**6. The teachers' attitudes about the use of social media in higher education**

The research conducted in the Republic of Croatia, in the institutions Algebra University College and University of Applied Sciences Baltazar Zaprešić in the year 2019, on the convenient sample of 73 teachers in scientific-teaching and associate positions as shown in the until now partially published research [3, 13].

It was necessary to investigate teachers' perception of social media and whether and to what extent teachers use social media for higher education. The subject of this research was social media and whether teachers use it for higher education. The goal was to examine how teachers evaluate the role and importance of social media as a communication channel for the needs of higher education.

The study aims to ascertain whether teachers use social media for higher education and demographic factors like age, gender, and the scientific field of the teacher's primary teaching and/or associated profession affect their use of social media for higher education, as well as teachers' attitudes, social influence, and anxiety when using social media.

The specially constructed survey questionnaire was designed according to the adapted UTAUT model [14]. The use of technology, in general, can be influenced by numerous factors; therefore, in 2003, Venkatesh et al., based on a review of eight models of earlier theories and by consolidating constructs, created and empirically validated the unified theory of acceptance and use of technology (UTAUT). According to the UTAUT model [13], behavioral intention (intention to use in the next 1224 months) and (actual) behavior, that is, technology use, are distinguished. It is assumed that behavioral intention is significantly influenced by:

While behavioral intention and facilitating conditions (a person's degree of belief that there is an organizational and technological infrastructure that supports the use of technology) significantly contribute to the actual use of the system.

The structure of the sample according to age was as follows: 0% of teachers were younger than 20 years of age, 8.2% were 2130 years of age, and the same proportion of teachers was 61 years of age or older. The largest share is teachers aged 3140, 39.7% of them, and teachers aged 4150, whose share was 30.1%. 13.7% of teachers were in the age group 5160.

The total ratio of participating teachers by gender was 56.2% of the male population and only 43.8% of the female population. The male gender was slightly more represented among teachers.

The results of this research showed that gender, age, and the scientific field of the teacher's profession do not significantly affect the actual use of social media by teachers, but there are statistically significant relationships between individual teachers' attitudes toward the use of social media, social influence, variations in anxiety during of social media use [13], expected work performance and teachers'

intention to use social media for higher education purposes on the frequency of teacher use of social media, as summarized in **Table 3**.

It is significant to notice that the results of this research showed that demographic characteristics of teachers such as age, gender, and the scientific field of the teacher's profession do not affect the frequency of teachers' use of social media for higher

#### **Table 3.**

*A summary of factors that (do not) influence the frequency of teachers' use of social media for higher education purposes; Pearson's chi-square test, N = 73 [3].*

education, and this is also the case with individual attitudes toward use, social influences, and anxiety during use. However, it is not negligible that at the same time the frequency of teachers' use of social media for higher education would have a significant positive impact on higher education institutions through the implementation of education for both teachers and students on the use of social media, which could reduce their feeling that the use of social media is for higher education a little scary.

Likewise, regarding the frequency of teachers' use of social media for higher education, it is significant that students believe that teachers should use social media for higher education, as well as support the faculty administration regarding the use of social media for higher education.

Additionally, the research showed that there is no statistically significant relationship between teachers'self-confidence when using social media for higher education purposes, organizational factors, facilitating conditions for using social media for higher education purposes, and the expected ease (effort, effort) of using social media for higher education purposes. And the frequency of teachers' use of social media for higher education purposes. However, the results also showed that there is a statistically significant relationship between the expected work performance of using 'the use of social media for study purposes enables students to achieve better results during their studies and the teacher's intention to use social media for higher education in the next 12 months and the frequency of teacher use social media for the needs of higher education.

To gain an even deeper insight into teachers' attitudes about social media to the needs of higher education, teachers were asked to select which characteristics of social media teachers consider being advantageous. More than half of the teachers'survey point out easier and faster access to information, when and where it is needed, sharing ideas and experiences, photos and videos, flexibility in choosing technologies, quick feedback, and the possibility of creating digital content, as the main advantages of social media. While less than 20% of them pointed out reliability in continuous use over a longer period and the possibility of testing existing teaching models as advantages. The results are presented in percentages in **Table 4**.

Also, teachers were asked to select which characteristics of social media teachers consider disadvantaged. More than half of the interviewed teachers pointed out fewer

**Table 4.**

*Characteristics of social media that teachers consider to be advantages, N = 73 [3].*

characteristics as the main disadvantages than as advantages and that; neglecting direct communication (face-to-face), the possibility of false identities, and privacy issues (lack of privacy … ), while less than 10% pointed out that they are monetarily quantified (everything becomes "business" and "numbers"), they hide behind technologies and concepts that have not yet been sufficiently defined/researched, become a type of used web, that is, a medium for people with a low level of digital skills, time and knowledge spent on using it, the speed of the program is incomparably lower than the speed of desktop programs, the content means nothing to itself, it is only electronic "waste." The results are presented in percentages in **Table 5**.

**Table 5.**

*Characteristics of social media that teachers consider to be disadvantages, N = 73 [3].*


*2.4. Techno-Economic Assumptions*

The techno-economic parameters as of 2015 of each desalination technology are shown in Table 4. The operating costs were adjusted so that electrical and thermal requirements were excluded, as these were modeled explicitly. The techno-economic parameters of the energy components are shown in Appendix C.

**Table 4.** Techno-economic parameters of desalination technologies.


**Author details**

*Cyberspace*

strategies.

*hybrid HUMINT* operatives.

organizations, including the defense and security community, of a concept of *hybrid resilience*, of which *cyber resilience* is just an aspect. In this sense, in what regards CYBERINT [28], its focus needs to address the profile of cyber-threats and *cyop* profiles associated with hybrid strategies, in the sense that tactical dynamics of cyberattacks may obey to the pattern needed for a given hybrid strategy, and it needs to cooperate with HUMINT/CI in order to find countermeasures against

The concept of *hybrid resilience* as the ability to resist and recover from *hybrid campaigns* should be a major component of countries' national defense and security

Now, secondly, organizations should have training and a *hybrid defense and CI division* or at least subcontract specialized people in this area, covering both *cyber*

Faced with the threat of economic, financial, and (geo) political hybrid warfare, any country's major business and financial targets should have specialized training programs and people involved in *hybrid defense strategies* and *hybrid resilience*, including CI-based defense against possible disruption from what may become the

It is not enough to secure the technical side of cybersecurity, and one needs to address the social and human aspect of cyber intrusion, in which people's behavior can be turned against them, including the behaviors and vulnerabilities that come

Campaigns in the standard media against fake contents need to be addressed, as well as large-scale educational programs that should start in schools, educating civil society on the correct usage of cyberspace, on both the positive and negative, on how people can protect themselves against cyberbullying and hybrid campaigns, and on how people should read and reflect on the contents that they read and share. While these are some of the major changes needed to be implemented for any country's successful *national hybrid defense strategy*, there is a main point of *hybrid resilience* that was already identified in the old Chinese and Japanese classics, in particular in *Tai Kung's Six Secret Teachings* [4] and in the *Bansenshukai* [5]: without good governance there is always a fundamental vulnerability to hybrid strategies. The three major crisis profiles that were addressed in [29] and recovered in Section 2 come out of bad governance that is unable to face crises that affect its country's people (*resilience problems*), that is totalitarian and oppressive and that enforces its rule by force or has alienated a large part of its people due to rising inequalities and widespread political, business, and financial corruption (*legitimacy problems*), or that is unable to manage its territory (*authority problems*). All these three problems

open up any country to *hybrid threats* and reduce a country's *hybrid resilience*.

*defense* and *cyber resilience* as well as *hybrid defense* and *resilience*.

new disruptive face of HUMINT: the *hybrid HUMINT*.

from incorrect social network usage.

**74**

Carlos Pedro Gonçalves Institute of Social and Political Sciences, University of Lisbon, Lisbon, Portugal

\*Address all correspondence to<EMAIL_ADDRESS>
© 2019 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.


**7. Conclusions**

In this paper, the principle of wireless vehicle charging and the associated process chain were presented. Using the example of a demonstrator set up in the E|Profil project, the process chain for manufacturing a secondary system was presented. The next step is the integration of the charging technology into the infrastructure. As part of the E|Road project launched at FAU in summer 2021, the necessary production steps for concrete roads will be investigated. Important research aspects here are:

The completion of this extensive research work is intended to demonstrate that inductive charging technology is a feasible solution for the mobility of the future.

**Author Contributions:** Conceptualization, writing—original draft preparation and supervision A.K.; processes, writing—review and editing M.K., J.S., M.M. and M.W.; review and supervision, J.F. All authors have read and agreed to the published version of the manuscript.

**Funding:** This work was supported by the German Ministry for Economic Affairs (BMWi) and DLR by founding the project E|Profil under Grant FKZ 01MV18003A.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** Data of the project and to the machines is published online at www. faps.fau.de, accessed on 30 August 2022.

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


**Author details**

Ting-Wei Wang1,2 and Ting-Tse Lin3,4,5\*

1 Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA

2 Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA

3 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan

4 Cardiovascular Center, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan

5 College of Medicine, National Taiwan University, Taipei, Taiwan

\*Address all correspondence to<EMAIL_ADDRESS>
© 2021 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.


**Part 2**

**Acoustic Waves as Investigative Tools**

122 Acoustic Waves – From Microdevices to Helioseismology

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Thompson (Wiley, New York, 1971) vol. 4.

**6**

*Italy*

**Acoustic Waves:**

Marco G. Beghi

**A Probe for the Elastic Properties of Films**

Films and thin films are exploited by an ever increasing number of technologies. The properties of films can be different from those of the same material in bulk form, and can depend on the preparation process, and on thickness. Specific techniques are needed for their measurement. Whenever films or thin layers have structural functions, as in micro electro-mechanical systems (MEMS), a precise characterization of their stiffness is crucial for the design of devices. The same can be said for the design of devices which exploit thin layers to support surface acoustic waves (surface acoustic wave filters). More generally, knowledge of the elastic properties is interesting because such properties depend on the

The most widespread technique for the mechanical characterization of films, instrumented indentation, induces both elastic and inelastic strains. It also characterizes irreversible deformation, but the extraction of the information concerning the elastic behaviour is non trivial. To overcome this difficulty, several measurement methods have been developed, which exploit vibrations as a probe of the material behaviour. These methods intrinsically involve only elastic strains, and are non destructive. This is true at any length scale, and is peculiarly useful at micrometric and sub-micrometric scales, where the exploitation of other

Both propagating waves and standing waves can be exploited, with excitation which can be either monochromatic (e.g. resonance techniques) or impulsive, therefore broadband, requiring an analysis of the response either in the time domain (the so called picoseconds ultrasonics) or in the frequency domain (the so called laser ultrasonics). The propagation velocities of vibrational modes are obtained, from which the stiffness is derived if an

Older resonance techniques have been developed to be operated with thin slabs, also exploiting optical measurements of displacement. In the measurement of films and small structures, the advantages of light, a contact-less and inertia-less probe, are substantial, and are increasingly exploited. The laser ultrasonics technique, commercially available since some years ago, measures waves travelling along the film surface. The so called picosecond ultrasonics technique measures waves travelling across the film thickness; it is a relatively sophisticated optical technique, which exploits femtosecond laser pulses in a pump-and-probe measurement scheme. For best performance it needs the deposition of

**1. Introduction**

structural properties.

types of probes can become critical.

independent value of the mass density (the inertia) is available.

*Politecnico di Milano, Energy Department and NEMAS Center, Milano*


**1. Introduction**

#### *P. F. Drucker:*

'*The customer is the foundation of a business and keeps it in existence. He alone gives employment*' [1].

The beginning of the twenty-first century is characterized by unprecedented growth in globalization due to the rapid distribution of information, made possible by modern information

© 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. © 2017 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.

technologies. Numerous spheres of human activity shift in relation to the development of new technologies, the dawn of new economics and the growth of competition due to rapid fluctuations in the cycles of boom and crisis. In recent decades, development has gradually changed from a curved or spiral path into the reverse, the unexpected and almost unpredictable. According to Drucker: '*There is only one certainty: the future will be different from what we have today*' [1].

Turbulence, chaos and discontinuity, as manifestations of the current global world, bring new views on the measurement and management of corporate performance. Current conditions place more importance on non-financial indicators, which, in connection with financial indicators, can better identify the conditions influencing changes in the parameters of corporate performance. The new direction of corporate management, oriented towards performance, is associated with the transition from static models to dynamic models, which react flexibly to changes in the business environment. A holistic interdisciplinary approach to corporate management plays a significant role in this process.

The introduction of new technologies enabling rapid production growth and a decrease in the price of products and services easily increases the excess of offer over demand. This increases pressure on competition, resulting in a battle over markets and new customers. Besides cost and quality, time becomes an important factor in this competition. The global economic environment, as we have known it over the last decade, has led to the individualization of industrial products in order to correspond to customer wishes and, at the same time, to a shortening of the life cycle. Such products also include automobiles.

Changes in the requirements for industrial products are related to the transition from classic large-scale production, producing standardized products to new production conditions of value for the customer, able to adapt to customer demands and individual needs. In the surroundings of global competition, it is very important for a company to measure customer satisfaction in order for the conditions for stable production growth to be created. Under these changes, corporate management style and management skills must also change.


**Abstract**

Eating disorders, the most lethal of all the psychiatric disorders, are frequently misdiagnosed as benign weight management problems, which contribute to their being underdiagnosed and under-reported. Though eating disorders are typically first identified through easily discernible weight change, their unseen origins lie in genetic propensities, neurobiology, environmental and family influences, inborn temperament, and trauma. Non-integrative, behaviorally based weight management solutions that call for dieting and meal plans alone, by ignoring the psychological underpinnings and neurobiological origins of dysfunctions driving these disorders, can potentially lead to loss of life and/or life quality.  It is for the intuitive and skillful diagnostician to determine whether the patient's desire for weight change is based on healthful autonomous discretion or on the dictates of compulsions based in lifethreatening pathology, thus informing treatment. Eating disorders are disorders of the core Self of self-regulation, self-perception, self-esteem and self-care, affecting life spheres far exceeding eating-lifestyle and weight management. Healing weight management problems requires integrative diagnosis and care, re-establishing one's healthy relationship with food, weight, and eating, as well as with one's re-integrated core self.

**Keywords:** weight management, diets, dieting, obesity, disordered eating, eating disorders, anorexia nervosa, bulimia nervosa, obsessive compulsive disorder, binge eating disorder, purging, food restriction, healthy eating, exercise bulimia, refeeding edema, diabulimia

#### **1. Introduction**

Most individuals seeking advice about weight management issues approach healthcare professionals with the intention of improving their health, well-being, and appearance by losing weight and altering their metabolic function. Typically, first responders, be they parents, nutritionists, physicians, nurses, coaches, or personal trainers, offer non-integrative behavioral approaches to weight management in the form of prescriptive diet plans. In the absence of underlying pathology or compulsions that may drive dysfunctional eating behaviors, such simple solutions may be adequate. But when the origin of an individual's desire and efforts to lose weight resides in underlying eating pathology, purely behavioral solutions can mask potentially life-threatening dysfunctions. Sometimes hiding in plain sight, otherwise benign disordered eating (DE) habits may ultimately take on an element of compulsivity, leading to chronic illnesses such as heart disease, diabetes, and/or as heart disease or diabetes and/or the eventual onset of a life-threatening clinical eating disorder (ED) in genetically susceptible individuals. It is for the astute and intentional diagnostician to sniff out, intuit, or otherwise identify the potential for pathological origins within a constellation of seemingly benign weight management dysfunctions by determining whether a patient's desire for weight change is based on healthful, autonomous discretion or on the dictates of a tyrannical and potentially lethal eating disorder. Overlooking the nature and severity of DE behaviors or warning signs of a clinical ED can carry dire consequences. By partnering with the patient to affirm or negate a diagnostic hunch, the clinician informs appropriate treatment, promoting disease prevention or the achievement of a timely and sustainable problem resolution. systems, developmental life stages, and self-concept issues culminating in body image perception and preoccupations. The confluence of normal child development and early bodily maturation, environmental triggers gleaned through social media, attitudes in the home, and peer pressure can lead to high-risk responses in teens and young adults which might include dieting, excessive exercise, abuse of diet pills, purging, food restriction, or eating only when hungry/skipping meals. In response to a societal disconnect between biology and culture, as girls grow older, they are expected to grow smaller. Studies show that 42% of first to third grade girls wish to be thinner [1] and, in the attempt to change one's natural body shape and size, 81% of 10-year-old girls feel better about themselves when they are dieting [2], creating a greater risk of obesity in adulthood. 25% of American men and 45% of American women are dieting on any given day [3], giving rise to cravings, malnutrition, metabolic dysfunction, and increased overweight once the individual "falls off the dieting wagon." It has been reported that 35% of "occasional dieters" progress to pathological dieting and DE, and as many as 25% progress to partial or full syn-

*Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis…*

It is for the perceptive and responsive diagnostician to determine at what point, along the healthy eating continuum, eating behaviors cross the thin line between normal eating and various forms and degrees of eating pathology and compulsions. A patient of mine with binge eating disorder (BED) assumed that she was in "remission" until, "It suddenly occurred to me that this was not just about having an extra piece of pie … this was starting to feel like an all-out binge." Pathology exists when food, exercise, or the abuse of dietary substances is used to resolve emotional problems or in response to posttraumatic stress; when food serves purposes other than satiating hunger, fueling the body, or sociability; when the act of eating evokes guilt and fear; when eating habits become inflexible, immoderate, imbalanced, and excessive; when compulsive thoughts, such as calculating caloric intake, and preoccupations about becoming fat preclude other thinking, interfering with learning and normal daily function; and when attitudes and beliefs about food and eating are

*When a child who is a healthy eater runs out the door without breakfast because (s)he is late for the school bus, she will surely want to snack during the morning or eat a bigger lunch to make up for the calories lost. The child with an ED who runs out the door without breakfast does so because (s)he would otherwise be wracked with fear, anxiety, and guilt that the calories she might ingest would make her fat. This child would feel compelled to calculate how many calories (s)he can allow herself to ingest throughout the rest of the day so as not to gain a single ounce.*

**3. Weight management diagnosticians face multiple challenges**

cate to clinicians is often not accurate or comprehensive; and what patients request of health professionals is frequently not what they need. Falling between the cracks of accurate assessment and appropriate treatment, DE and potentially

lethal ED all too frequently remain misunderstood, underdiagnosed, and undertreated [5] by myopic, underinformed physicians, psychotherapists, and nutritionists who lack an integrative "big picture" perspective of the possible existence of underlying, co-occurring diagnoses that need to be revealed, monitored, and treated. The diagnosis of a clinical ED remains elusive, with more than

one half of all cases remaining undetected [6].

In the face of weight management issues, information that patients communi-

drome eating disorders [4].

*DOI: http://dx.doi.org/10.5772/intechopen.92152*

misguided.

**163**

#### **2. The continuum of healthy eating**

The nature and quality of eating patterns reside along a continuum that includes eating behaviors and self-care. Along the span of this continuum, healthy eating patterns may evolve into disordered eating patterns, potentially leading to deadly ED in genetically susceptible individuals. At one end of the continuum, healthy eating behaviors mark the achievement of a fit and effectively functional body capable of sustaining its own ideal set point weight through healthy eating and selfcare (**Figure 1**). At the opposite end of the continuum, life-threatening ED represent the tip of an underlying emotional, physiological, and neurobiological iceberg. A clinical ED marks the fragmentation or loss of the core self and, with it, the patient's lost capacity for self-regulation, self-trust, self-esteem, and self-care. Feelings of guilt and of shame typically foster secrecy, denial, and reluctance to seek or sustain care. Ambiguous and inconstant DE behaviors exist somewhere between the polarities of healthy eating and potentially life-threatening ED. Some DE patterns that may appear to be pathological may actually represent variations of normal and benign behaviors, being shared by otherwise healthy eaters. As an example, healthy eaters who choose to indulge excessively in the lavish offerings of dessert buffets, typically consider such an opportunity benign and not-to-be-missed, guiltfree, gastronomic sensory and aesthetic delight.

The evolution of dysfunction along the eating continuum is influenced by the melding of eating lifestyle with genetic propensities, inborn temperament, value

#### **Figure 1.**

*Along the continuum of healthy eating, the evolution of healthy eating to DE, and from DE to a clinical ED, represents a journey of developing pathology; likewise, recovery from eating pathology represents a journey in the opposite direction, towards developing health.*

*Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis… DOI: http://dx.doi.org/10.5772/intechopen.92152*

systems, developmental life stages, and self-concept issues culminating in body image perception and preoccupations. The confluence of normal child development and early bodily maturation, environmental triggers gleaned through social media, attitudes in the home, and peer pressure can lead to high-risk responses in teens and young adults which might include dieting, excessive exercise, abuse of diet pills, purging, food restriction, or eating only when hungry/skipping meals. In response to a societal disconnect between biology and culture, as girls grow older, they are expected to grow smaller. Studies show that 42% of first to third grade girls wish to be thinner [1] and, in the attempt to change one's natural body shape and size, 81% of 10-year-old girls feel better about themselves when they are dieting [2], creating a greater risk of obesity in adulthood. 25% of American men and 45% of American women are dieting on any given day [3], giving rise to cravings, malnutrition, metabolic dysfunction, and increased overweight once the individual "falls off the dieting wagon." It has been reported that 35% of "occasional dieters" progress to pathological dieting and DE, and as many as 25% progress to partial or full syndrome eating disorders [4].

It is for the perceptive and responsive diagnostician to determine at what point, along the healthy eating continuum, eating behaviors cross the thin line between normal eating and various forms and degrees of eating pathology and compulsions. A patient of mine with binge eating disorder (BED) assumed that she was in "remission" until, "It suddenly occurred to me that this was not just about having an extra piece of pie … this was starting to feel like an all-out binge." Pathology exists when food, exercise, or the abuse of dietary substances is used to resolve emotional problems or in response to posttraumatic stress; when food serves purposes other than satiating hunger, fueling the body, or sociability; when the act of eating evokes guilt and fear; when eating habits become inflexible, immoderate, imbalanced, and excessive; when compulsive thoughts, such as calculating caloric intake, and preoccupations about becoming fat preclude other thinking, interfering with learning and normal daily function; and when attitudes and beliefs about food and eating are misguided.

*When a child who is a healthy eater runs out the door without breakfast because (s)he is late for the school bus, she will surely want to snack during the morning or eat a bigger lunch to make up for the calories lost. The child with an ED who runs out the door without breakfast does so because (s)he would otherwise be wracked with fear, anxiety, and guilt that the calories she might ingest would make her fat. This child would feel compelled to calculate how many calories (s)he can allow herself to ingest throughout the rest of the day so as not to gain a single ounce.*

#### **3. Weight management diagnosticians face multiple challenges**

In the face of weight management issues, information that patients communicate to clinicians is often not accurate or comprehensive; and what patients request of health professionals is frequently not what they need. Falling between the cracks of accurate assessment and appropriate treatment, DE and potentially lethal ED all too frequently remain misunderstood, underdiagnosed, and undertreated [5] by myopic, underinformed physicians, psychotherapists, and nutritionists who lack an integrative "big picture" perspective of the possible existence of underlying, co-occurring diagnoses that need to be revealed, monitored, and treated. The diagnosis of a clinical ED remains elusive, with more than one half of all cases remaining undetected [6].

appearance by losing weight and altering their metabolic function. Typically, first responders, be they parents, nutritionists, physicians, nurses, coaches, or personal trainers, offer non-integrative behavioral approaches to weight management in the form of prescriptive diet plans. In the absence of underlying pathology or compulsions that may drive dysfunctional eating behaviors, such simple solutions may be adequate. But when the origin of an individual's desire and efforts to lose weight resides in underlying eating pathology, purely behavioral solutions can mask potentially life-threatening dysfunctions. Sometimes hiding in plain sight, otherwise benign disordered eating (DE) habits may ultimately take on an element of compulsivity, leading to chronic illnesses such as heart disease, diabetes, and/or as heart disease or diabetes and/or the eventual onset of a life-threatening clinical eating disorder (ED) in genetically susceptible individuals. It is for the astute and intentional diagnostician to sniff out, intuit, or otherwise identify the potential for pathological origins within a constellation of seemingly benign weight management dysfunctions by determining whether a patient's desire for weight change is based on healthful, autonomous discretion or on the dictates of a tyrannical and potentially lethal eating disorder. Overlooking the nature and severity of DE behaviors or warning signs of a clinical ED can carry dire consequences. By partnering with the patient to affirm or negate a diagnostic hunch, the clinician informs appropriate treatment, promoting disease prevention or the achievement of a timely and sustainable problem resolution.

The nature and quality of eating patterns reside along a continuum that includes eating behaviors and self-care. Along the span of this continuum, healthy eating patterns may evolve into disordered eating patterns, potentially leading to deadly ED in genetically susceptible individuals. At one end of the continuum, healthy eating behaviors mark the achievement of a fit and effectively functional body capable of sustaining its own ideal set point weight through healthy eating and selfcare (**Figure 1**). At the opposite end of the continuum, life-threatening ED represent the tip of an underlying emotional, physiological, and neurobiological iceberg. A clinical ED marks the fragmentation or loss of the core self and, with it, the patient's lost capacity for self-regulation, self-trust, self-esteem, and self-care. Feelings of guilt and of shame typically foster secrecy, denial, and reluctance to seek or sustain care. Ambiguous and inconstant DE behaviors exist somewhere between the polarities of healthy eating and potentially life-threatening ED. Some DE patterns that may appear to be pathological may actually represent variations of normal and benign behaviors, being shared by otherwise healthy eaters. As an example, healthy eaters who choose to indulge excessively in the lavish offerings of dessert buffets, typically consider such an opportunity benign and not-to-be-missed, guilt-

The evolution of dysfunction along the eating continuum is influenced by the melding of eating lifestyle with genetic propensities, inborn temperament, value

*Along the continuum of healthy eating, the evolution of healthy eating to DE, and from DE to a clinical ED, represents a journey of developing pathology; likewise, recovery from eating pathology represents a journey in the*

**2. The continuum of healthy eating**

*Weight Management*

free, gastronomic sensory and aesthetic delight.

*opposite direction, towards developing health.*

**Figure 1.**

**162**

*A patient of mine had been treated by a psychiatrist for 7 years, during which time, she never told him that she vomited 30 times a day, for fear of his finding her "disgusting" and therefore refusing to treat her. This physician failed to "read between the lines" of her symptoms and to intuit and investigate the presence of an ED from the constellation of personality traits, temperament, and behaviors that she did reveal to him. Through our work together, she came to understand her problem and her self. The quality of our relationship led to the improvement of all her significant relationships—with food, with her self, and with others.*

healthier.'" The term "healthy eating" not infrequently becomes a euphemism for food restriction, or 'clean eating,' potentially triggering the onset of orthorexia in ED individuals. Further complicating the diagnostic process, ED symptoms vary appreciably from patient to patient, with; every ED a 'thumbprint.' Fully half of the ED population suffers from the difficult-to-identify condition called "other specified feeding or eating disorder" (OSFED), previously known as "eating disorder not otherwise specified" (EDNOS) [7]. OSFED describes atypical AN (without low weight) and atypical BN or BED (with lower frequency of behaviors, purging disorder, and/or night eating syndrome). Patients who do not meet the strict diagnostic cutoffs for full criteria for AN and BN often remain undiagnosed despite the seriousness of their illness, foregoing or delaying necessary treatment [8]. Patients with clinical ED are often reticent, within a diagnostic interview, to divulge a stigmatized disorder. A recent discovery, important for its potential to reduce the degree of stigma that is associated with ED nondisclosure revealed that 20% of the neurobiology of AN could be derived from metabolic genes (possibly activated by a state of starvation) [9].

*Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis…*

**3.1 Myths and misconceptions regarding clinical ED abound**

individuals are exceedingly thin."

*DOI: http://dx.doi.org/10.5772/intechopen.92152*

body and multiple pathways in the brain [10].

*3.1.1 The physician's role in weight management detection*

look opportunities for early disease recognition.

charts, precluding early disease prevention.

represent a "clean bill of health."

of ED:

**165**

Consider the following examples of decoys to the recogntion and understanding

• People mistakenly assume that AN is easy to spot, believing that "all anorexic

restoration of weight marks a full recovery from an ED. In fact, ED recovery is marked by neurobiological, emotional, cognitive, and behavioral changes that lead to the reintegration of the individual's core self and the normalization of body fat mass and sexual hormones, which have a widespread impact on the

• Despite the widely accepted misconception that ED represent an incurable "life sentence," about half of those individuals with AN or BN attain a full recovery, 30% achieve a partial recovery, and 20% show no substantial improvement [11].

Though early detection of ED warning signs is pivotal in disease prevention and/ or promoting a timely recovery, the medical community has been known to over-

• Because signs of an ED rarely appear in blood tests until advanced stages of disease, normal test results in early stages of ED are often misconstrued to

• Pediatricians frequently overlook the significance of precipitous weight loss in children when their numbers fall within the range of normal on the growth

amenorrhea, erroneously assuming that hormone replacement will counteract

• Gynecologists regularly prescribe birth control pills for ED patients with

or reverse bone loss and improve reproductive functionality [12].

• It is a commonly believed misconception that an AN individual's full

The unique requirements of weight management issues demand the uniquely specialized skills of an informed, intentional, and intuitive diagnostician, capable of hearing what has not yet been spoken. Within the context of initial history-taking, the nature of weight-related dysfunctions is likely to remain elusive in the absence of an active probe for problem origins in pathology. The diagnostician's enlightened line of questioning will substantiate, or negate, such a presence, revealing the subtleties of distinctions between the nature of eating behaviors as they reside along the healthy eating continuum. When eating behaviors do appear to cross the line into pathology, the diagnostician takes on the role of crisis interventionist, through immediate responsiveness to the needs of the moment through an investigation into the past. Because the patient's quality of life may depend upon assessment accuracy, the obligation for first responders or clinicians to detect, explore, and interpret issues yet to be unearthed becomes a unique challenge within the confines of the limited timeframe of a single-session weight management consultation. On high alert for potentially unseen issues, the proactive first responder must be prepared to offer psychoeducation, a plan of action, and, where appropriate, referrals to collaborating experts and/or higher-level treatment milieus.

*Esther was a 29-year-old woman who came to treatment for depression, poor selfesteem, and relationship problems. In response to her description of her college days during which she spoke of herself as perfectionistic, highly compulsive, anxious, and depressed, I chose to wonder aloud if she had ever struggled with an ED or other eating-related issues. "My God!" she responded. "How did you know? I have never told a soul!" By understanding the nature of her personality structure and recognizing characteristics of her emotional functioning, I was able to intuit and surmise the possible existence of a past ED, which upon inquiry, I discovered had yet to be fully resolved. Following the tenet of John Muir, "If we try to pick out anything by itself, we find it hitched to everything else in the universe." By following my hunch and having made this discovery, I was able to launch the ED treatment process immediately.*

Where the clinician's depth and breadth of understanding of weight management issues is limited and non-integrative, the patient is liable to leave the treatment office with a diet plan in hand, yet without a practicable and sustainable solution for pressing weight-related concerns. More significantly, the loss of a timely and poignant opportunity for the patient to discover unknown problem origins and aspects of self and personality represents a lost opportunity for self-reflection, selfawareness, and self-integration, all leading to healthier lifestyle choices.

Factors further clouding the differential diagnosis of eating-related pathology include the elusive assessment of evolving and ambiguous DE patterns, and the widespread misunderstanding and erroneous information surrounding the issues of eating, weight control, and ED. In asking my ED patients what triggered the onset of their ED, a frequently heard response is that they "started to diet in an effort to lose weight, and ultimately found themselves feeling compelled to eat 'healthier and

*Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis… DOI: http://dx.doi.org/10.5772/intechopen.92152*

healthier.'" The term "healthy eating" not infrequently becomes a euphemism for food restriction, or 'clean eating,' potentially triggering the onset of orthorexia in ED individuals. Further complicating the diagnostic process, ED symptoms vary appreciably from patient to patient, with; every ED a 'thumbprint.' Fully half of the ED population suffers from the difficult-to-identify condition called "other specified feeding or eating disorder" (OSFED), previously known as "eating disorder not otherwise specified" (EDNOS) [7]. OSFED describes atypical AN (without low weight) and atypical BN or BED (with lower frequency of behaviors, purging disorder, and/or night eating syndrome). Patients who do not meet the strict diagnostic cutoffs for full criteria for AN and BN often remain undiagnosed despite the seriousness of their illness, foregoing or delaying necessary treatment [8]. Patients with clinical ED are often reticent, within a diagnostic interview, to divulge a stigmatized disorder. A recent discovery, important for its potential to reduce the degree of stigma that is associated with ED nondisclosure revealed that 20% of the neurobiology of AN could be derived from metabolic genes (possibly activated by a state of starvation) [9].


*2.2. Nozzle Design*

A bespoke SBS concentric nozzle was used to produce PVDF submicron fibres and was supplied by AREKA group, Istanbul, Turkey. A schematic of the nozzle used for the CFD model to predict air flow characteristics is shown in Figure 1. The polymer solution syringe is inserted through the opening at the left end of the nozzle that passes all the way through and comes out from the right end of the nozzle. In the middle is an air inlet (~4 mm diameter) that transfers air into the air chamber. To build pressure, the air chamber has four holes with internal diameters of ~1 mm each. These holes are covered with a cap that leaves a very narrow fissure for the air to come out 360◦ around the concentric polymer solution syringe. To ease manufacturing, the nozzle consists of four metallic sections (Figure 2) which are assembled to form the nozzle unit. Consequently, the experiments were carried out using this assembled nozzle. Most of the CFD models in the reviewed literature were carried out in 2D systems which were then extrapolated to 3D [18]. However, in this study, a 3D nozzle was employed which was also used in the experiments and using the same system for theoretical calculations will provide a more realistic comparison.


*5.2. The βE-Coefficient*

We chose to calculate the βE *coefficient* over 9 months. Examining the phase plot for the period 1989M1 to 1992M10 in Figure 2e and following the βE(9) from left to right during the same time window in Figure 2a, the βE will first show a small positive peak, then after 1990 a sharp negative peak and last a horizontal "no change" trend.