**3. Results**

Several studies from Asian countries showed that in many cases could be visible former experience with crisis situation and it means also preparedness of a responsible government to that situation. Moreover, there might be visible cultural dimensions, which have been mentioned as the collectiveness or the individualism. Important could be fast political decisions and a respond of citizens. For instance, one excellent example is Taiwan. Taiwanese government is one of the most successful examples of crisis management implementation in the world. The first information about the virus appeared on 21st of January 2020. Taiwanese government has actively and really efficiently sent all instructions about the protection against a new form of virus to the citizens and did not try to hide any information, which is a sign of democratic and responsible government. One of the crucial tasks was a control of the healthcare supply chain affordable to the country and its citizens and a tight co-operation with the academic institutions in a matter of the antiviral

*A risk management approach to a crisis.*

drugs development. For instance, the figures by April 9th, about 79 days after first case appeared, the number of cases was 379 and deaths only 5. These numbers were much lower than the numbers in China in that time, which is a result of a quick response, geographical advantage (an Island separated by a sea), preparedness and different cultural and political approach despite of being Chinese culture, but with a totally different political attitude. When we compare the numbers of the evidence of this virus to the situation in China, by April 9, in China the number of confirmed cases was 175,74 times the number in Taiwan and the number of deaths 5,300 times the number in Taiwan (in Taiwan 4,7 cases and 0,06 deaths per day).

Another example of success might be found in Malaysia and Vietnam. Similarly, as in Taiwan, Malaysia and Vietnam are culturally close to Confucianism. It means that governmental leadership might be easier because of that collectivist feelings and a meaning of collective good is deeper incorporated in their cultures. It means hegemony of duty to society over individual needs. This was visible in those countries, where for instance citizens of Taiwan regularly wear facemasks in public despite of the fact that the evidence of COVID-19 is very low. Governments in Asia need not always remind people to wear masks, keep distance and stay home.

In Malaysia, COVID-19 infection started to spread early March and rocketed to 8 800 cases early June, but later due to the discipline and facemasks, responsibility of the citizens and government regulations obedience, the number of cases dropped. Ethnic Malay cultures in Malaysia and Indonesia promote banding together against common threats.

Malaysia is also one success example of the cultural influence, governmental approach and responsibility of citizens; however, there could also play important role the geographical indicators and a distance from the neighbouring countries. Boundaries, geographical distance, social distance and political capability might be decisive factors of successful outcome of such pandemic situation caused by a virus.

Similarly, Vietnam was able to keep the situation of their country with just 401 cases in the beginning under control; however, there might be visible not only cultural, but also political influence and more governmental control as a consequence of former historical and political development. Despite of it, Vietnam could be a success story to the world.

In the United States, the virus started to develop in early March, but in comparison the above mentioned countries, the numbers have climbed in June 2020. It might be a cultural attitude and power distance characteristics, but Americans are not unified in the rule to wear masks and abandon their personal freedom to decide personally. This might be a problem in several western countries all over the world, for instance also in Europe or even in Eastern Europe (a case of Czech Republic).

On the opposite to the U.S.A., another country at the North American continent, Canada knows as a multicultural country focused on social, health, and community principles. Canada has a different story as for instance the U.S.A. and the rest of western world (particular countries). Based on a research of Zhang and Young-Leslie who have been collecting data mainly through focus groups and surveys of Canadians from across the country, several results could indicate a cultural and political approach as well the attitudes of different cultures to the rules given by Canadian government as a result to the pandemic situation. The research showed that some rules as face masks wearing was quite common even before the COVID-19 outbreak among some cultures, for instance as a result of fair pollution or sensitivity to toxins in the air. Those cultures were from East Asia, for instance China, Korea, Vietnam, and Japan. In some cases, these inhabitants tried to avoid harsh weather or wanted to keep anonymity. In a poll conducted by Leger and the Association for Canadian Studies, 51 per cent of Canadians surveyed said they've worn masks while doing their grocery shopping. Fifty-three per cent said masks

**213**

*The Cultural Differences in the Perception and Application of Crisis Management in Tourism*

should be mandatory in public and confined spaces like shopping malls and public transit. Public acceptance of protective face masks has evolved dramatically in Canada since the beginning of the COVID-19 pandemic, according to new psychology research from the University of Alberta. It is important to state that North-American people, a generation of people who are still alive and the middle aged or young generation never experienced Spanish flu. This could be also stated about a majority of people in the world because this flu was typical for the beginning of the 20th century and not many people are still alive from that period of time. This might be also important fact in general judgment of the behaviour of some people who do not believe in this real health problem and think this might be only made up artificially and distributed by media. However, there are again political, cultural

Zhang and Young-Leslie also found there were differences between non-Chinese-speaking Asian-Canadians and recent immigrants, where the assimilated Chinese non-Chinese speaking Asian Canadians felt to be more targeted as new immigrants, which is also an important sign of a stigma. However, based on this research and results, it could be visible that cultural influence and a period of life in different country and culture might have an influence on behaviour of people. Richard Schultz, an expert on federalism and a 40-year veteran of teaching politics at McGill University mentioned important statement on Canada, which should be discussed in order to understand the differences among the development in the epidemic outbreak in Canada and the U.S.A. There is this culture (in Canada) of … more deeply rooted community and social services. We fight about the size of government, we fight about deficits -- but when push came to shove, we said, 'Look, there's no one fighting this.' … it does say something to me about the vast cultural difference between the United States and Canada. "Professor Schulz continues" Political scholars have long seen Canada as one of the world's most decentralized federations -- a place where Ottawa yields much to the provinces and territories, which manage key services like health and education." (https://www.ctvnews.ca/ health/coronavirus/compared-to-u-s-canada-s-covid-19-response-a-case-study-in-

However, in the question of crisis solving, there has been a strong consensus and co-operation among the provinces and the federal government. Important is also a consensus with the communities and citizens, businesses and economic support in the time of crisis to overcome the negative consequences. Professor Schulz commented that "And yet, I think this is a highly exceptional case that we're dealing with. We have the 10 provinces and the federal government -- in a way that I haven't witnessed in the 56 years I've been studying it -- working relatively collaboratively, co-operatively together on this issue.", which confirms the above stated ideas (https://www.ctvnews.ca/health/coronavirus/compared-to-u-s-canada-scovid-19-response-a-case-study-in-political-civility-1.4895357) [16]. It might be more explained by one fact that Canada has had already an experience with SARS outbreak in 2004 and a positive outcome of this situation was preparedness for the epidemiological and crisis situation. Important role might play also cultural factors as has been mentioned above and the fact that Canada is a country with strongly

In Canada, the outbreak of SARS (Severe Acute Respiratory Syndrome) did not have an extreme impact on mortality of people because only 45 people died, but an immediate effect was evident in tourism industry. Over 1/3 of 95 000 employees in tourism was laid off (based on Smith Travel Research) after the SARS outbreak and total decrease of tourism revenue due to SARS was 500 million in Toronto, Ontario in the following months. From April to June 2004, the number of international visitors declined 14%, their spending declined 13% and the travel deficit in the income

*DOI: http://dx.doi.org/10.5772/intechopen.97779*

political-civility-1.4895357).

developed common sense feeling.

and geographical differences among countries and people.

#### *The Cultural Differences in the Perception and Application of Crisis Management in Tourism DOI: http://dx.doi.org/10.5772/intechopen.97779*

should be mandatory in public and confined spaces like shopping malls and public transit. Public acceptance of protective face masks has evolved dramatically in Canada since the beginning of the COVID-19 pandemic, according to new psychology research from the University of Alberta. It is important to state that North-American people, a generation of people who are still alive and the middle aged or young generation never experienced Spanish flu. This could be also stated about a majority of people in the world because this flu was typical for the beginning of the 20th century and not many people are still alive from that period of time. This might be also important fact in general judgment of the behaviour of some people who do not believe in this real health problem and think this might be only made up artificially and distributed by media. However, there are again political, cultural and geographical differences among countries and people.

Zhang and Young-Leslie also found there were differences between non-Chinese-speaking Asian-Canadians and recent immigrants, where the assimilated Chinese non-Chinese speaking Asian Canadians felt to be more targeted as new immigrants, which is also an important sign of a stigma. However, based on this research and results, it could be visible that cultural influence and a period of life in different country and culture might have an influence on behaviour of people.

Richard Schultz, an expert on federalism and a 40-year veteran of teaching politics at McGill University mentioned important statement on Canada, which should be discussed in order to understand the differences among the development in the epidemic outbreak in Canada and the U.S.A. There is this culture (in Canada) of … more deeply rooted community and social services. We fight about the size of government, we fight about deficits -- but when push came to shove, we said, 'Look, there's no one fighting this.' … it does say something to me about the vast cultural difference between the United States and Canada. "Professor Schulz continues" Political scholars have long seen Canada as one of the world's most decentralized federations -- a place where Ottawa yields much to the provinces and territories, which manage key services like health and education." (https://www.ctvnews.ca/ health/coronavirus/compared-to-u-s-canada-s-covid-19-response-a-case-study-inpolitical-civility-1.4895357).

However, in the question of crisis solving, there has been a strong consensus and co-operation among the provinces and the federal government. Important is also a consensus with the communities and citizens, businesses and economic support in the time of crisis to overcome the negative consequences. Professor Schulz commented that "And yet, I think this is a highly exceptional case that we're dealing with. We have the 10 provinces and the federal government -- in a way that I haven't witnessed in the 56 years I've been studying it -- working relatively collaboratively, co-operatively together on this issue.", which confirms the above stated ideas (https://www.ctvnews.ca/health/coronavirus/compared-to-u-s-canada-scovid-19-response-a-case-study-in-political-civility-1.4895357) [16]. It might be more explained by one fact that Canada has had already an experience with SARS outbreak in 2004 and a positive outcome of this situation was preparedness for the epidemiological and crisis situation. Important role might play also cultural factors as has been mentioned above and the fact that Canada is a country with strongly developed common sense feeling.

In Canada, the outbreak of SARS (Severe Acute Respiratory Syndrome) did not have an extreme impact on mortality of people because only 45 people died, but an immediate effect was evident in tourism industry. Over 1/3 of 95 000 employees in tourism was laid off (based on Smith Travel Research) after the SARS outbreak and total decrease of tourism revenue due to SARS was 500 million in Toronto, Ontario in the following months. From April to June 2004, the number of international visitors declined 14%, their spending declined 13% and the travel deficit in the income

*Issues on Risk Analysis for Critical Infrastructure Protection*

drugs development. For instance, the figures by April 9th, about 79 days after first case appeared, the number of cases was 379 and deaths only 5. These numbers were much lower than the numbers in China in that time, which is a result of a quick response, geographical advantage (an Island separated by a sea), preparedness and different cultural and political approach despite of being Chinese culture, but with a totally different political attitude. When we compare the numbers of the evidence of this virus to the situation in China, by April 9, in China the number of confirmed cases was 175,74 times the number in Taiwan and the number of deaths 5,300 times

Another example of success might be found in Malaysia and Vietnam. Similarly, as in Taiwan, Malaysia and Vietnam are culturally close to Confucianism. It means that governmental leadership might be easier because of that collectivist feelings and a meaning of collective good is deeper incorporated in their cultures. It means hegemony of duty to society over individual needs. This was visible in those countries, where for instance citizens of Taiwan regularly wear facemasks in public despite of the fact that the evidence of COVID-19 is very low. Governments in Asia need not always remind people to wear masks, keep distance and stay home.

In Malaysia, COVID-19 infection started to spread early March and rocketed to 8 800 cases early June, but later due to the discipline and facemasks, responsibility of the citizens and government regulations obedience, the number of cases dropped. Ethnic Malay cultures in Malaysia and Indonesia promote banding together against

Malaysia is also one success example of the cultural influence, governmental approach and responsibility of citizens; however, there could also play important role the geographical indicators and a distance from the neighbouring countries. Boundaries, geographical distance, social distance and political capability might be decisive factors of successful outcome of such pandemic situation caused by a virus. Similarly, Vietnam was able to keep the situation of their country with just 401 cases in the beginning under control; however, there might be visible not only cultural, but also political influence and more governmental control as a consequence of former historical and political development. Despite of it, Vietnam could be a

In the United States, the virus started to develop in early March, but in comparison the above mentioned countries, the numbers have climbed in June 2020. It might be a cultural attitude and power distance characteristics, but Americans are not unified in the rule to wear masks and abandon their personal freedom to decide personally. This might be a problem in several western countries all over the world, for instance also in Europe or even in Eastern Europe (a case of Czech Republic). On the opposite to the U.S.A., another country at the North American continent, Canada knows as a multicultural country focused on social, health, and community principles. Canada has a different story as for instance the U.S.A. and the rest of western world (particular countries). Based on a research of Zhang and Young-Leslie who have been collecting data mainly through focus groups and surveys of Canadians from across the country, several results could indicate a cultural and political approach as well the attitudes of different cultures to the rules given by Canadian government as a result to the pandemic situation. The research showed that some rules as face masks wearing was quite common even before the COVID-19 outbreak among some cultures, for instance as a result of fair pollution or sensitivity to toxins in the air. Those cultures were from East Asia, for instance China, Korea, Vietnam, and Japan. In some cases, these inhabitants tried to avoid harsh weather or wanted to keep anonymity. In a poll conducted by Leger and the Association for Canadian Studies, 51 per cent of Canadians surveyed said they've worn masks while doing their grocery shopping. Fifty-three per cent said masks

the number in Taiwan (in Taiwan 4,7 cases and 0,06 deaths per day).

**212**

common threats.

success story to the world.

from international tourism was over 1.1 billion CAD together with the decrease of employment in tourism by 2.4% ([17]; KPMG; PKF Consulting). Based on the Canadian Charter of Rights and Freedoms, Federal government has a power to act in a matter of health protection in a case of health protection of the whole country despite a fact that health care, public health lies under the jurisdiction of the provinces. Some formerly experienced problems and failings during SARS outbreak in 2004 lead to a stronger federalism in this question, which had an influence on Canadian story in pandemic fight. It might be a real problem in the second largest country in the world, but the outcome was not catastrophic and when we compare the situation in the U.S.A., Canada was able to cope the crisis situation much more efficiently. Fierlbeck commented that Canada, because of historical circumstances, really has what I would call a reasonable institutional framework for co-ordination between jurisdictions". (https://www.ctvnews.ca/health/coronavirus/compared-tou-s-canada-s-covid-19-response-a-case-study-in-political-civility-1.4895357).

The success lesson could be taught from Slovakia in the 1st wave of COVID-19 situation, where mostly several key factors played the most important role, the quick introduction of protective rules, which were especially rooted in wearing protective masks and gloves. The strict rules were implemented in order to protect citizens as for instance a penalty of breaking a quarantine order. Slovakia belonged to the first countries in the world (second after the Czech Republic in Europe) to order face masks to become mandatory inside buildings (stores, schools, etc.) and in public spaces. This decision was made even earlier as the World Health Organization advised people to wear masks in public. By March 13, one week after Slovakia confirmed its first coronavirus case the Slovak governmental representatives appeared in masks in front of media and demonstrated their compassion with the existing situation and the seriousness of the health care problem caused by the COVID-19 virus. The message was sent to the public: "Protect others and you'll be protected … It's not embarrassing. It helps everyone." Important decision was a nationwide lockdown. The reason might be a fear of the situation in the world, especially in Italy and Spain and a fear to cope a pandemic situation, which could be overwhelming and devastating for the Slovak healthcare system. (https:// www.theatlantic.com/international/archive/2020/05/slovakia-mask-coronaviruspandemic-success/611545/) [18].

When analysing the success factors of Slovakia in a survey about the successful measures fighting against the virus of COVID-19, the most important were classified the rule of wearing face masks, gloves, especially in very frequent spaces. About 90 percent of the respondents have limited their travelling, either by public transport or by car. This had a strong consequence on tourism and travel agencies and airports experienced a strong decline of passengers (about 80%). (https://newsnow.tasr.sk/featured/ survey-over-90-of-slovaks-view-coronavirus-related-measures-as-appropriate/)

Unfortunately, this is not a case of the 2nd COVID-19 wave in Slovakia, where the situation is becoming more difficult. Slovakia and Czech Republic are culturally very close countries in some aspects and at the beginning of the pandemic situation in Slovakia was second after Czech Republic to implement face masks duty after the outbreak of COVID-19 in their countries. Both countries have a democratic government, which was elected in free elections and the development in fighting the epidemic situation was at the beginning similar, despite a slightly higher numbers in Czech Republic due to the number of citizens and a proximity to western countries, which were more affected in that period of time. In the first wave of pandemic situation both countries were cases of good results. In June the situation has been improved and both countries opened the economy, schools and some travelling to safe countries was fully introduced. However, it is visible from the development in

**215**

**4. Conclusion**

*The Cultural Differences in the Perception and Application of Crisis Management in Tourism*

both countries that Slovak citizens were more careful in opening and did not abandon some formerly introduced regulations. Slovaks are people who obey the rules and it is more collectivist society with a masculine characteristic. This cannot be fully generalized, but when we compare Czechs and Slovaks, there are differences. This might be a reason why there exist now such differences in the number of infected people, mortality and 14-day cumulative number of cases per 100 000 when we compare both countries now. In Czech Republic (now takes 2nd place in Europe in the daily increase of numbers of infected people), there are 49 290 cases, daily increase ranks from 2000 to over 3000 infected people, mortality is 503 and 14th day cumulative number of COVID-19 cases per 100 000 is 37,9. The expectation based on the European Centre for the Prevention and Control of Diseases the expected daily increase in Czech Republic could be 8000 cases a day. Finally, the government decided to renew the meetings of the General Crises Committee and decided about a personal change of a Minister of Health Care. In Slovakia, on the other hand are 6 677 infected, mortality is 40 and the 14-day cumulative number of COVID-19 is 37,9 per 100 000. Slovakia had to restrict the travelling rules from Czech Republic and there are several strict restrictions, which will try to avoid spreading the virus. Slovak government tries despite very friendly contacts with Czech government to look at the case as the negative externality, which might be a danger for Slovak citizens. Culturally, Czech people could be characterized as more feminine society (in comparison to Slovakia as more masculine society), more individualistic society closer to western European countries and a society with not such a tendency to obey rules (refusal to wear masks inside, for instance) and keep all restrictions, especially in big cities. Cultural dimension, political rule, governance and also the number of visitors with tourism or business aim might be a decisive reason for Czech Republic to be in such a situation. In all aspects, economy and consequently even tourism suffers more when people are not administered properly or there is lack of control from a government. Obviously, this pandemic situation might lead to stronger governmental role in a country and in tourism business as well. It might be a lesson for the countries and governments of those countries how to solve the situation more effectively. The effective crisis management and organizational learning processes should be helpful not only to understand the differences among cultures, but especially could solve problems in a faster and progressive way.

Competitiveness of countries, which is based not only on comparative advantage, but also the competitive forces as for instance is safety and security, has tremendous impact on economy and tourism as well. The world is in continual change, which could be positive or negative. Some changes might be totally unexpected and devastating for the economy and the most dangerous are consequences for the human´s health and life, which is a case of pandemic COVID-19, which affected the whole world since January 2000. In this chapter, we tried to discuss not only managerial preparation and the existence of models of crisis and management from former crisis situations, but also preparedness of several countries to cope critical situation, the role of mass media and business culture and especially the influence of cultural differences in managerial decisions, in behavior of citizens generally and in the discussed countries. Hofstede [4] explained five dimensions of national culture, which influence a behavior of different cultures and it means also countries with people living predominantly from this cultural group. Those typical independent dimensions are: power distance; uncertainty avoidance; individualism versus collectivism; masculinity versus femininity; and long-term versus

*DOI: http://dx.doi.org/10.5772/intechopen.97779*

#### *The Cultural Differences in the Perception and Application of Crisis Management in Tourism DOI: http://dx.doi.org/10.5772/intechopen.97779*

both countries that Slovak citizens were more careful in opening and did not abandon some formerly introduced regulations. Slovaks are people who obey the rules and it is more collectivist society with a masculine characteristic. This cannot be fully generalized, but when we compare Czechs and Slovaks, there are differences.

This might be a reason why there exist now such differences in the number of infected people, mortality and 14-day cumulative number of cases per 100 000 when we compare both countries now. In Czech Republic (now takes 2nd place in Europe in the daily increase of numbers of infected people), there are 49 290 cases, daily increase ranks from 2000 to over 3000 infected people, mortality is 503 and 14th day cumulative number of COVID-19 cases per 100 000 is 37,9. The expectation based on the European Centre for the Prevention and Control of Diseases the expected daily increase in Czech Republic could be 8000 cases a day. Finally, the government decided to renew the meetings of the General Crises Committee and decided about a personal change of a Minister of Health Care. In Slovakia, on the other hand are 6 677 infected, mortality is 40 and the 14-day cumulative number of COVID-19 is 37,9 per 100 000. Slovakia had to restrict the travelling rules from Czech Republic and there are several strict restrictions, which will try to avoid spreading the virus. Slovak government tries despite very friendly contacts with Czech government to look at the case as the negative externality, which might be a danger for Slovak citizens. Culturally, Czech people could be characterized as more feminine society (in comparison to Slovakia as more masculine society), more individualistic society closer to western European countries and a society with not such a tendency to obey rules (refusal to wear masks inside, for instance) and keep all restrictions, especially in big cities. Cultural dimension, political rule, governance and also the number of visitors with tourism or business aim might be a decisive reason for Czech Republic to be in such a situation. In all aspects, economy and consequently even tourism suffers more when people are not administered properly or there is lack of control from a government. Obviously, this pandemic situation might lead to stronger governmental role in a country and in tourism business as well. It might be a lesson for the countries and governments of those countries how to solve the situation more effectively. The effective crisis management and organizational learning processes should be helpful not only to understand the differences among cultures, but especially could solve problems in a faster and progressive way.


**9. Revision mastopexy/augmentation**

 Revision mastopexy/augmentation surgery can be quite difficult but also very rewarding and is a necessary component for anyone offering these procedures. The acknowledgment of an undetermined blood supply and the potential for NAC ischemia is paramount when considering revision surgery. Although prior operative reports may be beneficial, they can be unreliable as to the actual pedicle utilized and great caution must be used. Avoidance of wide excision patterns or significant

#### *The Art of Body Contouring*

 undermining is advisable. Occasionally multiple pedicles can be combined in some situations to help limit ischemia when the prior pedicle use is unknown (**Figure 17**). Foremost, patients requiring a second mastopexy with or without implant replacement should be informed and educated about potential loss of skin and/or the NAC. Some revision cases may require staging, particularly if they have large subglandular implants, due to the inability to depend on accessory central blood supply to the nipple. The addition of capsular contracture and need for capsulectomy adds even more risk. These patients likely require explantation and capsulectomy first followed by revision mastopexy/augmentation secondarily. When choosing to perform a simultaneous revision mastopexy augmentation and pocket exchange the surgeon must be extra diligent to limit any maneuver that compromises vascularity more than absolutely required (**Figure 18**). The pectoral artery branches have

#### **Figure 17.**

*Patients who have had previous mastopexy & augmentation of an unknown pedicle type present potentially more risk. When possible, using limited dissection and a combined pedicle such as the superomedial-inferior (SMI) shown can avoid unwanted disruption of already decreased vascularity to the NAC.*

#### **Figure 18.**

*The patient shown has the classic problem from a circumferential mastopexy that stretched vertically and residual ptosis. She was corrected by complete capsulectomies, new total submuscular implants and revision vertical mastopexy.*

#### **Figure 19.**

*Revision on a patient who had a circumferential mastopexy and the more common widening pattern of scar formation. The patient wanted smaller areola with better scars, perkier breast and slightly smaller size breast than before.*

#### **Figure 20.**

*The figure demonstrates revision on a patient with multiple past surgeries of various types and chronic history of capsular contracture. Damage to the residual muscle necessitates the use of an acellular dermal matrix to connect the residual lateral pectoralis border to the new IMF.*

already been severed from the past Submammary augmentation removing the normal central pedicle portion of vascularity.

 Unsatisfactory scarring is typically the most required revision and fortunately is often fairly straightforward. The opposing forces of mastopexy skin excision and augmenting breast volume may lead to widened and unsatisfactory scars on occasion. This is usually remedied with standard scar revision techniques and has a high rate of success with a careful tension free closure. NAC irregularity or asymmetry can be seen and is typically improved best by adding a vertical incision to reduce tension around the NAC. Of particular note is the tendency for isolated periareolar lifts to widen with time, independent of suture type used and especially when combined with augmentation (**Figure 19**). The proper correction of this relies on the addition of a small vertical

#### **Figure 21.**

*Damage to the residual muscle shown was corrected by excising the old capsules from multiple surgeries and developing an inferolateral submuscular flap to elevate the serratus and external oblique as shown. Recruited muscle and fascia was used in place of an ADM.*

#### **Figure 22.**

*Simultaneous correction of ptosis and symmastia was performed using an inverted T mastopexy because of the extent of excess skin and new pocket creation to correct the symmastia.*

component with periareolar revision. This will take tension off the new areolar diameter and return a more conical appliance to the breast that is often flattened with Benelli-type lifts.

Implant malposition is a common complication with augmentation alone and is certainly encountered with post mastopexy/augmentation. The most common malposition is inferiorly and laterally. Standard pocket modification procedures are similarly beneficial as they are post augmentation alone. However, soft tissue reinforcement may be required as some patients will have less than desired intrinsic tissue integrity. Acellular dermis and bio-resorbable silk derived scaffolds are the mainstays of tissue reinforcement in reconstructive cases and have been used with success in the revision of cosmetic breast cases (**Figure 20**) [3]. This is particularly true when capsular contracture exists and multiple surgeries in the past have taken place. Occasional localized adjacent muscle flaps can be used to

cover the gaps and gain better implant coverage (**Figure 21**). Revision of symmastia if found simultaneously with ptosis issues requires either staging, new pocket development, or ADM usage (**Figure 22**).


**Modelling and Process Control of Fuel Cell Systems**

Editors

**Mohd Azlan Hussain Wan Ramli Wan Daud**

MDPI • Basel • Beijing • Wuhan • Barcelona • Belgrade • Manchester • Tokyo • Cluj • Tianjin

*Editors* Mohd Azlan Hussain University of Malaya Malaysia

Wan Ramli Wan Daud Universiti Kebangsaan Malaysia Malaysia

*Editorial Office* MDPI St. Alban-Anlage 66 4052 Basel, Switzerland

This is a reprint of articles from the Special Issue published online in the open access journal *Processes* (ISSN 2227-9717) (available at: https://www.mdpi.com/journal/processes/special issues/fuel cell model).

For citation purposes, cite each article independently as indicated on the article page online and as indicated below:

LastName, A.A.; LastName, B.B.; LastName, C.C. Article Title. *Journal Name* **Year**, *Volume Number*, Page Range.

**ISBN 978-3-0365-0574-9 (Hbk) ISBN 978-3-0365-0575-6 (PDF)**

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**Author details**

**Figure 22.** Velocity magnitude contours at the inlet, outlet, and five middle cross sections.

**Figure 23.** Temperature contours at the five keeper cross sections.

270 Numerical Simulations in Engineering and Science

**Figure 24.** Velocity magnitude contours at the five keeper cross sections.

Lei-Yong Jiang\*, Yinghua Han, Michele Capurro and Mike Benner

\*Address all correspondence to<EMAIL_ADDRESS>
Aerospace, National Research Council of Canada, Ottawa, Ontario, Canada


**11. Conclusions**

Diagnosis of β-thalassemia and HbE requires laboratory investigations. Screening tests are used to search for carriers, while confirmatory tests are carried out in those samples positive for screening tests with the aim to make the definite diagnosis. There are several pitfalls in these laboratory tests, both in screening tests and confirmatory tests that must not be overlooked, otherwise misdiagnosis will occur.

#### **Acknowledgements**

The author thanks Mr. Eaktong Limveeraprachak of Sawan Pracharak Hospital, Nakorn Sawan Province, Thailand for providing hemoglobin typing results put in this chapter.

**155**

**Author details**

Thanusak Tatu

provided the original work is properly cited.

Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand

© 2020 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,

\*Address all correspondence to<EMAIL_ADDRESS><EMAIL_ADDRESS>
*Laboratory Diagnosis of β-Thalassemia and HbE DOI: http://dx.doi.org/10.5772/intechopen.90317*

#### **Conflict of interest**

The authors declare no conflict of interest.

*Laboratory Diagnosis of β-Thalassemia and HbE DOI: http://dx.doi.org/10.5772/intechopen.90317*

*Beta Thalassemia*

βO-thalassemia (βE

be done.

occur.

this chapter.

**11. Conclusions**

**Acknowledgements**

**Conflict of interest**

The authors declare no conflict of interest.

ing the hemoglobin typing results.

hemoglobin typing results of the patients. If the patients of β-thalassemia disease (βO/βO) have just received blood transfusion, their hemoglobin types will be A2AF, instead of A2F which is the real hemoglobin type of the βO/βO. If patients of HbE/

blood transfusion should always be taken into account when reading and interpret-

α-thalassemia 1/HbE carrier are lower than those of the single HbE carrier (22.8 ± 4.4% vs. 27.6 ± 3.3%) [84]. Therefore, if HbE carriers have low HbE levels as well as MCV/MCH, further identification of α-thalassemia 1 genotype must

Diagnosis of β-thalassemia and HbE requires laboratory investigations. Screening tests are used to search for carriers, while confirmatory tests are carried out in those samples positive for screening tests with the aim to make the definite diagnosis. There are several pitfalls in these laboratory tests, both in screening tests and confirmatory tests that must not be overlooked, otherwise misdiagnosis will

The author thanks Mr. Eaktong Limveeraprachak of Sawan Pracharak Hospital, Nakorn Sawan Province, Thailand for providing hemoglobin typing results put in

Co-existence of α-thalassemia 1 in β-thalassemia carrier and in HbE carrier can be found some regions. This is called double α-thalassemia 1/β-thalassemia carriers and double α-thalassemia 1 and HbE carriers. Results of one-tube osmotic fragility test are always positive in double α-thalassemia 1/β-thalassemia carriers, being the same as that of the single β-thalassemia carrier. However, MCV/MCH in double α-thalassemia 1/β-thalassemia carriers are slightly higher than those in the single β-thalassemia carriers (70.7 ± 2.6 vs. 68.4 ± 2.7 for MCV, 21.0 ± 1.2 vs. 20.7 ± 0.9 for MCH) [83]. HbA2 level in double α-thalassemia 1/β-thalassemia carriers is lower than that in single β-thalassemia carrier (5.27 ± 0.77% vs. 5.65 ± 0.78%) [29]. In contrast, the results of one-tube osmotic fragility test of double α-thalassemia 1/ HbE carrier are usually positive, being different from those of single HbE which can be either positive or negative. The MCV/MCH in double α-thalassemia 1/ HbE carrier are lower than those of the single HbE carrier (68.7 ± 8.9 fL vs. 75.7 ± 7.5 fL for MCV, 22.5 ± 3.1 pg vs. 24.9 ± 2.8 pg for MCH). HbE level in double

be EFA, instead of EF which is the real hemoglobin type of βO/βE

/βO) have recent blood transfusion, their hemoglobin types will

. Therefore, recent

**154**


**6.1 Cell harvest methods**

The algae cell harvest from pond water and the subsequent water reuse have been one of the major obstacles for the algae-to-fuel approach. Microalgae cell harvest is technically challenging, especially considering the low cell densities (typically in the range of 0.3–5 g/L) of autotrophic microalgae due to limited light penetration, the small size of the oleaginous algal cells (typically in the range of 2–40 um), and their similar density to water (Li, Horsman et al. 2008). Oleaginous microalgae cells are usually suspended in the water and are hard to settle by natural gravity force due to their negative charges. The recovery of microalgae biomass generally requires one or more solid–liquid separation steps, and usually accounts for 20–30% of the total costs of production, according to one source (Uduman, Qi et al. 2010).

How to harvest microalgae cells is dependent on the characteristics of the microalgae, such as size and density(Olaizola 2003). All of the available harvest approaches, which include flocculation, flotation, centrifugal sedimentation, and filtration, have limitations for effective, cost-efficient production of biofuel (Shelef, Sukenik et al. 1984). For instance, flotation methods, based on the trapping of algae cells using dispersed micro-air bubbles, is

Different fermentation processes are applied to obtain high productivity of lipids and high conversion ratio of substrate for the fermentation, such as batch cultivation, fed-batch cultivation, and continous cultivation. Fed-batch cultivatioin is a modified batch model that can reach high cell density and it has many applications in the fermentative lipid accumulation process. For example, *Rhorosporidum toruloides* reach much higher cell density with 48% lipid compared to its batch cultivation (Li, Zhao et al. 2007). The high productivity of fed-batch cultivation was conformed by *Phodotorula glutinis* (Xue, Miao et al. 2008), *C. curvatus* (Meesters, Huijberts et al. 1996), and *L. starkeyi* (Yamauchi, Mori et al. 1983). Continuous cultivation has advantages of easy maintenance and time-saving, although it is difficult to control the contamination. It has limited applicatioins in the fermentative lipid

Besides the commonly used submerged cultivations, solid state fermentation, as a compact process for lipid production, showed many advantages, such as low requirements to the raw materails; low capital cost; low energy expenditure; less expensive downstream processing; less water usage and low water output; potential higher volumetric productivity; less fermentation space; easy operation and maintenance. The research for *Aspergillus oryzae* growing on rice bran and wheat bran through solid state fermentation resulted to the lipid content of cell biomass at about 10-11% (Da Silveira, Oliveira et al. 2010). The lipid yield reached 62.87 mg/gds in solid state fermentation on the 6th day after Plackett-Burman design (PBD) by *A. oryzae* A-4 (Lin, Cheng et al. 2010) . Currently, the solid state fermentation research is still in its infancy and many barriers are hindering this process from commercilization. The lipid yield is relatively low compared to submerge cultivation. Modern biotechnological approaches, such as heterogenous expression of hydrolytic enzymes and UV radiation, are available to enhance the hydrolytic enzymes production (Li, Yang et al. 2010; Awan, Tabbasam et al. 2011). Semi-solid state fermentation is used to avoid high sugar concentration on the surface of lignocellulose. An oleaginous fungus *M. isabellina*  was cultured at semi-solid state fermentation with the results of 11g oil per 100g sweet

The algae cell harvest from pond water and the subsequent water reuse have been one of the major obstacles for the algae-to-fuel approach. Microalgae cell harvest is technically challenging, especially considering the low cell densities (typically in the range of 0.3–5 g/L) of autotrophic microalgae due to limited light penetration, the small size of the oleaginous algal cells (typically in the range of 2–40 um), and their similar density to water (Li, Horsman et al. 2008). Oleaginous microalgae cells are usually suspended in the water and are hard to settle by natural gravity force due to their negative charges. The recovery of microalgae biomass generally requires one or more solid–liquid separation steps, and usually accounts for 20–30% of the total costs of production, according to one source

How to harvest microalgae cells is dependent on the characteristics of the microalgae, such as size and density(Olaizola 2003). All of the available harvest approaches, which include flocculation, flotation, centrifugal sedimentation, and filtration, have limitations for effective, cost-efficient production of biofuel (Shelef, Sukenik et al. 1984). For instance, flotation methods, based on the trapping of algae cells using dispersed micro-air bubbles, is

accumulation.

sorghum (Economou, Makri et al. 2010) .

**6. Cell harvest and lipid extraction**

**6.1 Cell harvest methods**

(Uduman, Qi et al. 2010).

very limited in its technical and economic viability. Most conventional and economical separation methods such as filtration and gravitational sedimentation are widely applied in wastewater treatment facilities to harvest relatively large (>70 µm) microalgae such as *Coelastrum* and *Spirulina*. However, they cannot be used to harvest algae species approaching bacterial dimensions (<30 µm) like *Scenedesmus*, *Dunaliella*, and *Chlorella* (Brennan and Owende 2010), to which most oleaginous microalgae species belong. Centrifugation is a method widely used to recover microalgae biomass, especially smallsized algae cells; however, its application is restricted to algae cultures for high-value metabolites due to intensive energy needs and high equipment maintenance requirements. While flocculation is used to harvest small-sized microalgae cells, it is a preparatory step to aggregate the microalgae cells and increase the particle size so that other harvesting methods such as filtration, centrifugation, or gravity sedimentation can be applied (Molina Grima, Belarbi et al. 2003). Several flocculants have been developed to facilitate the aggregation of microalgae cells, including multivalent metal salts like ferric chloride (FeCl3), aluminium sulphate (Al2(SO4)3), and ferric sulphate (Fe2(SO4)3), and organic polymers such as Chitosan (Li, Horsman et al. 2008). Chemical flocculation can be reliably used to remove small algae cells from pond water by forming large-sized (1–5 mm) flocs (Sharma, Dhuldhoya et al. 2006). However, the chemical reactions are highly sensitive to pH and the high doses of flocculants required produce large amounts of sludge and may leave a residue in the treated effluent. In summary, most technologies including chemical and mechanical methods greatly increase operational costs for algal production and are only economically feasible for production of high-value products (Park, Craggs et al. 2011).

Besides traditional methods mentioned above, there are several new technology developments in this field. DOE-ARPA-E recently funded a research project for Algae Venture Systems (AVS) to develop a Harvesting, Dewatering, and Drying (AVS-HDD) technology by using the principles of liquid adhesion and capillary action to extract water from dilute microalgae solutions. Attached algal culture systems have been developed for growing microalgae on the surface of polystyrene foam (Wilkie and Mulbry 2002) (Johnson and Wen 2010) to simplify the cell harvest. New bioflocculants, which are more environmentally friendly, are also proposed to address the cost and environmental concerns for current flocculation method (Uduman, Qi et al. 2010). All these methods are innovative and will decrease the harvest cost to some extent if developed successfully, but heavy investments on equipment and chemical supplies are still needed.

Dr. Bo Hu's research group at University of Minnesota developed an innovative approach to enhance natural algae aggregation and to encourage simple gravity settling or filtration by co-culturing filamentous fungal cells at the end of the microalgae cultures. Instead of suspended culture, this approach uses pelletized or granulized culture where cells form pellets in culture medium. In submerged cultures, many filamentous microorganisms tend to aggregate and grow as pellets/granules. They are spherical or ellipsoidal masses of hyphae with variable internal structure, ranging from loosely packed hyphae, forming "fluffy" pellets, to tightly packed, compact, dense granules (Hu and Chen 2007; Hu and Chen 2008; Hu, Zhou et al. 2009; Chunjie Xia 2011). Besides merits from the cell immobilization, there are several other advantages, especially for the micro-oil production: a). easy to harvest cells, and b). easy to re-use pond water (Johnson and Wen 2010; Xia 2011). As the first research group to introduce pelletized liquid fermentation (PLF) into biofuel production, this research group at University of Minnesota found key operational conditions that induce the fungal pelletization. They discovered that changing conditions

Microbial Biodiesel Production - Oil Feedstocks Produced from Microbial Cell Cultivations 105

Supercritical fluid extraction takes advantage that some chemicals behave as both a liquid and a gas, and have increasing solvating power when they are raised above their critical temperature and pressure points. Carbon dioxide is the most commonly used supercritical fluid, sometimes modified by co-solvents such as ethanol or methanol. Critical temperature and critical pressure of carbon dioxide is at 31°C and 74 bar, respectively (Cooney, Young et al. 2009). Supercritical fluids produce highly purified extracts without using toxic solvent; and the process is fast and safe for thermally sensitive products. Supercritical CO2 extraction efficiency is affected by four main factors: pressure, temperature, CO2 flow rate, and extraction time. Ethanol (10 -15%), co-solvent, lead to similar results of Bligh and Hyer method at extracting oil from *Arthrospira maxima* and *Spirulina platensis* (Mendes, Reis et al. 2006; Sajilata, Singhal et al. 2008). The limitation of supercritical fluid extraction is high

Besides the methods mentioned above, numerous technologies are being tested at different labs to harvest lipids from cells. Genetic engineering has been applied to improve the porosity of the cell membranes in order to increase the release of lipids directly from the cells (Greenwell, Laurens et al. 2010). Enzymes treatment and pulsed electric field technology are other effective methods to break the cell wall and membrane and enhance the mass transfer across the cell membrane for oil extraction (Shah, Sharma et al. 2004; Guderjan, Elez-Martinez et al. 2007). Microwave technology is a portential pretreatment method, which heats the cell components in order to increase the release of oil. Oil yield increased from 4.8% to 17.7% from microalgae *Crypthecodinium chnii* when microwave was applied (Cravotto, Boffa et al. 2008). Microwave technology is featured for its time-savings, but its disadvantages include the oxidative damage to products and its intense energy need. Sonnication is a timely and efficient method, free of toxic materials. Cavitation occurs when high voltage is applied into cell lipids. Vapour bubbles form with negative pressure and cause a violent collapse when compressed under positive pressure while growing; then the cell contents are released (Wei, Gao et al. 2008). The sonnication is, however, difficult to

A complete techno-econoic analysis for the microbial biodiesel production is difficult, especially considering that most of the technologies are still in the early research stage. Initial investment into microalgal biofuels has mostly failed and several early start-up companies have closed. Different versions of economic analysis for microalgae biofuel production have been published recently, and Table 4 lists an analysis conducted by Seed

Table 4 shows that although photobioreactor has a higher cell concentration and utilizes CO2, its cost to produce lipid is the highest of all methods. Heterotrophic fermentation, however, appears to be the most economically feasible route to produce microbial biodiesel. Techno-economic analyses may vary from different research group, but their conclusions are similar. The biomass and oil generated from heterotrophic fermentation are more close to current fossile fuel cost. Heterotrophic fermentation relies less on local climate conditions and can be carried out in close fermentors, which may facilitate their commercialization.

**7. Techno-economic analysis and life cycle assessment**

Science Ltd, sporsored by the British Columbia Innovation Council in Canada.

**6.2.3 Supercritical fluid extraction**

capital cost and high cost for maintainence.

**6.2.4 Other methods**

scale-up.

during cell cultivation can force fungal cells to aggregate and form pellets. This method avoids traditional approaches that use CaCO3 powder to induce the fungal pelletization (Liao, Liu et al. 2007; Liu, Liao et al. 2008), which are costly and cause solid waste disposal issues. Self aggregated pelletization/granulation dramatically improves mass transfer and cell cultivation performance and facilitates cell harvest and separation. A simple filtration can be used to separate the cell biomass from the fermentation broth. This approach brings tremendous advantages to decrease the harvest cost of biofuel production, especially when the raw materials only contain very diluted sugar, (which are the cases for many agricultural waste). This would appear to be the most promising option to achieve both a high-quality treated effluent in terms of total suspended solids and economically recovering algal biomass for biofuel use (Uduman, Qi et al. 2010). It will also be more environmentally sound than current procedures which may need chemical addition.

#### **6.2 Lipid extraction methods**

Oil extraction also contributes a large part of the cost in the process to generate microbial biodiesel. Several oil extraction technologies are currently available to process the microbial biomass in order to meet the requirement of being low cost, easy and safe to operate, and environmentally friendly.

#### **6.2.1 Mechanical methods**

Mechanical methods include pressing, bead milling, and homogenization. Pressing is a technology to harvest lipids out of cells by high pressure. Bead milling works in a container to destruct the cell wall by high speed small beads. Homogenization provides a sudden pressure change when cells go through an orifice. The mechanical technologies are often used in combination with solvent methods to separate the lipid from the cell biomass. The mechanical methods are energy intensive and better operated at the high cell density condition; in addition, pretreatments are necessary to obtain high recovery ratio (Greenwell, Laurens et al. 2010).

#### **6.2.2 Solvent extraction methods**

Solvent extraction is a commonly used method for soybean processing, and it is also used to extract lipids from microbial cells. Organic solvents should be insoluble in water, be easy to obtain, have a low boiling point, and be reusable. Current industrial solvents for microlipids accumulation include hexane, chloroform, acetone, benzene, and cyclohexane, can dissolve lipid without residual cell. The extraction process is significantly affected by operation condition, such as temperature and pressure. Accelerated solvent extraction (ASE) is named when the operation temperature is higher than that of solvent boiling point, which can be used for oil extraction from dry biomass (Cooney, Young et al. 2009). Mixture chloroform and methanol (Bligh and Hyer method) is the most common organic solvent to extract oil from biomass. This organic mixture can extract oil not only from dry biomass but also from wet biomass. However, the efficiency is different at certain condition (Zhu, Zhou et al. 2002). The efficiency of oil extraction was not working well at wet *Mortierella alpina* biomass. The process generated large amounts of wastewater and solvent often contaminated the final products. Simultaneous extraction and tranesterification is more efficient (15-20%) than the separate process (Belarbi, Molina et al. 2000); however, the important point of the simultaneous process is to balance the reaction time for the best components of product (Lewis, Nichols et al. 2000).

#### **6.2.3 Supercritical fluid extraction**

104 Biodiesel - Feedstocks and Processing Technologies

during cell cultivation can force fungal cells to aggregate and form pellets. This method avoids traditional approaches that use CaCO3 powder to induce the fungal pelletization (Liao, Liu et al. 2007; Liu, Liao et al. 2008), which are costly and cause solid waste disposal issues. Self aggregated pelletization/granulation dramatically improves mass transfer and cell cultivation performance and facilitates cell harvest and separation. A simple filtration can be used to separate the cell biomass from the fermentation broth. This approach brings tremendous advantages to decrease the harvest cost of biofuel production, especially when the raw materials only contain very diluted sugar, (which are the cases for many agricultural waste). This would appear to be the most promising option to achieve both a high-quality treated effluent in terms of total suspended solids and economically recovering algal biomass for biofuel use (Uduman, Qi et al. 2010). It will also be more environmentally

Oil extraction also contributes a large part of the cost in the process to generate microbial biodiesel. Several oil extraction technologies are currently available to process the microbial biomass in order to meet the requirement of being low cost, easy and safe to operate, and

Mechanical methods include pressing, bead milling, and homogenization. Pressing is a technology to harvest lipids out of cells by high pressure. Bead milling works in a container to destruct the cell wall by high speed small beads. Homogenization provides a sudden pressure change when cells go through an orifice. The mechanical technologies are often used in combination with solvent methods to separate the lipid from the cell biomass. The mechanical methods are energy intensive and better operated at the high cell density condition; in addition, pretreatments are necessary to obtain high recovery ratio (Greenwell,

Solvent extraction is a commonly used method for soybean processing, and it is also used to extract lipids from microbial cells. Organic solvents should be insoluble in water, be easy to obtain, have a low boiling point, and be reusable. Current industrial solvents for microlipids accumulation include hexane, chloroform, acetone, benzene, and cyclohexane, can dissolve lipid without residual cell. The extraction process is significantly affected by operation condition, such as temperature and pressure. Accelerated solvent extraction (ASE) is named when the operation temperature is higher than that of solvent boiling point, which can be used for oil extraction from dry biomass (Cooney, Young et al. 2009). Mixture chloroform and methanol (Bligh and Hyer method) is the most common organic solvent to extract oil from biomass. This organic mixture can extract oil not only from dry biomass but also from wet biomass. However, the efficiency is different at certain condition (Zhu, Zhou et al. 2002). The efficiency of oil extraction was not working well at wet *Mortierella alpina* biomass. The process generated large amounts of wastewater and solvent often contaminated the final products. Simultaneous extraction and tranesterification is more efficient (15-20%) than the separate process (Belarbi, Molina et al. 2000); however, the important point of the simultaneous process is to balance the reaction time for the best components of product

sound than current procedures which may need chemical addition.

**6.2 Lipid extraction methods**

environmentally friendly.

**6.2.1 Mechanical methods**

Laurens et al. 2010).

**6.2.2 Solvent extraction methods**

(Lewis, Nichols et al. 2000).

Supercritical fluid extraction takes advantage that some chemicals behave as both a liquid and a gas, and have increasing solvating power when they are raised above their critical temperature and pressure points. Carbon dioxide is the most commonly used supercritical fluid, sometimes modified by co-solvents such as ethanol or methanol. Critical temperature and critical pressure of carbon dioxide is at 31°C and 74 bar, respectively (Cooney, Young et al. 2009). Supercritical fluids produce highly purified extracts without using toxic solvent; and the process is fast and safe for thermally sensitive products. Supercritical CO2 extraction efficiency is affected by four main factors: pressure, temperature, CO2 flow rate, and extraction time. Ethanol (10 -15%), co-solvent, lead to similar results of Bligh and Hyer method at extracting oil from *Arthrospira maxima* and *Spirulina platensis* (Mendes, Reis et al. 2006; Sajilata, Singhal et al. 2008). The limitation of supercritical fluid extraction is high capital cost and high cost for maintainence.

### **6.2.4 Other methods**

Besides the methods mentioned above, numerous technologies are being tested at different labs to harvest lipids from cells. Genetic engineering has been applied to improve the porosity of the cell membranes in order to increase the release of lipids directly from the cells (Greenwell, Laurens et al. 2010). Enzymes treatment and pulsed electric field technology are other effective methods to break the cell wall and membrane and enhance the mass transfer across the cell membrane for oil extraction (Shah, Sharma et al. 2004; Guderjan, Elez-Martinez et al. 2007). Microwave technology is a portential pretreatment method, which heats the cell components in order to increase the release of oil. Oil yield increased from 4.8% to 17.7% from microalgae *Crypthecodinium chnii* when microwave was applied (Cravotto, Boffa et al. 2008). Microwave technology is featured for its time-savings, but its disadvantages include the oxidative damage to products and its intense energy need. Sonnication is a timely and efficient method, free of toxic materials. Cavitation occurs when high voltage is applied into cell lipids. Vapour bubbles form with negative pressure and cause a violent collapse when compressed under positive pressure while growing; then the cell contents are released (Wei, Gao et al. 2008). The sonnication is, however, difficult to scale-up.