Comparison of patients with thyreopathy to healthy population
\r\n\tHealth and mental health issues of both children and adults and evidence-based treatments will be included. The types of sexual violence that occur and prevention efforts that have – or have not – been made to address the occurrence of these types of violence will be covered.
\r\n\r\n\tCultural and governmental policies, as well as legal and jurisdiction issues to address victims of these crimes, will also be incorporated in the book. For instance, Meagan’s Law and its worthiness in protecting children will be incorporated as well as the Federal program to reimburse victims of online child pornography and the legal entanglements and ramifications of that program.
\r\n\r\n\tThe typology of offenders and the effectiveness of treatment will also be addressed.
\r\n\tFinally, the direction of prevention strategies, treatment needs for both victims and offenders, and policy issues to move the field forward, particularly in terms of research, will be presented. The field of sexual violence has made significant strides in the past 45 years in terms of understanding sexually deviant behavior, the impact on children who then experience the symptoms of that trauma in adulthood, how to effectively interview sexually victimized children, and finally, treatment and social mores that make disclosure possible and recovery hopeful.
In the contemporary, or in endocrinological literature, there is still increasing interest in psychological or psychosocial aspects of thyreopathy (thyroid disease). Unfortunately, this theme is rather marginalized in the Czech Republic therefore we have begun to be interested in this topic (Janečková, 2007a, 2008a; Mandincová 2008a, 2008b, 2009a, 2009b, 2011a, 2011b).
\n\t\t\tWe have delivered an overview of the research findings in journal Czechoslovak Psychology (Janečková, 2007b) and at conferences (Janečková, 2007c, 2008c). It is possible to trace down four main lines of the research abroad (see chap. 1.1 – 1.4).
\n\t\t\tOne part of the research aimed at the role of stress in pathogenesis of thyreopathies, within their process and prognosis, some of them also included research of modifying stress factors, but their importance has not been fully appreciated.
\n\t\t\t\tAlthough a lot of studies stated connection between stress and autoimmune disease, most of evidence is indirect and a mechanism, which the autoimmune disease is influenced by, is not fully recognised. Just the relation between Graves’ disease origination and higher levels of stress is considered to be the best indirect proof of the thyroid autoimmune disease, though it is still the subject of discussions. Most of contemporary studies support hypothesis that stress effects origination and clinical course of Graves\' disease. Stress influences immune system directly or indirectly through nervous and endocrine system. These immune modulators can lead to a development of autoimmune illness in genetically predisposed individuals (Mizokami et al. 2004; comp. Schreiber, 1985). Depression can be applied as an intervening variable between life stress and an outbreak of autoimmune disease, because evidence it modifies immune response is available (Harris, Creed, Brugha, 1992).
\n\t\t\t\tAnciently it was observed that hyperthyroidism was preceded by presence of life stresses. Even the latest study confirms the effect of stress on Graves\' disease development. Patients with Graves’ disease were researched exclusively. An exception is a research comprising also patients with non-autoimmune hyperthyroidism (Matos-Santos et al., 2001), which results can show the fact that stress contributes to origination of non-autoimmune hyperthyroidism, but less than with autoimmune Graves\' disease. Recent studies looked into life events and observed more negative life events in patients with Graves\' disease compared to a control group (Kung, 1995; Lee et al., 2003; Matos-Santos et al., 2001; Radosavljević et al., 1996; Sonino, et al., 1993; Winsa et al., 1991; Yoshiuchi et al., 1998a, 1998b). Some earlier studies rejected the relation between stressful events and hyperthyroidism origination. However, they had considerable methodological problems to which can be attributed the fact that a consistent coherence was not found. Most probably, a difference in Martin-du Pan’s research was not proved due to the same reasons (1998, as cited in Mizokami et al., 2004), because he arguably created a control group. Some studies (Kung, 1995; Winsa et al., 1991; Yoshiuchi et al., 1998b) integrated modifying factors into the research – evaluation of coping and social support. Furthermore, Kung (1995) and Yoshiuchi et al. (1998b) realized that life events occur rarely and they cannot reflect total stress that an individual experiences and the source of distress can also be hassles or daily stresses and minor events.
\n\t\t\t\tMuch less prospective studies dealing with the effect of stress on hyperthyroidism course were carried out, yet they denote that more important life events and daily hassles can be of a negative effect on Graves’ disease course (Ferguson-Rayport, 1956, as cited in Whybrow, 1991; Fukao et al., 2003; Hobbs, 1992; Yoshiuchi et al., 1998a). Already Schreiber (1985) speaks about the fact as a psychological stress, difficult task from an environment and individual’s reaction to it can exacerbate calmed hyperthyroidism, and even hypothyroidism.
\n\t\t\t\tIt is difficult to evaluate stress influence on origination and course of another autoimmune disease – Hashimoto‘s thyroidism, because it is quite often developed inconspicuously, the stress influence could have been overlooked (Mizokami et al., 2004).
\n\t\t\tAnother group of surveys researched a personality of a sick. The research into a personality was very popular with researchers (Ham, Alexander and others), especially in 50s and 60s of 20th century, when specific personality traits predisposing to hyperthyroidism were sought. Later studies proved neither typical personality, nor found a specific conflict in childhood (in Whybrow, 1991; Rodewig, 1993; Kaplan, Sadock, Grebb, 1994). Robbins and Vinson (1960) also regard the result of their study as an evidence of the fact that the personality role was overestimated in hyperthyroidism. At present, these issues are getting into the background compared to other research topics.
\n\t\t\t\tInfluence of the thyroid disease on a personality and relation between personality traits and thyreopathy is realised in a quite difficult way. It is difficult to make a decision what the cause and consequence is. Harineková (1976) describes specific personality characteristics in girls with eufunctional goitre. Similarly, Ma, Luo and Zeng (2002) found some personality characteristics in adult patients different from the control group. Jenšovský et al. (2000, 2002) did not prove changes of personality traits in individuals with subclinical hypothyroidism during T4 treatment in the Czech study. Caparevic et al. (2005) examined patients with nodular goitre with whom the occurrence of mental disorders was reduced after an operation. Yang and Zang (2001) indicate that the choice of coping strategy is influenced by the personality in the patients with Graves’ disease. Fukao et al. (2003) carried out a prospective research in Japan and they realised that some personality traits worsen the prognosis of treated Graves\' disease.
\n\t\t\tNewly, works calling for usage of psychological means in the treatment of thyreopathies occasionally appear. Available resources discuss these issues, especially with hyperthyroidism treatment. Monographs provide only general recommendations concerning suitability of psychotherapy (e.g. Baštecký et al., 1993; Kaplan et al., 1994; Markalous & Gregorová, 2007). A few works confirm successful treatment of patients with hyperthyroidism with a combination of conventional medicine and psychological means (Fukao et al., 2000, as cited in Fukao et al., 2003; Zeng et al., 2003; comp. Brown et al., 2010).
\n\t\t\t\tIn a British study Lincoln et al. (2000) realised that patients with hyperthyroidism do not have enough knowledge concerning this disease. Likewise, treated patients with hypothyroidism were not satisfied with insufficient or misleading information that was provided by the doctors on the disease and its treatment (Mc Millan et al., 2004). Air et al. (2006, 2007) state that it is not possible to rely on the Internet as a tool of patients’ education, because the information concerning thyroid carcinoma on the web sites was quite often incomplete and outdated. Roberts et al. (2008) surveyed which information would be necessary for the patients with the carcinoma. Sawka et al. (2011) have developed a computerized educational tool (called a decision aid) to inform patients about available treatment options and have been utilized in oncologic decision-making. Huang et al. (2004) rightfully assume that a big potential is hidden in nurses’ care (comp. Filická & Hadačová, 2006; Olosová & Filická, 2006).
\n\t\t\t\tWe are informed on a range of organisations that help patients in thyroid disease or they associate them, and on a big amount of information materials for these patients (more detailed Janečková, 2008b; Mandincová, 2010). On the other hand, a lot of Czech patients have very little quality information and educational materials on the disease and its consequences, diagnostics and treatment. More or less, there is only one web site created by a female patient after a thyroid operation (available at www.stitnazlaza.estranky.cz dated 04/09/2011). As well as, special organisations supporting or associating patients, self-supporting groups are still missing. Practically, the situation in the Czech Republic has not change within the last two years.
\n\t\t\t\tWe suppose if the mental disorder was not diagnosed in the patient with thyreopathy, the role of psychological and psychosocial means and psychotherapy itself has not been fully appreciated in their treatment (comp. Sinclair, 2006). Austrian researchers (König et al., 2007), among others, point out the importance of psychological and psychosocial methods introduction into the healthcare system with these patients. Ponto and Kahaly (2010) recommend psychosomatic treatment also in the ills with orbitopathy, as well as Hirsch et al. (2009) and Lee et al. (2010) in patients with carcinoma.
\n\t\t\tThe recent studies especially deal with examining health status and/or quality of life that often include examining of mental condition and cognitive functioning.
\n\t\t\t\tMeasuring quality of life has become a key part in the evaluation of the disease impact and treatment or intervention effect (Razvi, McMillan, Weaver, 2005). Residual symptoms can often persist with the patient even after adequate treatment. Psychiatric symptoms usually subside with a suitable treatment nevertheless long-lasting disorders can contain a degree of disease process irreversibility and provoke highly individual affective response according to psychological losses and gains of individual patients. The quality of life can be seriously endangered even in case that the patient should be well (at least from the hormonal viewpoint). Therefore the contradiction in health perception among the patients, their partners and doctors is often emphasized in the quality of life research. The emphasis is often placed on laboratory measurements ‘hard’ data, but ‘soft’ data gained with reliable methods for quality of life evaluation are underestimated (Sonino, Fava, 1998). To assess seriousness of the disease and response to treatment it is necessary, except for biochemical test, to observe the symptoms, health status and quality of life with the help of suitable methods. The relation between physiological and clinical evaluation and consequences that are given by the patient is in fact moderate and rather changeable (Razvi, McMillan, Weaver, 2005). The results of many studies dealing with the health status measurement, alternatively quality of life, often signal their independence on the thyroid functioning (Biondi et al., 2000; Elberling et al., 2004; Wekking et al, 2005). Also König et al. (2007) realised that the evaluation of subjective and objective health status in the ills with thyroid have considerably differed, before the treatment and even after it.
\n\t\t\t\tThe patients with non-treated thyreopathy independently of the type of disease suffer from a whole range of symptoms and their health status, alternatively quality of life, is considerably disrupted in most aspects. Moreover, it shows that this disruption persists in many patients for a long time, even if they are treated. Substantial part of patients with thyreopathy experience limitations in their common activities, they feel worsen health status and disruption of social and emotional areas. Cognitive ailments and tiredness are also frequent. Cosmetic problems are also usual. Long-term consequences of the treated by thyreopathies are very frequent. Approximately 1/2 of patients have stated total deterioration of the health status, alternatively quality of life, limitation in usual activities, as well as social and emotional problems. Two thirds feel tiredness and approximately one third is anxious, they have cognitive and sexual problems. Moreover, the patients with earlier hyperthyroidism very often suffer from classic symptoms of hypothyroidism and, vice versa, symptoms of hyperthyroidism persist approximately in one third. Patients with eufunctional goitre have been examined the least, there does not exist a study which would indicate that such patients suffer from cognitive ailments (Watt et al., 2006).
\n\t\t\t\tBut insufficient defining the sample of patients (i.e. type of thyreopathy) and confusion or incorrect usage of basic notions is quite typical for current studies dealing with patients in thyreopathy. Only a few studies research patients’ quality of life in the true sense of the word (Abraham-Nordling, 2005; Dow, Ferrell, Anello, 1997; Huang et al., 2004; McMillan et al., 2004, 2005; Terwee 1998, 1999, 2002). A lot of works confuse the evaluation of the quality of life for the measurement of symptoms non/presence, health status, psychical status, eventually mental well-being are often incorrectly described as the quality of life. People, whose health is bad, do not have to necessarily feel worsen quality of life. Incorrect understanding of the notions leads to the fact that the results of these studies can be incorrect or misleading, because a method for evaluation of one variable is used for measurement of something else. Moreover, available specific tools lack convincing data on validity, the exceptions are GO-QOL, ThyDQoL and ThyTSQ, which are of good psychometric characteristics. A disadvantage of the tools is that they only focus on a specific type of thyroid disease therefore they are not applicable across different thyreopathies. For a long time there has not been created a questionnaire that would cover all the relevant aspects of thyreopathies in longitudinal studies, when there can happen changes of hormonal status based on the character of the disease or treatment. (Razvi, Mc Millan, Weaver, 2005; Watt et al., 2006). According to available data we were the first who tried to create such method (Janečková 2001, 2006). Currently ThyPRO is being developed with promising psychometric characteristics focused on patients with any benign thyroid disorders (Watt et al., 2009).
\n\t\t\t\tThere are studies which prove that despite the treatment of hypothyroidism with hormone T4 substitution, a lot of patients quote more or less vague complaints and feel worsened quality of life (Mc Millan et al., 2004, 2005, 2008; Saravanan et al., 2002; Wekking et al., 2005).
\n\t\t\t\t\tResearches of alternative therapy – treatment with hormone T4 and T3 combined substitution have been carried out. Based on Grozinsky-Glasberg et al.’s (2006) meta-analysis and Ma et al.’s (2009) systematic review it can be summed up that combined T4 and T3 treatment does not improve well-being, cognitive function, or health status compared with T4 itself. This is proved with works by Appelhof et al., 2005; Clyde et al., 2003; Joffe et al., 2004; Meng et al., 2004; Nygaard et al., 2009; Regalbuto et al., 2007; Saravanan et al., 2005; Sawka et al., 2003; Siegmund et al., 2004; Valizadeh et al., 2009; Walsh et al., 2003 and others. Whereas first works signalled differences in favour of combined T4 and T3 (Bunevičius et al., 1999, 2002\n\t\t\t\t\t\t; Bunevičius & Prange, 2000).
\n\t\t\t\t\tHormonal therapy is considered as a very successful for reduction of morbidity and mortality. On the other hand, there are also real deficiencies that we have to be aware of – it is always dealt with imitation of normal hormone secretion. Additionally, it is difficult to quantify the effect of hormones on the level of tissues. Being aware of hormonal therapy deficiencies we can avoid incorrect marking of patients’ complaints. In fact, it is probable that deficiencies of biological therapy partially participate in the complaints. On the contrary, it is important to strive for this treatment further improvement, because we contribute to creation a “chronic endocrine patient” (Kaplan, Sarne, Schneider, 2003; Lamberts, Romijn, Wiersinga, 2003; Romijn, Smit, Lamberts, 2003). There are several proofs that patients do not follow sufficient treatment that can be indicative of their dissatisfaction with the treatment (McMillan et al., 2004). There are a lot of organisations abroad associating patients with thyroid disease, especially those dissatisfied patients create a big stress on professional public, they have reservations about the diagnostics and therapy (they criticise laboratory testing as a diagnostic criteria, or they prefer dried pork thyroid to synthetic hormone substitution).
\n\t\t\t\tA study realising that in patients with Graves‘ disease persists worsen health status in some aspects even after reaching the euthyreosis has been carried out (Elberling et al., 2004). Abraham–Nordling et al. (2005) have concluded similar results, but they have not found dependence of the health status on the way of therapy (surgical, drug, radioiodine). According to Watt et al. (2005) specialists and patients’ opinions on the most important aspects of the quality of life with Graves’ disease are significantly different. According to the patients, it is higher tiredness, perception of heart beating and internal restlessness, according to the endocrinologists it is dealt with hand shake, increased perspiration and weight loss.
\n\t\t\t\t\tPersistence of worsened health status even after the hyperthyroidism treatment has been proved by Fahrenfort, Wilterdink and Van-der-Veen (2000). Paschke et al.’s (1990, as cited in Rodewig, 1993) study indicates that higher anxiety appears in patients with hyperthyroidism in euthyroid status.
\n\t\t\t\t\tStudies of the quality of life are also focused on the patients with orbitopathy connected with Graves\' disease. Orbitopathy (even in a moderate form) significantly influences patients’ quality of life (Egle et al., 1999; Kahaly et al., 2002, 2005), and this negative influence is not in accordance with usual clinical evaluation (Gerding et al., 1997) and it often persists even many years after the treatment (Terwee et al., 2002). Other surveys have been devoted to the development of specific GO-QOL method that measures psychosocial consequences of a changed look and the consequences of diplopia (double vision) and worsen sharpness in common sight functioning (Terwee et al., 1998, 1999, 2001; Wiersinga et al., 2004). An interesting qualitative study in patients with orbitopathy has been carried out (Estcourt et al., 2008).
\n\t\t\t\tEvaluation of the quality of life and health status is especially important in the patients with thyroid carcinoma because they can experience changes of hormone statuses within the treatment – from long-term use of supra-physiological doses of T4 hormone (subclinical hyperthyroidism) to short-term time-limited period of T4 discontinuation (hypothyroidism) that is required by the preparation for diagnostics or radioiodine therapy.
\n\t\t\t\t\tAvailable studies are identical that there is a significant deterioration of patient’s health status with short T4 discontinuation (Botella-Carretero et al., 2003; Pacini et al., 2006; Schroeder et al., 2006; Tagay et al., 2005). Due to the fact that T4 discontinuation is of a significant effect on patient’s health status, other methods or preparation for diagnostics or radioiodine therapy have been sought. Usage of rhTSH (recombinant human thyrotropin hormone) is considered as a suitable method instead of the previous one what leads to improvement of patient’s compliance and maintenance of patient’s common daily routine and productivity (Duntas, Biondi, 2007).
\n\t\t\t\t\tConcerning the patients undergoing long-term usage of supra-physiological doses of T4, the research findings with mentioned above methods application are inconsistent – the results of some studies signal deterioration of the health status, even if less significant than in patients after T4 discontinuation (Botella-Carretero et al., 2003, Tagay et al., 2005), other studies have not found disturbed health status (Eustatia-Rutten et al., 2006; Schroeder et al., 2006).
\n\t\t\t\t\tThe first studies in general methods of quality of life have been carried out in China. Hou et al. (2001) have found out that the quality of life in patients with non-papillary carcinoma was worse in some aspects in comparison with other patients. Huang et al. (2004) have carried out measurement of patients’ quality of life after removing the carcinoma surgically when the level of the result score was analogous to other chronically ill.
\n\t\t\t\t\tRecently, the research has especially focused on follow up of patients with differentiated thyroid cancer. Impaired health status and quality of life have been surveyed in them (Hoftijzer et al., 2008; Lee et al., 2010). Quality-of-life and health status parameters were inversely affected by duration of cure and consequently may be restored after prolonged follow-up (Giusti et al., 2011; Gómez et al., 2010; Hoftijzer et al., 2008; Malterling et al., 2010; Pelttari et al., 2009). Special attention should be paid in patients with more severe staging on diagnosis (Almeida et al., 2009; Giusti et al., 2011). An interesting qualitative study has been carried out in this topic (Sawka et al., 2009).
\n\t\t\t\tIn connection with laboratory diagnostics improvement the research of subclinical thyroid disorder moves forward. Some patients may suffer from clinical symptoms resembling hypothyroidism or hyperthyroidism, and others do not. There is not a consensus concerning the fact whether these diseases should be treated (Stárka, Zamrazil et al., 2005), therefore the research in health status and some aspects of quality of life are becoming more important.
\n\t\t\t\t\tA lot of studies observing patients with non-treated subclinical hypothyroidism proved deterioration in some aspects of the health status (Appolinario et al., 2005; Baldini et al., 1997, 2009; Monzani et al., 1993; Razvi et al., 2005). However, the results of works observing if the therapy with T4 hormone is beneficial are disputable. Some studies mention specific effects (Baldini et al., 1997, 2009; Bono et al., 2004; Jenšovský et al., 2000, 2002; Monzani et al., 1993;), other works do not prove positive changes (e.g. Parle et al., 2010). Recent study by Jorde et al. (2006) does not either demonstrate the profit of T4 treatment, but it does not find any differences among patients with subclinical hypothyroidism, concerning the health status, as well as by Vigário et al. (2009), Park et al. (2010).
\n\t\t\t\t\tCompared to the control group, the research results by Biondi et al. (2000) testify for deterioration of some health status aspects with non-treated patients with endogenous subclinical hyperthyroidism.
\n\t\t\t\tOnly little attention was paid to the patients with euthyroid goitre within the research of quality of life and health status. The results of the studies in non-treated and treated patients signal deteriorated health status in some aspects (Bianchi et al., 2004; Janečková, 2001, 2006; König et al., 2007).
\n\t\t\t\t\tIt is supposed that just a regular monitoring of patient’s euthyroid status with nodules in thyroid reduces the quality of his life; on the other hand, more significant deterioration of the quality of life would occur if the patient was not dispensarized within his course of life (Dietlein & Schicha, 2003; Vidal-Trécan et al., 2002).
\n\t\t\t\tThe aim of our research was to map psychosocial aspects of thyroid disease (thyreopathy). We have especially focused on patients’ quality of life, role of stress and coping with it, including protective factors (resilience and social support); at the same time we tried to compare the results with the healthy population. It dealt with comparing the patients in thyroid disease who have undergone an operation, including their follow up after surgery.
\n\t\t\tWe have looked into this topic from the viewpoint of two relatively young disciplines, namely health psychology and, at the same time, we are inspired by positive psychology. Health psychology represents one of the fastest developing spheres of present psychology; it is a relatively young discipline. Mostly there is a consensus that it is dealt with a discipline that applies psychological knowledge into the sphere of health, diseases and the healthcare system (comp. Kebza, 2005; Křivohlavý, 2009; Mohapl, 1992; Vašina, 1999). Many psychologists are aware of the necessity of a change, but not in a radical diversion from existing negative topics in psychology (basically given by the historic development), but rather in the sense of the whole picture completion with “positive” topics. It is due to the fact that absence of negative aspects is not the same as presence of the positive ones. Dissatisfaction with the existing state, newly oriented constituent psychological research, new attitudes to the representatives of different psychological disciplines have gradually flown into a bigger stream that has taken a shape and determined itself as the positive psychology (Kebza, 2005; Křivohlavý, 2010; Mareš, 2001; Seligman, 2000).
\n\t\tIn correspondence with our research aim we have chosen non-experimental research plan (Hendl, 2006), where its core does not consist in an invasion or in a deliberate manipulation with the observed variables. Sometime such research plans are called as sample surveys. We understand our study as a descriptive research focused on exploration, description and orientation, or confirmation of carried out research, eventually prediction. We have used differentiation overview where we have compared patients in thyreopathy to health population, or patients with different types of thyreopathies among each other. We have presumed to compare health population with the ills in thyreopathy as a whole, because it is known from literature that within the course of this disease there can occur changes of hormonal status based on the disease or treatment character. We have used a development overview (a specific type of a differentiation overview) in the sense of longitudinal follow up of patients after 3 and 6 months since surgery where we try to capture a change of observed variables in time in patients with thyreopathy overall, or in the patients with different types of thyreopathies. We want to avoid frequent, quite easy process of measuring the status only before and after the change, what is rightly criticised (Břicháček, 2006), especially in measuring the quality of life (Mareš, 2005). We have also followed in our orientation research (Janečková, 2001, 2006), where we have especially focused on the thyroid disease as a mental strain (stress) and we have researched the consequences that this disease brings to the patients, its diagnostics and treatment. With respect to the research problem, the choice of a mixed research strategy has been considered as the most suitable one (quantitatively-qualitative).
\n\t\t\tThe patients have almost always been asked by the doctor, who operated them on, to take part in this research. Then, the researcher conducted an interview with the patient. At first, he described him simply the aim and character of the research, then there was the dialogue itself and in the end, the patients were given questionnaires and instructions to them. The patient was informed to fill in the questionnaire 1 or 2 days before release from hospital (even due to the fact he will probably feel himself well), what was followed, with some exceptions. Being released from hospital, the researched person handed in the filled in questionnaire in a sealed envelope. Data collection after 3 and 6 months has also been realised in the hospital in a group form. The group was always formed by patients who were operated on within ± 14 days. At first, they filled in the questionnaires, then and individual semi-structured dialogue was carried out with them. The research has been approved by an ethics committee of the involved hospital.
\n\t\tThe examined sample was created by the patients with thyroid operation carried out within the period from January 2006 to January 2007. The data were gained from 143 patients, 132 women (92.3 %) and 11 men (7.7 %). Average age of the patients was 51.9 ± 14.4 years. It was dealt with 45 patients with hyperthyroidism, 70 with nodular goitre, 17 with carcinoma (7 papillary carcinoma, 7 papillary microcarcinoma, 3 medullary carcinoma) and 11 with thyroiditis. Concerning the patients in nodular goitre, 36 of them underwent hemithyroidectomy and 34 of them total thyroidectomy. Patient’s hormone level was adjusted within the hospitalisation in the way so that he would be euthyroid. Originally, according to thyroid function there were 45 patients hyperfunctional, 89 eufunctional and 9 hypofunctional. 68 patients did not take any specific medication, 39 took thyrostatics and 36 took synthetic thyroid hormones. An average length of thyreopathy from the diagnosis was 5.6 ± 8.7 years. Co-morbidity of diseases in patients with thyreopathy was also followed, when the doctor confirmed with all of them that, from an objective viewpoint, no one of them suffers from more serious disease than it corresponds to common population of the same age. We also inquired if the patient did not experience any important changes in his recent life. Persons from the control group were asked the same, because it could influence for example the results in the questionnaires.
\n\t\t\tAltogether 91.1% of addressed patients with thyreopathy took part in the research within their hospitalisation. After 3 months since surgery, 131 patients continued in the research and, after 6 months, 125 patients from the original sample (143 people). Altogether 87.4% of patients from the original sample finished the longitudinal follow up. “Wear and tear” of the sample occurred approximately in the same percentage with men and women. In general it can be said that we were successful in reaching quite a high percentage of filled in questionnaires and a small wear and tear of the sample (experimental mortality) during the longitudinal follow up. Probably due to this reason, that nearly all patients were enthusiastic about nice approach to them by the medical staff, especially by the doctor and they felt gratitude for that.
\n\t\t\tSelection of people into the control sample was given by respondents’ availability and their willingness to participate in the research. In a maximum extent, we equalised this file with a group of patients according to criteria, such as sex, age and residence in the same region. We excluded people who were in the past, or who are currently treated with thyreopathy, or who are in medical dispensarization due to the mentioned above disease. Due to the fact that it was quite difficult to gather needed amount of healthy people, at the same time an avalanche selection, or the method of snowball, was applied (Ferjenčík, 2010; Miovský, 2006). Finally, the control sample was formed by 137 healthy people not suffering from thyreopathy, 127 women and 10 men. Average age of the respondents was 51.5 ± 14.8 years. Altogether, the questionnaires were filled in by 86.2 % of responded healthy people.
\n\t\tWhile choosing the method of data collection we endeavoured so that they were relevant to the aim of the research and observed variables based on the studied literature. We chose methods with good psychometric characteristics. All the persons were administrated with 7 tested methods and a semi-structured interview was carried out.
\n\t\t\t\n\t\t\t\t
SOC (sense of coherence) questionnaire contains 29 items, the extent of scores is 29 to 230. The method is based on Antonovsky’s conception of SOC resilience and was translated by Křivohlavý. Except for the total coherence (integrity) of a personality, it measures 3 dimensions of SOC – comprehensibility (C), manageability (MA) and meaningfulness (ME). Křivohlavý (1990) mentions correlation of SOC, among others with Spielberger’s STAI questionnaire.
\n\t\t\t\n\t\t\t\t
Perceived social support scale was surveyed by means of PSSS self-assessment method by Blumental et al. (1987). It consists of 12 basic and 4 additional items by means of which a person assesses availability of social support and satisfaction with it. The questionnaire items are assessed on a 7-point scale of Likert’s type, where an individual expresses the extent of his agreement or disagreement with the given statement. A total score and 3 constituent scores are inquired – social support from an important, not specified person (PSSS_A), from family members (PSSS_B), and from friends (PSSS_C). Other 4 items (scales) that were added by Vašina (1999) allow to compare social support evaluation from the family, friends, co-workers and superiors.
\n\t\t\t\n\t\t\t\t
We used COPE questionnaire created by the team of Carver, Scheier and Weintraub (1989), in the Czech Republic translated by Vašina (2002), to find out coping strategies. Through 15 scales the method captures 15 groups, types of coping strategies. Each type is diagnosed with the help of 4 items on a 4-level scale from “I do not react like this” to “I react like this quite often”. The authors of the method were thinking about a problem, whether the choise of specific types of reaction depends on a situation or on personal traits (similarly to Spielberger in STAI method), and with the help of a suitably chosen instruction they managed to capture dispositional and situational coping reactions (Vašina, 1999). In our study we have rather focused on general tendency of strategy selection. The questionnaire contains either, reactions that can be regarded as adaptive, effective, or maladaptive, ineffective. Each scale is unipolar, it means its missing does not mean that the present is the opposite. The method contains at least 2 pairs of opposite tendencies when it can be presupposed that a man can use wide repertoire of strategies in specific periods of life, including both opposite tendencies. Carver emphasizes that neither any total COPE score is counted from the method, nor the scales are divided into problem-focused and emotion-focused coping strategies. He rather pays attention to each scale separately and he observes what relation it is to other variables. He recommends so that each researcher would identify in their data own factors because different samples show different regularities of relations (dated 04/09/2011 available from http://www.psy.miami.edu/faculty/ccarver/sclCOPEF.html).
\n\t\t\t\n\t\t\t\t
SEIQoL is a method detecting individual quality of life, based on a interview. Altogether it requires a period of 10 to 20 minutes and it is suitable for research and clinical purposes (O\'Boyle et al., 1994, as cited in Křivohlavý, 2009; O\'Boyle et al., 1995). It has been used for different groups of patients even in healthy people (e.g. Buchtová, 2004; Koukola & Ondřejová, 2006; Rybářová et al., 2006; Řehulka & Řehulková, 2003). According to authors’ conception, the quality of life of an individual, it depends on his own system of values that is fully respected within this method detection. The individual determines, considers and evaluates aspects of life that are essential for him in the specific situation and time (Křivohlavý, 2002). In the Czech Republic, this method was translated by Křivohlavý (2009). The result is calculation of a table (table – quality of life) and graphic presentation (line – life satisfaction). Analytic approach is necessary for the scale calculated from component areas, graphic scale requires holistic approach. Because most of the respondents wanted to fill in the form on their own, we especially built on written answers (similarly, e.g. Koukola & Ondřejová, 2006; Rybářová et al., 2006). We consider it as an advantage, because it is very difficult for a researcher not to influence a proband during the dialogue. Westerman et al. (2006) refer on the fact that it can easily happen the researcher (inadvertently) influences the interviewed and a big attention should be paid to this. Further on, they mention that, in different times, the patients indicate different key topics (reconceptualisation) and they can change the rate of importance in the same topics (recalibration), when both kinds of changes signal change of values (Schwartz & Sprangers, 1999, as cited in Westerman et al., 2006; comp. Mareš, 2005). Therefore, O\'Boyle et al. (1995) recommend so that the respondents would always form new key areas in prospective studies, what we have kept. Křivohlavý (2002) also states that the areas can change within the course of life.
\n\t\t\t\n\t\t\t\t
To measure anxiety we have used STAI by Spielberger (1980) that we have translated from Slovak into Czech. This widely usable method enables to distinguish anxiety as a status and anxiety as a personality trait (anxiousness). This can be an advantage in usage with a longitudinal follow up. But it can be benefited from in patients even with first questionnaires administration after operation, because some patients can experience a high level of anxiety during hospitalisation, otherwise, they do not have the tendency to react in their lives like this. No less important advantage of this questionnaire compared to other ones is that it is more suitable for patients with thyreopathy. Anxiety is more likely deduced from feelings (feelings of tension, nervousness, fear, worries vs. feelings of calm, safety, satisfaction), than from physical symptoms, these could be more likely display of thyroid disorder that anxiety. State Anxiety Scale and Trait Anxiety Scale are always formed with 20 items that are assessed on the scale from 1 to 4.
\n\t\t\t\n\t\t\t\t
Beck’s questionnaire BDI for detection of depression belongs among the most frequent self-assessment methods for detection of depressive symptoms. In order to burden the patient as little as possible, we have used shortened version in our study with 13 items that is also considered as valid and reliable enough (Reynold & Gould, 1981). A person evaluates each item on four-point assessment scale from 0 to 3.
\n\t\t\t\n\t\t\t\t
To detect Rotter’s (1966, e.g. as cited in Kebza & Šolcová, 2008) LOC we have used visual analogue scale. The researched person was asked a question “To what extent do you suppose your life is in your hands (you can influence it, you control its course)?“. As an answer he shall illustrate graphically his position between two extremes “not at all – completely” on a line segment of 100 mm long. LOC can reach the scores from 0 to 100. The more the score is closer to 100 (vs. closer to 0), the more it approaches internal locus of control (vs. external locus of control).
\n\t\t\t\n\t\t\t\t
The interview was always carried out with approximately 80% of the patients, who filled in the questionnaires, in each administration of questionnaires (i.e. at the period of hospitalisation, 3 and 6 months since surgery). At least once a dialogue was carried out with each patient (except for 4), but usually three times. Altogether more than 300 dialogues of average length of approximately 20 minutes were realised. With respect to the research extensity, the interviews were recorded in a form of detailed notes. First three pilot depth interviews helped to map important topics and based on them a structure of semi-structured interview was created.
\n\t\t\tStatistical data processing was carried out with the help of statistical programme SPSS 14.0. To assess differences between averages of two groups, T-test was used (comp. Reiterová, 2007, 2009). To observe changes in patients in time, an analysis of variance was used for repeated measurements (general linear model). To detect level of the relation (dependence) tightness between two variables we used a correlation analysis. (Hendl, 2006). We assessed data of qualitative character through content analysis (Hendl, 2009; Silverman, 2005; Miovský, 2006). χ2 test of independence was used in SEIQoL method to detect whether frequency distribution in individual areas (life goals or cues) depends on (relates to) belonging to a group (the ills x the healthy). On the other hand, assessment of changes in frequency distribution in individual areas with 3 measurements in patients in time was detected with the help of Cochran’s test. With respect to the low number of people, in some areas, it was not possible to carry out statistical test in all areas and to draw attention to all substantively significant differences.
\n\t\tBased on the studies of these issues, we define the hypotheses as follows:
\n\t\t\tH1: We suppose the patient with thyreopathy will be less resilient (they will be with less sense of coherence and with a tendency to external locus of control) that the control group. It is described in the literature that people with a high level of resilience are physically healthier and there is a higher probability with them to stay healthy (e.g. Kebza, 2005; Kebza & Šolcová, 2008; Křivohlavý, 1990; Vašina, 1999). Moreover, a difficult life situation can result in lowering the feeling of control over the life (comp. Kebza, 2005; Křivohlavý, 2002).
\n\t\t\tH2: We suppose the ills with thyreopathy will use rather non-effective coping strategies compared to the control group. The problems of coping strategies with thyreopathies are not examined a lot, the attention was only paid to Graves\' disease, and yet it is called for more research into modifying stress factors in this diagnose (e.g. Rosch, 1993). Kung’s (1995) and Winsy et al.’s (1991) studies have not proved differences between the healthy and ills. On the other hand, Yoshiuchi et al. (1998b) has found out that the group of health women compared to the female patients scored higher in problem-focused coping strategy, the group of healthy men compared to the patients waited till the situation passes. Ma, Luo and Zeng (2002) have realised in ill people non-effective coping strategies, compared to the healthy ones.
\n\t\t\tH3: We suppose the patients with thyreopathy will show lower quality of life, less life satisfaction than the control group. Deteriorated health status and quality of life, limitations in usual activities, social and emotional troubles occur with not only untreated patients, but as well as with the half of treated patients, and with one third even anxiety and so on. (Razvi et al., 2005; Watt et al., 2006).
\n\t\t\tH4: We suppose the patients with thyreopathy will experience more negative emotions (depression and anxiety) that the control group. It is known that especially anxiety and depression occur in patients with different diagnoses (e.g. Kukleta, 2001; Vymětal, 2003).
\n\t\t\tH5: We suppose the patients with thyreopathy will perceive higher social support compared to the healhy ones. With regard to the fact it is dealt with a planned operation mobilisation of patient social network and providing increased social support can be presupposed, and even from the side of medical staff. Otherwise, social support has been researched only in patients with Graves\' disease, and this areas also considers it as insufficient, e.g. Rosch (1993). Differences between the ills and healthy ones have not been proved (Winsa et al, 1991; Yoshiuschi et al., 1998b). Ma, Luo and Zeng’s (2002; comp. Kukleta, 2001) research was an exception, were less support was shown in patients probably due to the reason the disease is developed with insufficient social support in an easier way.
\n\t\t\tH6: We suppose that increase of resilience occurs in time within a half-year follow up in patients (growth of the sense for coherence and tendency to internal locus of control). The researches show that even if the sense for coherence can show itself as a stable trait, difficult life situations can change man’s view of the world (Schnyder, 2000). After experiencing surgery (situation with less control) patients can gradually perceived a growth of the control over their lives (comp. Kebza, 2005; Křivohlavý, 2002).
\n\t\t\tH7: We suppose that the patients with thyreopathy will begin to choose effective coping strategies in time within a half-year follow up. Even earlier experience plays a specific role in managing and choice of coping strategy (comp. Baumgartner, 2001). The patients could acquire more adaptive strategies of manageability with the help of coping with surgery and they could be stimulated to this by the contacts with doctors, and so on.
\n\t\t\tH8: We suppose there occur improvement in quality of life and life satisfaction in patients in time within a half-year follow up. Satisfaction and quality of life usually increases with decrease of health problems that we suppose after an operation (comp. Křivohlavý, 2002; Kebza, 2005; Křížová, 2005).
\n\t\t\tH9: We suppose that decrease of negative emotions (depression and anxiety) occur in patients with thyreopathy within a half-year follow up. There should be less negative emotions with presupposed improvement of the health status due to the surgery (comp. Vymětal, 2003).
\n\t\t\tH10: We suppose that decrease of perceived social support occur in patients with thyreopathy within a half-year follow up. After initial mobilisation of the social support (including medical staff) due to the surgery, there will be its decrease, when the surroundings begin to consider the patient as “healthy”, “cured”.
\n\t\t\tWith respect to these unexplored issues we have also been interested in answers to the following explorative questions:
\n\t\t\tQ1: What are the differences in the observed variables among the patients with different thyreopathies? Insufficient defining the sample of patients (i.e. type of thyreopathy) is typical for contemporary studies dealing with patients with thyreopathy (Watt et al., 2006). We regard comparison of such type a very interesting and we have not been informed on any similar researches.
\n\t\t\tQ2: What is the composition of the key areas (life topics) in the framework of quality of life, what importance and satisfaction with individual areas patients with thyreopathy will mention within the follow up period and how it is going to be in the control group? It is necessary to await that disease, treatment effects the quality of life not only in its total height, but also concerning the composition and importance of individual areas (cues) and their satisfaction with them (Křivohlavý, 2002).
\n\t\t\tQ3: Which variable does the quality of life relate to? Connection of the quality of life with resilience and social support is described in the literature, on the contrary, stress and negative emotions should deteriorate it. (comp. Kebza, 2005; Křivohlavý, 2002, 2009).
\n\t\tA statistically significant difference between the patients and the control group has not been proved in average scores of the total sense of coherence. An significant difference of average scores have not been proved in scores between the patients and the control group, neither in comprehensibility, nor in manageability, or in meaningfulness. Significantly higher variance (p < 0.05) has been found out in comprehensibility with a healthy control group than in patients.
Statistically significant difference has not been proved in average scores of completely perceived social support between the experimental and control groups. Statistically significant difference has not been proved between the two groups in the social support from an important, not closely specified person, neither concerning the social support from friends. It shows that the patients perceive significantly higher (p < 0.05) social support from the family that in the control group.
Statistically significant difference of averages has not been found out in patients and healthy persons in any of the coping strategies. An exception is a strategy of “planning” where it has been showed on the edge of statistical significance, respectively closely behind it, that it is used more frequently by the healthy respondents than the ills with thyreopathy.
On the edge of statistical significance, respectively closely behind it, it is indicated that higher life satisfaction has been mentioned by the member of the control group that the patients. The patients have stated significantly higher quality of life (p < 0.05) than the persons not suffering from thyreopathy.
The ills have scored significantly higher (p < 0.05) in state anxiety and anxiousness than the healthy persons.
Statistically significant difference in average scores of depression has not been proved between the patients and the control group.
Significantly higher tendency (p < 0.01) to internality (internal locus of control) and, therefore, to the feeling they have the life in their hands, have had the healthy people compared to the ills. Higher variance in locus of control on the edge of statistical significance has been found out in the patients compared with controls.
Variables | \n\t\t\t\t\t\t\tPatients compared to healthy ones | \n\t\t\t\t\t\t||
SOC | \n\t\t\t\t\t\t\tME - meaningfulness | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t |
MA - manageability | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
C - comprehensibility | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
sense of coherence | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
PSSS | \n\t\t\t\t\t\t\tA - significant others | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t |
B -family | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t|
C - friends | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
perceived social support | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
COPE | \n\t\t\t\t\t\t\tplanning | \n\t\t\t\t\t\t\t↓ | \n\t\t\t\t\t\t\tclose t. ed. | \n\t\t\t\t\t\t
QoL | \n\t\t\t\t\t\t\ttable - quality of life | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t
line - life satisfaction | \n\t\t\t\t\t\t\t↓ | \n\t\t\t\t\t\t\tclose t. ed. | \n\t\t\t\t\t\t|
STAI | \n\t\t\t\t\t\t\tstate anxiety | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t
trait anxiety | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t|
BDI | \n\t\t\t\t\t\t\tdepression | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t |
LOC | \n\t\t\t\t\t\t\tlocus of control | \n\t\t\t\t\t\t\t↓ | \n\t\t\t\t\t\t\t/p"/0.01/ | \n\t\t\t\t\t\t
Caption: ↑ means that patients in the given variable scored higher than healthy population↓ means that patients in the given variable scored lower than healthy population„close t. ed.“ is an abbreviation for close to the edge of statistical significance \n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t
Comparison of patients with thyreopathy to healthy population
Hypotheses H1 to H5 have been proved only partially (see Tab. 1). The patients with thyreopathy, compared to the healthy persons, significantly perceive higher social support from the family, they are more anxious and on the edge of significance they are less satisfied with the life. Even other literature resources state that the disease causes the need for help (e.g. Baštecká, 2003; Haškovcová, 1985). Razvi, McMillan, Weaver (2005) and Watt et al. (2006) summarize similar findings of some aspects sides concerning the quality of life. The healthy persons score significantly higher in locus of control and in coping strategy of “planning” on the edge of significance that is often regarded as an effective strategy. Differences between the patients and the healthy persons have not been found out in sense of coherence and depression. A paradox finding, that total higher quality of life is in patients compared to the healthy ones, has been explained in compliance with the quantitative data from the interviews. The patients have made an impression that they rather overestimated (idealised) the satisfaction evaluation in individual areas, especially within the period of hospitalisation, but also a little bit 3 months after it. As if due to the fact they have occurred in a difficult situation and they are to cope with it, they needed to see their life more positively and not to admit dissatisfaction with individual areas of life. Results graphically illustrated on the line segment of satisfaction level have been much more credible. Because the scale of life satisfaction requires holistic approach, but analytic assessment is necessary for the scale of total quality of life calculated from individual parts (comp. Rybářová et al., 2006), it is possible that real emotional status has been reflected on the line segment of satisfaction display, whereas the total calculated quality of life reflected their wish rather than the reality. On the other hand, for example Edelmann (1997, as cited in Baštecká et al., 2003), Moons et al. (2004) have stated that the quality of life does not have to unfold from the presence of a disease, so from the health status.
\n\t\t\tStatistically significant difference in average scores of the whole sense of coherence within the follow up period has not been proved. Statistically significant difference in average scores of manageability have not been proved, nor in the average scores of meaningfulness within the follow up period. The difference between the averages have been indicated on the edge of statistical significance and a significant linear growth (p < 0.05) of comprehensibility has been proved in the patients with thyroid disease during the follow up.
We have found out a statistically significant difference (p < 0.05) in average scores of total perceived social support within the follow up period and a significant quadratic trend has been proved (p < 0.05) – at first, more significant decrease of totally perceived social support occurs in the patients after 3 months and to its slight increase after 6 months. Statistically significant difference in averages of perceived social support from an important, not specified person has not been proved in patients within the follow up period. We have realised a statistically significant difference (p < 0.05) in average scores and a significant linear decrease (p < 0.05) of perceived social support from the family members in the patients within the follow up period. Also a statistically significant difference (p < 0.05) in averages of perceived social support from friends in patients within the follow up period a significant quadratic trend (p < 0.05) has been found out – during the follow up period after the surgery, at first, the decrease of perceived social support from friends occurred after 3 months and, after 6 months, it increased.
A difference in averages, close to the edge of significance, appeared in patients during the follow up after the surgery, and on the edge of significance there was indicated a linear decrease in “use of emotional social support”. Statistically significant difference (p < 0.01) has been found out in averages with scale of “focus on and venting of emotion” and it was dealt with a quadratic trend (p < 0.05) – within the follow up period after surgery, at first, decrease of average score in coping strategy of “focus on and venting of emotions” in patients after 3 months and, after 6 months, it increased. We have not found out any statistically significant differences in averages in other coping strategies within the follow up period.
Statistically significant difference in averages of the life satisfaction level in the patients has not been found out during the follow up. On the edge of statistical significance, respectively close to it there has been indicated a significant difference in averages and a significant linear decrease of quality of life (p < 0.05) has been proved in patients within the follow up period.
We have proved statistically significant difference (p < 0.05) in average scores and statistically significant linear decrease (p < 0.05) of state anxiety within the follow up period. Also a statistically significant difference (p < 0.01) in averages have been realised and a significant linear decrease (p < 0.01) of anxiousness during the follow up.
We have not proved a statistically significant difference of depression averages in patients during the follow up.
A difference in average scores on the edge of statistical significance has been indicated and a statistically significant linear trend (p < 0.05) to higher internality (internal locus of control) has been proved within the follow up period.
Hypothesis H10 has been confirmed, hypotheses H6 and H9 have been proved partially, hypotheses H7 and H8 have not been proved (see Tab. 2). During the half-year follow up period there occurred significant decrease of anxiety in patients, an increase in comprehensibility and in the feeling of the control over the situation has been indicated on the edge of significance (comp. Kebza, 2005; Kebza & Šolcová, 2008). Our finding is in compliance with the fact that in managing a difficult situation a man at first tries to understand it (comprehensibility) (comp. Mareš, 2007, 2008, 2009; Mareš et al., 2007). A linear decrease in coping strategy of “use of emotional social support” was indicated in patients within the follow up, and a significant decrease was indicated in perceived social support from the family, apparently due to the fact the stress situation of operation passed. Total social support, support from friends and coping strategy of “focus on and venting of emotions” changed in a quadratic way – at first, there was a significant decrease after 3 months, and a slight increase after 6 months after hospitalisation. Apparently it relates to the fact, the patient can feel himself isolated during the first 3 months after the surgery. Close to the edge of statistical significance a decrease in total quality of life was indicated in patients within the follow up, that relates to original overvaluation of life satisfaction with individual areas, but at the same time it can relate to the fact what was apparent in first interviews with them– inappropriate expectations in relation to the medical intervention (they expected complete cure). It is similarly reflected by Vavrda (2005), comp. Calman (1984, as cited in Křivohlavý, 2002).
\n\t\t\t\tVariables | \n\t\t\t\t\t\t\tFollow up of patients during 6 months (trend) | \n\t\t\t\t\t\t||
SOC | \n\t\t\t\t\t\t\tME - meaningfulness | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t |
MA - manageability | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
C - comprehensibility | \n\t\t\t\t\t\t\tlinear ↑ | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t|
sense of coherence | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
PSSS | \n\t\t\t\t\t\t\tA - significant others | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t |
B -family | \n\t\t\t\t\t\t\tlinear ↓ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t|
C - friends | \n\t\t\t\t\t\t\tquadratic | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t|
perceived social support | \n\t\t\t\t\t\t\tquadratic | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t|
COPE | \n\t\t\t\t\t\t\tuse of emotional social support | \n\t\t\t\t\t\t\tlinear ↓ | \n\t\t\t\t\t\t\tclose t. ed. | \n\t\t\t\t\t\t
focus on & venting of emotions | \n\t\t\t\t\t\t\tquadratic | \n\t\t\t\t\t\t\t/p"/0.01/ | \n\t\t\t\t\t\t|
QoL | \n\t\t\t\t\t\t\ttable - quality of life | \n\t\t\t\t\t\t\tlinear ↓ | \n\t\t\t\t\t\t\tclose t. ed. | \n\t\t\t\t\t\t
line - life satisfaction | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | |
STAI | \n\t\t\t\t\t\t\tstate anxiety | \n\t\t\t\t\t\t\tlinear ↓ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t
trait anxiety | \n\t\t\t\t\t\t\tlinear ↓ | \n\t\t\t\t\t\t\t/p"/0.01/ | \n\t\t\t\t\t\t|
BDI | \n\t\t\t\t\t\t\tdepression | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t |
LOC | \n\t\t\t\t\t\t\tlocus of control | \n\t\t\t\t\t\t\tlinear ↑ | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t
Caption: ↑ means that the given variable was dealt with a linear increase↓ means that the given variable was dealt with a linear decreasedepicted curve illustrates course of a quadratic trend„ed.“ is an abbreviation for edge of statistical significance„close t. ed. “ is an abbreviation for close to the edge of statistical significance \n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t
Follow up of patients with thyreopathy since surgery during the period of six months
There were not found out statistically significant differences of averages among the patients with different types of thyreopathies, nor in the total sense of coherence, or in manageability or meaningfulness within any of the 3 measurements. Comparing the average scores of comprehensibility there were not found any significant differences during 1st measurement, bur with 2nd and 3rd measurements, there were indicated lower average scores of comprehensibility on the edge of statistical significance in patients with carcinoma compared to other types of thyreopathies.
Statistically significant differences of averages were not proved in patients with different types of thyreopathies, neither in total perceived social support, nor in the social support from significant others, in social support from family members and from friends. Concerning the variances there was not found any statistically significant difference in the sphere of social support from friends within 1st measurement, but they showed higher variance in social support from friends in 2nd measurement (p < 0.05) and, the patients with carcinoma especially in 3rd measurement, compared to other ills.
We did not prove any statistically significant differences of average scores in different coping strategies, except for 2, in 1st measurement among the patients with different types of thyreopathies. The results on the edge of statistical significance indicate that the patients with carcinoma probably coped stress more often through “positive reinterpretation and growth” within 1st measurement, and, conversely, they used less coping strategy of “humour”, compared to the patients with other types of thyreopathies.
During 2nd measurement, the patients with thyroid carcinoma use coping strategy of “humour” significantly less frequently (p < 0.05) and more frequent “use of instrumental social support” was indicated on the edge of significance than in patients with nodular goitre. The patients with hyperthyroidism used significantly more often (p < 0.05) “planning” strategy during 2nd measurement and more frequent coping through “suppression of competing activities”, through “restraint coping” and through “focusing on and venting of emotions” was indicated on the edge of statistical significance, compared to other patients. During 2nd measurement there were not proved any statistically significant differences of averages in other coping strategies among the patients with different types of thyreopathies.
We did not find statistically significant differences of averages in any of the coping strategies in patients with different types of thyreopathies within 3rd measurement.
Higher variance in coping strategy of “religious coping” was indicated in patients with carcinoma, compared to other patients, on the edge of significance, within 2nd measurement, and especially within 3rd measurement (p < 0.05).
Results on the edge of statistical significance (p = 0.05) within 1st measurement indicate higher life satisfaction in patients with nodular goitre compared to other patients. During 2nd and 3rd measurements, any statistically significant differences in averages of satisfaction were not found out. Statistically significant difference in averages with quality of live among the patients with different types of thyreopathies was not proved in any of the measurements.
Statistically significant difference in averages of anxiousness among the patients with different types of thyreopathies was not proved in any of the measurements. Higher average scores of state anxiety in patients with carcinoma were indicated on the edge of significance during 2nd and 3rd measurements compared to other ills. During 2nd measurement there was indicated difference in variances on the edge of significance, where the highest variance was in the results of patients with carcinoma.
Statistically significant difference in depression among patients with different types of thyreopathies was not proved within any measurement.
Comparing the average scores of locus of control there were not found any statistically significant differences in 1st and 3rd measurements. A higher tendency to externality (external locus of control) and the feeling they cannot influence their lives were indicated in patients with carcinoma on the edge of statistical significance during 2nd measuring compared to other patients.
Comparison of patients with different types of thyreopathies brought interesting results (see Tab. 3.). The patients with nodular goitre were significantly more satisfied with life at the time of surgery than other patients. The most significant difference from other types of
\n\t\t\t\tVariables | \n\t\t\t\t\t\t\tCarcinomas | \n\t\t\t\t\t\t||||||
Sugery | \n\t\t\t\t\t\t\t3 months | \n\t\t\t\t\t\t\t6 months | \n\t\t\t\t\t\t|||||
SOC | \n\t\t\t\t\t\t\tC - comprehensibility | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↓ ed. | \n\t\t\t\t\t\t\t↓ ed. | \n\t\t\t\t\t\t|||
PSSS | \n\t\t\t\t\t\t\tC - friends | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↑s2 /p"/0.05/ | \n\t\t\t\t\t\t\t↑s2 /p"/0.01/ | \n\t\t\t\t\t\t|||
COPE | \n\t\t\t\t\t\t\tsuppression of competing activities | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↓ ed. | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t | |||
use of instrumental social support | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↑ ed. | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t | ||||
positive reinterpretation & growth | \n\t\t\t\t\t\t\t↑ ed. | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t | ||||
focus on & venting of emotions | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↓ ed. | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t | ||||
religious coping | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↑s2 ed. | \n\t\t\t\t\t\t\t↑s2 /p"/0.05/ | \n\t\t\t\t\t\t||||
humor | \n\t\t\t\t\t\t\t↓ ed. | \n\t\t\t\t\t\t\t↓ /p"/0.05/ | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t | ||||
STAI | \n\t\t\t\t\t\t\tstate anxiety | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↑ ed. | \n\t\t\t\t\t\t\t↑ ed. | \n\t\t\t\t\t\t|||
LOC | \n\t\t\t\t\t\t\tlocus of control | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t | ↓ ed. | \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t | |||
Variables | \n\t\t\t\t\t\t\tNodular goitres at the time of surgery | \n\t\t\t\t\t\t||||||
QoL | \n\t\t\t\t\t\t\tline - life satisfaction | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t||||
Variables | \n\t\t\t\t\t\t\tHyperthyroidism after 3 months since surgery | \n\t\t\t\t\t\t||||||
COPE | \n\t\t\t\t\t\t\tplanning | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t||||
suppression of competing activities | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t|||||
restraint coping | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t|||||
focus on & venting of emotions | \n\t\t\t\t\t\t\t↑ | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t|||||
Caption: ↑ means that patients with this diagnose scored higher in the given variable that other patients↓ means that patients with this diagnose scored lower in the given variable that other patients„ ed.“ is an abbreviation for edge of statistical significance \n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t
Comparison of results in patients with different types of thyreopathies
thyreopathies is in patients with thyroid carcinoma. Only a small amount of these was in our researched file, but we will try to indicate statistically significant and marginally significant differences and trends. The biggest differences appear after 3 months since surgery when patients with carcinoma score lower in coping strategies as “humour”, “suppression of competing activities” and “focus on and venting emotions”, as well as in locus of control. In the period after 3 and 6 months since surgery the patients with carcinoma are more anxious compared to the others and score lower in comprehensibility. Bigger interindividual differences can be captured in carcinomas compared to the others after 3 and 6 months since surgery in coping strategy in “religious coping” and in social support from friends. Support from friends is probably related to what the patients referred to during the interviews; some of them hid till the end of observation from their family and friends that thyroid cancer had been found out with them. Tschuschke (2004) also refers on similar findings, for example a tendency to apply mechanisms of suppression and increased level of anxiety in patients with carcinoma.
\n\t\t\tStatistically significant difference in average scores of life satisfaction was not proved, neither in total quality of life within the observed period, nor in patients with hyperthyroidism, or in patients with carcinoma. We found out a statistically significant difference in average scores in patients with nodular goitre and a significant linear decrease of life satisfaction was proved (always for p < 0.05) and in total quality of life (always to p < 0.01). Patients with nodular goitre, who underwent total thyroidectomy, had lower level of life satisfaction in 3rd measuring on the edge of significance compared to those who underwent hemithyroidectomy. We attribute this finding to the fact that nodular goitre recently undergoing total intervention experienced more changes in life than those with hemithyroidectomy.
Statistically significant difference in averages of locus of control was not proved during the follow up period in patients with nodular goitre. The patients with nodular goitre, who had already undergone hemithyroidectomy, had higher tendency to internality (internal locus of control) with 3rd measurement on the edge of significance compared to those who had undergone total thyroidectomy. We attribute this finding to the fact that nodular goitre recently undergoing total intervention experienced more changes in life than those with hemithyroidectomy. Differences on the edge of significance in average scores of locus of control were indicated in patients with hyperthyroidism and carcinoma within the observed period. During operation follow up, the linear trend to higher internality (internal locus of control) was indicated on the edge of significance in patients with hyperthyroidism. During operation follow up, the quadratic trend was indicated on the edge of significance in patients with carcinoma – at first, after 3 months, there was a tendency to higher externality (external locus of control) and after 6 month, conversely, to higher internality (internal locus of control) than the original level was.
The results indicate (see Tab. 4, Fig. 1-3), that it is probable, the observed changes in time in life satisfaction rate, in total quality of life and in locus of control are effected by type of thyreopathy. Concerning nodular goitres, there occur a significant reduction in the level of life satisfaction and total quality of life during the half-year follow up; in other types of thyreopathies, significant changes of these variables do not occur in any direction. This corresponds with our finding resulting from interviews that people who had some difficulties before intervention adapt better and express higher satisfaction with their status than people who did not have any problems (most often nodular goitres). In patients with hyperthyroidism there occurs increase of internality on the edge of significance during follow up, but in the patients with carcinoma, at first a significant decrease occurs after 3 months and, after 6 months, there occurs increase to higher level that it was at the time of hospitalisation. Last-mentioned disease can be considered as the most serious from the viewpoint of control loss over the situation development (comp. Kebza, 2005; Kebza & Šolcová, 2008).
\n\t\t\t\tVariables | \n\t\t\t\t\t\t\tNodular goitre follow up during 6 months (trend) | \n\t\t\t\t\t\t||||
QoL | \n\t\t\t\t\t\t\ttable - quality of life | \n\t\t\t\t\t\t\tlinear ↓ | \n\t\t\t\t\t\t\t/p"/0.01/ | \n\t\t\t\t\t\t||
line - life satisfaction | \n\t\t\t\t\t\t\tlinear ↓ | \n\t\t\t\t\t\t\t/p"/0.05/ | \n\t\t\t\t\t\t|||
Variables | \n\t\t\t\t\t\t\tCarcinomas follow up during 6 months (trend) | \n\t\t\t\t\t\t||||
LOC | \n\t\t\t\t\t\t\tlocus of control | \n\t\t\t\t\t\t\tquadratic | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t||
Variables | \n\t\t\t\t\t\t\tHyperthyroidism follow up during 6 months (trend) | \n\t\t\t\t\t\t||||
LOC | \n\t\t\t\t\t\t\tlocus of control | \n\t\t\t\t\t\t\tlinear ↑ | \n\t\t\t\t\t\t\ted. | \n\t\t\t\t\t\t||
Caption: ↑ means that the given variable was dealt with a linear increase↓ means that the given variable was dealt with a linear decrease depicted curve illustrates course of a quadratic trend„ ed.“ is an abbreviation for edge of statistical significance \n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t
Follow up results of patients with different types of thyreopathies since sugery during the period of six months in selected variables
Monitoring of average scores of total quality of life in SEIQoL (table) during the six-month period in patients with different types of thyreopathies
Monitoring of average scores of life satisfaction in SEIQoL (line) during the six-month period in patients with different types of thyreopathies
Monitoring of average scores of LOC (locus of control) during the six-month period in patients with different types of thyreopathies
Respondents’ answers regarding quality of life were divided into 11 categories (excluding a collective category: other): family, health, work, interpersonal relationships, leisure, material security, mental well-being, spiritual dimension, education, living conditions and good old age. All above mentioned categories appeared in the group of patients and in the control group. Patients with thyroid gland, when compared to healthy people, mentioned life and social security within more categories (work, mental well-being, living conditions). In category family, they reported close people, mainly those that are somehow depended on them (children, old parents). Patients, more than the controls, had more answers connected with health of close people. During follow up, patients didn´t change their understanding of content of individual categories.
Respondents of all groups most often mentioned cues: 1. family, 2. health and 3. work. Patients frequently reported life goals as good old age, or mental well-being, while the control group reported more leisure and education. During the follow up of patients with thyreopathy changes occurred in the distribution of frequencies (significant and the significance edge) for more than half the categories.
The most important cues for all respondent groups were 1. family, 2. health, 3. spiritual dimension, rarely good old age, which otherwise closely followed the spiritual dimension. It seems that during follow up of patients there was, on the edge of significance, a sign of decline for family and increase for health. Apparently there is also a change in the spiritual dimension category; its importance (with probands who recorded it) is highly evaluated within 3 months after surgery.
We have a reason to believe that the patients rather overevaluated (idealized) a situation while evaluating satisfaction for individual categories, sometimes slightly also after 3 months; therefore we cannot objectively assess the shift over time or differences between patients and control group. All observed groups assessed life conditions and material security as the least satisfactory, patients at the time of surgery recorded little satisfaction with mental well-being and after 3 to 6 month showed little satisfaction with category work.
The answers of respondents in the quality of life were categorized into 11 (or 12) areas that occurred both in patients and controls. Patients put more emphasis on life securities and care for close people dependent on them. In connection with their own illness they were apparently aware of what would happen to their children or parents dependent on them if something happened to them. Respondents of all groups mentioned as the most frequent and the most important goals family and health. Findings of Buchtová (2004) and Rybářová et al. (2006) correspond. Spiritual dimension category was little recorded but the people that recorded it saw its importance right after family and health (comp. Rybářová et al., 2006). Patients frequently reported categories of good old age and mental well-being because these areas can be threaten by the disease. Also, at the time of surgery, they were least satisfied with mental well-being. Their dissatisfaction with the work within 3 and 6 months after surgery is probably due to return to work, which can be difficult. The spiritual dimension is gaining importance within 3 months after surgery which is likely due to demands for coping with surgery. Experiencing difficult situations can lead to awareness of the importance of faith (comp. Hodačová, 2007). In our findings there were changes in patients´ reconceptualisation (change of key topics), and recalibration (change of importance) (e.g. Schwartz & Sprangers, 1999, as cited in Westerman et al., 2006; comp. Mareš, 2005). During interviews we noted that one of our patients with carcinoma, 6 months after surgery, had so called posttraumatic growth. Higher levels of satisfaction of patients are explained by their overvaluation (idealization) of a life situation (see also chap. 7.1 and 7.9).
\n\t\t\t\t\n\t\t\t\t\t\t
It included mentions of family members – mostly mentioned children, mainly by patients, desire for having children, then a partner, siblings, and only patients recorded in their answers parents. Patients seem to be more aware of what would happen to their children or parents dependent on them if something happened to them. Healthy and ill people associated this category with concepts such as family relationships and satisfaction, happiness in family. They perceived the family as a place that should provide support and help with governance of love, peace, cohesiveness, harmony and understanding. They recorded also a topic of raising children.
\n\t\t\t\t\t\n\t\t\t\t\t\t
It contained mainly answers specifying the person or persons who should be healthy – the most frequent goal was to be healthy and health of close people, a lot of responses concerned the health of loved ones (most frequently with patients), only little less his/her own health. Healthy people rather than patients stated a healthy lifestyle. Sometimes formulation in terms of: health is the most important value, appeared.
\n\t\t\t\t\t\n\t\t\t\t\t\t
Answers related to feelings of satisfaction, peace and happiness. Patients are featured responses expressing a desire for life securities.
\n\t\t\t\t\t\n\t\t\t\t\t\t
It included themes of work, employment, profession – his/her own work was most mentioned, and then the same number of responses focused on career and caring for family members to have a job and succeed in it. A number of formulations expressed a goal to have a job. The patients had a topic of having secured job.
\n\t\t\t\t\tPatients and healthy persons expected peace, satisfaction and financial security at work they also show the importance of interpersonal relationships in the workplace, the work to be interesting, allowing self-realization.
\n\t\t\t\t\t\n\t\t\t\t\t\t
It contained topics related to awareness of society, nature - respondents mostly wished for world peace, the same number of responses went to topics about environment and events in society, politics. Patients recorded answers about social security.
\n\t\t\t\t\t\n\t\t\t\t\t\t
It contained mainly friendly relations and relationships with people in general – in connection with this, the respondents mentioned love, understanding and harmony between people. Some of them were also aware of their own share in relationships and reported character behaviour to others (willingness to help, be polite, etc.). Several responses were related to relations with neighbours.
\n\t\t\t\t\t\n\t\t\t\t\t\t
The answers were mainly related to respondents’ own education and training, but also to education of their children.
\n\t\t\t\t\t\n\t\t\t\t\t\t
It included the pursuit of contented old age, some people mentioned self-sufficiency. This category was recorded by both groups of respondents in their elderly age.
\n\t\t\t\t\t\n\t\t\t\t\t\t
It contained a variety of leisure activities, rest was mentioned only exceptionally. As for activities, respondents most frequently reported sport, followed by gardening, culture, travel, household chores, but also reading, nature (including walks in the countryside) and others.
\n\t\t\t\t\t\n\t\t\t\t\t\t
In both groups it related to material and financial security, provisions. About 2/3 of answers were formed by subcategory finance, 1/3 was associated with housing.
\n\t\t\t\t\t\n\t\t\t\t\t\t
It included topics related to faith or spiritual life. There were not only traditional religious answers (God, prayer, etc.), but also answers expressing some sort of overlap (spiritual growth, to understand the meaning of life, respect for life, look for better side of matters, etc.)
\n\t\t\t\tPatients more satisfied with life, healthy people more satisfied with life and healthy people reporting about higher quality of life were more resilient (rather with internal locus of control, with a higher sense of coherence), perceived higher social support and were less anxious and depressed. Results of all questionnaires and scales in patients were more dependent of level of life satisfaction than total quality of life consisting of different areas.
The results of all methods used for patients do not depend on the length of diagnosis, nor the age or marital status as in the control group, they usually only moderately correlate with recent in/experienced life changes. Educated patients and educated healthy people have a higher sense of coherence and are less anxious.
Our findings regarding the relationship of other variables to measure satisfaction and overall quality of life correspond with the findings reported in several studies (e.g. Matuz, 2006) as well as in literature about health psychology (e.g. Kebza, 2005; Křivohlavý, 2009).
\n\t\t\tWe identified four types of general coping strategies based on preference or rejection of some partial methods of coping, as measured using the COPE method. They were strategies that we called strategy of active, constructive coping, a passive strategy, a emotion-focused strategy and strategy for obtaining a distance.
\n\t\t\t\tIn many respects, our results correspond with Vašina’s (2002) findings.
\n\t\t\tFor completeness, we mapped the psychosocial factors of patients with thyroid gland, depending on their economic activity. Patients with thyroid gland didn´t show any statistically significant differences in any of the examined characteristics between economically active people and pensioners. In this case an intervening variable is obviously important– most likely it is the thyroid gland disease.
\n\t\t\t\tWhereas in old-age pensioners not suffering from thyroid disease we found significantly higher levels of anxiousness (p < 0,01) compared with healthy economically active people. Compared to old-age pensioners not suffering from thyroid disease, healthy economically active people scored significantly in sense of coherence (p < 0,05) and had more internal locus of control (p = 0,055). Higher levels of anxiousness in old-age pensioners is probably related to their age and situation, as well as feeling that their life is determined by external circumstances, which they cannot affect. Křivohlavý (2009) indicates higher anxiety associated with a lower level of sense of coherence.
\n\t\t\tMany patients did not felt subjectively well, long before the correct diagnosis was established. Thyroid disease in the early days was often mistaken for mental illness – by both healthcare professionals and patients who then feared to search the doctors.
Patients in the time before surgery reported diverse and varying physical and mental symptoms – especially tiredness, anxiety, irritability, sadness.
The patients considered a psychological stress as the most common reason for a disease breakout (roughly half of patients). All expected a full recovery after the surgery, which is not possible.
At the time of surgery, patients felt social support from their families, but not at work. They rather feared situations at work, and thought they might lose their jobs.
The patients gave the impression of overestimating (idealizing) the situation when evaluating satisfaction for each category, especially at the time of surgery, and a little after 3 months.
Patients would need more information about the recovery, especially in the first 3 months, (primarily about the state of scars) and further prognosis for thyreopathy.
Satisfaction or dissatisfaction, which they expressed with their health status, related to whether and to what extent they experienced difficulties resulting from illness prior to surgery, and whether and with what effect they have been previously treated. The patients, who experienced difficulties resulting from their disease and hadn´t been cured, were more satisfied with their health status after the surgery.
If patients had no difficulties after the surgery, they believed that they will feel as good in future. If they had difficulties, they hoped to feel better.
Patients with cancer experienced disease differently than others. There were significant interindividual differences in coping with illness. 3 months after surgery, when they often responded with denial, were more dissatisfied with their condition than other patients. It was difficult for them to tell their close ones diagnosis. Compared to other patients, the topic of disease was topical even after 6 month after the surgery. In this time, one patient with cancer showed so called posttraumatic growth.
During follow up, patients reported more positive than negative consequences of surgery. As the most positive they considered improvement of health, further re-evaluation of values, which could indicate the direction to posttraumatic growth (comp. Costa & Pakenham, 2011). As the most negative consequences of the surgery they reported a scar and use of medication.
Overall, we observed three types of attitudes to an interview. The first type of patients was willing to share their illness and their life experiences. The second type of patients was particularly willing to share their experience with thyroid disease, physical condition, the diagnosis and treatment, in other areas they were less willing to share (seems consistent with the classical biomedical model). The third type consisted of patients who were generally more reserved, and answered any type of questions briefly.
\n\t\t\tComparisons of people with thyroid gland disease and healthy people, and longitudinal follow up of patients were carried out. In some psychosocial aspects the patients with thyreopathy differ from the general population, which does not suffer from this disease, independently of the thyreopathy type. Statistically, the patients were significantly more anxious and perceived higher social support from family when compared with the control group. The control group scored significantly higher in locus of control and on the edge of significance they felt more satisfied with life than the patients. During the six-month follow up after the surgery, some indicators of quality of life were improved. We found a statistically significant decrease in anxiety and social support. Comprehensibility and the feeling of having my life firmly in my hands increased on the edge of significance. One patient with cancer we even saw so called posttraumatic growth. Results of total quality of life calculated from individual categories cannot be evaluated fully psychometrically, since the situation was most likely overvalued (idealized) by patients mainly during hospitalization and a bit after 3 month after the surgery. Results recorded in graphics on segment line of life satisfaction were more plausible. Life satisfaction and quality of life significantly positively correlated with sense of coherence, with the locus of control and perceived social support, and significantly negatively correlated with anxiety and depression.
\n\t\t\tDivision of patients by type of thyreopathy to nodular goitre (including thyroiditis), hyperthyroidism, and cancer was critical for the research. Patients with eufunctional nodular goitre in some respects also differ from healthy population. These have been studied very rarely; they are even assigned to the control group as healthy people during research on other types of thyreopathies. Patients who benefited from surgery the most were those who had some difficulties before the surgery (usually with hyperthyroidism) they better adapted to the surgery and expressed satisfaction with their condition. Dissatisfaction or worse quality of life was recorded by patients who had an impression of being without difficulties before the surgery, and suddenly they experience some and must use hormone replacement (usually nodular goitre, rarely carcinomas). The biggest relief is experienced by patients, who had some symptoms and were not treated by other means than surgical, as manifestations of their disease didn´t last long. Patients with thyroid carcinoma differ from other types of thyreopathies the most.
\n\t\t\tPatients in our country do not have comparable information in terms of quantity and quality when compared to patients in traditionally democratic countries, and they do not have background of patient organizations.
\n\t\t\tWe are aware of the limitations of our work. In particular, it would be necessary to increase the number of surveyed people. It would be necessary to include a larger number of men into the set of surveyed people (but there is low incidence of this disease with men). Members of the control group in our survey honestly declared that they are not, and were not, treated or monitored for thyroid disease. When choosing members of the control group, it would be most suitable to have each member screened for thyreopathy, which would be, on the other hand, costly. When comparing patients with healthy population it would be better to set a paired control group and adjust it according to status and demographic features. In regards to the specificity of the sample, results cannot be generalized or only with some reservations. On the other hand, it is a six-month follow up of almost the entire population of patients who underwent thyroid surgery in one of the hospitals in the Czech Republic, which is very valuable for better exploration of this issue. It would be useful to verify our results in another, similar department or collect data from more departments focusing on thyroid surgeries, in the same time. In future, it would be good to keep only the most informative methods in a battery of tests, in order not to bother the patients unnecessarily. It should be strictly monitored whether patients fill out a questionnaire at the time of hospitalization under the same conditions. As for the longitudinal follow up, it would be necessary to make more than 3 measurements in time to be able to better predict events. It would also be valuable if follow up could last longer than 6 months. Research of patients treated by means other than surgical could be very useful. We believe that it would be very desirable to continue in the research of these issues, because the current findings give us more questions and directions of interest than „finished " and clear answers.
\n\t\t\tWe are not aware of any similar research in the Czech Republic on this topic. The performed research is in such a stage and complexity unique even for the English literature. We believe that this issue deserves a greater attention of researchers and psychotherapists because many of the untreated and treated patients may suffer from a variety of symptoms, experience worse health status and quality of life. It would be useful to concentrate on preoperative preparation of a patient and work with his expectations while doing it.
\n\t\tHumic substances are principal compounds that account for 80–90% of soil organic matter [1]. Owing to their complexes of bioactive substances, humic substances can control the stability and ecosystem in soil [2]. Humic substances are organic macromolecules with multiple properties and contain a wide variety of structural functional groups [3], arising from physical, chemical, and microbiological processes [4]. In aquatic system, humic substances account for 40–60% of natural organic matter [5]; thus, they can have significant impact on water quality. In natural water resources, humic substances are formed from the degradation of plants, animal residues, and soil surface runoff [6]. In the events of torrential rainfall, storm events, and summer monsoon season, humic substances are abundantly formed from upstream land use and soil surface runoff [7, 8, 9]. Thus, it is essential to study the humic substances extracted from upland soils for water quality management.
Humic substances are mainly divided into humic acids, fulvic acids, and humin [10]. Humic acids are soluble in water only at pH >2, fulvic acids are soluble in water in all pH conditions, whereas humin is insoluble in water [11]. Thus, because of their solubility, humic and fulvic acids play indispensable roles in dissolving organic matter in aquatic system. Humic and fulvic acids majorly comprise carboxylic, phenolic, carbonyl, hydroxyl, amine, amide, and aliphatic moieties [12]. In surface water, fulvic acids account for the majority of humic substances, whereas humic acids account for only 10% of humic substances [6]. For the disinfection of water for drinking purpose, humic and fulvic acids present in water can react with disinfectant chemicals (i.e., chlorine and ozone) to form disinfection by-products (DBPs) such as trihalomethanes (THMs), haloacetic acids (HAAs), haloketones, and haloacetonitriles [13, 14]. Among these four DBPs, THMs and HAAs are the two most abundant halogenated DBPs [15, 16]. DBPs are considered to be dangerous to human health because of the presence of potential carcinogens [17] that particularly cause urinary bladder cancer [18, 19]. Humic and fulvic acids are the primary sorbent, which can impact the fate, mobility, and bioavailability of hydrophobic contaminants, especially the presence of polycyclic aromatic hydrocarbons (PAHs) in water system [20, 21]. PAHs contain more than two benzene rings [22] and are the most persistent and toxic organic micropollutants in surface water. Low concentrations of these hydrocarbons can have adverse effects on human health and aquatic systems because they contain carcinogenic, mutagenic compounds and potent immune suppressants [23, 24]. PAHs can be formed from biological process, industrial wastes, petroleum spills, incomplete combustion from nature sources (forest and brush fires), and/or human combustion sources (engine emissions) [24]. Recently, PAHs from urban runoff were reported to be a serious contaminant in rivers and lakes [9, 25, 26]. In addition, PAHs have been widely detected in surface water and drinking water at higher concentrations compared with other persistent organic pollutants [27, 28]. Of the 16 PAHs monitored by the US Environment Protection Agency, phenanthrene (PHE) was reported to be the most abundant PAH in surface water. Similar to humic and fulvic acids, PAHs can produce chlorinated PAHs during chlorination process for drinking water treatment. This is because PAHs contain an electronic-rich system that can be readily attacked electrophilically by hypochlorous acid [29]. The hypobromous acid might also be formed in the presence of Br− during chlorination because Br− ion is ubiquitous in both surface water and chlorine solution [30]. The hypobromous acid reacts with PAHs to form brominated PAHs. In comparison with PAHs, the chlorinated PAHs and brominated PAHs exhibit AhR activity, DNA damaging effects, and mutagenicity, and thus, they present a larger threat to human health [31, 32]. Hence, it is essential to investigate the characteristics of humic and fulvic acids and their PAHs sorption behavior in order to control the formation of DBPs from humic and fulvic acids as well as the formation of halogenated PAHs.
Many methods to identify the structure of humic and fulvic acids have been reported in the literature. Among them, 13C NMR is the most common method to identify functional groups and molecular structures such as aromatic and aliphatic C groups. In contrast, elemental analysis, which is a faster method than the 13C NMR method, reflects the atomic ratios that relate to aromatic C such as H/C and the derived sources of humic substance such as N/C [33]. The humic and fulvic acids can also be compared on the basis of molecular weight (MW) [34]. In addition, spectroscopic techniques such as UV–visible (Vis) absorbance and fluorescence are widely employed because of their simplicity, rapid process, and non-requirement of pretreatment of samples. Specific UV absorbance (SUVA) at 254 nm is an indicator for aromatic C, while their ratio E4/E6, S275–295, and S350–400 confirmed its humification and aromaticity [35]. Moreover, the sources of humic substance and its relationship with MW distribution humic substance can be determined using fluorescence properties and their index [36]. Although many studies have examined the characteristics of humic substances and their binding with PAHs, there is still a lack of sufficient information on the characteristics of humic and fulvic acids and their differences, formation of their DPBs, and binding behavior of their PAHs.
In this present study, humic and fulvic acids were extracted from soils and characterized by using 13C NMR, elemental analysis, MW, UV, and fluorescence methods. The study also reported the different formation of THMs and HAAs and the PHE behavior of humic and fulvic acids due to their different characteristics.
For this study, soil samples were collected from six different locations in Korea, and a minimum of 20 km distance was maintained between the sampling sites. Four of these samples were representative of granite soils and were named as Gori (KR), Wolseong (WS), Uljin (UJ), and Yeonggwang (YK). Two soil samples were collected from the foot of Mt. Seorak (Goseong (KS)) and from Mt. Hallan (Jeju Island, volcanic ash soil) (Halla (HL)). Three soil samples, namely Elliott Silt Loam Soil (Cat No. 1BS102M), Canadian peat moss soil sample (sphagnum peat moss), and Aldrich HA (Sigma-Aldrich, CAS no. 1415-93-6), were purchased and named as IHSS, Peat, and AL, respectively.
Humic and fulvic acids were extracted from six sampling soils (KR, WS, UJ, YK, KS, and HL) and Peat, according to the IHSS method [37] and ISO 12782-4:2012 [38]. The extracted fulvic acids were purified using XAD resin concentration and then passed through a Dowex-50X8(H+) column. The AL sample was purified using an acid–base precipitation method [10]. Figure 1 presents the extraction and purification process of humic and fulvic acids.
The extraction and purification process of humic and fulvic acids.
The UV–Vis absorbance of humic and fulvic acids in the 200–800 nm range was investigated using a UV–Vis spectrometer (Shimadzu, UV-1601PC). To measure the dissolves organic matter (DOC), samples were prepared at pH 7.0 and then filtered using a 0.45-μm membrane filter (cellulose acetate, Advantec). The ratio of UV absorbance at 254 nm to the DOC concentrations of the samples was calculated to determine the SUVA values. The UV–Vis absorbance ratio at 465 and 665 nm (E4/E6) and spectral slope were applied to characterize the humic material as well as the aromaticity. The spectra slope was calculated using log-transform linear regression at intervals of 275–295 nm (S275–295) and 350–400 nm (S350–400). These two narrow bands were chosen for spectral slope calculation because they present the greatest variations from a variety of sources (i.e., marsh, riverine, estuarine, coastal, and open ocean).
A fluorescence spectrometer (Perkin Elmer LS50B) was used to obtain synchronous fluorescence spectra. It is known that fluorescence intensity can alternate with measurement time depending on external conditions such as humidity. Thus, the measured fluorescence intensities were normalized as units of quinine sulfate (QSE) equivalents based on the fluorescence of a diluted series of quinine sulfate dehydrate in 0.05 M sulfuric acid at an excitation/emission wavelength of 350/450 nm. Both the excitation and emission slits were fixed at 10. The difference between the emission wavelength and the excitation wavelength (Δλ) was fixed at 30 nm and then measured from 250 to 600 nml to determine synchronous fluorescence spectrum. The relative fluorescence regions were classified into four groups: protein-like (%PLF) fluorescence, fulvic-like (%FLF) fluorescence, humic-like (%HLF) fluorescence, and terrestrial humic-like (%THLF) fluorescence. These groups of fluorescence regions corresponded to the relative percentage of fluorescence intensity at wavelengths of 250–300, 300–380, 380–420, and 420–600 nm, respectively.
The apparent weight-average molecular weight (MWw) values were determined using size exclusion chromatography. The polydispersity of samples with the relative precision of MWw and MWn were less than 5% and 7%, respectively. The elemental composition ratios of humic and fulvic acids (C/H, N/C, and (N + O)/C) were determined using CHNS-932 and VTF-900 (LECO Co.).
The cross-polarization magic-angle spinning method was used to determine carbon structure via 13C NMR spectroscopy (Bruker Avance II, 500 MHz). The spectrum was measured at 300 K with a 90-pulse width of 4.5 s, 1.5 ms contact time, 3 ms pulse delay time, and 6.0 kHz spinning speed. A qualitatively good signal-to-noise ratio was obtained by using a total of 3 × 104 scan signal free induction decays and a line broadening function of 40 Hz. Then, the C functional groups were determined by integrating the area of the spectra in the chemical shift area: 0–50 ppm (alkyl C), 50–110 ppm (O-alkyl C), 110–145 ppm (C,H-aryl), 145–165 ppm (O-aryl phenol), and 165–190 ppm (carboxyl).
Humic and fulvic acids extracted from six sampling soils (KR, WS, UJ, YK, KS, and HL), Peat, AL, and IHSS were diluted to 1 mg C/L. Then, 1 ml phosphate buffer was added to 50 ml of diluted humic and fulvic acids to adjust their pH value to 7.0 ± 0.2. Then, the humic and fulvic acids were incubated for 2–3 h before chlorination. Chlorination of the humic and fulvic acids was conducted using the Aldrich’s sodium hypochlorite solution (available chlorine >4%) (NaOCl). The glassware required for the experiment was washed with acetone and then baked at 400°C for 1 h to remove any remaining organic matter. A constant dose of 5 mg Cl2/L was added to each sample for chlorination. The final solutions were sealed and stored in the dark at 25°C for 24 h. Then, a 10% sodium sulfite solution was injected into the solutions to suppress the formation of additional by-products by residual chlorine.
THMs and HAAs were analyzed using USEPA Method 551.1 and Method 552.3. A micro-electron capture detector (Agilent 6890 GC-ECD) was used to conduct gas chromatography of the liquid–liquid extracts in order to quantify the different THMs and HAAs. This was followed by diazomethane derivatization. Four species of THM, i.e., such as chloroform (CF), dichlorobromomethane (DCBM), dibromochloromethane (DBCM), and bromoform, were measured. HAAs were analyzed using the Drinking Water Quality Process Test Method (ES 05552.2.). Three substances, i.e., dichloroacetic acid (DCAA), trichloroacetic acid (TCAA), and dibromoacetic acid (DBAA), were used in this analysis.
PHE (purity >97%) was purchased from Aldrich and used without further purification. The stock solution (1.0 mg/L) was prepared by dissolving an excess in methanol to make a saturated solution. This solution was filtered through a 0.45-μm cellulose acetate membrane filter (Advantec). In this filter, the sorption of PHE is negligible. The solution was sterilized by adding 5 mM CaCl2 and 0.01 mM HgCl2, and its pH was adjusted to 6 by adding either 0.1 M NaOH or 0.1 M HCl. Then, 100, 90, 80, 70, 60, 40, and 30% stock solution was used with 20 mg of humin added in a 10-mL glass vial in order to perform the PHE adsorption experiments. The headspace was kept minimal to reduce the solute vapor loss and minimize the effect of surface adsorption. In addition, separately manufactured vial caps were used. The experiment was conducted using a rotator (at 30 rpm). Based on the preliminary tests for apparent equilibrium, the reaction time was set to 5 d. After the reaction, a centrifuge (5000 rpm, 15 min) was used to separate the supernatant and precipitate from each sample. The HPLC (YoungLin, UV730D) was used to measure PHE concentration in the supernatant. The mobile phase for HPLC was prepared using acetonitrile and ultrapure water (80:20 v/v) with a flow rate of 1.8 mL/min. A C18 4.6 × 150 mm reverse-phase column (Supelcosil LC-18DB) was used to perform separation analysis using a UV detector (at 254 nm).
A modified Freundlich adsorption isotherm Eq. (1) was used to analyze the adsorption results. The Freundlich equation is related to multi-layer and heterogeneous adsorption and is, thus, commonly applied to organic matter and hydrophobic pollutant adsorption [39]. The Freundlich adsorption constant (KFOC) and isotherm linearity constant (n) were derived from the slope and y-intercept, respectively, as per Eq. (1):
where SOC is the concentration of the PHE adsorbed on the humin (μg/kg C), Ce is the freely dissolved PHE concentration (μg/L), Cscl is the supercooled solubility of PHE at 25°C (5970 μg/L) in supercooled aqueous solution, and KFOC (μg/kg C) and n are the Freundlich adsorption model parameters (adsorption isotherm linearity increases as n increases). The single-point sorption is as follows:
From Freundlich sorption coefficient, the Gibbs energy change (△G) can be calculated as follows [40]:
where T is the absolute temperature in kelvins, R is the gas constant (8.314 J.mol−1.K−1), and K is the Freundlich adsorption coefficient (KOC). The K value is recalculated as a dimensionless coefficient by multiplying it by 55.5 (number of moles of water per liter of solution) to correct the △G° values [41]:
The humic acids exhibited higher values of elemental composition of H/C and N/C ratios compared with those of fulvic acids for almost samples (Figure 2). Fulvic acids exhibited higher values of (N + O)/C and, thus, presented higher polarity than those values for humic acids (Figure 2). Similar to previous research works, aromatic C (110–165 ppm) in humic acids was higher than that in fulvic acids, whereas the aliphatic C (0–110 ppm) exhibited the opposite trend (Figure 3). In addition, only O-alkyl C proportions in fulvic acids presented higher values compared with those in humic acids for all soil samples, except for Peat and HL soil. In contrast, O-alkyl C, C,H-aryl C, and O-aryl C exhibited the opposite trend. Moreover, the carboxyl and carbonyl groups (165–210 ppm) in fulvic acids were higher compared with the values in humic acids for all soil samples. Higher aromatic C compounds (C,H-aryl and O-aryl phenol) in humic acids indicated higher amount of lignin and polyphenol from various plants [42]. In addition, the presence of higher O-alkyl and carboxyl groups such as peptides and organic acids indicated higher solubility of humic acids compared with fulvic acids [43]. Fulvic acids contain high carboxyl groups, and hence, the appearance of both COOH and –HC=CH– structure in these acids might affect the result of H/C [44]. Thus, fulvic acids exhibited lower H/C ratios as compared to the values of these ratios in humic acids. The MWw values of humic acids ranged from 2545 to 4411 Da and were higher than the values of fulvic acids (from 1751 to 2584 Da). In comparison with fulvic acid, humic acids presented higher polydispersity index (MWw/MWn), revealing a larger distribution of MW for humic acids. Thus, humic acids extracted from soils revealed higher H/C (affected by COOH and –HC=CH– structure), N/C, MWw, and MWw/MWn and lower polarity and O-alkyl C compared with fulvic acids. In particular, fulvic acids contained higher aliphatic C owing to their extremely higher values of O-alkyl C.
Atomic ratios of humic acids (HA) and fulvic acids (FA) extracted from soils.
13C NMR spectra of (a) humic acids (HA); and (b) fulvic acids (FA) extracted from soils.
SUVA, E4/E6, S275–295, and S350–400 were employed to identify the difference in spectroscopic spectra between humic and fulvic acids. Humic acids presented higher SUVA values than those of fulvic acids, whereas E4/E6 exhibited the opposite trend. The negative relationship between E4/E6 and the degree of condensation of the aromatic carbon network and/or the MW has facilitated the increased usage of the E4/E6 ratio in the identification of humification and aromaticity of soil organic matter [35, 45, 46]. The lower values of E4/E6 for humic acids are associated with the higher values of SUVA, aromatic carbon (110–165 ppm), and MWw. Of all soil samples, S350–400 presented higher values of SUVA, aromatic carbon (110–165 ppm), and MWw for fulvic acids than for humic acids, whereas the soil sample S275–295 did not present any trend. Thus, spectra slope at longer wavelengths could be used as an effective index to distinguish the dissolved organic matter between humic acids and fulvic acids.
Figure 4 shows the synchronous fluorescence spectra of soil humic acids and fulvic acids. As shown in this figure, soil humic acids presented higher peaks at THLF regions, whereas fulvic acids exhibited lower peaks at FLF and HLF regions. With respect to fluorescence relative distribution, compared with fulvic acids, humic acids presented lower %FLF and %HLF, but higher %THLF values. The humification index (HIX) also presented higher values for humic acids than for fulvic acids. Based on these findings, it can be said that soil humic acids were more condense with polymerized humic-like structure (higher SUVA, aromatic C, MWw, and %THLF), whereas fulvic acids contained high levels of carbonyl and quinone, aliphatic groups, and oxygen functional groups related to fulvic- and humic-like fluorescence materials (higher (N + O)/C, E4/E6, S350–400, %FLF, %HLF O-alkyl, and carboxyl groups). These specific different molecular characteristics between humic and fulvic acids are important as they can aid in investigating the structural changes, generation of DBPs under chlorination, and PHE sorption behavior.
Fluorescence spectra of (a) humic acids*; and (b) fulvic acids extracted from soils. *
For the comparison of DBPs formation between humic and fulvic acids extracted from soils, the concentrations of THM, HAA, and their species (μg/L) were normalized to DOC (mg/L) and named as specific THM/HAA formation potential (STHMFP/SHAAFP) and CF, DCBM, DBCM, DCAA, TCAA, and DBAA. It was found that the formation of STHMFP and SHAAFP significantly differed between humic acids and fulvic acids. Humic acids exhibited higher STHMFP values that ranged from 141.9 to 194.6 μg/mg compared with the lower values in fulvic acids (98.7 to 100.6 μg/mg). In both humic acids and fulvic acids, chloroform was the most dominant compound of STHMFP, accounting for over 95% of STHMFP. Similar to the trend of the values of STHMFP, SHAAFP values for humic acids were found to be 5.5 times higher (ranging from 259.0 to 390.0 μg/mg) compared with the SHAAFP values for fulvic acids (ranging from 19.8 to 54.9 μg/mg). TCAA was the most abundant (83%) SHAAFP species in humic acids, whereas it accounted for only 17% in fulvic acids. In humic acids, SHAAFP (presenting as TCAA) presented higher values than STHMFP (presenting as CF). In contrast, STHMFP presented much higher values than SHAAFP for fulvic acids. During chlorination, humic molecules having higher aromatic content, such as humic acids, first reacted with chlorine to form TCAA and then form CF. This is the reason why TCAA production was higher than CF production [47]. In addition, fulvic acids contained alkyl, carbohydrate, and carboxyl groups that were less capable of producing CF and TCAA under chlorination than the aromatic carbon components [48]. Thus, the difference in DPB formation between humic and fulvic acids might be explained by the differences in their molecular structure.
After chlorination, both humic and fulvic acids exhibited lower SUVA and TOC values. TOC removal presented higher values for fulvic acids. This demonstrated the presence of more organic carbon components in fulvic acids that can be easily mineralized to CO2 during chlorination as compared to humic acids. During chlorination, 50–80% of chlorine oxidated humic substances into CO2, whereas only 5–10% of chlorine participated in the incorporation reaction to form DBPs [49]. SUVA presented higher reduction values for humic acids than for fulvic acids. This indicated that high aromatic C (presented by high SUVA values) were transformed into lower ones (lower SUVA) by splitting the aromatic rings and decomposing the unsaturated carbon rather than converting it into CO2. After chlorination, humic and fulvic acids showed different changes in terms of fluorescence relative distribution. Moreover, after chlorination, only %THLF values decreased for humic acids, whereas %FLF and %THLF reduced for fulvic acids. The values of Δ%FLF, Δ%HLF, and Δ%THLF were calculated based on the differences in each relative distribution before and after chlorination (FLbefore − FLafter). These values were used to further examine the mechanisms of chlorination for humic and fulvic acids.
The relationship between the changes in humic/fulvic acid characteristics (TOC removal, SUVA removal, Δ%FLF, Δ%HLF, and Δ%THLF) due to chlorination and their original structural characteristics (SUVA, MW, C,H-aryl, and O-alkyl) can clarify the chlorination-induced structural changes in humic and fulvic acid in more depth. SUVA values were found to be strongly positively correlated with SUVA removal for both humic and fulvic acids (p < 0.05). Moreover, SUVA values were strongly negatively correlated with TOC removal values for humic acids (p < 0.01) and non-significantly correlated with TOC removal values for fulvic acids (p > 0.1). The higher SUVA values and aromatic carbon contents of humic acids than those of fulvic acids resulted in the reaction of more aromatic carbon compounds in humic acids with chlorine. This led to the production of higher DBP. In addition, for humic acids, higher MWw materials with richer N groups and a higher proportion of O-alkyl C reacted with chlorine to yield higher reductions of TOC and FLF components. In comparison, lower MWw materials with a higher percentage of C,H-aryl and O-aryl phenol and fewer N groups were associated with a higher reduction in SUVA and THLF values. In other words, high-MWw humic acids with aliphatic properties, high nitrogen content, and a low degree of unsaturation mostly reacted with chlorine via an oxidation reaction. In comparison, low-MWw humic acids with high aromatic C and low nitrogen content mainly reacted with chlorine via incorporation.
The correlations between STHMFP and humic/fulvic acid characteristics determined the effects of the molecular structures of humic/fulvic acids on DBP production. For humic acids, STHMFP was positively correlated with C,H-aryl, O-aryl phenol, and alkyl C (p < 0.05) but negatively correlated with N/C ratio, MWw, TOC removal, Δ%FLF, O-alkyl C, and carboxyl (p < 0.05). In summary, low-MW aromatic C such as C,H-aryl, O-aryl phenol, and aliphatic C such as alkyl C in humic acids were considered as DBP precursors as they generated STHMFP during the chlorination reaction. On the contrary, high N groups of O-alkyl C in humic acids participated in oxidation reactions during chlorination. For fulvic acids, STHMFP presented a strong positive correlation with alkyl C and negative correlations with C,H-aryl and O-aryl phenol (p < 0.05). The chlorination mechanism of fulvic acids shown in our study differed from those reported in previous studies that demonstrated that aromatic C, especially phenol components, were associated with the highest value of STHMFP [50, 51]. The reasons behind these notable findings can be explained as follows. First, unlike those in the humic acids, the aromatic contents in fulvic acids might not play a major role in the generation of STHMFP via incorporation. Second, the presence of N groups combined with aromatic molecules in the fulvic acids resulted in the formation of N-DBPs, and not in the generation of STHMFP and SHAAFP [52]. In previous studies, amino acids such as aspartic acids and asparagine acids in humic substances were also reported to yield N-DBPs (i.e., dichloroacetonitrile and halonitromethanes) during chlorination [16, 53]. In the present study, there was no relationship between the SHAAFP and HAA species and the humic/fulvic acid characteristics. In summary, the low-MW and low-N/C components of aromatic C and alkyl C in the humic acids might form STHMFP via incorporation reactions. In comparison, only low-N/C aliphatic compounds such as alkyl generated STHMFP in the fulvic acids. This detail will be helpful in elucidating the formation of aromatic/aliphatic N-DBPs for humic and fulvic acids in future. MWw and Δ%THLF were the appropriate factors for predicting the values of STHMFP in humic acids. In comparison, Δ%FLF and Alkyl C were applied for fulvic acids.
In particular, this study presented a new interpretation of differences between humic/fulvic acids in terms of molecular structure characteristics and chlorine reaction, including oxidation and incorporation reaction, and successfully provided sufficient factors to predict THM generation.
All the experimental data of humic and fulvic acids fit well with the Freundlich model, presented by the high degree of correlations (R2 > 0.99). Also, for both humic and fulvic acids, all the sorption isotherms were non-linear (n < 1). For humic acids, PHE adsorption coefficient (KOC) ranged from 3.7 × 104 to 7.0 × 104 mL/g, while for fulvic acids, it ranged from 1.4 × 104 to 2.2 × 104 mL/g. The higher sorption affinity of humic acids might be explained by the higher aromatic and condense humic structure. High isotherm linearity (n) values were associated with a low degree of natural organic matter maturation and less heterogeneous sorption-site energy distribution [54]. The n values of humic acids were lower than those of fulvic acids. In humic acids, the hydrophobic nature enhanced more coiled or aggregated structures to provide specific non-ideal binding sites [55]. In addition, high polarity might reduce the sorption affinity [56]. The Gibbs free energy values were negative for both humic and fulvic acids at 20°C, revealing the thermodynamically favorable and spontaneous adsorption process [57].
For humic acids, sorption coefficient (logKOC) was positively related to HIX and negatively correlated with S350–400. In comparison, logKOC of fulvic acids presented positive correlation with %THLF and negative relationship with %FLF and E4/E6. No relationship was observed between logKOC and humic/fulvic acid relative carbon distribution. High sorption affinity was found to be positively related to the condense structure with high aromatic C and humification, presented by the high values of HIX and %THLF and low values of %FLF and E4/E6. For humic acids, n presented positive correlation with H/C, %FLF, and %HLF and negative relationship with SUVA and %THLF. However, no relationship was observed between n values and their structural characteristics for fulvic acids. The UV spectroscopic and fluorescence characteristics of humic and fulvic acids were primarily related to their sorption ability. In a previous study, PAH sorption ability was reported to be closely related to 3D fluorescence [58].
The principal component analysis was applied for 18 selected parameters in order to interpret the specific PHE binding behavior of humic and fulvic acids. The first two principal components (PCs) explained approximately 59.32% for PC1 and 14.70% for PC2 (Figure 5). PC1 was interpreted as a factor associated with the PHE sorption behavior, whereas PC2 presented for C,H-alkyl, H/C, and free energy. Thus, logKoc was found to be positively related to MWw, SUVA, HIX, %THLF, and Mw/Mn. Moreover, n values were positively correlated with %FLF, %HLF, E4/E6, and O-alkyl (Figure 5a). From the factor score plot presented in Figure 5b, the PHE sorption behavior of humic and fulvic acids was found to be completely different. Humic acids presented higher MWw, Mw/Mn, SUVA, and %THLF, which were related to sorption affinity (logKoc). In comparison, fulvic acids were related to higher n and fulvic−/humic-like components, lower degree of condensation of the aromatic carbon, and the MW (higher E4/E6 and O-alkyl). In summary, UV and fluorescence characteristics are powerful techniques to determine the PHE sorption behavior of humic and fulvic acids extracted from soils.
(a) Factor loading plot for selected structural characteristics and PHE sorption of humic and fulvic acids as the first two principal components; and (b) factor score plot for humic and fulvic acids as the first two principal components.
In this chapter, the structure characteristics of humic and fulvic acids extracted from soils were clarified. Soil humic acids were found to be more condensed and have a polymerized humic-like structure (higher SUVA, aromatic C, MWw, and %THLF). In comparison, fulvic acids contained high levels of carbonyl and quinone, more aliphatic groups, and more oxygen functional groups related to fulvic- and humic-like fluorescence materials (higher (N + O)/C, E4/E6, S350–400, %FLF, %HLF O-alkyl, and carboxyl groups). The differences in the molecular characteristics between humic and fulvic acids resulted in the differences in the generation of DBPs under chlorination and the PHE sorption behavior. For chlorination, the low-MW and low-N/C components of aromatic C and alkyl C in the humic acids might form STHMFP via incorporation reactions. However, only low-N/C aliphatic compounds such as alkyl generated STHMFP in the fulvic acids. Humic acids presented higher sorption coefficient (logKoc) because of the presence of higher MWw, Mw/Mn, SUVA, and %THLF. In comparison, fulvic acids are related to higher n and fulvic−/humic-like components and lower degree of condensation of the aromatic carbon and the MW. UV and fluorescence characteristics are powerful techniques to indicate the PHE sorption behavior of humic and fulvic acids extracted from soils. Compared with atomic ratio and relative C distribution, the UV and fluorescence characteristics approach provides the key information for water system managers to better predict and mitigate the formation of DBPs in chlorine-treated water and the behavior of hydrophobic organic contaminants in aquatic environment.
This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (Grant No. NRF-2020R1A6A1A03042742), and by the Korea Environment Industry & Technology Institute (KEITI) through the program for the management of aquatic ecosystem health, funded by the Korea Ministry of Environment (MOE) (Grant No. 2020003030005).
The authors declare no conflict of interest.
IntechOpen books are published online and are accessible for free.
\r\n\r\nHowever, if you are interested in ordering your hardcover copy, you can do so by contacting our Print Sales Department at orders@intechopen.com. All IntechOpen books are printed on demand in full-colour and delivered in signature packaging through FREE DHL Express delivery.
\r\n\r\nFor a quote or assistance please contact us directly at orders@intechopen.com The quote will be sent to you within 1-2 business days.
\r\n\r\nOur entire portfolio of over 5,500 books is also available through Amazon.
',metaTitle:"Order and delivery",metaDescription:"Our books are published online and are accessible for free. However, if you are interested in ordering your hardcover copy, you can do so by contacting our Print Sales Department at orders@intechopen.com. All IntechOpen books are printed on demand in full-colour and delivered in signature packaging through free DHL Express delivery. A selection of our books in soft cover is also available through Amazon.",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"Our books are available hardcover, printed in full colour and produced to the highest standards on PEFC™ and FSC certified paper, complying with principles of responsible forestry worldwide. The paper size is 180 x 260 mm (7 x 10.2 inches).
\\n\\nIntechOpen works with award winning print-houses and we hold to the fact that all of our printed products are of the highest quality.
\\n\\nIntechOpen books retail price range is:
\\n\\n100 - 159 GBP ex. VAT (available in USD and EUR)
\\n\\nDiscounts available:
\\n\\nBulk discounts are granted for orders of 10 copies and more.
\\n\\nThere is no minimum or maximum threshold on the quantity of book orders.
\\n\\nOrders have to be paid in advance and before printing. We accept payment in GBP, EUR and USD.
\\n\\nWe currently accept the following payment options:
\\n\\nWhen paying with a credit card, you will be redirected to the PayPal.com online payment portal.
\\n\\nIntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
\\n\\nIn accordance with the best security practice, we do not accept card orders via email.
\\n\\nThe combined printing and delivery time for orders vary from 7-15 business days, depending on the printed quantity and destination. This period does not include any customs clearance difficulties that may arise and that are beyond our control. Once your order has been printed and shipped, you will receive a confirmation email that includes your DHL tracking number. You can then track your order at www.dhl.com.
\\n\\nIf you do not receive your order within 30 days from the date your order is shipped, please contact us to inquire about the shipping status at orders@intechopen.com.
\\n\\nTax: Residents of European Union countries need to add a Book Value-Added Tax Rate based on their country of residence. Institutions and companies, registered as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen with their VAT registration number. This is made possible by the EU reverse charge method.
\\n\\nCustoms: free shipping does not include any duties, taxes or clearing charges levied by the destination country. These charges are the responsibility of the customer and will vary from country to country.
\\n\\nP.O. Boxes cannot be used as a Ship-To Address.
\\n\\nIntechOpen partners do not provide shipping service from Europe to the countries listed below. Please refrain from mailing items addressed to the countries listed below, until further notice.
\\n\\nWhen ordering our books from the countries listed below, please provide an alternative mailing address. For any further assistance, please contact us at orders@intechopen.com.
\\n\\nRestricted Ship-to Countries:
\\n\\nPOD products are non-returnable and non-refundable, except in the event of poor print quality or an error in quantity. If we delivered the item to you in error or the item is faulty, please contact us.
\\n\\nInspect your order carefully when it arrives. Any problems should be immediately reported to orders@intechopen.com.
\\n\\nPrint copies of our publications are most often purchased by universities, libraries, institutions and academia personnel, hence increasing the visibility and outreach of our authors' published work among science communities and institutions.
\\n\\nOur books are available at our direct Print Sales Department and through selected representatives throughout the world.
\\n\\nBooks International
\\n\\nRepresentative for: Brunei, Cambodia, Indonesia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam (ASEAN)
\\n\\nChina Publishers Services Ltd - CPS
\\n\\nRepresentative for: China, Taiwan, Hong Kong
\\n\\nIndia - CBS Publishers & Distributors Pvt. Ltd.
\\n\\nRepresentative for: India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Nepal, Maldives, Iran, Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunis, United Arab Emirates and Yemen
\\n\\nLSR Libros Servicios y Representaciones S.A. de C.V
\\n\\nRepresentative for Mexico, Chile and Colombia
\\n\\nMissing Link Versandbuchhandlung eG
\\n\\nRepresentative for: Germany, Austria, Switzerland
\\n\\nKuba Libri, s.r.o.
\\n\\nRepresentative for: Czech Republic
\\n\\nFor partnership opportunities, please contact orders@intechopen.com.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'Our books are available hardcover, printed in full colour and produced to the highest standards on PEFC™ and FSC certified paper, complying with principles of responsible forestry worldwide. The paper size is 180 x 260 mm (7 x 10.2 inches).
\n\nIntechOpen works with award winning print-houses and we hold to the fact that all of our printed products are of the highest quality.
\n\nIntechOpen books retail price range is:
\n\n100 - 159 GBP ex. VAT (available in USD and EUR)
\n\nDiscounts available:
\n\nBulk discounts are granted for orders of 10 copies and more.
\n\nThere is no minimum or maximum threshold on the quantity of book orders.
\n\nOrders have to be paid in advance and before printing. We accept payment in GBP, EUR and USD.
\n\nWe currently accept the following payment options:
\n\nWhen paying with a credit card, you will be redirected to the PayPal.com online payment portal.
\n\nIntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
\n\nIn accordance with the best security practice, we do not accept card orders via email.
\n\nThe combined printing and delivery time for orders vary from 7-15 business days, depending on the printed quantity and destination. This period does not include any customs clearance difficulties that may arise and that are beyond our control. Once your order has been printed and shipped, you will receive a confirmation email that includes your DHL tracking number. You can then track your order at www.dhl.com.
\n\nIf you do not receive your order within 30 days from the date your order is shipped, please contact us to inquire about the shipping status at orders@intechopen.com.
\n\nTax: Residents of European Union countries need to add a Book Value-Added Tax Rate based on their country of residence. Institutions and companies, registered as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen with their VAT registration number. This is made possible by the EU reverse charge method.
\n\nCustoms: free shipping does not include any duties, taxes or clearing charges levied by the destination country. These charges are the responsibility of the customer and will vary from country to country.
\n\nP.O. Boxes cannot be used as a Ship-To Address.
\n\nIntechOpen partners do not provide shipping service from Europe to the countries listed below. Please refrain from mailing items addressed to the countries listed below, until further notice.
\n\nWhen ordering our books from the countries listed below, please provide an alternative mailing address. For any further assistance, please contact us at orders@intechopen.com.
\n\nRestricted Ship-to Countries:
\n\nPOD products are non-returnable and non-refundable, except in the event of poor print quality or an error in quantity. If we delivered the item to you in error or the item is faulty, please contact us.
\n\nInspect your order carefully when it arrives. Any problems should be immediately reported to orders@intechopen.com.
\n\nPrint copies of our publications are most often purchased by universities, libraries, institutions and academia personnel, hence increasing the visibility and outreach of our authors' published work among science communities and institutions.
\n\nOur books are available at our direct Print Sales Department and through selected representatives throughout the world.
\n\nBooks International
\n\nRepresentative for: Brunei, Cambodia, Indonesia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam (ASEAN)
\n\nChina Publishers Services Ltd - CPS
\n\nRepresentative for: China, Taiwan, Hong Kong
\n\nIndia - CBS Publishers & Distributors Pvt. Ltd.
\n\nRepresentative for: India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Nepal, Maldives, Iran, Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunis, United Arab Emirates and Yemen
\n\nLSR Libros Servicios y Representaciones S.A. de C.V
\n\nRepresentative for Mexico, Chile and Colombia
\n\nMissing Link Versandbuchhandlung eG
\n\nRepresentative for: Germany, Austria, Switzerland
\n\nKuba Libri, s.r.o.
\n\nRepresentative for: Czech Republic
\n\nFor partnership opportunities, please contact orders@intechopen.com.
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{},profiles:[{id:"396",title:"Dr.",name:"Vedran",middleName:null,surname:"Kordic",slug:"vedran-kordic",fullName:"Vedran Kordic",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/396/images/7281_n.png",biography:"After obtaining his Master's degree in Mechanical Engineering he continued his education at the Vienna University of Technology where he obtained his PhD degree in 2004. He worked as a researcher at the Automation and Control Institute, Faculty of Electrical Engineering, Vienna University of Technology until 2008. His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. In the Engineering side, Digital Signal Processing, Computer Architecture, Electronics Devices, Digital Filtering and Engineering Management.\nApart from his Academic Interest and activities he loves sport especially, Cricket, Football, Snooker and Squash. He plays cricket for Esbjerg city in the second division team as an opener wicket keeper batsman. He is a very good player of squash but has not played squash since his arrival in Denmark.",institutionString:null,institution:null},{id:"611",title:"Prof.",name:"T",middleName:null,surname:"Nagarajan",slug:"t-nagarajan",fullName:"T Nagarajan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universiti Teknologi Petronas",country:{name:"Malaysia"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:6655},{group:"region",caption:"Middle and South America",value:2,count:5946},{group:"region",caption:"Africa",value:3,count:2452},{group:"region",caption:"Asia",value:4,count:12678},{group:"region",caption:"Australia and Oceania",value:5,count:1014},{group:"region",caption:"Europe",value:6,count:17699}],offset:12,limit:12,total:133952},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{topicId:"21"},books:[{type:"book",id:"11434",title:"Indigenous Populations - Perspectives From Scholars and Practitioners in Contemporary Times",subtitle:null,isOpenForSubmission:!0,hash:"c0d1c1c93a36fd9d726445966316a373",slug:null,bookSignature:"Dr. Sylvanus Gbendazhi Barnabas",coverURL:"https://cdn.intechopen.com/books/images_new/11434.jpg",editedByType:null,editors:[{id:"293764",title:"Dr.",name:"Sylvanus",surname:"Barnabas",slug:"sylvanus-barnabas",fullName:"Sylvanus Barnabas"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11436",title:"Beauty - Evolutionary, Social and Cultural Perspectives on Attractiveness",subtitle:null,isOpenForSubmission:!0,hash:"8f2773e5d4ffe767f38dd15712258e8c",slug:null,bookSignature:"Dr. Farid Pazhoohi",coverURL:"https://cdn.intechopen.com/books/images_new/11436.jpg",editedByType:null,editors:[{id:"470837",title:"Dr.",name:"Farid",surname:"Pazhoohi",slug:"farid-pazhoohi",fullName:"Farid Pazhoohi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11443",title:"Empathy - Advanced Research and Applications",subtitle:null,isOpenForSubmission:!0,hash:"4c1042dfe15aa9cea6019524c4cbff38",slug:null,bookSignature:"Ph.D. Sara Ventura",coverURL:"https://cdn.intechopen.com/books/images_new/11443.jpg",editedByType:null,editors:[{id:"227763",title:"Ph.D.",name:"Sara",surname:"Ventura",slug:"sara-ventura",fullName:"Sara Ventura"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11444",title:"Happiness - Biopsychosocial and Anthropological Perspectives",subtitle:null,isOpenForSubmission:!0,hash:"fa84e7fc3611e5428e070239dcf5a93f",slug:null,bookSignature:"Dr. Floriana Irtelli and Prof. Fabio Gabrielli",coverURL:"https://cdn.intechopen.com/books/images_new/11444.jpg",editedByType:null,editors:[{id:"174641",title:"Dr.",name:"Floriana",surname:"Irtelli",slug:"floriana-irtelli",fullName:"Floriana Irtelli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11478",title:"Recent Advances in the Study of Dyslexia",subtitle:null,isOpenForSubmission:!0,hash:"26764a18c6b776698823e0e1c3022d2f",slug:null,bookSignature:"Prof. Jonathan Glazzard",coverURL:"https://cdn.intechopen.com/books/images_new/11478.jpg",editedByType:null,editors:[{id:"294281",title:"Prof.",name:"Jonathan",surname:"Glazzard",slug:"jonathan-glazzard",fullName:"Jonathan Glazzard"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11777",title:"LGBT Communities",subtitle:null,isOpenForSubmission:!0,hash:"e08bb222c250dcebf093b7ab595a14a7",slug:null,bookSignature:"Dr. Deborah Woodman",coverURL:"https://cdn.intechopen.com/books/images_new/11777.jpg",editedByType:null,editors:[{id:"463750",title:"Dr.",name:"Deborah",surname:"Woodman",slug:"deborah-woodman",fullName:"Deborah Woodman"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11781",title:"Family Therapy - Recent Advances in Clinical and Crisis Settings",subtitle:null,isOpenForSubmission:!0,hash:"8c5b7d5e4233594de70d2f830209b757",slug:null,bookSignature:"Dr. Oluwatoyin Olatundun Ilesanmi",coverURL:"https://cdn.intechopen.com/books/images_new/11781.jpg",editedByType:null,editors:[{id:"440049",title:"Dr.",name:"Oluwatoyin Olatundun",surname:"Ilesanmi",slug:"oluwatoyin-olatundun-ilesanmi",fullName:"Oluwatoyin Olatundun Ilesanmi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11782",title:"Personality Traits - The Role in Psychopathology",subtitle:null,isOpenForSubmission:!0,hash:"d3a491e5194cad4c59b900dd57a11842",slug:null,bookSignature:" Vladimir V. Kalinin",coverURL:"https://cdn.intechopen.com/books/images_new/11782.jpg",editedByType:null,editors:[{id:"31572",title:null,name:"Vladimir V.",surname:"Kalinin",slug:"vladimir-v.-kalinin",fullName:"Vladimir V. Kalinin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11783",title:"Motivation and Success",subtitle:null,isOpenForSubmission:!0,hash:"f660b7cd35b9af94bdfc3564df138161",slug:null,bookSignature:"Dr. Simon George Taukeni",coverURL:"https://cdn.intechopen.com/books/images_new/11783.jpg",editedByType:null,editors:[{id:"202046",title:"Dr.",name:"Simon George",surname:"Taukeni",slug:"simon-george-taukeni",fullName:"Simon George Taukeni"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12109",title:"Identifying Occupational Stress and Coping Strategies",subtitle:null,isOpenForSubmission:!0,hash:"09a2f5fe50b90b20637b7aceccf1cfdd",slug:null,bookSignature:"Dr. Kavitha Palaniappan",coverURL:"https://cdn.intechopen.com/books/images_new/12109.jpg",editedByType:null,editors:[{id:"311189",title:"Dr.",name:"Kavitha",surname:"Palaniappan",slug:"kavitha-palaniappan",fullName:"Kavitha Palaniappan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12127",title:"The Psychology of Sports",subtitle:null,isOpenForSubmission:!0,hash:"4bf52abfe589a320744c40ca5fe41a89",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12127.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12135",title:"Parenting",subtitle:null,isOpenForSubmission:!0,hash:"5fcfe3872ea161c9c879e0667a220ca8",slug:null,bookSignature:"",coverURL:"//cdnintech.com/web/frontend/www/assets/cover.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:40},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:13},{group:"topic",caption:"Business, Management and Economics",value:7,count:7},{group:"topic",caption:"Chemistry",value:8,count:23},{group:"topic",caption:"Computer and Information Science",value:9,count:24},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:17},{group:"topic",caption:"Engineering",value:11,count:66},{group:"topic",caption:"Environmental Sciences",value:12,count:10},{group:"topic",caption:"Immunology and Microbiology",value:13,count:16},{group:"topic",caption:"Materials Science",value:14,count:26},{group:"topic",caption:"Mathematics",value:15,count:11},{group:"topic",caption:"Medicine",value:16,count:124},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:8},{group:"topic",caption:"Neuroscience",value:18,count:4},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:9},{group:"topic",caption:"Physics",value:20,count:10},{group:"topic",caption:"Psychology",value:21,count:10},{group:"topic",caption:"Robotics",value:22,count:2},{group:"topic",caption:"Social Sciences",value:23,count:9},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:4}],offset:12,limit:12,total:14},popularBooks:{featuredBooks:[{type:"book",id:"10901",title:"Grapes and Wine",subtitle:null,isOpenForSubmission:!1,hash:"5d7f2aa74874444bc6986e613ccebd7c",slug:"grapes-and-wine",bookSignature:"Antonio Morata, Iris Loira and Carmen González",coverURL:"https://cdn.intechopen.com/books/images_new/10901.jpg",editors:[{id:"180952",title:"Prof.",name:"Antonio",middleName:null,surname:"Morata",slug:"antonio-morata",fullName:"Antonio Morata"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11012",title:"Radiopharmaceuticals",subtitle:"Current Research for Better Diagnosis and Therapy",isOpenForSubmission:!1,hash:"f9046d6f96148b285e776f384991120d",slug:"radiopharmaceuticals-current-research-for-better-diagnosis-and-therapy",bookSignature:"Farid A. Badria",coverURL:"https://cdn.intechopen.com/books/images_new/11012.jpg",editors:[{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10787",title:"Hepatocellular Carcinoma",subtitle:"Challenges and Opportunities of a Multidisciplinary Approach",isOpenForSubmission:!1,hash:"bc00a66513e51003e5dbbc0294e0fc3d",slug:"hepatocellular-carcinoma-challenges-and-opportunities-of-a-multidisciplinary-approach",bookSignature:"Georgios Tsoulfas",coverURL:"https://cdn.intechopen.com/books/images_new/10787.jpg",editors:[{id:"57412",title:"Prof.",name:"Georgios",middleName:null,surname:"Tsoulfas",slug:"georgios-tsoulfas",fullName:"Georgios Tsoulfas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10841",title:"Hydrolases",subtitle:null,isOpenForSubmission:!1,hash:"4e868cde273d65a7ff54b1817d640629",slug:"hydrolases",bookSignature:"Sajjad Haider, Adnan Haider and Angel Catalá",coverURL:"https://cdn.intechopen.com/books/images_new/10841.jpg",editors:[{id:"110708",title:"Dr.",name:"Sajjad",middleName:null,surname:"Haider",slug:"sajjad-haider",fullName:"Sajjad Haider"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10797",title:"Cell Culture",subtitle:"Advanced Technology and Applications in Medical and Life Sciences",isOpenForSubmission:!1,hash:"2c628f4757f9639a4450728d839a7842",slug:"cell-culture-advanced-technology-and-applications-in-medical-and-life-sciences",bookSignature:"Xianquan Zhan",coverURL:"https://cdn.intechopen.com/books/images_new/10797.jpg",editors:[{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9537",title:"Human Rights in the Contemporary World",subtitle:null,isOpenForSubmission:!1,hash:"54f05b93812fd434f3962956d6413a6b",slug:"human-rights-in-the-contemporary-world",bookSignature:"Trudy Corrigan",coverURL:"https://cdn.intechopen.com/books/images_new/9537.jpg",editors:[{id:"197557",title:"Dr.",name:"Trudy",middleName:null,surname:"Corrigan",slug:"trudy-corrigan",fullName:"Trudy Corrigan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10193",title:"Multidisciplinary Experiences in Renal Replacement Therapy",subtitle:null,isOpenForSubmission:!1,hash:"3c4738671bb3e815744d1e04df7ba879",slug:"multidisciplinary-experiences-in-renal-replacement-therapy",bookSignature:"Ane C.F. Nunes",coverURL:"https://cdn.intechopen.com/books/images_new/10193.jpg",editors:[{id:"55270",title:"Prof.",name:"Ane",middleName:null,surname:"Claudia Fernandes Nunes",slug:"ane-claudia-fernandes-nunes",fullName:"Ane Claudia Fernandes Nunes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10983",title:"Conifers",subtitle:"Recent Advances",isOpenForSubmission:!1,hash:"3e524d29fc3f95c3389efbd41463dab6",slug:"conifers-recent-advances",bookSignature:"Ana Cristina Gonçalves and Teresa Fonseca",coverURL:"https://cdn.intechopen.com/books/images_new/10983.jpg",editors:[{id:"194484",title:"Prof.",name:"Ana Cristina",middleName:null,surname:"Gonçalves",slug:"ana-cristina-goncalves",fullName:"Ana Cristina Gonçalves"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10539",title:"Ginseng",subtitle:"Modern Aspects of the Famed Traditional Medicine",isOpenForSubmission:!1,hash:"5f388543a066b617d2c52bd4c027c272",slug:"ginseng-modern-aspects-of-the-famed-traditional-medicine",bookSignature:"Christophe Hano and Jen-Tsung Chen",coverURL:"https://cdn.intechopen.com/books/images_new/10539.jpg",editors:[{id:"313856",title:"Dr.",name:"Christophe",middleName:"F.E.",surname:"Hano",slug:"christophe-hano",fullName:"Christophe Hano"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10881",title:"Drug Repurposing",subtitle:"Molecular Aspects and Therapeutic Applications",isOpenForSubmission:!1,hash:"eca3f2d5ca97b457d38a2442b36d3ac7",slug:"drug-repurposing-molecular-aspects-and-therapeutic-applications",bookSignature:"Shailendra K. Saxena",coverURL:"https://cdn.intechopen.com/books/images_new/10881.jpg",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9974",title:"E-Learning and Digital Education in the Twenty-First Century",subtitle:null,isOpenForSubmission:!1,hash:"88b58d66e975df20425fc1dfd22d53aa",slug:"e-learning-and-digital-education-in-the-twenty-first-century",bookSignature:"M. Mahruf C. Shohel",coverURL:"https://cdn.intechopen.com/books/images_new/9974.jpg",editors:[{id:"94099",title:"Dr.",name:"M. Mahruf C.",middleName:null,surname:"Shohel",slug:"m.-mahruf-c.-shohel",fullName:"M. Mahruf C. Shohel"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10356",title:"Natural Medicinal Plants",subtitle:null,isOpenForSubmission:!1,hash:"943e56ccaaf19ff696d25aa638ae37d6",slug:"natural-medicinal-plants",bookSignature:"Hany A. El-Shemy",coverURL:"https://cdn.intechopen.com/books/images_new/10356.jpg",editors:[{id:"54719",title:"Prof.",name:"Hany",middleName:null,surname:"El-Shemy",slug:"hany-el-shemy",fullName:"Hany El-Shemy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:4424},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"10901",title:"Grapes and Wine",subtitle:null,isOpenForSubmission:!1,hash:"5d7f2aa74874444bc6986e613ccebd7c",slug:"grapes-and-wine",bookSignature:"Antonio Morata, Iris Loira and Carmen González",coverURL:"https://cdn.intechopen.com/books/images_new/10901.jpg",publishedDate:"June 15th 2022",numberOfDownloads:2204,editors:[{id:"180952",title:"Prof.",name:"Antonio",middleName:null,surname:"Morata",slug:"antonio-morata",fullName:"Antonio Morata"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11012",title:"Radiopharmaceuticals",subtitle:"Current Research for Better Diagnosis and Therapy",isOpenForSubmission:!1,hash:"f9046d6f96148b285e776f384991120d",slug:"radiopharmaceuticals-current-research-for-better-diagnosis-and-therapy",bookSignature:"Farid A. Badria",coverURL:"https://cdn.intechopen.com/books/images_new/11012.jpg",publishedDate:"June 15th 2022",numberOfDownloads:1182,editors:[{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10787",title:"Hepatocellular Carcinoma",subtitle:"Challenges and Opportunities of a Multidisciplinary Approach",isOpenForSubmission:!1,hash:"bc00a66513e51003e5dbbc0294e0fc3d",slug:"hepatocellular-carcinoma-challenges-and-opportunities-of-a-multidisciplinary-approach",bookSignature:"Georgios Tsoulfas",coverURL:"https://cdn.intechopen.com/books/images_new/10787.jpg",publishedDate:"June 15th 2022",numberOfDownloads:1006,editors:[{id:"57412",title:"Prof.",name:"Georgios",middleName:null,surname:"Tsoulfas",slug:"georgios-tsoulfas",fullName:"Georgios Tsoulfas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10841",title:"Hydrolases",subtitle:null,isOpenForSubmission:!1,hash:"4e868cde273d65a7ff54b1817d640629",slug:"hydrolases",bookSignature:"Sajjad Haider, Adnan Haider and Angel Catalá",coverURL:"https://cdn.intechopen.com/books/images_new/10841.jpg",publishedDate:"June 15th 2022",numberOfDownloads:863,editors:[{id:"110708",title:"Dr.",name:"Sajjad",middleName:null,surname:"Haider",slug:"sajjad-haider",fullName:"Sajjad Haider"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10797",title:"Cell Culture",subtitle:"Advanced Technology and Applications in Medical and Life Sciences",isOpenForSubmission:!1,hash:"2c628f4757f9639a4450728d839a7842",slug:"cell-culture-advanced-technology-and-applications-in-medical-and-life-sciences",bookSignature:"Xianquan Zhan",coverURL:"https://cdn.intechopen.com/books/images_new/10797.jpg",publishedDate:"June 15th 2022",numberOfDownloads:793,editors:[{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10193",title:"Multidisciplinary Experiences in Renal Replacement Therapy",subtitle:null,isOpenForSubmission:!1,hash:"3c4738671bb3e815744d1e04df7ba879",slug:"multidisciplinary-experiences-in-renal-replacement-therapy",bookSignature:"Ane C.F. Nunes",coverURL:"https://cdn.intechopen.com/books/images_new/10193.jpg",publishedDate:"June 15th 2022",numberOfDownloads:730,editors:[{id:"55270",title:"Prof.",name:"Ane",middleName:null,surname:"Claudia Fernandes Nunes",slug:"ane-claudia-fernandes-nunes",fullName:"Ane Claudia Fernandes Nunes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9537",title:"Human Rights in the Contemporary World",subtitle:null,isOpenForSubmission:!1,hash:"54f05b93812fd434f3962956d6413a6b",slug:"human-rights-in-the-contemporary-world",bookSignature:"Trudy Corrigan",coverURL:"https://cdn.intechopen.com/books/images_new/9537.jpg",publishedDate:"June 8th 2022",numberOfDownloads:2167,editors:[{id:"197557",title:"Dr.",name:"Trudy",middleName:null,surname:"Corrigan",slug:"trudy-corrigan",fullName:"Trudy Corrigan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10983",title:"Conifers",subtitle:"Recent Advances",isOpenForSubmission:!1,hash:"3e524d29fc3f95c3389efbd41463dab6",slug:"conifers-recent-advances",bookSignature:"Ana Cristina Gonçalves and Teresa Fonseca",coverURL:"https://cdn.intechopen.com/books/images_new/10983.jpg",publishedDate:"June 15th 2022",numberOfDownloads:600,editors:[{id:"194484",title:"Prof.",name:"Ana Cristina",middleName:null,surname:"Gonçalves",slug:"ana-cristina-goncalves",fullName:"Ana Cristina Gonçalves"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10539",title:"Ginseng",subtitle:"Modern Aspects of the Famed Traditional Medicine",isOpenForSubmission:!1,hash:"5f388543a066b617d2c52bd4c027c272",slug:"ginseng-modern-aspects-of-the-famed-traditional-medicine",bookSignature:"Christophe Hano and Jen-Tsung Chen",coverURL:"https://cdn.intechopen.com/books/images_new/10539.jpg",publishedDate:"June 15th 2022",numberOfDownloads:583,editors:[{id:"313856",title:"Dr.",name:"Christophe",middleName:"F.E.",surname:"Hano",slug:"christophe-hano",fullName:"Christophe Hano"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10881",title:"Drug Repurposing",subtitle:"Molecular Aspects and Therapeutic Applications",isOpenForSubmission:!1,hash:"eca3f2d5ca97b457d38a2442b36d3ac7",slug:"drug-repurposing-molecular-aspects-and-therapeutic-applications",bookSignature:"Shailendra K. Saxena",coverURL:"https://cdn.intechopen.com/books/images_new/10881.jpg",publishedDate:"June 1st 2022",numberOfDownloads:2231,editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"10755",title:"Corporate Governance",subtitle:"Recent Advances and Perspectives",isOpenForSubmission:!1,hash:"ffe06d1d5c4bf0fc2e63511825fe1257",slug:"corporate-governance-recent-advances-and-perspectives",bookSignature:"Okechukwu Lawrence Emeagwali and Feyza Bhatti",coverURL:"https://cdn.intechopen.com/books/images_new/10755.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"196317",title:"Associate Prof.",name:"Okechukwu Lawrence",middleName:null,surname:"Emeagwali",slug:"okechukwu-lawrence-emeagwali",fullName:"Okechukwu Lawrence Emeagwali"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11029",title:"Hepatitis B",subtitle:null,isOpenForSubmission:!1,hash:"609701f502efc3538c112ff47a2c2119",slug:"hepatitis-b",bookSignature:"Luis Rodrigo",coverURL:"https://cdn.intechopen.com/books/images_new/11029.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"73208",title:"Prof.",name:"Luis",middleName:null,surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10774",title:"Model Organisms in Plant Genetics",subtitle:null,isOpenForSubmission:!1,hash:"f6624b58571ac10c9b636c5d85ec5e54",slug:"model-organisms-in-plant-genetics",bookSignature:"Ibrokhim Y. Abdurakhmonov",coverURL:"https://cdn.intechopen.com/books/images_new/10774.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"213344",title:"Prof.",name:"Ibrokhim Y.",middleName:null,surname:"Abdurakhmonov",slug:"ibrokhim-y.-abdurakhmonov",fullName:"Ibrokhim Y. Abdurakhmonov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11332",title:"Essential Oils",subtitle:"Advances in Extractions and Biological Applications",isOpenForSubmission:!1,hash:"742e6cae3a35686f975edc8d7f9afa94",slug:"essential-oils-advances-in-extractions-and-biological-applications",bookSignature:"Mozaniel Santana de Oliveira and Eloisa Helena de Aguiar Andrade",coverURL:"https://cdn.intechopen.com/books/images_new/11332.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"195290",title:"Ph.D.",name:"Mozaniel",middleName:null,surname:"Santana De Oliveira",slug:"mozaniel-santana-de-oliveira",fullName:"Mozaniel Santana De Oliveira"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11080",title:"Engineering Principles",subtitle:"Welding and Residual Stresses",isOpenForSubmission:!1,hash:"6c07a13a113bce94174b40096f30fb5e",slug:"engineering-principles-welding-and-residual-stresses",bookSignature:"Kavian Omar Cooke and Ronaldo Câmara Cozza",coverURL:"https://cdn.intechopen.com/books/images_new/11080.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"138778",title:"Dr.",name:"Kavian",middleName:"Omar",surname:"Cooke",slug:"kavian-cooke",fullName:"Kavian Cooke"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10839",title:"Protein Detection",subtitle:null,isOpenForSubmission:!1,hash:"2f1c0e4e0207fc45c936e7d22a5369c4",slug:"protein-detection",bookSignature:"Yusuf Tutar and Lütfi Tutar",coverURL:"https://cdn.intechopen.com/books/images_new/10839.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10858",title:"MOOC (Massive Open Online Courses)",subtitle:null,isOpenForSubmission:!1,hash:"d32f86793bc72dde32532f509b1ec5b0",slug:"mooc-massive-open-online-courses-",bookSignature:"Dragan Cvetković",coverURL:"https://cdn.intechopen.com/books/images_new/10858.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11371",title:"Cerebral Circulation",subtitle:"Updates on Models, Diagnostics and Treatments of Related Diseases",isOpenForSubmission:!1,hash:"e2d3335445d2852d0b906bb9750e939f",slug:"cerebral-circulation-updates-on-models-diagnostics-and-treatments-of-related-diseases",bookSignature:"Alba Scerrati, Luca Ricciardi and Flavia Dones",coverURL:"https://cdn.intechopen.com/books/images_new/11371.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"182614",title:"Dr.",name:"Alba",middleName:null,surname:"Scerrati",slug:"alba-scerrati",fullName:"Alba Scerrati"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11120",title:"Environmental Impact and Remediation of Heavy Metals",subtitle:null,isOpenForSubmission:!1,hash:"9e77514288e7394f1e6cd13481af3509",slug:"environmental-impact-and-remediation-of-heavy-metals",bookSignature:"Hosam M. Saleh and Amal I. Hassan",coverURL:"https://cdn.intechopen.com/books/images_new/11120.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",middleName:null,surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10696",title:"Applications of Calorimetry",subtitle:null,isOpenForSubmission:!1,hash:"8c87f7e2199db33b5dd7181f56973a97",slug:"applications-of-calorimetry",bookSignature:"José Luis Rivera Armenta and Cynthia Graciela Flores Hernández",coverURL:"https://cdn.intechopen.com/books/images_new/10696.jpg",editedByType:"Edited by",publishedDate:"June 23rd 2022",editors:[{id:"107855",title:"Dr.",name:"Jose Luis",middleName:null,surname:"Rivera Armenta",slug:"jose-luis-rivera-armenta",fullName:"Jose Luis Rivera Armenta"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"174",title:"Dentistry",slug:"dentistry",parent:{id:"16",title:"Medicine",slug:"medicine"},numberOfBooks:32,numberOfSeries:1,numberOfAuthorsAndEditors:1009,numberOfWosCitations:764,numberOfCrossrefCitations:497,numberOfDimensionsCitations:1162,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"174",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"9493",title:"Periodontology",subtitle:"Fundamentals and Clinical Features",isOpenForSubmission:!1,hash:"dfe986c764d6c82ae820c2df5843a866",slug:"periodontology-fundamentals-and-clinical-features",bookSignature:"Petra Surlin",coverURL:"https://cdn.intechopen.com/books/images_new/9493.jpg",editedByType:"Edited by",editors:[{id:"171921",title:"Prof.",name:"Petra",middleName:null,surname:"Surlin",slug:"petra-surlin",fullName:"Petra Surlin"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9588",title:"Clinical Concepts and Practical Management Techniques in Dentistry",subtitle:null,isOpenForSubmission:!1,hash:"42deab8d3bcf3edf64d1d9028d42efd1",slug:"clinical-concepts-and-practical-management-techniques-in-dentistry",bookSignature:"Aneesa Moolla",coverURL:"https://cdn.intechopen.com/books/images_new/9588.jpg",editedByType:"Edited by",editors:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10126",title:"Dental Caries",subtitle:null,isOpenForSubmission:!1,hash:"0878a332413e67a1aa0a16fabeed9046",slug:"dental-caries",bookSignature:"Efka Zabokova Bilbilova",coverURL:"https://cdn.intechopen.com/books/images_new/10126.jpg",editedByType:"Edited by",editors:[{id:"275097",title:"Associate Prof.",name:"Efka",middleName:null,surname:"Zabokova Bilbilova",slug:"efka-zabokova-bilbilova",fullName:"Efka Zabokova Bilbilova"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9387",title:"Oral Diseases",subtitle:null,isOpenForSubmission:!1,hash:"76591a3bd6bedaa1c8d1f72870268e23",slug:"oral-diseases",bookSignature:"Gokul Sridharan, Anil Sukumaran and Alaa Eddin Omar Al Ostwani",coverURL:"https://cdn.intechopen.com/books/images_new/9387.jpg",editedByType:"Edited by",editors:[{id:"82453",title:"Dr.",name:"Gokul",middleName:null,surname:"Sridharan",slug:"gokul-sridharan",fullName:"Gokul Sridharan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8202",title:"Periodontal Disease",subtitle:"Diagnostic and Adjunctive Non-surgical Considerations",isOpenForSubmission:!1,hash:"0aee9799da7db2c732be44dd8fed16d8",slug:"periodontal-disease-diagnostic-and-adjunctive-non-surgical-considerations",bookSignature:"Nermin Mohammed Ahmed Yussif",coverURL:"https://cdn.intechopen.com/books/images_new/8202.jpg",editedByType:"Edited by",editors:[{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8837",title:"Human Teeth",subtitle:"Key Skills and Clinical Illustrations",isOpenForSubmission:!1,hash:"ac055c5801032970123e0a196c2e1d32",slug:"human-teeth-key-skills-and-clinical-illustrations",bookSignature:"Zühre Akarslan and Farid Bourzgui",coverURL:"https://cdn.intechopen.com/books/images_new/8837.jpg",editedByType:"Edited by",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan"}],equalEditorOne:{id:"52177",title:"Prof.",name:"Farid",middleName:null,surname:"Bourzgui",slug:"farid-bourzgui",fullName:"Farid Bourzgui",profilePictureURL:"https://mts.intechopen.com/storage/users/52177/images/system/52177.png",biography:"Prof. Farid Bourzgui obtained his DMD and his DNSO option in Orthodontics at the School of Dental Medicine, Casablanca Hassan II University, Morocco, in 1995 and 2000, respectively. Currently, he is a professor of Orthodontics. He holds a Certificate of Advanced Study type A in Technology of Biomaterials used in Dentistry (1995); Certificate of Advanced Study type B in Dento-Facial Orthopaedics (1997) from the Faculty of Dental Surgery, University Denis Diderot-Paris VII, France; Diploma of Advanced Study (DESA) in Biocompatibility of Biomaterials from the Faculty of Medicine and Pharmacy of Casablanca (2002); Certificate of Clinical Occlusodontics from the Faculty of Dentistry of Casablanca (2004); University Diploma of Biostatistics and Perceptual Health Measurement from the Faculty of Medicine and Pharmacy of Casablanca (2011); and a University Diploma of Pedagogy of Odontological Sciences from the Faculty of Dentistry of Casablanca (2013). He is the author of several scientific articles, book chapters, and books.",institutionString:"University of Hassan II Casablanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Hassan II Casablanca",institutionURL:null,country:{name:"Morocco"}}},equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",isOpenForSubmission:!1,hash:"b81d39988cba3a3cf746c1616912cf41",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",bookSignature:"Alaa Eddin Omar Al Ostwani",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",editedByType:"Edited by",editors:[{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"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7497",title:"Computer Vision in Dentistry",subtitle:null,isOpenForSubmission:!1,hash:"1e9812cebd46ef9e28257f3e96547f6a",slug:"computer-vision-in-dentistry",bookSignature:"Monika Elzbieta Machoy",coverURL:"https://cdn.intechopen.com/books/images_new/7497.jpg",editedByType:"Edited by",editors:[{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,isOpenForSubmission:!1,hash:"7cb94732cfb315f8d1e70ebf500eb8a9",slug:"trauma-in-dentistry",bookSignature:"Serdar Gözler",coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",editedByType:"Edited by",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,isOpenForSubmission:!1,hash:"2c77384eeb748cf05a898d65b9dcb48a",slug:"current-approaches-in-orthodontics",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",editedByType:"Edited by",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7056",title:"An Update of Dental Implantology and Biomaterial",subtitle:null,isOpenForSubmission:!1,hash:"fab27916553ca6427ec1be823a6d81f2",slug:"an-update-of-dental-implantology-and-biomaterial",bookSignature:"Mazen Ahmad Almasri",coverURL:"https://cdn.intechopen.com/books/images_new/7056.jpg",editedByType:"Edited by",editors:[{id:"150413",title:"Dr.",name:"Mazen Ahmad",middleName:null,surname:"Almasri",slug:"mazen-ahmad-almasri",fullName:"Mazen Ahmad Almasri"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7244",title:"Periodontology and Dental Implantology",subtitle:null,isOpenForSubmission:!1,hash:"b83fa9a75b23711bfaaa169dfb1b94ec",slug:"periodontology-and-dental-implantology",bookSignature:"Jane Manakil",coverURL:"https://cdn.intechopen.com/books/images_new/7244.jpg",editedByType:"Edited by",editors:[{id:"68285",title:"Dr.",name:"Jane",middleName:null,surname:"Manakil",slug:"jane-manakil",fullName:"Jane Manakil"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:32,seriesByTopicCollection:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0}],seriesByTopicTotal:1,mostCitedChapters:[{id:"18416",doi:"10.5772/16475",title:"Dental Implant Surface Enhancement and Osseointegration",slug:"dental-implant-surface-enhancement-and-osseointegration",totalDownloads:18671,totalCrossrefCites:38,totalDimensionsCites:99,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"S.Anil, P.S. Anand, H. Alghamdi and J.A. Jansen",authors:[{id:"25232",title:"Prof.",name:"Sukumaran",middleName:null,surname:"Anil",slug:"sukumaran-anil",fullName:"Sukumaran Anil"},{id:"28373",title:"Prof.",name:"John",middleName:null,surname:"Jansen",slug:"john-jansen",fullName:"John Jansen"},{id:"77058",title:"Dr.",name:"Seham",middleName:null,surname:"Alyafei",slug:"seham-alyafei",fullName:"Seham Alyafei"},{id:"82073",title:"Dr.",name:"Subhash",middleName:null,surname:"Narayanan",slug:"subhash-narayanan",fullName:"Subhash Narayanan"}]},{id:"18415",doi:"10.5772/16936",title:"Osseointegration and Bioscience of Implant Surfaces - Current Concepts at Bone-Implant Interface",slug:"osseointegration-and-bioscience-of-implant-surfaces-current-concepts-at-bone-implant-interface",totalDownloads:12497,totalCrossrefCites:16,totalDimensionsCites:42,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Mustafa Ramazanoglu and Yoshiki Oshida",authors:[{id:"26726",title:"Prof.",name:"Yoshiki",middleName:null,surname:"Oshida",slug:"yoshiki-oshida",fullName:"Yoshiki Oshida"},{id:"29841",title:"Prof.",name:"Mustafa",middleName:null,surname:"Ramazanoglu",slug:"mustafa-ramazanoglu",fullName:"Mustafa Ramazanoglu"}]},{id:"48165",doi:"10.5772/60010",title:"3D Scanning, Imaging, and Printing in Orthodontics",slug:"3d-scanning-imaging-and-printing-in-orthodontics",totalDownloads:6510,totalCrossrefCites:22,totalDimensionsCites:39,abstract:null,book:{id:"4574",slug:"issues-in-contemporary-orthodontics",title:"Issues in Contemporary Orthodontics",fullTitle:"Issues in Contemporary Orthodontics"},signatures:"Emilia Taneva, Budi Kusnoto and Carla A. Evans",authors:[{id:"96409",title:"Prof.",name:"Carla",middleName:null,surname:"Evans",slug:"carla-evans",fullName:"Carla Evans"},{id:"96472",title:"Prof.",name:"Budi",middleName:null,surname:"Kusnoto",slug:"budi-kusnoto",fullName:"Budi Kusnoto"},{id:"172854",title:"Dr.",name:"Emilia Taneva",middleName:null,surname:"Taneva",slug:"emilia-taneva-taneva",fullName:"Emilia Taneva Taneva"}]},{id:"18426",doi:"10.5772/18746",title:"Factors Affecting the Success of Dental Implants",slug:"factors-affecting-the-success-of-dental-implants",totalDownloads:17464,totalCrossrefCites:9,totalDimensionsCites:35,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Carlos Nelson Elias",authors:[{id:"32438",title:"Prof.",name:"Carlos",middleName:null,surname:"Elias",slug:"carlos-elias",fullName:"Carlos Elias"}]},{id:"32161",doi:"10.5772/38059",title:"Caries Through Time: An Anthropological Overview",slug:"caries-archaeological-and-historical-record",totalDownloads:6517,totalCrossrefCites:4,totalDimensionsCites:33,abstract:null,book:{id:"1742",slug:"contemporary-approach-to-dental-caries",title:"Contemporary Approach to Dental Caries",fullTitle:"Contemporary Approach to Dental Caries"},signatures:"Luis Pezo Lanfranco and Sabine Eggers",authors:[{id:"115399",title:"Dr.",name:"Luis",middleName:null,surname:"Pezo-Lanfranco",slug:"luis-pezo-lanfranco",fullName:"Luis Pezo-Lanfranco"}]}],mostDownloadedChaptersLast30Days:[{id:"61046",title:"Optical Diagnostics to Improve Periodontal Diagnosis and Treatment",slug:"optical-diagnostics-to-improve-periodontal-diagnosis-and-treatment",totalDownloads:7053,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The performance of clinicians undertaking periodontal assessment or periodontal therapy can be improved by using optical methods as adjuncts to visual inspection and periodontal probing. Subtle changes that occur over time in periodontal tissues that are below the detection limit of visual examination or periodontal probing can be found and tracked accurately over time using 3D imaging, fluorescence spectroscopy, and optical coherence tomography. During debridement of teeth and dental implants, the effective removal of subgingival microbial biofilms and dental calculus deposits can be enhanced using magnifying loupes and operating microscopes and by novel methods based on the interactions of light with bacterial deposits, such as differential reflectometry and light-induced fluorescence. While such techniques can also be used using initial case assessment, their primary purpose is for checking debridement procedures, since the point when bacterial deposits are no longer present represents an endpoint for treatment. The concept of real-time feedback has been developed, using fluorescence readings to control the removal of deposits. Overall, optical methods can support traditional periodontal diagnosis and improve treatment planning and clinical periodontal care.",book:{id:"7244",slug:"periodontology-and-dental-implantology",title:"Periodontology and Dental Implantology",fullTitle:"Periodontology and Dental Implantology"},signatures:"Fardad Shakibaie and Laurence Walsh",authors:[{id:"179467",title:"Prof.",name:"Laurence",middleName:null,surname:"Walsh",slug:"laurence-walsh",fullName:"Laurence Walsh"},{id:"235443",title:"Dr.",name:"Fardad",middleName:null,surname:"Shakibaie",slug:"fardad-shakibaie",fullName:"Fardad Shakibaie"}]},{id:"24363",title:"Biomechanics of Tooth-Movement: Current Look at Orthodontic Fundamental",slug:"biomechanics-of-tooth-movement-current-look-at-orthodontic-fundamental",totalDownloads:26685,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"277",slug:"principles-in-contemporary-orthodontics",title:"Principles in Contemporary Orthodontics",fullTitle:"Principles in Contemporary Orthodontics"},signatures:"Joanna Antoszewska and Nazan Küçükkeles",authors:[{id:"50158",title:"Prof.",name:"Joanna",middleName:null,surname:"Antoszewska",slug:"joanna-antoszewska",fullName:"Joanna Antoszewska"}]},{id:"71271",title:"Flap Techniques in Dentoalveolar Surgery",slug:"flap-techniques-in-dentoalveolar-surgery",totalDownloads:2524,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Most dentoalveolar procedures involve the reflection of mucosal flaps. This step is crucial for exposure or removal of impacted teeth, implant bed preparation, exposure of the alveolar bone for augmentation, periodontal surgeries, and repair of mucosal soft tissue defects, such as oroantral fistula. Because of the rich vascularity of the oral mucosa, great freedom is allowed for flap design, but it tends to result in carelessness and lack of thoughtful planning, which may lead to uneventful outcomes or/and complications. In this chapter, we review oral anatomy, classification, indications, and complications of common oral flap techniques; common flap designs are illustrated, and their fundamental principles are highlighted. The review has covered various flap designs based on their indications. Yet the common flap’s principles are fundamental for all types of flaps regardless of their application, namely, it should provide wide exposure, clear vision, good access, and assure rich vascularity and good final aesthetic outcome.",book:{id:"9387",slug:"oral-diseases",title:"Oral Diseases",fullTitle:"Oral Diseases"},signatures:"Randa Abdulmoein AlFotawi",authors:[{id:"308701",title:"Dr.",name:"Randa",middleName:"Abdulmoein",surname:"Alfotawi",slug:"randa-alfotawi",fullName:"Randa Alfotawi"}]},{id:"65088",title:"Evaluation and Management of Mandibular Fracture",slug:"evaluation-and-management-of-mandibular-fracture",totalDownloads:2862,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The mandibular bone is an important component of the facial bone, which has a unique role in digestive system, speech, and facial esthetics. For these important functions of mandibular bone, it is vital that surgeons should not only treat function but also consider the esthetics together. Mandibular fractures are among the most common traumatic injuries of the maxillofacial region. Even though treatment modalities are well established and being practiced for a long time, untreated and postoperative complications still decrease the patient’s quality of life. This chapter aims to describe the cause, clinical presentations, diagnoses, and current treatment methods on the basis of resent literature.",book:{id:"7572",slug:"trauma-in-dentistry",title:"Trauma in Dentistry",fullTitle:"Trauma in Dentistry"},signatures:"Guhan Dergin, Yusuf Emes and Buket Aybar",authors:[{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin"},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes"},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar"}]},{id:"56461",title:"Permanent Maxillary and Mandibular Incisors",slug:"permanent-maxillary-and-mandibular-incisors",totalDownloads:2611,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The permanent incisors are the front teeth that erupt between 6 and 8 years of age. They are eight in number, four upper and four lower, two centrals and two laterals. They have sharp biting surfaces designed for shearing and cutting of food materials into small chewable pieces. They are the teeth most visible to the others during eating, smiling and talking, and thus, they have high aesthetic value for the individuals. The unique characteristics, arch position, function, development and chronological age of each tooth will be highlighted. In addition, the different aspects with their geometric outlines, outlines and surface anatomy of these teeth will be described. A brief explanation about the pulp cavity, tooth socket and normal occlusion for each tooth will be included.",book:{id:"5814",slug:"dental-anatomy",title:"Dental Anatomy",fullTitle:"Dental Anatomy"},signatures:"Mohammed E. Grawish, Lamyaa M. Grawish and Hala M. Grawish",authors:[{id:"82989",title:"Prof.",name:"Mohammed",middleName:"E",surname:"Grawish",slug:"mohammed-grawish",fullName:"Mohammed Grawish"}]}],onlineFirstChaptersFilter:{topicId:"174",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81595",title:"Prosthetic Concepts in Dental Implantology",slug:"prosthetic-concepts-in-dental-implantology",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.104725",abstract:"This chapter will address evidence-based prosthetic concepts in dental implantology as well as clinical evidence with focus on appropriate logic and technical skills. Those prosthetic factors are as just important as surgical factors, and long-term success can only be achieved if both of those factors are considered, respected, and strictly followed from planning to prosthetic phase of treatment. This chapter will deal with materials selection for prosthetic part, shape, size, and design of supracrestal parts of abutments and their influence on soft tissue and bone stability around dental implants. Furthermore, one of most important decisions is about choosing the proper way of retention: screw- vs. cement-retained restorations, and it will be discussed in detail. Additionally, emergence profile and its function in soft tissues adaptation and adhesion to different prosthetic materials also have important role in long-term success of dental implant restorations.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Ivica Pelivan"},{id:"80964",title:"Upper Airway Expansion in Disabled Children",slug:"upper-airway-expansion-in-disabled-children",totalDownloads:35,totalDimensionsCites:0,doi:"10.5772/intechopen.102830",abstract:"Breathing is essential for life in all of its stages. Cellular, mitochondrial respiration requires an adequate supply of oxygen, provided by the air we breathe, after airway conduction, treatment by the lungs, and transport to tissues. At different stages of life, pediatric dentists and orthodontists can intervene in the upper airway, expanding it, which helps with ventilation. The greater airway space, if used, contributes in different ways to the child’s development and the recovery of respiratory problems and should always be present as a weapon that physicians and the population should know. The value of the techniques becomes even more important when applied to children and young people with disabilities who can significantly improve their development and performance. Rapid Maxillary Expansion and Extraoral Traction Appliances are two important pediatric resources to treat these children. Clinical practice of the authors, is discussed, emphasizing the importance of early intervention and the need for multi and interdisciplinary collaboration in the follow-up of disabled people.",book:{id:"10827",title:"Oral Health Care - An Important Issue of the Modern Society",coverURL:"https://cdn.intechopen.com/books/images_new/10827.jpg"},signatures:"David Andrade, Joana Andrade, Maria-João Palha, Cristina Areias, Paula Macedo, Ana Norton, Miguel Palha, Lurdes Morais, Dóris Rocha Ruiz and Sônia Groisman"},{id:"80963",title:"Pain Perception in Patients Treated with Ligating/Self-Ligating Brackets versus Patients Treated with Aligners",slug:"pain-perception-in-patients-treated-with-ligating-self-ligating-brackets-versus-patients-treated-wit",totalDownloads:20,totalDimensionsCites:0,doi:"10.5772/intechopen.102796",abstract:"This study compared the perception of pain experienced by patients undergoing orthodontic treatment with conventional, self-ligating brackets and aligners, and investigated the impact that pain had on their daily lives. 346 consecutive patients were included in the study: 115 patients treated with conventional brackets, 112 Patients treated with self-ligating brackets, and 119 patients treated with aligners. The quantitative aspect of pain was assessed using the Visual Analogue Scale, while the qualitative aspect of pain was evaluated using the Moroccan Short Form of McGILL Pain questionnaire. In all three groups experienced pain after activation tended to decrease in the following week. This pain was greater in patients with conventional braces and less in patients with aligners. Using the M-SF-MPQ to describe the qualitative aspect of the pain revealed that the “cramping مزير,” “aching تيألم ” aspect was most accentuated in the 3 groups. Medication intake was correlated with the intensity of pain experienced in all 3 systems. As for the impact of pain on daily activities, patients in groups of conventional and self-ligating braces showed more pain than those in the aligners group. Overall, aligners were less painful than conventional and self-ligating appliances. Patients did not suffer from an alteration in their quality of life due to orthodontic treatment.",book:{id:"10780",title:"Current Trends in Orthodontics",coverURL:"https://cdn.intechopen.com/books/images_new/10780.jpg"},signatures:"Farid Bourzgui, Rania Fastani, Salwa Khairat, Samir Diouny, Mohamed El Had, Zineb Serhier and Mohamed Bennani Othmani"},{id:"80839",title:"Herbs and Oral Health",slug:"herbs-and-oral-health",totalDownloads:55,totalDimensionsCites:0,doi:"10.5772/intechopen.103715",abstract:"Herbal medicine has long been used to prevent and control disease, and it can minimize the potential side effects of chemical products. However, side effects from herbs do exist. Most of the challenges with herbal medicine revolves around inadequate information about the effect of herbs in the oral cavity, the mechanism of action, and potential side effects. There are several herbs described in this chapter have anti-inflammatory, anti-bacterial, anti-viral, anti-fungal in oral micro-organisms. It includes aloe vera, ginger, clove, cinnamon, garlic, neem, miswak, turmeric, tulsi, green tea, chamomile, fenugreek, anise plant, peppermint, bloodroot, caraway, eucalyptus, phyllanthus emblica, black seed, myrrh, rosemary, sage, and thyme; some may act as an alternative management option to current treatments for oral conditions such as caries prevention, gingivitis, periodontitis, oral burn, ulcers and inflammation, after extraction, dry mouth, pain reduction, anesthesia, intracanal medications, ill-fitting dentures, peri-implant mucositis and peri-implantitis. It can be used in several forms such as mouthwashes, toothpastes, topical agents or local drug delivery devices. However, more research is needed to understand their mechanisms and potential side effects.",book:{id:"10827",title:"Oral Health Care - An Important Issue of the Modern Society",coverURL:"https://cdn.intechopen.com/books/images_new/10827.jpg"},signatures:"Zuhair S. Natto"},{id:"80500",title:"Novel Dental Implants with Herbal Composites: A Review",slug:"novel-dental-implants-with-herbal-composites-a-review",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.101489",abstract:"Missing a permanent tooth is a miserable condition faced by a common man. A tooth decay, periodontitis, mechanical trauma, or any systemic complications lead to such a complication. These bone defects when left untreated lead to severe resorption of the alveolar bone. A proper dental filling with an appropriate bone substitute material could prevent such resorption and paves a way for subsequent implant placement. Dental implants are considered as the prime option by dentists to replace a single tooth or prevent bone resorption. A variety of bone substitutes are available differ in origin, consistency, particle size, porosity, and resorption characteristics. Herbal composites in dentistry fabricated using biphospho-calcium phosphate, casein, chitosan, and certain herbal extracts of Cassia occidentalis, Terminalia arjuna bark, Myristica fragans also were reported to possess a higher ossification property, osteogenic property and were able to repair bone defects. C. occidentalis was reported to stimulate mineralization of the bone and osteoblastic differentiation through the activation of the PI3K-Akt/MAPKs pathway in MC3T3-E1 cells of mice. This implant proved better osteoconductivity and bioactivity compared to pure HAP and other BCP ratios. Terminalia Arjuna was also worked in the incorporation in the graft to enhance the osteogenic property of the implant and gave good results. Another implant bone graft was synthesized containing BCP, biocompatible casein, and the extracts of Myristica fragans and subjected to in vitro investigations and the results revealed the deposition of apatite on the graft after immersing in SBF and also the ALP activity was high when treated with MG-63 cells, NIH-3 T3, and Saos 2 cell lines. This study indicates that the inclusion of plant extract enhances the osteogenic property of the graft. Thus, these novel dental implants incorporated with herbal composites evaluated by researchers revealed an enhanced bone healing, accelerates osseointegration, inhibits osteopenia, and inhibits inflammation. This application of herbal composite inclusion in dentistry and its applications has a greater potential to improve the success rate of dental implants and allows the implications of biotechnology in implant dentistry.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Gopathy Sridevi and Seshadri Srividya"},{id:"78320",title:"Implant-Retained Maxillary and Mandibular Overdentures - A Solution for Completely Edentulous Patients",slug:"implant-retained-maxillary-and-mandibular-overdentures-a-solution-for-completely-edentulous-patients",totalDownloads:63,totalDimensionsCites:0,doi:"10.5772/intechopen.99575",abstract:"The main goal of modern removable prosthodontics is to restore the normal appearance, function, esthetics and speech in each completely edentulous patient. However, if all teeth are missing in a patient, it becomes very complicated to achieve it using traditional protocols. Therefore, implants were introduced into removable prosthodontics to ensure better retention and stability of the conventional dentures. In case of a large amount of bone missing in the jaw it is necessary to ensure the functioning of the dentures constructing various additional stabilizing and retentive prosthodontic solutions on the osseointegrated implants. Numerous types of attachment systems have been used recently for relating implant-retained overdentures to underlying implants: basically splinting (various bar shape designs) and non-splinting attachments (various ball type attachment, magnet attachment, telescopic coping systems). Indications for their use depend on the surgical and prosthodontic factors such as the number and position of the implants, the amount of free intermaxillary space and the type and size of the overdentures. Different indications, types of the overdentures and the attachment systems will be discussed in this chapter.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Dubravka Knezović Zlatarić, Robert Ćelić and Hrvoje Pezo"}],onlineFirstChaptersTotal:53},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:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:31,numberOfPublishedChapters:314,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:105,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:16,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:4,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:14,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"22",title:"Business, Management and Economics",doi:"10.5772/intechopen.100359",issn:"2753-894X",scope:"\r\n\tThis series will provide a comprehensive overview of recent research trends in business and management, economics, and marketing. Topics will include asset liability management, financial consequences of the financial crisis and covid-19, financial accounting, mergers and acquisitions, management accounting, SMEs, financial markets, corporate finance and governance, managerial technology and innovation, resource management and sustainable development, social entrepreneurship, corporate responsibility, ethics and accountability, microeconomics, labour economics, macroeconomics, public economics, financial economics, econometrics, direct marketing, creative marketing, internet marketing, market planning and forecasting, brand management, market segmentation and targeting and other topics under business and management. This book series will focus on various aspects of business and management whose in-depth understanding is critical for business and company management to function effectively during this uncertain time of financial crisis, Covid-19 pandemic, and military activity in Europe.
",coverUrl:"https://cdn.intechopen.com/series/covers/22.jpg",latestPublicationDate:"June 23rd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:1,editor:{id:"356540",title:"Prof.",name:"Taufiq",middleName:null,surname:"Choudhry",slug:"taufiq-choudhry",fullName:"Taufiq Choudhry",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000036X2hvQAC/Profile_Picture_2022-03-14T08:58:03.jpg",biography:"Prof. Choudhry holds a BSc degree in Economics from the University of Iowa, as well as a Masters and Ph.D. in Applied Economics from Clemson University, USA. In January 2006, he became a Professor of Finance at the University of Southampton Business School. He was previously a Professor of Finance at the University of Bradford Management School. He has over 80 articles published in international finance and economics journals. His research interests and specialties include financial econometrics, financial economics, international economics and finance, housing markets, financial markets, among others.",institutionString:null,institution:{name:"University of Southampton",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:5,paginationItems:[{id:"86",title:"Business and Management",coverUrl:"https://cdn.intechopen.com/series_topics/covers/86.jpg",editor:{id:"128342",title:"Prof.",name:"Vito",middleName:null,surname:"Bobek",slug:"vito-bobek",fullName:"Vito Bobek",profilePictureURL:"https://mts.intechopen.com/storage/users/128342/images/system/128342.jpg",biography:"Dr. Vito Bobek works as an international management professor at the University of Applied Sciences FH Joanneum, Graz, Austria. He has published more than 400 works in his academic career and visited twenty-two universities worldwide as a visiting professor. Dr. Bobek is a member of the editorial boards of six international journals and a member of the Strategic Council of the Minister of Foreign Affairs of the Republic of Slovenia. He has a long history in academia, consulting, and entrepreneurship. His own consulting firm, Palemid, has managed twenty significant projects, such as Cooperation Program Interreg V-A (Slovenia-Austria) and Capacity Building for the Serbian Chamber of Enforcement Agents. He has also participated in many international projects in Italy, Germany, Great Britain, the United States, Spain, Turkey, France, Romania, Croatia, Montenegro, Malaysia, and China. Dr. Bobek is also a co-founder of the Academy of Regional Management in Slovenia.",institutionString:"Universities of Applied Sciences FH Joanneum, Austria",institution:null},editorTwo:{id:"293992",title:"Dr.",name:"Tatjana",middleName:null,surname:"Horvat",slug:"tatjana-horvat",fullName:"Tatjana Horvat",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hXb0hQAC/Profile_Picture_1642419002203",biography:"Tatjana Horvat works as a professor for accountant and auditing at the University of Primorska, Slovenia. She is a Certified State Internal Auditor (licensed by Ministry of Finance RS) and Certified Internal Auditor for Business Sector and Certified accountant (licensed by Slovenian Institute of Auditors). At the Ministry of Justice of Slovenia, she is a member of examination boards for court expert candidates and judicial appraisers in the following areas: economy/finance, valuation of companies, banking, and forensic investigation of economic operations/accounting. At the leading business newspaper Finance in Slovenia (Swedish ownership), she is the editor and head of the area for business, finance, tax-related articles, and educational programs.",institutionString:null,institution:{name:"University of Primorska",institutionURL:null,country:{name:"Slovenia"}}},editorThree:null,editorialBoard:[{id:"114318",title:"Dr.",name:"David",middleName:null,surname:"Rodeiro",slug:"david-rodeiro",fullName:"David Rodeiro",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS2a8QAC/Profile_Picture_2022-04-22T08:29:52.jpg",institutionString:null,institution:{name:"University of Santiago de Compostela",institutionURL:null,country:{name:"Spain"}}},{id:"114073",title:"Prof.",name:"Jörg",middleName:null,surname:"Freiling",slug:"jorg-freiling",fullName:"Jörg Freiling",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS2UPQA0/Profile_Picture_1642580983875",institutionString:null,institution:{name:"University of Bremen",institutionURL:null,country:{name:"Germany"}}},{id:"202681",title:"Dr.",name:"Mojca",middleName:null,surname:"Duh",slug:"mojca-duh",fullName:"Mojca Duh",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSD2dQAG/Profile_Picture_1644907300283",institutionString:null,institution:{name:"University of Maribor",institutionURL:null,country:{name:"Slovenia"}}},{id:"103802",title:"Ph.D.",name:"Ondrej",middleName:null,surname:"Zizlavsky",slug:"ondrej-zizlavsky",fullName:"Ondrej Zizlavsky",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQJQA0/Profile_Picture_1643100292225",institutionString:null,institution:{name:"Brno University of Technology",institutionURL:null,country:{name:"Czech Republic"}}},{id:"190913",title:"Dr.",name:"Robert M.X.",middleName:null,surname:"Wu",slug:"robert-m.x.-wu",fullName:"Robert M.X. Wu",profilePictureURL:"https://mts.intechopen.com/storage/users/190913/images/system/190913.jpg",institutionString:"Central Queensland University",institution:{name:"Central Queensland University",institutionURL:null,country:{name:"Australia"}}}]},{id:"87",title:"Economics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/87.jpg",editor:{id:"327730",title:"Prof.",name:"Jaime",middleName:null,surname:"Ortiz",slug:"jaime-ortiz",fullName:"Jaime Ortiz",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002zaOKZQA2/Profile_Picture_1642145584421",biography:"Dr. Jaime Ortiz holds degrees from Chile, the Netherlands, and the United States. He has held tenured faculty, distinguished professorship, and executive leadership appointments in several universities around the world. Dr. Ortiz has previously worked for international organizations and non-government entities in economic and business matters, and he has university-wide globalization engagement in more than thirty-six countries. He has advised, among others, the United Nations Development Program, Inter-American Development Bank, Organization of American States, Pre-investment Organization of Latin America and the Caribbean, Technical Cooperation of the Suisse Government, and the World Bank. Dr. Ortiz is the author, co-author, or editor of books, book chapters, textbooks, research monographs and technical reports, and refereed journal articles. He is listed in Who’s Who in the World, Who’s Who in America, Who’s Who in Finance and Business, Who’s Who in Business Higher Education, Who’s Who in American Education, and Who’s Who Directory of Economists. Dr. Ortiz has been a Fulbright Scholar and an MSI Leadership Fellow with the W.K. Kellogg Foundation. His teaching interests revolve around global economies and markets while his research focuses on topics related to development and growth, global business decisions, and the economics of technical innovation.",institutionString:null,institution:{name:"University of Houston",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"104262",title:"Dr.",name:"Chee-Heong",middleName:null,surname:"Quah",slug:"chee-heong-quah",fullName:"Chee-Heong Quah",profilePictureURL:"https://mts.intechopen.com/storage/users/104262/images/system/104262.jpg",institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},{id:"236659",title:"Prof.",name:"Monica Violeta",middleName:null,surname:"Achim",slug:"monica-violeta-achim",fullName:"Monica Violeta Achim",profilePictureURL:"https://mts.intechopen.com/storage/users/236659/images/system/236659.jpg",institutionString:null,institution:{name:"Babeș-Bolyai University",institutionURL:null,country:{name:"Romania"}}},{id:"202039",title:"Dr.",name:"Nahanga",middleName:null,surname:"Verter",slug:"nahanga-verter",fullName:"Nahanga Verter",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCwtQAG/Profile_Picture_1643101901237",institutionString:null,institution:{name:"Mendel University Brno",institutionURL:null,country:{name:"Czech Republic"}}},{id:"107745",title:"Emeritus Prof.",name:"Panagiotis E.",middleName:null,surname:"Petrakis",slug:"panagiotis-e.-petrakis",fullName:"Panagiotis E. Petrakis",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRzzaQAC/Profile_Picture_1644221136992",institutionString:null,institution:{name:"National and Kapodistrian University of Athens",institutionURL:null,country:{name:"Greece"}}},{id:"196259",title:"Dr.",name:"Ryan Merlin",middleName:null,surname:"Yonk",slug:"ryan-merlin-yonk",fullName:"Ryan Merlin Yonk",profilePictureURL:"https://mts.intechopen.com/storage/users/196259/images/system/196259.jpg",institutionString:null,institution:{name:"American Institute for Economic Research",institutionURL:null,country:{name:"United States of America"}}}]}]},overviewPageOFChapters:{paginationCount:13,paginationItems:[{id:"82285",title:"Parvovirus Vectors: The Future of Gene Therapy",doi:"10.5772/intechopen.105085",signatures:"Megha Gupta",slug:"parvovirus-vectors-the-future-of-gene-therapy",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"81793",title:"Canine parvovirus-2: An Emerging Threat to Young Pets",doi:"10.5772/intechopen.104846",signatures:"Mithilesh Singh, Rajendran Manikandan, Ujjwal Kumar De, Vishal Chander, Babul Rudra Paul, Saravanan Ramakrishnan and Darshini Maramreddy",slug:"canine-parvovirus-2-an-emerging-threat-to-young-pets",totalDownloads:15,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"81271",title:"The Diversity of Parvovirus Telomeres",doi:"10.5772/intechopen.102684",signatures:"Marianne Laugel, Emilie Lecomte, Eduard Ayuso, Oumeya Adjali, Mathieu Mével and Magalie Penaud-Budloo",slug:"the-diversity-of-parvovirus-telomeres",totalDownloads:38,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"79209",title:"Virtual Physiology: A Tool for the 21st Century",doi:"10.5772/intechopen.99671",signatures:"Carmen Nóbrega, Maria Aires Pereira, Catarina Coelho, Isabel Brás, Ana Cristina Mega, Carla Santos, Fernando Esteves, Rita Cruz, Ana I. Faustino-Rocha, Paula A. Oliveira, João Mesquita and Helena Vala",slug:"virtual-physiology-a-tool-for-the-21st-century",totalDownloads:150,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Veterinary Anatomy and Physiology",coverURL:"https://cdn.intechopen.com/books/images_new/10665.jpg",subseries:{id:"19",title:"Animal Science"}}}]},overviewPagePublishedBooks:{paginationCount:11,paginationItems:[{type:"book",id:"7233",title:"New Insights into Theriogenology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7233.jpg",slug:"new-insights-into-theriogenology",publishedDate:"December 5th 2018",editedByType:"Edited by",bookSignature:"Rita Payan-Carreira",hash:"74f4147e3fb214dd050e5edd3aaf53bc",volumeInSeries:1,fullTitle:"New Insights into Theriogenology",editors:[{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}}]},{type:"book",id:"7144",title:"Veterinary Anatomy and Physiology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7144.jpg",slug:"veterinary-anatomy-and-physiology",publishedDate:"March 13th 2019",editedByType:"Edited by",bookSignature:"Catrin Sian Rutland and Valentina Kubale",hash:"75cdacb570e0e6d15a5f6e69640d87c9",volumeInSeries:2,fullTitle:"Veterinary Anatomy and Physiology",editors:[{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}}]},{type:"book",id:"8524",title:"Lactation in Farm Animals",subtitle:"Biology, Physiological Basis, Nutritional Requirements, and Modelization",coverURL:"https://cdn.intechopen.com/books/images_new/8524.jpg",slug:"lactation-in-farm-animals-biology-physiological-basis-nutritional-requirements-and-modelization",publishedDate:"January 22nd 2020",editedByType:"Edited by",bookSignature:"Naceur M'Hamdi",hash:"2aa2a9a0ec13040bbf0455e34625504e",volumeInSeries:3,fullTitle:"Lactation in Farm Animals - Biology, Physiological Basis, Nutritional Requirements, and Modelization",editors:[{id:"73376",title:"Dr.",name:"Naceur",middleName:null,surname:"M'Hamdi",slug:"naceur-m'hamdi",fullName:"Naceur M'Hamdi",profilePictureURL:"https://mts.intechopen.com/storage/users/73376/images/system/73376.jpg",biography:"Naceur M’HAMDI is Associate Professor at the National Agronomic Institute of Tunisia, University of Carthage. He is also Member of the Laboratory of genetic, animal and feed resource and member of Animal science Department of INAT. He graduated from Higher School of Agriculture of Mateur, University of Carthage, in 2002 and completed his masters in 2006. Dr. M’HAMDI completed his PhD thesis in Genetic welfare indicators of dairy cattle at Higher Institute of Agronomy of Chott-Meriem, University of Sousse, in 2011. He worked as assistant Professor of Genetic, biostatistics and animal biotechnology at INAT since 2013.",institutionString:null,institution:null}]},{type:"book",id:"8460",title:"Reproductive Biology and Technology in Animals",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/8460.jpg",slug:"reproductive-biology-and-technology-in-animals",publishedDate:"April 15th 2020",editedByType:"Edited by",bookSignature:"Juan Carlos Gardón Poggi and Katy Satué Ambrojo",hash:"32ef5fe73998dd723d308225d756fa1e",volumeInSeries:4,fullTitle:"Reproductive Biology and Technology in Animals",editors:[{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón",slug:"juan-carlos-gardon",fullName:"Juan Carlos Gardón",profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:"Catholic University of Valencia San Vicente Mártir, Spain",institution:null}]}]},openForSubmissionBooks:{paginationCount:6,paginationItems:[{id:"11475",title:"Food Security Challenges and Approaches",coverURL:"https://cdn.intechopen.com/books/images_new/11475.jpg",hash:"090302a30e461cee643ec49675c811ec",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 5th 2022",isOpenForSubmission:!0,editors:[{id:"292145",title:"Dr.",name:"Muhammad",surname:"Haseeb Ahmad",slug:"muhammad-haseeb-ahmad",fullName:"Muhammad Haseeb Ahmad"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11450",title:"Environmental Impacts of COVID-19 Pandemic on the World",coverURL:"https://cdn.intechopen.com/books/images_new/11450.jpg",hash:"a58c7b02d07903004be70f744f2e1835",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 10th 2022",isOpenForSubmission:!0,editors:[{id:"63465",title:"Prof.",name:"Mohamed Nageeb",surname:"Rashed",slug:"mohamed-nageeb-rashed",fullName:"Mohamed Nageeb Rashed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11477",title:"Public Economics - New Perspectives and Uncertainty",coverURL:"https://cdn.intechopen.com/books/images_new/11477.jpg",hash:"a8e6c515dc924146fbd2712eb4e7d118",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 27th 2022",isOpenForSubmission:!0,editors:[{id:"414400",title:"Dr.",name:"Habtamu",surname:"Alem",slug:"habtamu-alem",fullName:"Habtamu Alem"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11457",title:"Forest Degradation Under Global Change",coverURL:"https://cdn.intechopen.com/books/images_new/11457.jpg",hash:"8df7150b01ae754024c65d1a62f190d9",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"June 1st 2022",isOpenForSubmission:!0,editors:[{id:"317087",title:"Dr.",name:"Pavel",surname:"Samec",slug:"pavel-samec",fullName:"Pavel Samec"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11474",title:"Quality of Life Interventions - Magnitude of Effect and Transferability",coverURL:"https://cdn.intechopen.com/books/images_new/11474.jpg",hash:"5a6bcdaf5ee144d043bcdab893ff9e1c",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"July 7th 2022",isOpenForSubmission:!0,editors:[{id:"245319",title:"Ph.D.",name:"Sage",surname:"Arbor",slug:"sage-arbor",fullName:"Sage Arbor"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11473",title:"Social Inequality - Structure and Social Processes",coverURL:"https://cdn.intechopen.com/books/images_new/11473.jpg",hash:"cefab077e403fd1695fb2946e7914942",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"July 13th 2022",isOpenForSubmission:!0,editors:[{id:"313341",title:"Ph.D.",name:"Yaroslava",surname:"Robles-Bykbaev",slug:"yaroslava-robles-bykbaev",fullName:"Yaroslava Robles-Bykbaev"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:5,paginationItems:[{id:"82269",title:"CSR Reporting and Blockchain Technology",doi:"10.5772/intechopen.105512",signatures:"Pattarake Sarajoti, Pattanaporn Chatjuthamard, Suwongrat Papangkorn and Piyachart Phiromswad",slug:"csr-reporting-and-blockchain-technology",totalDownloads:0,totalCrossrefCites:null,totalDimensionsCites:0,authors:null,book:{title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg",subseries:{id:"86",title:"Business and Management"}}},{id:"82270",title:"From Corporate Social Opportunity to Corporate Social Responsibility",doi:"10.5772/intechopen.105445",signatures:"Brian Bolton",slug:"from-corporate-social-opportunity-to-corporate-social-responsibility",totalDownloads:0,totalCrossrefCites:null,totalDimensionsCites:0,authors:null,book:{title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg",subseries:{id:"86",title:"Business and Management"}}},{id:"82339",title:"Green Human Resource Management: An Exploratory Study from Moroccan ISO 14001 Certified Companies",doi:"10.5772/intechopen.105565",signatures:"Hosna Hossari and Kaoutar Elfahli",slug:"green-human-resource-management-an-exploratory-study-from-moroccan-iso-14001-certified-companies",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg",subseries:{id:"86",title:"Business and Management"}}},{id:"82194",title:"CSR and Female Directors: A Review and Future Research Agenda",doi:"10.5772/intechopen.105112",signatures:"Pattarake Sarajoti, Pattanaporn Chatjuthamard, Suwongrat Papangkorn and Sirimon Treepongkaruna",slug:"csr-and-female-directors-a-review-and-future-research-agenda",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg",subseries:{id:"86",title:"Business and Management"}}},{id:"81831",title:"Deep Network Model and Regression Analysis using OLS Method for Predicting Lung Vital Capacity",doi:"10.5772/intechopen.104737",signatures:"Harun Sümbül",slug:"deep-network-model-and-regression-analysis-using-ols-method-for-predicting-lung-vital-capacity",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Decision Science - Recent Advances and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11604.jpg",subseries:{id:"86",title:"Business and Management"}}}]},subseriesFiltersForOFChapters:[{caption:"Business and Management",value:86,count:5,group:"subseries"}],publishedBooks:{paginationCount:1,paginationItems:[{type:"book",id:"11392",title:"Leadership in a Changing World",subtitle:"A Multidimensional Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11392.jpg",slug:"leadership-in-a-changing-world-a-multidimensional-perspective",publishedDate:"May 11th 2022",editedByType:"Edited by",bookSignature:"Muhammad Mohiuddin, Bilal Khalid, Md. Samim Al Azad and Slimane Ed-dafali",hash:"86a6d33cf601587e591064ce92effc02",volumeInSeries:1,fullTitle:"Leadership in a Changing World - A Multidimensional Perspective",editors:[{id:"418514",title:"Dr.",name:"Muhammad",middleName:null,surname:"Mohiuddin",slug:"muhammad-mohiuddin",fullName:"Muhammad Mohiuddin",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038UqSfQAK/Profile_Picture_2022-05-13T10:39:03.jpg",institutionString:"Université Laval",institution:{name:"Université Laval",institutionURL:null,country:{name:"Canada"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Business and Management",value:86,count:1}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:1}],authors:{paginationCount:25,paginationItems:[{id:"429683",title:"Dr.",name:"Bilal",middleName:null,surname:"Khalid",slug:"bilal-khalid",fullName:"Bilal Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/429683/images/system/429683.png",biography:"Dr. Bilal Khalid received a Ph.D. in Industrial Business Administration from KMITL Business School, Bangkok, in 2021, and a master’s in International Business Management from Stamford International University, Bangkok, in 2017. Dr. Khalid\\'s research interests include leadership and negotiations, digital transformations, gamification, eLearning, blockchain, Big Data, and management of information technology. Dr. Bilal Khalid also serves as an academic editor at Education Research International and a reviewer for international journals.",institutionString:"KMITL Business School",institution:{name:"King Mongkut's Institute of Technology Ladkrabang",country:{name:"Thailand"}}},{id:"418514",title:"Dr.",name:"Muhammad",middleName:null,surname:"Mohiuddin",slug:"muhammad-mohiuddin",fullName:"Muhammad Mohiuddin",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038UqSfQAK/Profile_Picture_2022-05-13T10:39:03.jpg",biography:"Dr. Muhammad Mohiuddin is an Associate Professor of International Business at Laval University, Canada. He has taught at Thompson Rivers University, Canada; University of Paris-Est, France; Osnabruck University of Applied Science, Germany; and Shanghai Institute of Technology and Tianjin University of Technology, China. He has published research in Research Policy, Applied Economics, Review of Economic Philosophy, Strategic Change, International Journal of Logistics, Sustainability, Journal of Environmental Management, Journal of Global Information Management, Journal of Cleaner Production, M@N@GEMENT, and more. He is a member of CEDIMES Institut (France), Academy of International Business (AIB), Strategic Management Society (SMS), Academy of Management (AOM), Administrative Science Association of Canada (ASAC), and Canadian council of small business and entrepreneurship (CCSBE). He is currently the director of the Research Group on Contemporary Asia (GERAC) at Laval University. He is also co-managing editor of Transnational Corporations Review and a guest editor for Electronic Commerce Research and Journal of Internet Technology.",institutionString:"Université Laval",institution:{name:"Université Laval",country:{name:"Canada"}}},{id:"189147",title:"Dr.",name:"Hailan",middleName:null,surname:"Salamun",slug:"hailan-salamun",fullName:"Hailan Salamun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/189147/images/19274_n.jpeg",biography:"Hailan Salamun, (Dr.) was born in Selangor, Malaysia and graduated from Tunku Ampuan Jamaah Religious High School at Shah Alam. Obtained a degree from the International Islamic University (UIA), Gombak in the field of Islamic Revealed Knowledge and Heritage. Next, I furthered my studies to the professional level to obtain a Diploma in Education at UIA. After serving for several years in school, I furthered my studies to the Master of Dakwah and Leadership at Universiti Kebangsaan Malaysia (UKM), Bangi. I graduated with a Doctor of Philosophy in Principalship Leadership from the University of Malaya (UM) in 2010. I am currently a senior lecturer in the Department of Nationalism and Civilization, Center for Basic and Continuing Education, Universiti Malaysia Terengganu. Prior to that, I had served in several educational institutions such as schools, the Institute of Teacher Education (IPG), and also the University of Malaya. I am also actively involved in paper presentation, writing and publishing. My research interests are focused on leadership, education, society and Islamic civilization. This area of research requires a detailed understanding of Islamic studies and research studies in leadership. Another research interest that I have explored recently is the politics of the Malay community and also the leadership of the mosque.",institutionString:null,institution:{name:"Universiti Malaysia Terengganu",country:{name:"Malaysia"}}},{id:"442081",title:"Dr.",name:"Audrey",middleName:null,surname:"Addy",slug:"audrey-addy",fullName:"Audrey Addy",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kwame Nkrumah University of Science and Technology",country:{name:"Ghana"}}},{id:"437993",title:"Mr.",name:"Job",middleName:null,surname:"Jackson",slug:"job-jackson",fullName:"Job Jackson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Management College of Southern Africa",country:{name:"South Africa"}}},{id:"428495",title:"Prof.",name:"Asyraf",middleName:null,surname:"Ab Rahman",slug:"asyraf-ab-rahman",fullName:"Asyraf Ab Rahman",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universiti Malaysia Terengganu",country:{name:"Malaysia"}}},{id:"429650",title:"Dr.",name:"Jacqueline",middleName:null,surname:"Kareem",slug:"jacqueline-kareem",fullName:"Jacqueline Kareem",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Christ University",country:{name:"India"}}},{id:"421041",title:"Dr.",name:"Sunil",middleName:null,surname:"Kumar Ramdas",slug:"sunil-kumar-ramdas",fullName:"Sunil Kumar Ramdas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jain University",country:{name:"India"}}},{id:"421833",title:"Mr.",name:"Eugene",middleName:null,surname:"Owusu-Acheampong",slug:"eugene-owusu-acheampong",fullName:"Eugene Owusu-Acheampong",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"239876",title:"Ph.D.",name:"Luciana",middleName:null,surname:"Mourão",slug:"luciana-mourao",fullName:"Luciana Mourão",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Salgado de Oliveira",country:{name:"Brazil"}}},{id:"421735",title:"Dr.",name:"elizabeth",middleName:null,surname:"addy",slug:"elizabeth-addy",fullName:"elizabeth addy",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"442083",title:"Dr.",name:"James",middleName:null,surname:"Addy",slug:"james-addy",fullName:"James Addy",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"437991",title:"Prof.",name:"Muhammad",middleName:null,surname:"Hoque",slug:"muhammad-hoque",fullName:"Muhammad Hoque",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"421006",title:"Dr.",name:"Anna",middleName:null,surname:"Uster",slug:"anna-uster",fullName:"Anna Uster",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"470243",title:"Dr.",name:"Md Samim",middleName:null,surname:"Al Azad",slug:"md-samim-al-azad",fullName:"Md Samim Al Azad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"470244",title:"Dr.",name:"Slimane",middleName:null,surname:"Ed-dafali",slug:"slimane-ed-dafali",fullName:"Slimane Ed-dafali",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"421011",title:"Dr.",name:"Afatakpa",middleName:null,surname:"Fortune",slug:"afatakpa-fortune",fullName:"Afatakpa Fortune",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"446057",title:"Mr.",name:"Okedare",middleName:null,surname:"David Olubukunmi",slug:"okedare-david-olubukunmi",fullName:"Okedare David Olubukunmi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"421778",title:"Dr.",name:"Fatimah",middleName:"Saeed",surname:"AlAhmari",slug:"fatimah-alahmari",fullName:"Fatimah AlAhmari",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"421024",title:"Prof.",name:"Harold Andrew",middleName:null,surname:"Patrick",slug:"harold-andrew-patrick",fullName:"Harold Andrew Patrick",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"421065",title:"Ms.",name:"Euzália",middleName:null,surname:"do Rosário Botelho Tomé",slug:"euzalia-do-rosario-botelho-tome",fullName:"Euzália do Rosário Botelho Tomé",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"421053",title:"Associate Prof.",name:"Ken",middleName:null,surname:"Kalala Ndalamba",slug:"ken-kalala-ndalamba",fullName:"Ken Kalala Ndalamba",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"421826",title:"Dr.",name:"Inusah",middleName:null,surname:"Salifu",slug:"inusah-salifu",fullName:"Inusah Salifu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"420823",title:"Prof.",name:"Gardênia da Silva",middleName:null,surname:"Abbad",slug:"gardenia-da-silva-abbad",fullName:"Gardênia da Silva Abbad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"437613",title:"MSc.",name:"Juliana",middleName:null,surname:"Legentil",slug:"juliana-legentil",fullName:"Juliana Legentil",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]}},subseries:{item:{id:"90",type:"subseries",title:"Human Development",keywords:"Neuroscientific research, Brain functions, Human development, UN’s human development index, Self-awareness, Self-development",scope:"