{id:"239876",title:"Ph.D.",name:"Luciana",middleName:null,surname:"Mourão",slug:"luciana-mourao",fullName:"Luciana Mourão"}]},{id:"55244",title:"Corporate Governance and Fraud: Evolution and Considerations",slug:"corporate-governance-and-fraud-evolution-and-considerations",totalDownloads:3104,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"There are many definitions of Corporate Governance, as a structure, as process, as policies, as mechanisms, but despite their differences of focus, they mainly addressed the sustainable economic growth and protection of shareholders and other stakeholder’s rights. The purpose here is to present the evolution of the main principles and frameworks as corporate and financial environment changes and set new challenges. Some important scandals that revealed the weaknesses of corporate governance frameworks are described to complement the comprehension of the object of it. It is detached the aspects simulated or ignored and the subsequent enforcement and monitoring response. Discussion about the new challenges, what corporate governance is supposed to provide and what it can promote, closes this chapter.",book:{id:"5968",slug:"corporate-governance-and-strategic-decision-making",title:"Corporate Governance and Strategic Decision Making",fullTitle:"Corporate Governance and Strategic Decision Making"},signatures:"Ana Paula Paulino da Costa",authors:[{id:"201677",title:"Dr.",name:"Ana Paula P.",middleName:null,surname:"Costa",slug:"ana-paula-p.-costa",fullName:"Ana Paula P. Costa"}]}],onlineFirstChaptersFilter:{topicId:"63",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"76373",title:"Managing Conflict in Faith-Based Organizations in Zimbabwe",slug:"managing-conflict-in-faith-based-organizations-in-zimbabwe",totalDownloads:303,totalDimensionsCites:0,doi:"10.5772/intechopen.96932",abstract:"One of the basic theories commonly believed in the secular world today is that conflict is inevitable which means that individuals and groups have needs, interests, dislikes, likes, partnerships, values and preferences which are often not compatible. This is also true of faith-based organizations. Using the Apostolic Faith Mission in Zimbabwe church as a point of reference, this article argues that in Christian circles there is need to deliberately develop a perspective of conflict that reflects conflict as a positive force that generates both co-existence and growth in the church to counter the conventional view in the majority of churches that consider conflict as a destructive force. In the Apostolic Faith Mission church, intra-church disputes have a negative effect on the wellbeing of individuals and groups (the church) as conflict creates rivalry, hostility, divisions, hate, breakaways, among others. This is because a strongly adversarial attitude to conflict of all sorts is reflected in the approach of the church to conflict and in particular, some pastors have responded with legal action against the disciplinary activities of the church. Consequently, this article suggests that faith-based organizations should appreciate the importance of conflict for positive growth and development as a good number of Christians today are still pessimistic about conflict.",book:{id:"8452",title:"Organizational Conflict - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/8452.jpg"},signatures:"Norman Chivasa"},{id:"75982",title:"How Task Conflict Can Support Creative Problem Solving in Teams by Stimulating Knowledge Sharing, Critical and Creative Thinking and Meta-Cognition",slug:"how-task-conflict-can-support-creative-problem-solving-in-teams-by-stimulating-knowledge-sharing-cri",totalDownloads:281,totalDimensionsCites:0,doi:"10.5772/intechopen.96600",abstract:"This study explores how task conflict can support creative problem solving in teams and the cognitive processes applied. As multidisciplinary teams can be diverse in nature, they may not always partake competently in the pooling of information, and as a result task conflict may arise due to differences in mental models. Under certain conditions task conflict is considered to be beneficial to creative problem solving because it stimulates knowledge exchange and integration and constructive criticism to reach co-created decisions and solutions. Four case studies were conducted to analyse the discourse of teams carrying out design and innovation projects. Task conflict was found to have a positive impact on creative problem solving in the application of four cognitive processes: knowledge processing, critical and creative thinking and metacognition (team self-reflection). Task conflict was positively related to creativity in the proposal of solution alternatives. The successful application of the cognitive processes was dependent on an awareness of when task conflict is appropriate and high level social skills. The findings have implications for managers of teams solving complex problems. They highlight how the cognitive processes can be constructively used to stimulate and manage conflict to effectively solve problems in teams.",book:{id:"8452",title:"Organizational Conflict - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/8452.jpg"},signatures:"Louise Kiernan, Ann Ledwith and Raymond Lynch"},{id:"75879",title:"Intergroup Conflict and Organizational Performance: A Case of Kiboga Hospital, Uganda",slug:"intergroup-conflict-and-organizational-performance-a-case-of-kiboga-hospital-uganda",totalDownloads:325,totalDimensionsCites:0,doi:"10.5772/intechopen.96150",abstract:"The study aimed at finding out whether there is a relationship between intergroup conflicts and organizational Performance, using the case of Kiboga hospital. The study contributes to the body of existing literature by laying down strategies for managing and reducing intergroup conflicts. The study employed a cross-sectional research design along with a quantitative approach. The study population was 95 of which a sample size of 76 respondents was selected using Krejcie and Morgan table. Data was collected by the use of a questionnaire which was self-administered. Data were analyzed by the use of Statistical Package for Social Science (SPSS) through descriptive statistics and correlation analysis. Results revealed that respondents consented that intergroup conflicts affect performance with an average mean of 4.154 and a standard deviation of 1.092. A correlation coefficient of 0.903 which is significant at 0.01, revealed that there is a significant relationship between intergroup conflicts and performance which lead to the rejection of a null hypothesis. The study concluded that moderate levels of conflicts improve performance since they stimulate thinking and creativity in decision making towards goal achievement. However, extreme levels of conflict reduce performance in terms of patient care for our case of investigation. The study recommended strategies management can employ to manage extreme levels of conflicts to improve patient care.",book:{id:"8452",title:"Organizational Conflict - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/8452.jpg"},signatures:"Antony Tebitendwa"},{id:"75316",title:"Conflicts in Environmental and Agricultural Organizations in the Far North Region of Cameroon",slug:"conflicts-in-environmental-and-agricultural-organizations-in-the-far-north-region-of-cameroon",totalDownloads:248,totalDimensionsCites:0,doi:"10.5772/intechopen.95860",abstract:"The population of the Far North Region of Cameroon suffers the most from poverty and huge environmental challenges. As a result, they have the highest concentration of environmental organizations in Cameroon. Data was collected by interviewing key informants who work in environmental and agricultural companies. It was discovered that conflicts in such organizations are caused by the differences people have in terms of opinions, interests and needs as they work together with each other. Their strictness with one another also causes conflict especially when doing dirty or difficult work tasks. Conflict also comes about when the religious values of each other is not respected especially that of the Muslims in Christians dominated companies. There is also generational conflict which is characterized by the confrontation between the older and less educated generation who have some experience and young graduates who would like to implement new practices. Other causes are discrimination where workers are not promoted basing on merit but on their ethnic relation to one another. There is equally an economic cause which is due to the non-distribution of part of the substantial profits that some companies make to their employees as well as too low salary and poor work tasks distribution.",book:{id:"8452",title:"Organizational Conflict - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/8452.jpg"},signatures:"Nanche Billa Robert"},{id:"74723",title:"Rhetoric Communication to Handle Interpersonal Conflicts at Workplaces",slug:"rhetoric-communication-to-handle-interpersonal-conflicts-at-workplaces",totalDownloads:294,totalDimensionsCites:0,doi:"10.5772/intechopen.95526",abstract:"Organisations are large platforms amalgamating people from diverse backgrounds, mindsets, experiences, opinions and beliefs. It is likely that at times there may be a clash in personalities leading to conflicts. While conflicts resolved create productive workplaces, on the contrary unresolved conflicts generate dissatisfaction and discontent among the people further leading to inefficiency among the employees directly hampering the organisation as a whole. Communication is understood as the most indispensable factors that moulds and reflects in our everyday relationships. Because of its dynamism and complexity, communication forms the essence of interpersonal relationships in organisational contexts. Understanding the vitality of communication, the concept this paper explores is how rhetoric communication, an Aristotelian principle may help resolving interpersonal conflicts, creating a win-win situation and further extending healthy interpersonal relationships at workplaces.",book:{id:"8452",title:"Organizational Conflict - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/8452.jpg"},signatures:"Mitashree Tripathy"},{id:"74603",title:"Power Asymmetry, Negotiations and Conflict Management in Organizations",slug:"power-asymmetry-negotiations-and-conflict-management-in-organizations",totalDownloads:518,totalDimensionsCites:0,doi:"10.5772/intechopen.95492",abstract:"Relationships are seldom equal. In fact, social interactions involve most of the times power asymmetric relationships. Especially in organizations people are daily faced with situations where they are either in a powerful or in a powerless position compared to others. Power stems from various sources and takes several forms. For instance, people are powerful when they can administer punishments or rewards, when they are in a hierarchically higher position than others, when they have knowledge and expertise, when they are admired and respected, and when they have alternative options which enable them to make choices. Importantly, power determines the way people interact with each other and subsequently, the way they engage in conflicts and conflict resolution. Power-holders are best able to asymmetrically enforce their will and therefore, they have the capability to determine the process and the outcome of a conflict. In this chapter, I present the major sources of power and the main differences between them. Consequently, I elaborate on the impact of power on conflict management based on the negotiation literature. I conclude by touching on the necessity to distinguish between two contradictory faces of power: power as opportunity and power as responsibility.",book:{id:"8452",title:"Organizational Conflict - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/8452.jpg"},signatures:"Kyriaki Fousiani"}],onlineFirstChaptersTotal:6},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. Barderas",slug:"oxidative-stress-in-cardiovascular-diseases",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Importance of Oxidative Stress and Antioxidant System in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11671.jpg",subseries:{id:"15",title:"Chemical Biology"}}}]},overviewPagePublishedBooks:{paginationCount:33,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. She has more than fifteen years of teaching and research experience. She has published more than 550 scientific publications/communications, including 15 books, 50 book chapters, 100 original research papers, 380 research communications in national and international conferences, and 12 patents. She is a member of the editorial board of five journals and acts as a reviewer for several national and international journals. 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Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\r\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\r\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Orthodontist, Assoc Prof in the Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. Her knowledge of English is at an advanced level.",institutionString:null,institution:null},{id:"332914",title:"Dr.",name:"Muhammad Saad",middleName:null,surname:"Shaikh",slug:"muhammad-saad-shaikh",fullName:"Muhammad Saad Shaikh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jinnah Sindh Medical University",country:{name:"Pakistan"}}},{id:"315775",title:"Dr.",name:"Feng",middleName:null,surname:"Luo",slug:"feng-luo",fullName:"Feng Luo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sichuan University",country:{name:"China"}}},{id:"344229",title:"Dr.",name:"Sankeshan",middleName:null,surname:"Padayachee",slug:"sankeshan-padayachee",fullName:"Sankeshan Padayachee",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"315727",title:"Ms.",name:"Kelebogile A.",middleName:null,surname:"Mothupi",slug:"kelebogile-a.-mothupi",fullName:"Kelebogile A. Mothupi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"423519",title:"Dr.",name:"Sizakele",middleName:null,surname:"Ngwenya",slug:"sizakele-ngwenya",fullName:"Sizakele Ngwenya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"337613",title:"Mrs.",name:"Tshakane",middleName:null,surname:"R.M.D. Ralephenya",slug:"tshakane-r.m.d.-ralephenya",fullName:"Tshakane R.M.D. Ralephenya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419270",title:"Dr.",name:"Ann",middleName:null,surname:"Chianchitlert",slug:"ann-chianchitlert",fullName:"Ann Chianchitlert",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419271",title:"Dr.",name:"Diane",middleName:null,surname:"Selvido",slug:"diane-selvido",fullName:"Diane Selvido",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419272",title:"Dr.",name:"Irin",middleName:null,surname:"Sirisoontorn",slug:"irin-sirisoontorn",fullName:"Irin Sirisoontorn",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}}]}},subseries:{item:{id:"23",type:"subseries",title:"Computational Neuroscience",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness",scope:"Computational neuroscience focuses on biologically realistic abstractions and models validated and solved through computational simulations to understand principles for the development, structure, physiology, and ability of the nervous system. 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Particularly interesting are models of various types of more compound functions and abilities, various and more general fundamental principles (e.g., regarding architecture, organization, learning, development, etc.) found at various spatial and temporal levels.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11419,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null,series:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403"},editorialBoard:[{id:"13818",title:"Dr.",name:"Asim",middleName:null,surname:"Bhatti",slug:"asim-bhatti",fullName:"Asim Bhatti",profilePictureURL:"https://mts.intechopen.com/storage/users/13818/images/system/13818.jpg",institutionString:null,institution:{name:"Deakin University",institutionURL:null,country:{name:"Australia"}}},{id:"151889",title:"Dr.",name:"Joao Luis Garcia",middleName:null,surname:"Rosa",slug:"joao-luis-garcia-rosa",fullName:"Joao Luis Garcia Rosa",profilePictureURL:"https://mts.intechopen.com/storage/users/151889/images/4861_n.jpg",institutionString:null,institution:{name:"University of Sao Paulo",institutionURL:null,country:{name:"Brazil"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",institutionURL:null,country:{name:"Turkey"}}}]},onlineFirstChapters:{paginationCount:7,paginationItems:[{id:"82777",title:"Sustainability and Social Investment: Community Microhydropower Systems in the Dominican Republic",doi:"10.5772/intechopen.105995",signatures:"Michela Izzo, Alberto Sánchez and Rafael Fonseca",slug:"sustainability-and-social-investment-community-microhydropower-systems-in-the-dominican-republic",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Globalization and Sustainability - Recent Advances, New Perspectives and Emerging Issues",coverURL:"https://cdn.intechopen.com/books/images_new/11476.jpg",subseries:{id:"91",title:"Sustainable Economy and Fair Society"}}},{id:"82387",title:"Kept Promises? 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