*1.1. Motivation*

Lithium metal has always been one of the most attractive candidates for anode materials in lithium batteries. This is due to its potential to extend the energy density of conventional lithiumion batteries. State-of-the-art Li-ion cells, depending on the cell chemistry, can deliver a specific energy density of 130 Wh·kg−1 to 250 Wh·kg−1 [1]. This is already behind the U.S. Department of Energy's (DOE) target for advanced batteries for electric vehicles [2]. Lithium has a theoretical specific capacity of 3860 mAh·g−1 and a higher redox potential of *φ*Li||H2 = −3.04 V versus standard hydrogen electrodes in comparison to electrodes based on graphite. This means using lithium (Li) instead of conventional intercalating anode materials like graphite (LiC6), which has a theoretical specific capacity of 372 mAh·g−1 that can increase the specific energy and volumetric energy density of cells significantly. In one study, researchers reported a 35% increase in specific energy and 50% increase in volumetric energy density when the graphite electrode is replaced with a Li metal electrode [3]. In addition to the aforementioned change in electrode material, they considered a solid electrolyte for the Li-metal cell and a liquid

**Citation:** Momeni Boroujeni, S.; Fill, A.; Ridder, A.; Birke, K.P. Influence of Temperature and Electrolyte Composition on the Performance of Lithium Metal Anodes. *Batteries* **2021**, *7*, 67. https://doi.org/10.3390/ batteries7040067

Academic Editor: Seokheun Choi

Received: 30 July 2021 Accepted: 29 September 2021 Published: 14 October 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

electrolyte for the conventional Li-ion cell in their estimates [3]. However, commercializing Li-metal batteries has been paused due to various challenges in both production and performance of lithium cells [4]. The issues with the production are that the Li surface is highly reactive and sensitive to humidity, oxygen and nitrogen, which are all present in the air atmosphere [5,6]. The challenges of the performance are given by the unstable and different Li growth morphology, low Coulombic efficiency, and considerable volume change during cycling [1]. Lithium metal cannot be utilized with known carbonate electrolytes because its electrochemical potential causes the electrolyte to continuously decompose until a passivating solid electrolyte interface (SEI) is built up [7]. One approach to utilizing the Li-metal is creating a stable and uniform SEI layer on the lithium surface that can withstand significant volumetric changes of Li during cycling. This is of critical concern to ensure safe and efficient lithium metal cells. Local variations in the SEI layer's composition might cause uneven Li deposition, resulting in changes in Li-ion conductivity across the electrode or SEI rupture, which can facilitate the creation of Li dendrites. Another approach is to use solid membranes, such as solid polymer electrolytes (SPE), which are less reactive to the Li [8] and their soft nature could withstand the extensive volume change of the Li anode [9]. In this study we focus on compatible liquid electrolytes in lithium cells. More experiments investigating the influence of different electrolyte compositions and the cycling conditions on effective SEI layer formation are much needed.


**1. Introduction**

Dementia is a neurodegenerative disorder characterized by a progressive decline in multiple cognitive domains leading to deterioration of daily living activities, including social and professional functioning. The aging population has been increasing gradually, and in 1990, 26 countries with more than 2 million elderly citizens aged 65 years and older were identified. It is expected that by 2013 another 34 nations will be added in the list. On the other hand, calculations made in 2000 about the number of elderly peoples (over 65 years old) in the world reached the 420 million (7%), and they estimated around 1 billion by 2030 (12%), mainly in developing countries [1].

Without doubt, the most common form of dementia in elderly people is Alzheimer disease (AD), but it can occur even in patients with 40 years of age.

AD is a progressive disorder of multifactorial origin, well defined clinically with a number of biomarkers also well documented. According to the World Alzheimer Report from 2015, AD will increase exponentially as population ages being one of the biggest problems of our society in this century [2]. Currently, 46.8 million people live with dementia all over the world, and this number will be duplicated every 20 years. Today, the calculated incidence of dementia is 9.9 million new patients, one new one every 3.2 s.

The Monzino 80+ population-based study made in 2015 found that one quarter of 80+-yearold person had dementia even in advanced stages which increased prevalence in extreme ages such as: 15.7% in persons aged 70–84 years to 52 and 65.9% in peoples aged 95–99 and in beyond 100 years, accordingly [3].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Another author reports that 24.3 million patients have dementia at the present moment, and the incidence is 4.6 new cases yearly. They said the number of patients will be duplicated every 20 years to more than 81 million (71%) by 2040 most of them in developing nations [4]. Other author highlighted that the number of patients living with dementia (PLWD) will be a triple by 2050 [5].

The Greek statesman and poet Solon established that if a male people's loss his capacity for judgment due to old age then terms of man's will might be invalidated, this happened in 550 BC and the Chinese authors considered the medical term of dementia related to "foolish

Introductory Chapter: Cognitive Disorders and Its Historical Background

http://dx.doi.org/10.5772/intechopen.77084

3

Two ancient Greeks Aristotle and Plato (**Figures 1** and **2**) wrote about mental decay in elderly persons and they considered that process as an inevitable one affecting all old peoples without possibility of its prevention. They also said that these kinds of person were not suitable to carry out high responsibilities or any position because this disorder affects their judgment,

A more advanced statement about dementia was established by Cicero who defined it as a process not inevitable related with the aging that "*affect only those old men who were weak-willed*." Cicero also said that dementia could not happen in those persons who remained mentally active and with the capacity to learn new things. Unfortunately, the Aristotle's medical writing prevailed for several centuries above the most modern Cicero's views on aging, and other physicians such as Galen and Celsus simply highlighted the Aristotle's belief [13]. Nevertheless, other authors from Greece and Rome delivered other ideas more similar to our modern concept of dementia including many cognitive and behavioral symptoms of dementia [14].

*May et al. [15] delivered the results of electronic searches of Zhong Hua Yi Dian ("Encyclopaedia of Traditional Chinese Medicine"), a CD of 1000 premodern (before 1950) medical books, for single herbs,*

They found 127 different books containing 731 citations about products for treatment of memory disorders. A total of 110 natural products for the management of memory problems were identified including yuan zhi (Polygala tenuifolia), fu shen (Poria cocos), and chang pu (Acorus spp.) All the above-mentioned products have been cited many times in the literature over the past 180 years.

**Figure 1.** Roman copy in marble of a Greek bronze bust of Aristotle by Lysippos, c. 330 BC. The alabaster mantle is modern. Born 384 BC in Northen Greece. Died 322 BC in Euboea Greece (Source: https://en.wikipedia.org/wiki/Aristotle).

*and other natural products used for dementia, memory disorders, and memory improvement.*

old person" [11].

imagination, reasoning and memory [12].

We also agree with Vito Moretti [6] who wrote about "Update on Dementia" that the whole society should be involved in the mental health promotion to reduce risk of dementia and in new priorities for research purposes to identify new approaches to this problem and eradicate stigma and discrimination.

The delivery of therapeutic agents specifically designed to enhance memory and cognition in AD patients is increasing gradually. The limited efficacy of the drugs currently available is well known, and the introduction of these medications has shed an entirely new light on the field. Therefore, we believe that this is the best time to look at the past to understand the present and perhaps gain insight into the future [7].


**2.4 Central component**

The central component is a public authority or a road operator who manages the cooperative applications or services. An example of such component is a traffic management center which uses roadside units to inform the drivers about traffic status or accidents in a specific road network and suggests alternative routes. The central component can receive information from vehicles or roadside units and in turn send information to them.


**4. Conclusion**

Staphylococcus is an adaptable pathogen and has ability to develop rapid antibiotic resistance. After 1980s development of newer classes of antibiotics is very limited. Rapid development of resistance will reduce the availability of antibiotic in clinical practice and this will cause serious health problem in future. Development of newer molecules in expensive clinical trials, the huge investment in target based discovery with the structural biology did not yield the hope for newer break throughs. Microorganisms are very crucial in developing resistance to novel therapeutic agent rapidly. This will development of more strategies to combat the antibiotic resistance. Antibiotic stewardship policy is mandatory to control the development and spread of antibiotic resistance in community and hospital settings.

*Insights Into Drug Resistance in* Staphylococcus aureus


*2.2. Employee's Job Strain and Safety Behavior*

Safety behavior has been considered as one of the most important safe performances in an organization, being defined as employees' behaviors which seek to prevent mental and physical hazards [12,32–34]. Many previous works have reported that safety behavior is closely associated with occupational injuries and accidents in various industries [33,35–37].

Based on previous studies [12,18–21], we suggest that job strain would decrease the level of an employee's safety behavior. As job strain increases, employees may experience functional diminishment in their cognitive/emotional/physical areas [18–20]. The loss of such functions has a serious adverse effect on an employee's abilities pertinent to both attention and prevention for safety [12,18–20]. According to the explanation of the stress–thought model, stress not only increases psychological anxiety and physical fatigue, which cause deterioration of cognitive functions, but also makes normal thinking impossible [19,20]. Considering that adequate situational judgments and decision-making processes are essential for conducting proper safety behavior, stress can have a critical and harmful effect on safety behavior. In addition, according to extant works which have explored the relationship between emotions and decision-making processes [38,39], individuals are likely to experience negative emotions when they are under stress. Then, these negative experiences would lower the level of their logical thinking and judgment ability, eventually resulting in impulsive decision-making and unsafe behavior [38,39]. Based on the above studies, we can hypothesize that job strain will reduce the level of employees' safety behavior.

**Hypothesis 2.** *An employee's strain is negatively related to his or her safety behavior.*

#### *2.3. Mediating Role of Job Strain between Transformational Leadership and Safety Behavior*

As described above, we suggest that an employee's job strain would mediate the relationship between transformational leadership and safety behavior. Based on the above arguments, we believe that transformational leadership may enhance the level of an employee's safety behavior by diminishing his or her job strain at work.

To integrate our hypotheses, which are described above, based on a theoretical ground, we have relied on the context–attitude-behavior framework [14,15] that bolsters the mediation structure. This perspective suggests that a variety of contexts at work (e.g., organizational systems, rules, leadership, and environments) are important preceding factors which significantly affect the attitudes and behavior of employees. Grounded on it, we expect that transformational leadership, as one of the critical contexts, would create employees' behavior (i.e., safety behavior) by affecting their attitude (i.e., job strain). Previous works theoretically and empirically bolster our hypotheses by demonstrating the negative association between transformational leadership and job strain [7,16,17] and job strain and safety behavior [12,18–21]. Thus, we hypothesize as follows.

**Hypothesis 3.** *Employees' job strain mediates the relationship between transformational leadership and safety behavior.*

#### *2.4. Moderating E*ff*ect of Employees' Self-E*ffi*cacy regarding Safety between Job Strain and Safety Behavior*

We suggest that there may be contingent factors which moderate the relationship between job strain and safety behavior. Although job strain would decrease the quality of an employee's safety behavior, there may be some buffering factors which can diminish the negative impact of job strain on safety behavior. Among various buffering factors, in this paper, we have focused on employees' self-efficacy regarding safety because the concept of self-efficacy has been known as one of the most fundamental variables which explain individuals' perceptions, attitudes, and behavior [22,23].

According to Bandura, self-efficacy is defined as the "beliefs in one's capabilities to organize and execute courses of action required in managing prospective situations. Efficacy beliefs influence how people think, feel, motivate themselves, and act" [22]. Previous works have reported the significant role of self-efficacy in various organizational outcomes [22–24]. This concept is considered as a both task-specific and general variable, and it has been known as a dispositional trait that significantly explains individual behaviors across various situations [40]. In this research, we have applied the concept into safety-related contexts. Thus, based on Eden and Zuk's definition [24], we have defined self-efficacy regarding safety as an individual's overall estimate or expectation of his or her ability to effectively deal with safety-related situations.

We believe that an employee's self-efficacy regarding safety can function as a buffering factor that diminishes the negative effects of job strain on the employee's safety behavior. As described above, job strain would deteriorate the quality of an employee's safety behavior. The employee's anxiety and physical fatigue at work which originate in job strain would diminish his or her cognitive functions, directly destroying adequate safe-related decision making. However, if the employee has a high level of self-efficacy regarding safety, he or she can protect himself/herself from the harmful influence of job strain. By virtue of the high-level of self-efficacy, he or she may feel considerable competence in effectively dealing with the harmful effects of job strain. Then, the negative psychological and physical states from job strain may no longer significantly decrease the quality of his or her safety behavior.

In contrast, when an employee has a low level of self-efficacy regarding safety, he or she may feel that he or she cannot deal with various problems from unsafe situations at work (e.g., how to implement safe-related rules and procedures or how to decrease the possibility of safe accidents). In that situation, the negative impact of job strain would be facilitated and amplified, significantly damaging the employee's cognitive abilities. Then, the quality of safe-related decision-making would be substantially decreased, critically destroying his or her safe behavior. Thus, we propose that

an employee's self-efficacy regarding safety may moderate the relationship between job strain and the employee's safety behavior (Please see Figure 1).

**Figure 1.** Framework of research model.

**Hypothesis 4:** *An employee's self-e*ffi*cacy regarding safety may moderate the relationship between his or her job strain and safety behavior.*

#### **3. Method**

#### *3.1. Data Collection*

Considering the residence and industry of the respondents, we chose and contacted companies which had more than 15 employees. Then, considering the size of the company, roughly 3–8 employees were randomly selected. Survey-trained researchers conducted the survey using structured questionnaires. When the quality of the response was bad, the survey was conducted again. Through these processes, data from 997 employees from 103 firms who adequately responded to all the items were utilized in the analysis. The characteristics of the sample are described below (Please see Table 1).

**Table 1.** Descriptive characteristics of our sample.

#### *3.2. Measures*

We measured the research variables with a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). Then, we computed internal consistency of the variables by using Cronbach alpha values.

#### 3.2.1. Transformational Leadership

We utilized 13 items that were adapted from the Multifactor Leadership Questionnaire (MLQ) to measure transformational leadership. The scale was developed by Bass and Avolio [30], consisting of four sub-dimensions: Idealized influence, inspirational motivation, intellectual stimulation, and individual consideration. The 13 items were selected by the suggestions of previous studies on transformational leadership [5–7]. Sample items were "the leader in my organization is a role model I want to be" and "my leader articulates a compelling vision of the future". The Cronbach alpha value was 0.92.

#### 3.2.2. Job Strain

To measure the level of job strain, we utilized 10 items of the job strain scale by adapting the scale of DeJoy and his colleagues [41]. The 10 items of job strain were selected by the authors because those adequately reflected the core components of the measure [41]. Sample items were "I feel nervous and strain because of work" and "I feel nervous when I work". The Cronbach alpha value was 0.85.

#### 3.2.3. Safety Behavior

We utilized 8 items of the Neal and Griffin's [36] scale to measure safety behavior. The scale consisted of two sub-dimensions: Safety participation (SP) and safety compliance (SC). Sample items included "I use all necessary safety equipment to do my job" (SC) and "I put in extra effort to improve the safety of workplace" (SP). The value of Cronbach alpha was 0.94.

#### 3.2.4. Self-Efficacy regarding Safety

To measure the level of employees' self-efficacy regarding safety, we utilized four items by adapting the self-efficacy scale of Bandura [42]. Sample items were "I am confident in reducing the risk of accidents" and "I am capable of maintaining and improving the safety of my workplace". The value of Cronbach alpha was 0.89.

#### 3.2.5. Control Variables

Considering that various factors can influence employees' safety behavior [33], we included employees' gender, tenure, position, and education level in our analysis to control for employees' safety behavior.

#### *3.3. Statistical Analysis*

Frequency analysis and correlation analysis were performed using the SPSS 21.0 program. Furthermore, we conducted a structural equation modeling (SEM) analysis by using the Amos 21.0 program. SEM, unlike the existing multiple regression analysis methodology, is capable of "simultaneously" analyzing the direct or indirect path between variables in an integrated model.

Considering the suggestion of Anderson and Gerbing [43], we took a two-step approach which includes the measurement model and the structural model. To evaluate the model fit of our hypothesized model, various fit indices such as the comparative fit index (CFI), the turker–lewis index (TLI), and the root mean square error of approximation (RMSEA) were utilized. According to previous studies [44,45], when the values of CFI and TLI of a certain model are greater than 0.90 and the value of RMSEA is less than 0.06, then the model can be considered as a good model. Based on this, bootstrapping analysis was conducted to confirm whether the indirect effect of our research model was significant.

#### **4. Results**

#### *4.1. Descriptive Statistics*

The descriptive statistics of this research are shown in Table 2. The main research variables including the independent variable, mediator, moderator, and dependent variable were highly correlated.

**Table 2.** Means, standard deviations, and correlations between variables.

Note: \* *p* < 0.01. With regard to gender, male is coded as 1, and female is coded as 2. With regard to position, general manager or higher are coded as 5, deputy general manager and department manager as 4, assistant manager as 3, clerk as 2, and others below clerk as 1. With regard to education, "below high school diploma" level is coded as 4, "community college" level as 3, "bachelor's" level as 2, and "master's degree or more" level is coded as 1.

#### *4.2. Measurement Model*

To check whether the level of discriminant validity was appropriate, we conducted a confirmatory factor analysis (CFA) for the research variables which were evaluated by the same employee (i.e., transformational leadership, job strain, safety behavior, and self-efficacy regarding safety). The four-factor model had a good fit to the observations (χ2 (df = 140) = 594.71; CFI = 0.965; TLI = 0.958; RMSEA= 0.057). Then, we conducted sequential chi-square (χ2) difference tests to compare the four-factor model with the three-factor, two-factor, and single-factor model, respectively. Specifically, considering that safety behavior and self-efficacy were very highly correlated, we made the two-factor model which loaded the two variables on the same factor The results of the test showed that the four-factor model had the best fit among all alternative models. Therefore, we believe that the research variables are distinctive (Please see Table 3).

**Table 3.** Chi-square difference tests among alternative measurement models.

Note: CFI means comparative fit index, TLI means turker–lewis index, and RMSEA means root mean square error of approximation. In addition, Tl means transformational leadership.

#### *4.3. Structural Model*

#### 4.3.1. Result of Mediation Analysis

We established a moderated mediation model by utilizing the SEM technique. In the analysis, the association between transformational leadership and safety behavior was mediated by employees' job strain.

The fit indices of our hypothetical model (Model 1) was good enough: χ2 = 323.22 (df = 77), CFI = 0.960, TLI = 0.945, and RMSEA = 0.057. In the model, all the control variables (i.e., gender, position, tenure, and education level) were not statistically significant. The model demonstrated that transformational leadership was significantly and negatively associated with job strain (β = −0.20, *p* < 0.001), and job strain was significantly and negatively related to safety behavior (β = −0.06, *p* < 0.05). The results suggest that Hypothesis 1 and 2 were supported.

#### 4.3.2. Result of Moderation Analysis

To test the moderating effect of employees' self-efficacy regarding safety, we built a moderated mediation model which simultaneously included both the mediation structure and moderation structure. The moderation effect of employees' self-efficacy regarding safety on the association between job strain and safety behavior was tested by the model (see Figure 2). As described above, job strain and safety behavior were transformed into mean-centered variables and the interaction term was calculated by multiplying the two transformed variables [46]. Please consider that centered variables are useful in (i) estimating the interaction terms without loss of correlations and (ii) decreasing and testing multicollinearities among research variables. In addition, we tested whether there was a multicollinearity bias between job strain and self-efficacy regarding safety by using the SPSS program. To test this, we calculated the variance inflation factors (VIF) and tolerances [47]. The VIF for job strain and self-efficacy regarding safety was 1.02 and 1.02, respectively, and the tolerance statistics were 0.99 and 0.99, respectively. Because the obtained VIF values were smaller than 10, as well as the tolerance statistics above 0.2, we can conclude that the two variables (job strain and self-efficacy regarding safety) were relatively free from the issue of multicollinearity.

The coefficient of the interaction term (β = 0.07, *p* < 0.01) was significant, implying that employees' self-efficacy regarding safety functions as a moderator in the association between job strain and safety behavior. In other words, when the level of an employee's self-efficacy regarding safety is high, the negative effect of job strain on safety behavior is decreased. Thus, the results support Hypothesis 4.

#### *4.4. Bootstrapping Analysis*

We conducted bootstrapping analysis with a sample of 5000 to test Hypothesis 3, which suggested that there is a mediating effect of job strain between transformational leadership and safety behavior. Note that the mediation effect is significant at a 5% level when the 95% bias-corrected confidence interval (CI) for the mediation effect does not include zero [48]. In the analysis, the bias-corrected CI for the effect on the pathway from transformational leadership to safety behavior via job strain excluded

zero (95% CI = (0.01, 0.04)). Thus, the result indicates that the mediation effect of job strain on the path was significant at the level of 5%, supporting Hypothesis 3.

**Figure 2.** The standardized estimate values of the final model. Notes: \* *p* < 0.05, \*\* *p* < 0.01, \*\*\* *p* < 0.001.

#### **5. Discussion**

In the present paper, we examined the underlying mechanisms of the relationship between transformational leadership and safety behavior. To empirically test our hypotheses, data from employees in South Korea were utilized. By conducting a moderated mediation model analysis with the SEM technique, we found that employees' job strain mediated the association between transformational leadership and safety behavior. In addition, employees' self-efficacy regarding safety functioned as a moderator in the relationship between job strain and safety behavior. In this section, some theoretical and practical implications can be drawn from our results.

#### *5.1. Theoretical Implication*

We believe that this research may contribute to extending transformational leadership and safety behavior literature by providing these theoretical implications.

First, we delved into the mediating role of job strain to explain the influence of transformational leadership on employees' safe behavior. Previous works which examined the association between these variables had paid less attention to the significance of job strain in describing intermediating processes in the link. Considering that employees' job strain substantially influences employees' perceptions, attitudes, and behaviors, eventually decreasing the quality of various organizational outcomes [10–13], our attempt to reveal the important role of job strain as a mediator in the transformational leadership–safety behavior link would be meaningful. Through it, we expect that this research may contribute to elaborating transformational leadership and safety behavior literature.

Second, we found a contingent factor which moderated the relationship between transformational leadership and employees' safety behavior. Although some previous studies have reported mediators in the link, those have paid less attention to the contingent or contextual factors which moderate the relationship. Of course we acknowledge that investigating mediators in the link would be highly required. However, to elaborately explain the intermediating mechanisms in the transformational leadership–safety behavior link, it is highly required to find certain conditions or contexts under which the mediators work well, since the mediating variables cannot always intermediate the link in all situations. Therefore, we expect that our finding that employees' self-efficacy regarding safety functions as a buffering factor to decrease harmful effects of job strain on safety behavior would enrich previous works on transformational leadership and safety behavior.

#### *5.2. Practical Implications*

We expect that our findings may provide business leaders with practical implications. First, leaders or top management teams who want to enhance employees' safety behavior through implementing transformational leadership would get some insights from this paper. Our results demonstrated that transformational leadership can increase the quality of an employee's safety behavior through decreasing his or her job strain. Thus, to check whether their attempt to enhance employees' safety behavior through facilitating transformational leadership is successful, the top management teams or leaders should monitor the changes in the level of employees' job strain as an indicator. If the level of job strain has not changed or has even increased, this would indicate that their transformational leadership does not function effectively enough to boost employees' safety behavior. In addition, the leaders using transformational leadership should focus their leadership behavior on employees' job strain by implementing "job strain-specific" leadership.

Second, the findings demonstrated that employees' self-efficacy regarding safety functions as a buffering factor in the association between employees' job strain and safety behavior. We expect that the results may emphasize the importance of employees' individual characteristics in preventing the harmful effects of job strain on safety behavior. As the finding suggests, an employee's job strain is not always harmful to his or her safety behavior. Its negative impact would be minimized when the employee has a high-level of self-efficacy regarding how to implement safe-related procedures and how to decrease the possibility of safe accidents. Therefore, we suggest that top management teams or leaders should attempt to foster employees' self-efficacy regarding safety by providing them with safe education programs, safety guidance, and safety systems in an organization.

### *5.3. Limitations and Suggestions for Future Studies*

Although we believe that this research has valuable implications from the theoretical and empirical point of view, it has some limitations which need to be addressed. First, in this study, we found that transformational leadership affects safety behavior through "psychological factors" such as job strain. However, prior to such psychological factors, "physical environments" or "physical states of employees" may affect safety behavior. Further studies are needed to verify this. Second, although we conducted a SEM analysis to test our mediation hypothesis, we could not adequately reveal the causal relationships that our research hypotheses claim since this study only utilized cross-sectional data. This should be complemented and alleviated by not only utilizing a longitudinal research design but also by considering the influence of third variables or alternative explanations [49]. In addition, future studies should deal with the fundamental concern that cross-sectional data cannot adequately describe and explain the interaction effects between variables. Third, the data of this study were collected through participants' self-reports. Since the employee's behavior which is reflected in the self-report survey may be different from his or her actual behavior, there needs to be adequate supplementation. For example, a third party's observation or behavioral assessment can be good alternative ways to collect data. Fourth, because the same respondents responded to our survey at the same time, they cannot be free from the common method bias problem. The problem is likely to lead to an overestimation of the correlation between the variables. This limitation needs to be dealt with. Lastly, this paper could not fully utilize the entire items of each measure for our research variables (i.e., transformational leadership and job strain). Although we chose core and essential items from the original version of the measures, future studies should use the full items of the original measures. Fifth, in this study, we only focused on employees' positive behavior, such as safety behavior, when we investigated the impact of transformational leadership in an organization. However, considering that negative behavior of employees also critically influences organizational outcomes, future studies are needed to deal with negative behavior such as unsafe behavior or counterproductive work behavior. Lastly, this paper did not adequately deal with the issue of nesting of data. Considering that some respondents may be nested into the same organization, the respondents are likely to share the same culture, climate, and leadership style. Thus, the perceptions of the respondents on their transformational leadership tend to be more similar within the organization than between organizations. This research could not deal with this issue. To complement it, additional multi-level approaches are recommended.

### **6. Conclusions**

Although this study has various limitations, we believe that it contributes to deepening the transformational leadership and safety behavior literature by investigating a mediating factor between transformational leadership and safety behavior, as well as a contingent factor through which job strain influences safety behavior. Specifically, through this study, we have shown two important findings. First, transformational leadership reduces the level of employees' job strain, and then the reduced strain ultimately increases their level of safety behavior. Second, although job strain decreases the quality of employees' safety behavior, their self-efficacy regarding safety functions as a buffering factor by moderating the relationship. The findings show that an employee's job strain plays an intermediating role in connecting transformational leadership with safety behavior. We also demonstrated the importance of self-efficacy regarding safety in minimizing the negative effects of job strain on safety behavior.

**Author Contributions:** B.-J.K. and S.-Y.J. contributed to all the processes including writing of the original draft, conceptualization, data collection, formal analysis, and methodology of this paper.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

International Journal of *Environmental Research and Public Health*


**6. Clinical Outcomes of Intravesical Botulinum Toxin A Injection for Patients with DM-Associated OAB**

Although numerous laboratory and clinical findings support that BoNT-A inhibits overactivity and chronic inflammation of OAB by different pathways, very few clinical studies have investigated intravesical BoNT-A treatment of patients with DM-associated OAB. Wang et al. reported the first retrospective study to compare the efficacy and safety of intravesical 100 U onabotulinumtoxinA injection in 48 patients with refractory type 2 DM-associated OAB [45]. During the 6-month follow-up period, similar success rates were noted between the diabetic and non-diabetic OAB groups (DM, 56% versus non-DM, 61%, *p* = 0.128). The disappearance rate of detrusor overactivity proved by videourodynamic studies was also similar in both groups (DM, 56.3%, versus non-DM, 47.8%, *p* = 0.41). However, the patients with DM more commonly had adverse events such as large postvoid residual urine volumes and general weakness than the non-DM group.

One hypothesis is that early phase DM causes compensated bladder function, and late-phase DM causes decompensated bladder function [46,47]. Thus, DHIC, a paradoxical condition involving both the storage and voiding phases of bladder function, could happen during the transition from OAB to underactive bladder in DM patients. An interesting study comparing the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with DHIC or OAB showed that the OAB symptoms in both groups significantly improved during the 3-month follow-up period [48]. However, the mean duration of therapeutic efficacy in patients with DHIC was significantly shorter than that of patients with OAB (4.9 ± 4.8 months versus 7.2 ± 3.3 months, *p* = 0.03). Additionally, the incidences of adverse events including acute urinary retention, large postvoid residual urine volume, urinary tract infection, gross hematuria, and general weakness were comparable in both groups.

Furthermore, Kuo et al. analyzed the adverse events after intravesical BoNT-A injection in 217 patients with idiopathic detrusor overactivity [49]. The results showed that male sex, large baseline postvoid residual urine, comorbidities, and higher doses of BoNT-A (>100 U) were risk factors for adverse events after BoNT-A injection for OAB. However, the occurrence of adverse events did not affect treatment outcome. As a result, intravesical BoNT-A injection is still recommended in patients with DM-associated OAB who develop DHIC. Patients should be informed of the possibility of shorter therapeutic duration and adverse events before injection.


*2.2. Composite Preparation*

The PLA resin and pulp fibers were dried at 80 ◦C for 5 h under vacuum. PLA/pulp fiber composites were manufactured according to two methods (Figure 1): (1) Pulp fiber (NPF), epoxidized Tung oil and PLA were mixed directly; (2) epoxidized Tung oil soaked pulp fibers (SPF) were mixed with PLA (Sce. To soak the pulp fibers with epoxidized Tung oil, epoxidized Tung oil was dissolved in methyl ethyl ketone (ratio of 1/20) and sprayed onto the pulp. After that, the mixtures were dried in an oven at 80 ◦C for 5 h for the reaction between Tung oil and pulp fiber to take place.

**Figure 1.** Two fabricating methods for Poly (lactic acid) (PLA)/pulp fiber (PF) composites.

The separated pulp fibers and epoxidized Tung oil or epoxidized Tung oil-soaked pulp fibers were melt-blended with PLA resin in an internal mixer model Plastograph® EC (Duisburg, Germany) at 150 ◦C with a rotor speed of 50 rpm for 6 min. The pulp fiber/PLA composites were compressed and moulded into 3-mm-thick plates on a GoTech hot press at 170 ◦C at a pressure of 50 psi for 5 min. Moulded samples were cut into specimens according to ASTM D638 and ISO 178 to determine tensile properties and flexural properties respectively. To study the effect of pulp fiber contents on the properties of composite, the pulp fibers were adding into PLA with different fiber contents (0%, 10%, 20%, 30%, 40% and 50%) in the presence of epoxidized Tung oil (in amount of 10% of fiber). To study the effect of pulp fiber contents on the properties of composite, the used epoxidized Tung oil contents were 0%, 5%, 7.5%, 10%, 15%, respectively.


*2.3.2. Learning to change irrational thinking for challenging psychosis*

on how the family member may have been feeling, suggesting that they were able to recognize and describe the person's emotional state), a broad range of coping strategies to reduce distress (e.g., asking for help from someone, using humor, taking time out away from stressful situations, distraction by carrying on with work and their normal routine), and realistic optimism for the future (they believe that illness would always be part of their family member's life, but they can modify their expectations from life) [54]. Another study suggested that coping through seeking emotional support, the use of religion/spirituality, active coping, acceptance, and positive reframing were associated with less distress, while coping through

The information level of relatives about psychosis determined their cognitive view to the illness. These two factors were found to be related to stress level, expressed emotion, and patients' symptom severity. Beliefs about symptoms that "the major attributes of illness representation are oriented around" are one of the important factors of Leventhal's illness perception model by which to understand the process and outcome of distress in the relatives of patients with schizophrenia [56]. The other factors are chronicity or recurrence of the condition (time line and cyclical time line), consequences, personal control, treatment control, illness coherence, causes of the condition, and patients' emotional response to their condition [57, 58].

In order to establish a balance between vulnerability and resilience, we are able to help the patient to manage his symptoms by means of enhanced medical and psychological treatments. Enhanced coping strategies enable the patient to adaptively cope with distress and to reduce anxiety and stress level. This process can help reducing the severity of hallucinations and delusions. Patients can learn to modify their own coping strategies, or to use adaptive ones. Therefore, the first part includes adaptive-coping strategies used in the treatment of

The patients may understand and try to improve their symptomatology with the help of cognitive conceptualization. Irrational thinking and maladaptive schemas should be handled with a collaborative approach. Stress-vulnerability logic may also be helpful to educate the patient about this conceptualization. In the second part described subsequently, these strate-

Social support is also an important factor for psychosis in terms of its relation with coping. In the third part, the role of social support in the development and maintenance of psychosis is

Following the success of Beck, clinicians have developed and used individual or group-based CBT programs for psychosis [1, 16, 17, 25, 26, 34, 59–63]. These programs generally included coping strategies because patients already have their own methods to reduce the distress caused by psychotic symptoms, so they can easily learn to enhance adaptive-coping mecha-

*2.3.1. Learning to use adaptive-coping strategies for challenging psychosis*

**2.3. Challenging psychosis: developing and enhancing adaptive strategies**

self-blame was associated with higher distress scores [55].

30 Psychosis - Biopsychosocial and Relational Perspectives

psychosis.

considered.

gies are summarized.

nisms or to develop new ones.

There is some evidence that the contents of delusions reflect concerns about individual's himself and how others evaluate him. The delusions can be understood in terms of cognitive biases processing the normal beliefs. There may be extreme cognitive biases underlying extreme beliefs. Psychotic patients are seemed to miscalculate the probability of an event that may occur. In fact, they are most likely to use less information to make decisions; in other words, they jump into the conclusions. Delusions could be accepted as a response to the individual's search for meaning within his personal world [65]. To assign and understand the delusions, it is important to formulate how strongly the belief is held, the context of delusions in a person's life, how understandable the belief is, and how much the person relates the experience to himself/herself [39].

Psychotic patients catastrophically perceive the psychotic symptoms. Diagnosis or stigmatization of the others may create a traumatic effect. Thus, it is important to use a normalizing rationale and change this desperate point of view. This rationale enables the patient to apprehend that everyone has a potential to develop psychosis. Stress-vulnerability model is helpful to offer a personalized view to the patient including biological, psychological, and social explanations of how he developed vulnerable features and which stressful events triggered his vulnerable potential to develop psychosis [65].

Cognitive therapy suggests that the events do not directly determine our feelings and behaviors; our perceptions and interpretations influence how we feel and behave. All of us have some cognitive biases which also include some typical thinking errors. Dichotomous thinking (black or white), arbitrary inference (jumping to conclusions), and selective abstraction (only focusing a little part of the overall picture) are some of the most observed thinking errors in psychosis. With the help of cognitive model, patient can understand that how he interprets the situations can affect how he feels and how he reacts that way. He also comprehends the relation between his irrational thinking and his symptomatology. Then, the patient and the therapist can collaboratively work on changing the interpretations of the problem and exploring more rational perceptions and more adaptive alternative responses [65].

*<IP_ADDRESS>. The role of social support in the maintenance and recovery of psychosis*

emotion, and accordingly to positively affect the treatment process [72].

*<IP_ADDRESS>. Integrating family members to cognitive-behavioral interventions for challenging*

individual to the use of adaptive-coping strategies [72].

improving interpersonal functioning [75].

via cognitive-behavioral therapy.

port network [73].

*psychosis*

**3. Conclusion**

Poor social networks may also cause more vulnerability during acute episode; therefore, psychotic symptoms can get worse and patients can continue withdrawals [69, 71]. Lack of positive social support was associated to higher levels of stress and psychopathology [68]. On the other hand, positive social support was clearly seen as a factor which motivated the

From Vulnerability to Resilience: A Coping Related Approach to Psychosis

http://dx.doi.org/10.5772/intechopen.78385

33

Most patients often receive support from close family, as compared to friends and other relatives. In addition, schizophrenic patients find it particularly difficult to find emotional support [73], but reported the need for more emotional support, advice, and trust-based relationships [74]. Some researchers tried to quantitatively and functionally complement the patients' sup-

The results of the studies of social support indicate that both family and peer-based social support interventions can be used clinically to improve social support, to decrease the expressed

There is substantial evidence that integrating family members to psychotic patient's treatment is very helpful to reduce relapses. Techniques used in family interventions often tend to be on CBT based. They usually focus on reducing high expressed emotion and improving interpersonal environment. The key elements of these interventions are assessment and problem formulation; psychoeducation about the nature of the illness, its prognosis and treatment; and problem-solving techniques aiming to reduce conflicts and concerns, setting goals and

The aim of this chapter was to understand the continuum between the normality and psychosis, to review the coping-related explanations and coping strategies for psychosis. It is important to understand patients' own coping mechanisms, as well as their relatives' coping strategies because of the relation between psychotic symptoms, "expressed emotion," and "social support." Studies show that most of these coping strategies used are maladaptive, thus it is important to educate patients about cognitive model and adaptive-coping strategies

It is remarkable that almost all cognitive explanations have a similarity with vulnerabilitystress model, and they resemble each other except a few differences. The author tries to summarize all these explanations herein subsequently and show in a schematic assumption

When a person with cognitive and physical vulnerability is exposed to stressful life events (e.g., low social support, environmental difficulties, or psychological traumas) which surpass his vulnerability limit, he may experience an anomalous experience. For example, he can hear a whisper

named as "a Coping Related Model for Psychosis" in **Figure 1**.

There is also a link between early psycho-social stressors, dysfunctional assumptions underlying core maladaptive schemas, and the psychotic symptoms. Fowler and colleagues [1] summarized the main schematic themes for psychosis, and they categorized five schemas including *the belief that the self is extremely vulnerable to harm*—for example, "I am unsafe," *the belief that one is highly vulnerable to losing self-control*—for example, "I am dangerous to others," *the belief that the self is doomed to social isolation* "I am totally alone in the world," *the belief in inner defectiveness*—for example, "I am damaged/deficient," *the belief in strict standards*—for example, "I must perform the optimum standard in all areas at all times (schema compensation). Other core maladaptive schemas such as "I am different," "I am special," and "I am abandoned" are also effective in the development and the maintenance of the psychotic symptoms, especially of the delusions [65].

### *2.3.3. The role of social support for challenging psychosis*

It is known that individuals with psychosis have smaller social networks and less satisfying relationships [66]. Social support is accepted as an important factor in every stage: in the development, maintenance, and recovery of psychosis.

#### *<IP_ADDRESS>. The role of social support in the development of psychosis*

Outcomes of the studies which examined the relation of positive social support/lack of social support and psychosis indicated many important results.

One of these studies in which the quantity and quality of social relationships in young adults at ultra-high-risk for psychosis were evaluated, fewer close friends, less diverse social networks, less perceived social support, poorer relationship quality with family and friends, and more loneliness were determined, and these features have been found to be related to low functioning, and also a high symptom severity [66]. Correlatively, Schuldberg and colleagues have found that high-risk individuals reported receiving significantly less positive social support from both friends and family [67]. The relationship between psychosis proneness and negative social support (e.g., hostility and criticism from others) has not been examined yet [68].

In a study that aimed to understand the gender differences between childhood physical and sexual abuse, social support and psychosis, it was suggested that especially for women with a child maltreatment history, powerful social network systems and perceptions of social support were found as important factors for resilience and against developing psychosis [69].

A study that examined the role of social support in delays between the onset of psychotic illness and initiation of an adequate treatment found that good social support was associated with a significant increase in this duration [70].

## *<IP_ADDRESS>. The role of social support in the maintenance and recovery of psychosis*

Poor social networks may also cause more vulnerability during acute episode; therefore, psychotic symptoms can get worse and patients can continue withdrawals [69, 71]. Lack of positive social support was associated to higher levels of stress and psychopathology [68]. On the other hand, positive social support was clearly seen as a factor which motivated the individual to the use of adaptive-coping strategies [72].

Most patients often receive support from close family, as compared to friends and other relatives. In addition, schizophrenic patients find it particularly difficult to find emotional support [73], but reported the need for more emotional support, advice, and trust-based relationships [74]. Some researchers tried to quantitatively and functionally complement the patients' support network [73].

The results of the studies of social support indicate that both family and peer-based social support interventions can be used clinically to improve social support, to decrease the expressed emotion, and accordingly to positively affect the treatment process [72].


*Article* **The Impact of Fortnightly Stratification Variability on the Generation of Baroclinic Tides in the Luzon Strait**

**Zheen Zhang 1,\*, Xueen Chen 1 and Thomas Pohlmann 2**

**Abstract:** The impact of fortnightly stratification variability induced by tide–topography interaction on the generation of baroclinic tides in the Luzon Strait is numerically investigated using the MIT general circulation model. The simulation shows that advection of buoyancy by baroclinic flows results in daily oscillations and a fortnightly variability in the stratification at the main generation site of internal tides. As the stratification for the whole Luzon Strait is periodically redistributed by these flows, the energy analysis indicates that the fortnightly stratification variability can significantly affect the energy transfer between barotropic and baroclinic tides. Due to this effect on stratification variability by the baroclinic flows, the phases of baroclinic potential energy variability do not match the phase of barotropic forcing in the fortnight time scale. This phenomenon leads to the fact that the maximum baroclinic tides may not be generated during the maximum barotropic forcing. Therefore, a significant impact of stratification variability on the generation of baroclinic tides is demonstrated by our modeling study, which suggests a lead–lag relation between barotropic tidal forcing and maximum baroclinic response in the Luzon Strait within the fortnightly tidal cycle.

**Keywords:** Luzon Strait; baroclinic tides; stratification variability; MITgcm

17


**Development of an e-Learning Recommender System Using Discrete Choice Models and Bayesian Theory: A Pilot Case in the Shipping Industry**

Amalia Polydoropoulou and Maria A. Lambrou

*University of the Aegean, Business School, Department of Shipping, Trade and Transport, Korai, Chios, Greece*


**Acknowledgements**

The authors thank the Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, for providing the facilities and financial support under "ETP-2013- 053 diagnostic services nexus for breast cancer." Gratitude is also due to Human Life Advancement Foundation (HLAF) for its financial support. Ethics approval was obtained entitled "FF-338-2012 Breast Cancer Diagnostic Imaging System Using Mammogram and Ultrasound" from UKM Medical Center, Malaysia, for collecting and studying breast cancer patient records.