types of research literature review

Reproduced from Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies . Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x

• Last Updated: Aug 6, 2024 2:29 PM
• URL: https://guides.lib.utexas.edu/systematicreviews

ON YOUR 1ST ORDER

Different Types of Literature Review: Which One Fits Your Research?

By Laura Brown on 13th October 2023

You might not have heard that there are multiple kinds of literature review. However, with the progress in your academic career you will learn these classifications and may need to use different types of them. However, there is nothing to worry if you aren’t aware of them now, as here we are going to discuss this topic in detail.

There are approximately 14 types of literature review on the basis of their specific objectives, methodologies, and the way they approach and analyse existing literature in academic research. Of those 14, there are 4 major types. But before we delve into the details of each one of them and how they are useful in academics, let’s first understand the basics of literature review.

What is Literature Review?

A literature review is a critical and systematic summary and evaluation of existing research. It is an essential component of academic and research work, providing an overview of the current state of knowledge in a particular field.

In easy words, a literature review is like making a big, organised summary of all the important research and smart books or articles about a particular topic or question. It’s something scholars and researchers do, and it helps everyone see what we already know about that topic. It’s kind of like taking a snapshot of what we understand right now in a certain field.

It serves with some specific purpose in the research.

• Provides a comprehensive understanding of existing research on a topic.
• Identifies gaps, trends, and inconsistencies in the literature.
• Contextualise your own research within the broader academic discourse.
• Supports the development of theoretical frameworks or research hypotheses.

4 Major Types Of Literature Review

The four major types include, Narrative Review, Systematic Review, Meta-Analysis, and Scoping Review. These are known as the major ones because they’re like the “go-to” methods for researchers in academic and research circles. Think of them as the classic tools in the researcher’s toolbox. They’ve earned their reputation because they have a unique style for literature review introduction , clear steps and specific qualities that make them super handy for different research needs.

1. Narrative Review

Narrative reviews present a well-structured narrative that reads like a cohesive story, providing a comprehensive overview of a specific topic. These reviews often incorporate historical context and offer a broad understanding of the subject matter, making them valuable for researchers looking to establish a foundational understanding of their area of interest. They are particularly useful when a historical perspective or a broad context is necessary to comprehend the current state of knowledge in a field.

2. Systematic Review

Systematic reviews are renowned for their methodological rigour. They involve a meticulously structured process that includes the systematic selection of relevant studies, comprehensive data extraction, and a critical synthesis of their findings. This systematic approach is designed to minimise bias and subjectivity, making systematic reviews highly reliable and objective. They are considered the gold standard for evidence-based research as they provide a clear and rigorous assessment of the available evidence on a specific research question.

3. Meta Analysis

Meta analysis is a powerful method for researchers who prefer a quantitative and statistical perspective. It involves the statistical synthesis of data from various studies, allowing researchers to draw more precise and generalisable conclusions by combining data from multiple sources. Meta analyses are especially valuable when the aim is to quantitatively measure the effect size or impact of a particular intervention, treatment, or phenomenon.

4. Scoping Review

Scoping reviews are invaluable tools, especially for researchers in the early stages of exploring a topic. These reviews aim to map the existing literature, identifying gaps and helping clarify research questions. Scoping reviews provide a panoramic view of the available research, which is particularly useful when researchers are embarking on exploratory studies or trying to understand the breadth and depth of a subject before conducting more focused research.

Different Types Of Literature review In Research

There are some more approaches to conduct literature review. Let’s explore these classifications quickly.

5. Critical Review

Critical reviews provide an in-depth evaluation of existing literature, scrutinising sources for their strengths, weaknesses, and relevance. They offer a critical perspective, often highlighting gaps in the research and areas for further investigation.

6. Theoretical Review

Theoretical reviews are centred around exploring and analysing the theoretical frameworks, concepts, and models present in the literature. They aim to contribute to the development and refinement of theoretical perspectives within a specific field.

7. Integrative Review

Integrative reviews synthesise a diverse range of studies, drawing connections between various research findings to create a comprehensive understanding of a topic. These reviews often bridge gaps between different perspectives and provide a holistic overview.

8. Historical Review

Historical reviews focus on the evolution of a topic over time, tracing its development through past research, events, and scholarly contributions. They offer valuable context for understanding the current state of research.

9. Methodological Review

Among the different kinds of literature reviews, methodological reviews delve into the research methods and methodologies employed in existing studies. Researchers assess these approaches for their effectiveness, validity, and relevance to the research question at hand.

10. Cross-Disciplinary Review

Cross-disciplinary reviews explore a topic from multiple academic disciplines, emphasising the diversity of perspectives and insights that each discipline brings. They are particularly useful for interdisciplinary research projects and uncovering connections between seemingly unrelated fields.

11. Descriptive Review

Descriptive reviews provide an organised summary of existing literature without extensive analysis. They offer a straightforward overview of key findings, research methods, and themes present in the reviewed studies.

12. Rapid Review

Rapid reviews expedite the literature review process, focusing on summarising relevant studies quickly. They are often used for time-sensitive projects where efficiency is a priority, without sacrificing quality.

13. Conceptual Review

Conceptual reviews concentrate on clarifying and developing theoretical concepts within a specific field. They address ambiguities or inconsistencies in existing theories, aiming to refine and expand conceptual frameworks.

14. Library Research

Library research reviews rely primarily on library and archival resources to gather and synthesise information. They are often employed in historical or archive-based research projects, utilising library collections and historical documents for in-depth analysis.

Each type of literature review serves distinct purposes and comes with its own set of strengths and weaknesses, allowing researchers to choose the one that best suits their research objectives and questions.

Choosing the Ideal Literature Review Approach in Academics

In order to conduct your research in the right manner, it is important that you choose the correct type of review for your literature. Here are 8 amazing tips we have sorted for you in regard to literature review help so that you can select the best-suited type for your research.

• Clarify Your Research Goals: Begin by defining your research objectives and what you aim to achieve with the literature review. Are you looking to summarise existing knowledge, identify gaps, or analyse specific data?
• Understand Different Review Types: Familiarise yourself with different kinds of literature reviews, including systematic reviews, narrative reviews, meta-analyses, scoping reviews, and integrative reviews. Each serves a different purpose.
• Consider Available Resources: Assess the resources at your disposal, including time, access to databases, and the volume of literature on your topic. Some review types may be more resource-intensive than others.
• Alignment with Research Question: Ensure that the chosen review type aligns with your research question or hypothesis. Some types are better suited for answering specific research questions than others.
• Scope and Depth: Determine the scope and depth of your review. For a broad overview, a narrative review might be suitable, while a systematic review is ideal for an in-depth analysis.
• Consult with Advisors: Seek guidance from your academic advisors or mentors. They can provide valuable insights into which review type best fits your research goals and resources.
• Consider Research Field Standards: Different academic fields have established standards and preferences for different forms of literature review. Familiarise yourself with what is common and accepted in your field.
• Pilot Review: Consider conducting a small-scale pilot review of the literature to test the feasibility and suitability of your chosen review type before committing to a larger project.

Bonus Tip: Crafting an Effective Literature Review

Now, since you have learned all the literature review types and have understood which one to prefer, here are some bonus tips for you to structure a literature review of a dissertation .

• Clearly Define Your Research Question: Start with a well-defined and focused research question to guide your literature review.
• Thorough Search Strategy: Develop a comprehensive search strategy to ensure you capture all relevant literature.
• Critical Evaluation: Assess the quality and credibility of the sources you include in your review.
• Synthesise and Organise: Summarise the key findings and organise the literature into themes or categories.
• Maintain a Systematic Approach: If conducting a systematic review, adhere to a predefined methodology and reporting guidelines.
• Engage in Continuous Review: Regularly update your literature review to incorporate new research and maintain relevance.

Some Useful Tools And Resources For You

Effective literature reviews demand a range of tools and resources to streamline the process.

• Reference management software like EndNote, Zotero, and Mendeley helps organise, store, and cite sources, saving time and ensuring accuracy.
• Academic databases such as PubMed, Google Scholar, and Web of Science provide access to a vast array of scholarly articles, with advanced search and citation tracking features.
• Research guides from universities and libraries offer tips and templates for structuring reviews.
• Research networks like ResearchGate and Academia.edu facilitate collaboration and access to publications. Literature review templates and research workshops provide additional support.

Some Common Mistakes To Avoid

Avoid these common mistakes when crafting literature reviews.

• Unclear research objectives result in unfocused reviews, so start with well-defined questions.
• Biased source selection can compromise objectivity, so include diverse perspectives.
• Never miss on referencing; proper citation and referencing are essential for academic integrity.
• Don’t overlook older literature, which provides foundational insights.
• Be mindful of scope creep, where the review drifts from the research question; stay disciplined to maintain focus and relevance.

While Summing Up On Various Types Of Literature Review

As we conclude this classification of fourteen distinct approaches to conduct literature reviews, it’s clear that the world of research offers a multitude of avenues for understanding, analysing, and contributing to existing knowledge.

Whether you’re a seasoned scholar or a student beginning your academic journey, the choice of review type should align with your research objectives and the nature of your topic. The versatility of these approaches empowers you to tailor your review to the demands of your project.

Remember, your research endeavours have the potential to shape the future of knowledge, so choose wisely and dive into the world of literature reviews with confidence and purpose. Happy reviewing!

Laura Brown, a senior content writer who writes actionable blogs at Crowd Writer.

• Research Guides
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Common Paper Types

• Literature Review
• Scoping Review
• Systematic Review
• Author Profile

Understanding Literature Reviews 

I.  Getting Started with a Workshop Video  (Highly recommended!)

• Searching for Literature Reviews: Before You Write, You Have to Find   https://www.youtube.com/watch?v=9la5ytz9MmM

          A lecture by the Writing Center, TAMU.

II.  What is a Literature Review?

• Generally, the purpose of a review is to analyze critically a segment of a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles. <http://writing.wisc.edu/Handbook/ReviewofLiterature.html>  
•  A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.  < http://writingcenter.unc.edu/resources/handouts-demos/specific-writing-assignments/literature-reviews >  
•  A literature review is a body of text that aims to review the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic...Its ultimate goal is to bring the reader up to date with current literature on a topic and forms the basis for another goal, such as future research that may be needed in the area. <http://en.wikipedia.org/wiki/Literature_review>

III.  What Major Steps Literature Reviews Require?

• 1. Develop a review protocol. Protocols define the scope of studies that will be reviewed, the process through which studies will be identified, and the outcomes that will be examined. Protocols also specify the time period during which relevant studies will have been conducted, the outcomes to be examined in the review, and keyword strategies for the literature search. 2. Identify relevant studies, often through a systematic search of the literature. 3. Screen studies for relevance and the adequacy of study design, implementation, and reporting. 4. Retrieve and summarize information on the intervention studied, the study characteristics, and the study findings. 5. Combine findings within studies and across studies when relevant. < http://ies.ed.gov/ncee/wwc/pdf/reference_resources/wwc_procedures_v2_1_standards_handbook.pdf>  
• The basic stages in a typical research project are: i) identify your topic of interest, ii) perform a literature review, iii) generate related questions, iv) state your unsolved problem or hypothesis, v) find or develop a solution, and vi) document your results.  
• The four stages required: Problem formulation—which topic or field is being examined and what are its component issues? Literature search—finding materials relevant to the subject being explored Data evaluation—determining which literature makes a significant contribution to the understanding of the topic Analysis and interpretation—discussing the findings and conclusions of pertinent literature < http://library.ucsc.edu/help/howto/write-a-literature-review#components >

IV.    What Basic Elements Comprise a Literature Review?   

• An overview of the subject, issue or theory under consideration, along with the objectives of the literature review
• Division of works under review into categories (e.g. those in support of a particular position, those against, and those offering alternative theses entirely)
• Explanation of how each work is similar to and how it varies from the others
• Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research    

          < http://library.ucsc.edu/help/howto/write-a-literature-review#components > V.    Which Citation Tool Are You Going to Use to Manage the Search Results?

•   Choose your citation tool before conducing your literature reviews. If you decide to use  RefWorks , the information can be found at  http://tamu.libguides.com/refworks .          

VII. Other Useful Guides

• Literature Reviews (University of North Carolina at Chapel Hill)
• The Literature Review: A Few Tips On Conducting It
• How to Write a Literature Review  (UCSC)
• Learn how to write a review of literature  (WISC)
• Reviewing the Literature
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• Last Updated: Aug 5, 2024 7:43 AM
• URL: https://tamu.libguides.com/c.php?g=1415100

Literature Reviews: Types of Literature

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Types of Literature

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• 5. Write the Review
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Different types of publications have different characteristics.

Primary Literature Primary sources means original studies, based on direct observation, use of statistical records, interviews, or experimental methods, of actual practices or the actual impact of practices or policies. They are authored by researchers, contains original research data, and are usually published in a peer-reviewed journal. Primary literature may also include conference papers, pre-prints, or preliminary reports. Also called empirical research .

Secondary Literature Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (such as meta-analysis and systematic reviews) and reference works. Professionals within each discipline take the primary literature and synthesize, generalize, and integrate new research.

Tertiary Literature Tertiary literature consists of a distillation and collection of primary and secondary sources such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices within the discipline.

Adapted from the Information Services Department of the Library of the Health Sciences-Chicago , University of Illinois at Chicago.

Types of Scientific Publications

These examples and descriptions of publication types will give you an idea of how to use various works and why you would want to write a particular kind of paper.

• Scholarly article aka empirical article
• Review article
• Conference paper

Scholarly (aka empirical) article -- example

Empirical studies use data derived from observation or experiment. Original research papers (also called primary research articles) that describe empirical studies and their results are published in academic journals.  Articles that report empirical research contain different sections which relate to the steps of the scientific method.

      Abstract - The abstract provides a very brief summary of the research.

     Introduction - The introduction sets the research in a context, which provides a review of related research and develops the hypotheses for the research.

     Method - The method section describes how the research was conducted.

     Results - The results section describes the outcomes of the study.

     Discussion - The discussion section contains the interpretations and implications of the study.

     References - A references section lists the articles, books, and other material cited in the report.

Review article -- example

A review article summarizes a particular field of study and places the recent research in context. It provides an overview and is an excellent introduction to a subject area. The references used in a review article are helpful as they lead to more in-depth research.

Many databases have limits or filters to search for review articles. You can also search by keywords like review article, survey, overview, summary, etc.

Conference proceedings, abstracts and reports -- example

Conference proceedings, abstracts and reports are not usually peer-reviewed.  A conference article is similar to a scholarly article insofar as it is academic. Conference articles are published much more quickly than scholarly articles. You can find conference papers in many of the same places as scholarly articles.

How Do You Identify Empirical Articles?

To identify an article based on empirical research, look for the following characteristics:

     The article is published in a peer-reviewed journal .

     The article includes charts, graphs, or statistical analysis .

     The article is substantial in size , likely to be more than 5 pages long.

     The article contains the following parts (the exact terms may vary): abstract, introduction, method, results, discussion, references .

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Review Typologies

There are many types of evidence synthesis projects, including systematic reviews as well as others. The selection of review type is wholly dependent on the research question. Not all research questions are well-suited for systematic reviews.

• Review Typologies (from LITR-EX) This site explores different review methodologies such as, systematic, scoping, realist, narrative, state of the art, meta-ethnography, critical, and integrative reviews. The LITR-EX site has a health professions education focus, but the advice and information is widely applicable.

Review the table to peruse review types and associated methodologies. Librarians can also help your team determine which review type might be appropriate for your project. 

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91-108.  doi:10.1111/j.1471-1842.2009.00848.x

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Systematic Reviews: Methods & Resources

• Methods & Resources
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• Manage citations using RefWorks This link opens in a new window
• Covidence Guide This link opens in a new window

Many organizations have created guidelines to standardize reporting of analytical research. See some of the main ones below. The NIH offers a useful chart of Research Reporting Guidelines , and you can find over 500 on the EQUATOR network

• PRISMA Guidelines Gold-standard guideline on how to perform and write-up a systematic review and/or meta-analysis of the outcomes reported in multiple clinical trials of therapeutic interventions
• AHRQ's Methods Guide for Effectiveness and Comparative Effectiveness Reviews
• Synthesis without meta-analysis (SWiM) in systematic reviews Campbell, M. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ, 368. Guideline on how to analyze evidence for a narrative review, to provide a recommendation based on heterogenous study types
• Methods Manual for Community Guide Systematic Reviews Community Preventive Services Task Force (2021). The Methods Manual for Community Guide Systematic Reviews. (Public Health Prevention systematic review guidelines)
• Planning Worksheet for Structured Literature Reviews Cornell University Library (2019). A basic framework for a literature review.
• STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement
• MOOSE Reporting Guidelines for Meta-analyses of Observational Studies Brooke BS, Schwartz TA, Pawlik TM. MOOSE Reporting Guidelines for Meta-analyses of Observational Studies. JAMA Surg. 2021;156(8):787–788. doi:10.1001/jamasurg.2021.0522

Tools and Guidance

• Right Review Flowchart to help you choose the proper review methodology for your project
• Systematic Review Accelerator Catalog of tools that support various tasks within the systematic review and wider evidence synthesis process. Tools include the 'Polyglot Search Translator'.
• Institute of Medicine. (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: National Academies
• Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals International Committee of Medical Journal Editors (2022)
• Cochrane Handbook for Systematic Reviews of Interventions
• Joanna Briggs Institute (JBI) Manual for Evidence Synthesis Provides guidance on how to analyze both quantitative and qualitative research
• Cochrane Qualitative & Implementation Methods Group. (2019). Training resources.
• Meeting the review family: exploring review types and associated information retrieval requirements Sutton, A., Clowes, M., Preston, L., & Booth, A. (2019). Health information and libraries journal, 36(3), 202–222. https://doi.org/10.1111/hir.12276
• Studying a Study and Testing a Test: Reading Evidence-based Health Research Riegelman, R. K., & Nelson, B. A. (2021). 7th ed. Wolters Kluwer Health. Textbook that describes quantitative statistical methods used in health sciences research

Software tools for systematic reviews

• Covidence Available for free to GW affiliates, this is a popular tool for facilitating screening decisions, used by the Cochrane Collaboration. Register for an account.
• Statistical software available at Himmelfarb SPSS, SAS, Stata, NVivo, Atlas.ti, and MATLAB
• RedCAP Software to create survey forms for research or data collection or data extraction.
• SRDR tool from AHRQ Free, web-based and has a training environment, tutorials, and example templates of systematic review data extraction forms
• RevMan 5 ReviewManager (RevMan) is Cochrane's bespoke software for writing Cochrane Reviews.
• Rayyan Free, web-based tool for collecting and screening citations. It has options to screen with multiple people, masking each other.
• GradePro Free, web application to create, manage and share summaries of research evidence (called Evidence Profiles and Summary of Findings Tables) for reviews or guidelines, uses the GRADE criteria to evaluate each paper under review.
• DistillerSR Needs subscription. Create coded data extraction forms from templates.
• EPPI Reviewer Needs subscription. Like DistillerSR, tool for text mining, data clustering, classification and term extraction
• SUMARI Needs subscription. Qualitative data analysis.
• Dedoose Needs subscription. Qualitative data analysis, similar to NVIVO in that it can be used to code interview transcripts, identify word co-occurence, cloud based.

Forest Plot Generators

• Meta-Essentials a free set of workbooks designed for Microsoft Excel that, based on your input, automatically produce meta-analyses including Forest Plots. Produced for Erasmus University Rotterdam joint research institute.
• Neyeloff, Fuchs & Moreira Another set of Excel worksheets and instructions to generate a Forest Plot. Published as Neyeloff, J.L., Fuchs, S.C. & Moreira, L.B. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 5, 52 (2012). https://doi-org.proxygw.wrlc.org/10.1186/1756-0500-5-52
• For R programmers instructions are at https://cran.r-project.org/web/packages/forestplot/vignettes/forestplot.html and you can download the R code package from https://github.com/gforge/forestplot
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Introduction to Systematic Reviews

In this guide.

• Introduction
• Types of Reviews
• Systematic Review Process
• Protocols & Guidelines
• Data Extraction and Screening
• Resources & Tools

Before You Start Checklist

Are you ready to carry out a knowledge synthesis project such as a systematic review, meta-analysis, or scoping review? Remember that systematic reviews require:

• a team to carry out screening, extraction, and critical appraisal methods
• a significant amount of time to complete
• enough high quality studies to make a systematic review feasible
• a rigorous protocol (that should be registered)
• adherence to transparent and rigorous methods
• a strong project management component with defined goals, responsibilities, deliverables, and timelines 
• financial resources to complete the project 

What Review Is Right For You?

If you're unsure what type of knowledge synthesis best suits your research purposes, follow along this flowchart or complete this short quiz to find your personalized review methodologies: https://whatreviewisrightforyou.knowledgetranslation.net/

Reproduced from  "What type of review could you write?" Yale Medical Library. 

Types of Knowledge Syntheses

Conducting effective reviews is essential to advance the knowledge and understand the breadth of research on a topic; synthesize existing evidence; develop theories or provide a conceptual background for subsequent research; and identify research gaps. However, there are over 100 different kinds of reviews to choose from. The following provides a comparison of common review types.

Reproduced from Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26 (2), 91-108. DOI: 10.1111/J.1471-1842.2009.00848.X

Fifty Shades of Review - Dr Andrew Booth from ScHARR Library on Youtube .

Books on Knowledge Synthesis

• Finding What Works in Health Care by Jill Eden (Editor); Laura Levit (Editor); Alfred Berg (Editor); Sally Morton (Editor); Committee on Standards for Systematic Reviews of Comparative Effectiveness Research; Institute of Medicine; Board on Health Care Services Staff ISBN: 0309164257 Publication Date: 2011

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Types of Scholarly Articles

Engl105 - scholarly articles 101: types of scholarly articles.

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Research Articles

Review articles, tips & practice.

• How to Read a Scholarly Article
• Extend Your Knowledge

Sometimes a professor might ask you to find original research or may ask you to not use literature reviews/systematic reviews as sources, but what do those terms mean? How can we tell if our potential source meets our professor's criteria?

In a research article, an original study is conducted by the authors. They collect and analyze data, sharing their methods and results, and then draw conclusions from their analysis. The kind of study performed can vary (surveys, interviews, experiments, etc.), but in all cases, data is analyzed and a new argument is put forth. Research articles are considered primary sources.

• Note: research articles will often contain a section titled "literature review" - this is a section that looks at other existing research as a foundation for their new idea. Simply seeing the words "literature review" does not automatically mean an article is a review article- it is important to look closer

Below is a screenshot of the abstract of the article Effectiveness of Health Coaching in Diabetes Control and Lifestyle Improvement: A Randomized-Controlled Trial , with some words underlined that let us know that a study was conducted and that this is a research article.

A review article gathers multiple research articles on a certain topic, summarizing and analyzing the arguments made in those articles. A review article might highlight patterns or gaps in the research, might show support for existing theories, or suggest new directions for research, but does not conduct original research on a subject. Review articles can be a great place to get an overview of the existing research on a subject. A review article is a secondary source.

• Looking in the reference section of a literature or systematic review can be a good place to find original research studies.

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• Article 1- Research or Review?
• Article 2- Research or Review?

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• Last Updated: Aug 7, 2024 2:00 PM
• URL: https://guides.lib.unc.edu/scholarly-articles-101

• Open access
• Published: 01 August 2024

Literature review of complementary and alternative therapies: using text mining and analysis of trends in nursing research

• Jihye Nam   ORCID: orcid.org/0000-0002-5534-2660 1 ,
• Hyejin Lee   ORCID: orcid.org/0000-0002-8501-0560 1 ,
• Seunghyeon Lee   ORCID: orcid.org/0009-0005-6411-364X 1 &
• Hyojung Park   ORCID: orcid.org/0000-0002-7804-0593 1  

BMC Nursing volume  23 , Article number:  526 ( 2024 ) Cite this article

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This study aimed to review the literature on complementary and alternative therapies, utilizing text mining and trend analysis in nursing research. As CAM becomes increasingly prevalent in healthcare settings, a comprehensive understanding of the current research landscape is essential to guide evidence-based practice, inform clinical decision-making, and ultimately enhance patient outcomes.

This study aimed to identify CAM-related literature published from 2018 to 2023. Using the search terms 'complementary therap*', 'complementary medicine', 'alternative therap*', and 'alternative medicine', we performed a comprehensive search in eight databases, including EMBASE, Cochrane Central, PubMed Central, Korea Education and Research Information Service (RISS), Web of Science, KMbase, KISS, and CINAHL. From the text network and topic modeling analysis of 66,490 documents, 15 topics were identified. These topics were classified into two nursing-related topics through an academic classification process involving three doctors with doctoral degrees, three nurses, and three pharmacists. Based on the classified topics, research trends were comparatively analyzed by re-searching the database for 12 nursing and 22 non-nursing literature.

This study found that in nursing literature, yoga is used to improve mental symptoms such as stress and anxiety. In non-nursing literature, most of the experimental studies on complementary and alternative therapies were conducted in a randomized manner, confirming that a variety of physiological and objective indicators were used. Additionally, it was discovered that there were differences in the diversity of research subjects and research design methods for the same intervention method. Therefore, future research should focus on broadening the scope of subjects and measurement tools in nursing studies. Additionally, such studies should be conducted with randomization and generalizability in the experimental design in mind.

This study employed text network analysis and text mining to identify domestic and international CAM research trends. Our novel approach combined big data-derived keywords with a systematic classification method, proposing a new methodological strategy for trend analysis. Future nursing research should focus on broadening the scope of subjects, diversifying measurement tools, and emphasizing randomization and generalizability in experimental designs.

Peer Review reports

The World Health Organization (WHO) defines complementary and alternative medicine (CAM) as healthcare practices outside a country's traditional or conventional medicine [ 1 ]. According to the National Center for Complementary and Integrative Health (NCCIH), CAM encompasses nutritional approaches (e.g., herbs), psychological methods (e.g., mindfulness), physical therapies (e.g., massage), integrated mind–body practices (e.g., yoga or auricular acupressure), and modalities that combine psychology and nutrition [ 2 ]. This definition suggests CAM may facilitate holistic nursing by addressing both psychological and physical aspects [ 3 ]. Consequently, substantial CAM research is conducted in nursing internationally [ 4 , 5 ], spanning areas like pain, depression, anxiety, chronic disease symptoms, sleep disturbances, and vomiting [ 4 , 5 , 6 ]. Classification systems exist, with the Korean Nursing Association (2023) delineating 12 CAM subcategories [ 6 ] and NCCIH outlining 76 therapies across major categories like nutrition, body, and psychotherapies [ 4 , 5 , 6 , 7 ]. The multitude of CAM types has prompted trend identification research, including reviews on Chinese medicine for allergic rhinitis, aromatherapy, auricular acupressure, and CAM for COVID-19 [ 6 , 8 ]. However, many previous studies have significant limitations in comprehensively identifying overall research trends in CAM. First, they tend to focus narrowly on specific diseases or treatments, lacking a broader perspective on the field as a whole [ 6 , 8 ]. Second, the use of search queries containing keywords from a specific discipline or arbitrarily selected by researchers introduces bias and hinders the identification of overarching trends [ 9 , 10 ]. These limitations highlight the need for a more systematic and data-driven approach to analyzing CAM research trends [ 11 , 12 , 13 ]. A previous study [ 14 , 15 ] suggested the use of text mining technique as an approach for literature review [ 16 ]. To date, the analysis on research trend in nursing has been conducted more than five years after publication or has only been conducted with partial analyses through literature reviews and text mining [ 17 , 18 , 19 ].

The overarching goal was to extract keywords identifying domestic and international CAM research trends using text network analysis and analyze these trends within the nursing field. Specific objectives were: 1) Identify frequency, degree centrality, closeness centrality, and betweenness centrality for keywords appearing in domestic and international CAM studies; 2) Identify key themes within these studies; 3) Discern nursing keywords among sub-topic groups; 4) Analyze and compare nursing and other disciplinary literature based on findings; and 5) Analyze the trend of CAM in nursing based on extracted nursing keywords.

Study design and methodological framework

This study employs a novel methodological framework that combines text mining techniques with expert validation to identify and analyze CAM research trends in a comprehensive and data-driven manner. The framework consists of the following key steps.

Data collection: A comprehensive search of multiple databases is conducted to collect a broad range of CAM-related literature across various disciplines.

Text preprocessing involves several techniques to prepare the data for analysis. These include natural language processing, stopword removal, and synonym standardization.

Keyword extraction and network analysis: Text mining techniques, including term frequency-inverse document frequency (TF-IDF) and centrality analysis, are applied to extract key topics and analyze their relationships within the literature.

Topic modeling: Latent Dirichlet Allocation (LDA) is used to identify latent topics within the literature and visualize their proportions and relationships.

Expert validation: An expert panel of physicians, nurses, and pharmacists is consulted to validate the relevance and credibility of the identified topics and classify them into respective academic fields.

Focused literature analysis: Based on the expert-validated nursing-related topics, a focused re-search and analysis of the literature are conducted to identify trends specific to nursing research on CAM.

This multi-step framework allows for a more comprehensive and less biased exploration of CAM research trends by leveraging text mining techniques to process large volumes of literature, identify key topics, and uncover patterns that may not be apparent through traditional review methods [ 14 , 15 , 16 ]. The integration of expert validation ensures the relevance and credibility of the findings, while the focused analysis of nursing literature provides insights specific to the nursing discipline within the broader context of CAM research. The process of selecting studies for our analysis is illustrated in Fig.  1 , which provides a clear visual representation of the key steps involved, from the initial database search to the final classification of studies into nursing and other disciplines. This multi-step approach, combined with the visual aid, enhances the clarity and transparency of our methodology, allowing readers to better understand and contextualize the subsequent data analysis steps.

Flow diagram for literature selection process

Literature selection

This study focused on complementary and alternative medicine studies conducted in the fields of medicine, public health, and nursing in Korea and abroad. After specifying the research title and abstract as the search scope to extract the literature and build a database, the literature related to nursing was classified based on the topics derived through text network analysis and then, the literature that met the selection criteria was secondarily extracted and analyzed through the abstract screening. The three researchers checked the consistency of the study selection process and if there was any discrepancy, the final decision was made through consensus among the researchers.

The selection criteria for the literature were: (1) domestic and foreign studies published within the last five years (January 2018 to September 2023) that conducted studies on complementary and alternative medicine; and

The exclusion criteria for the literature were grey literatures, dissertations, and studies for which original texts are not available.

Data collection strategies

In this study, the database was selected by referring to the COSI (Core, Standard, Ideal) [ 20 ] model presented by the National Library of Medicine for literature search. EMBASE, Cochrane Central, and PubMed Central were selected as the core databases.

On the other hand, the standard databases selected were the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Korean database services such as the Research Information Sharing Service (RISS), KMbase, and Korean studies Information Service System (KISS). These Korean databases were included to ensure a comprehensive coverage of potentially relevant studies published in South Korea, as they index a wide range of domestic and international journals, conference proceedings, and dissertations across various disciplines, including those related to CAM. However, it is important to note that the inclusion of these Korean databases does not limit the scope of our study to Korean literature only, as the majority of our analysis focuses on studies published in English and indexed in the core and standard international databases.

In addition, the Web of Science was selected to include a wider range of literature for the ideal database, and the period of literature search focused on the last five years, from 1 January 2018 to 15 September 2023. to capture the most recent trends in CAM research following the last comprehensive analysis of CAM research trends conducted in 2018 by Sung et al. [ 19 ]. This time frame was chosen to provide an updated and comprehensive analysis of CAM research trends, building upon the findings of previous studies and identifying new patterns and areas of focus that have emerged in recent years, given the rapid evolution of CAM research and the increasing integration of CAM into mainstream healthcare.

The data collection procedure was limited for both domestic and foreign studies. In case of foreign studies, ‘English’ was limited as the search language, ‘abstract and title’ were identified as the field, ‘article’ was set as the document form, and the keywords were ‘complementary therap*,’ ‘complementary medicine,’ ‘alternative therap*,’ and ‘alternative medicine.’ For the Korean studies, ‘Korean’ was limited as the search language, ‘abstract and title’ were identified as the field, ‘article’ was set as the document form, and the search keywords used were ‘보완대체,’ ‘대체요법,’ and ‘대체의학.’ In searching for the secondary literature, studies in the field of nursing were presented to a group of nine experts including physicians, nurses, and pharmacists with a master's degree or higher, and then the relevant areas were classified to extract the keywords. These keywords were then used in the text mining search. Topic words, the majority of which were classified as nursing, were re-searched in the collected database. The literature selection and classification process were carried out independently by three researchers and promoted through discussions between the researchers.

Data analysis process

Data extraction.

A comprehensive literature search was conducted across eight databases: CINAHL, Cochrane, EMBASE, KISS, Kmbase, PubMed, RISS, and Web of Science. This extensive search yielded a total of 77,062 studies. To ensure the integrity and non-redundancy of our dataset, we employed a rigorous two-step deduplication process. First, we utilized the 'Find Duplicates' function in EndNote software for initial automatic deduplication. This function systematically identifies and groups potential duplicate records based on shared metadata such as title, authors, year, and DOI. Through this automated process, 12,107 duplicate records were identified and removed.

Following the automated process, we conducted a manual review to identify and remove any remaining duplicates that the software might have missed. This careful manual screening allowed us to catch subtle duplicates that automated systems might overlook, such as those with slight variations in titles or author names. Through this manual review, an additional 465 duplicate records were identified and removed. In total, our rigorous two-step deduplication process resulted in the removal of 12,572 duplicate records. Of these, 12,107 were removed through automated deduplication and 465 through manual review. After deduplication, 64,490 unique studies were retained for further analysis. These studies were systematically organized by title and subjected to a thorough text preprocessing phase. During this phase, unstructured words were sorted and cleaned using the social networking program Netminer 4.3.3 and text editor Notepad + + (version 8.5.8).

Also, stopwords such as pronouns, adverbs, and numbers were deleted through natural language processing, while exception list, defined words, and thesaurus were registered. The exception list and thesaurus were selected by the three researchers, and if they failed to reach a unanimous agreement, the keywords were refined through consultation and the abstracts and preambles were reviewed again to examine the context in which the words were used. In case of the exception list, literature search keywords or stopwords such as pronouns, adverbs, numbers, and special symbols were considered, while ‘complementary,’ ‘medicine,’ ‘alternative,’ ‘therapeutic,’ ‘therapy,’ ‘therap,’ ‘therapies,’ ‘the,’ ‘a,’ ‘and,’ ‘of,’ ‘for,’ ‘in,’ ‘to,’ and ‘among’ were excluded. Special symbols like ‘’,:'"()&-?# <  >  + "",‘ were excluded as well. As for defined words, ‘cells → cell,’ ‘effects → effect,’ ‘staphylococcus aureus → staphylococcus,’ ‘aureus → staphylococcus,’ ‘characteristics → characterization,’ ‘efficacy → effect,’ ‘rat → mice,’ ‘radio → radiation,’ ‘systems → system,’ ‘agents → agent,’ ‘activity → activation,’ ‘carcinoma → cancer,’ ‘cases → case,’ ‘mouse → mice,’ ‘practices → practice,’ ‘radio sensitization → radiation,’ ‘years → year,’ ‘α → alpha,’ and ‘β → beta’ were selected, and data sorting for synonyms was performed. As a result of the analysis, a database consisting of 464,625 words was constructed.

Data analysis

In this study, text mining and topic modeling analysis were employed using textom and RStudio (4.3) to identify keywords related to CAM. Word analysis, TF-IDF, and degree centrality analysis were performed through text mining, with results presented via visualization. TF-IDF determines if a keyword holds actual significance within a document, as words with high TF and TF-IDF values appear frequently and are more likely keywords or important terms [ 21 , 22 ]. Following previous studies [ 22 , 23 ], the minimum word length was set to two, with the top 20 words extracted per topic. Text network analysis created word networks expressing co-occurrence frequency as links [ 24 ]. To gauge word occurrence frequency, words were converted to word-word one-mode, and degree centrality analysis identified highly influential network words. The results of these analyses, including frequency, TF-IDF, degree centrality, closeness centrality, and betweenness centrality of core keywords, can be found in Table 1 .

This study utilized Latent Dirichlet Allocation (LDA) for topic modeling, a statistical method that estimates the probability distribution of topics within documents based on the Document Term Matrix (DTM). Following established practices in the literature, we set the Markov Chain Monte Carlo (MCMC) parameters to alpha = 1.44, beta = 0.001, and iterations = 1,000 [ 25 ]. To determine the optimal number of topics, we iteratively tested configurations ranging from 1 to 20 topics. Through a combination of silhouette clustering analysis and researcher consensus, we identified that a 15-topic model best represented the research trends in our corpus.

LDA visualization indicated that larger topic sizes represented greater proportions within the analyzed studies [ 25 ]. We confirmed that the ideal number of topics, where topics do not overlap and have distinct boundaries, is 15, as shown in Fig.  2 . To validate the relevance and credibility of the topic modeling results, we consulted an expert panel consisting of physicians, nurses, and pharmacists with master's or doctoral degrees. The panel members were asked to classify the 15 derived topics into their respective academic fields. Based on the survey results, two topics (Topics 4 and 7) were identified as nursing-related, with the majority of the expert panel categorizing them as such.

LDA topic modeling visualization

Using the words from these two nursing-related topics, a keyword search was conducted within the database to identify the final set of literature containing these terms. The selected literature was then classified as either nursing-related or non-nursing-related based on the following criteria: (1) the study was published by a nursing school or department, (2) the authors were nurses or nursing researchers, (3) the authors were hospital-affiliated nurses, or (4) the study was published in a nursing journal. The classification process was carried out independently by three authors, and the final categorization was determined through a verification process among them.

Literature review

After the three researchers re-searched the database built based on the sub-words of the extracted topics, a total of 35 articles were selected, including 13 nursing-related literatures and 22 other discipline-related literatures. The sub-words used for the re-search were derived from Topic 4 and Topic 7 in Table 2  and were classified using the PICO (Population, Intervention, Comparison, Outcome) framework. The population-related sub-words included 'patient,' 'students,' and 'nursing.' The intervention-related sub-words were 'yoga,' 'treatment,' 'radiation,' 'acupuncture,' 'education,' and 'cam.' The comparison-related sub-word was 'placebo,' and the outcome-related sub-words included 'anxiety,' 'depression,' 'symptoms,' 'knowledge,' 'attitudes,' and 'perceptions.' These PICO-classified sub-words were used to conduct the database re-search.

In order to examine the research trends in nursing and other related fields, general characteristics (author, country of publication, year of publication) and research characteristics (research design model, statistical method, research subject, intervention method, outcome variable, measurement instruments) were identified, presented, and compared. Meanwhile, the three researchers independently prepared a characteristic table to ensure the accuracy of the extracted contents and if there was any discrepancy, one data was selected through the discussion process until a consensus was reached and a characteristic table was constructed.

To assess the quality of the selected studies, we employed the Mixed Methods Appraisal Tool (MMAT), a concise tool designed to evaluate various study designs, including qualitative, randomized controlled trials, non-randomized studies, quantitative descriptive studies, and mixed methods studies [ 26 ]. This comprehensive tool allowed us to systematically evaluate the methodological rigor of our diverse selection of studies. Each study was evaluated against five MMAT criteria specific to its design, focusing on aspects such as research question appropriateness, data collection methods, and result interpretation. Our assessment revealed varying levels of methodological quality. Among nursing studies (A1-A12), 25% were high quality (5/5 criteria met), 58.3% moderate quality (4/5 criteria), and 16.7% low quality (3/5 criteria). Importantly, all included studies met at least 3 out of the 5 MMAT criteria, indicating an overall moderate to high quality across the selected literature. This suggests that the studies included in our analysis provide a reliable foundation for drawing conclusions. Studies that did not meet all criteria were carefully reviewed, and their potential limitations were considered when interpreting their findings. The MMAT provided a useful overview of study quality and was deemed suitable for assessing methodological rigor while maintaining the feasibility of our analysis. This approach ensured a balanced and nuanced interpretation of the evidence in the field of complementary and alternative medicine. The detailed results of this quality assessment can be found in Tables 3  and 4 .

Data collection and ethical considerations

Since the data used in this study did not contain information that can identify individuals, the study was conducted after obtaining an IRB approval (IRB No: ewha-202311–0008-01) from the Institutional Review Board of Ewha Womans University.

Analysis of word frequency and centrality

The frequency and percentage of the top 20 words related to complementary and alternative medicine are shown in Table 1 . The frequency and percentage of the top 20 words related to complementary and alternative medicine are shown in Table 1 . The table presents the top 20 keywords ranked by frequency, TF-IDF, degree centrality, closeness centrality, and betweenness centrality. The frequency column indicates the number of times each keyword appears in the analyzed documents, while the TF-IDF column represents the importance of each keyword within the entire document set. Degree centrality, closeness centrality, and betweenness centrality are network analysis measures that indicate the importance and influence of each keyword within the text network. The words with the highest frequency included ‘cell’ (7,653 times), ‘patient’ (6,910 times), ‘treatment’ (6,851 times), ‘cancer’ (6,722 times), ‘study’ (6,295 times), and ‘effect’ (6,203 times). The words with the highest values of TF-IDF, in order, were ‘cell,’ ‘effect,’ ‘cancer,’ ‘patient,’ ‘treatment,’ and ‘study.’ As a result of centrality analysis, the top six common words, in order, were ‘effect,’ ‘treatment,’ ‘study,’ ‘analysis,’ ‘disease,’ and ‘approach.’ Except for common words, the words with the highest values in the centrality analysis, in order, were ‘model,’ ‘patient,’ ‘activation,’ and ‘use.’ The words with the highest values for closeness centrality were ‘factor,’ ‘model,’ ‘patient,’ and ‘activation,’ while the words with the highest values for betweenness centrality were ‘factor,’ ‘model,’ ‘type,’ and ‘activation.’

Results of the topic modeling

The LDA visualization provides insights into the relative importance and distinctiveness of identified topics. In this visualization, the size of each topic circle is proportional to its prevalence within the analyzed corpus, with larger circles indicating topics that are more frequently discussed across the literature. Interestingly, we observed that some topics, despite being represented by smaller circles, were positioned at considerable distances from other topics. This spatial separation suggests that these topics, while perhaps less prevalent, possess high discriminant validity and represent distinct thematic areas within the field of complementary and alternative medicine research. This interpretation is consistent with established principles in topic modeling, where spatial relationships in visualizations can indicate semantic distinctiveness. An expert panel of 9 individuals (3 doctors, 3 nurses, and 3 pharmacists), each holding a master's or doctoral degree, conducted a survey to classify the topics based on the keywords. The topic that received the most votes from the panel was designated as the representative field for that topic. Based on the resulting values of the topic modeling, 20 sub-words for each topic were presented and provided in Table 2 , Topics 1–3, 5–6, and 9–15 were classified as Medicine, Topics 4 and 7 as Nursing, and Topics 8 and 10 as Pharmacology.

The process of selecting studies for our analysis is illustrated in Fig.  2 . To determine the optimal number of topics for our analysis, we conducted Latent Dirichlet Allocation (LDA) visualization. As Greene et al. [ 25 ] suggest, larger topic sizes in LDA visualization indicate a greater proportion of that topic within the analyzed studies. We tested topic numbers ranging from 1 to 20, seeking a configuration where topics were visually distinct and non-overlapping. This approach aligns with Liu et al. [ 24 ], who note that topics with high discriminant validity appear as small but clearly separated clusters. After careful visual analysis, we determined that 15 topics provided the most coherent and distinct groupings, as shown in Fig.  2 . This visualization demonstrates the independence and non-overlapping nature of our identified topics, supporting the robustness of our topic modeling approach. Based on the resulting values of the topic modeling, 20 sub-words for each topic were presented and provided in Table 2 . The expert panel's classification suggested that Topics 4 and 7 had relevance to nursing research. However, upon closer examination of the keywords included in these topics, it became apparent that they also encompassed literature from other medical disciplines. While the expert panel's classification indicated these topics were nursing-related, the presence of medical terminology suggested a broader interdisciplinary scope. This highlighted the limitations in identifying nursing-specific research using the current topic modeling approach. To address this issue and clarify the nursing-specific research within these topics, a further refinement of the literature search was conducted using the PICO framework. The keywords from Topics 4 and 7 were used to formulate a focused research question and search strategy. This targeted approach yielded a final selection of 12 nursing-specific articles and 22 articles from other disciplines. By employing the PICO framework and leveraging the keywords from the identified nursing-related topics, it was possible to isolate the nursing research within the broader interdisciplinary landscape.

The words included in topic 4 were the following: ‘trial,’ ‘effect,’ ‘yoga,’ ‘treatment,’ ‘radiation,’ ‘phage,’ ‘protocol,’ ‘anxiety,’ ‘dose,’ ‘zinc,’ ‘symptoms,’ ‘depression,’ ‘placebo,’ ‘acupuncture,’ ‘feasibility,’ ‘training,’ ‘insights,’ ‘toxicity,’ ‘mri,’ and ‘emergency.’ The words included in the topic 7 were: ‘role,’ ‘survey,’ ‘practice,’ ‘evidence,’ ‘failure,’ ‘utilization,’ ‘heart,’ ‘students,’ ‘cam,’ education,’ ‘healthcare,’ ‘valve,’ ‘knowledge,’ ‘communication,’ ‘narrative,’ ‘practitioners,’ ‘attitudes,’ ‘nursing,’ ‘perceptions,’ and ‘pseudomonas.’

The characteristics of the 12 studies included in the literature review analysis are shown in Table 3 .

Of the 12 final literature selections in nursing, there were four randomized controlled trials [A2] [A4] [A7] [A8], three non-randomized comparative trials [A3] [A5] [A6], four descriptive survey studies [A1] [A9] [A10] [A11], and one qualitative study [A12]. Regarding the country of the study’s publication, there were five studies from the United States, three from the United Kingdom, two from Germany and Turkey, and one from Australia. As for the statistical techniques that appeared with high frequency, 10 studies, which were [A1] [A2] [A3] [A4] [A5] [A7] [A8] [A9] [A10] [A11,] used independent t-test, and it was used in most studies. On the other hand, χ2 test was used in seven studies [A3] [A4] [A7] [A8] [A9] [A10] [A11] and one-way analysis of variance was used in four studies [A1] [A9] [A10] [A11]. Regarding the studies that were conducted targeting patients, there was one study conducted on cancer patients [A5], one study on women with post-traumatic stress disorder caused by a car accident [A8], one study on hypertension patients [A7], and one study on breast cancer patients undergoing chemoradiotherapy [A4]. There were seven studies conducted on medical staffs [A1] [A3] [A6] [A9] [A10] [A11] [A12] and one study conducted on nursing students [A2]. Among the interventional therapies used in clinical trials, the most common one was yoga, which was identified in three studies. Specifically, there was one study that used yoga therapy for chemotherapy patients [A5], laughter yoga for nursing students [A2], and yoga therapy for women with post-traumatic disorder [A8]. There were also studies conducted on virtual cancer education program [A6], education on complementary and alternative medicine [A3], auricular acupressure for hypertensive patients [A7], and music therapy for those with breast cancer [A4]. In the studies conducted among medical professionals and nursing students, knowledge [A1] [A3] [A6] [A9] [A10] [A11], attitudes [A1] [A3] [A10] [A11], and usage surveys [A1] [A11] were identified as measurement variables, whereas depression [A8], pain [A7], quality of life [A7], and anxiety [A8] [A4] were identified as the measurement variables in the studies conducted on patients.

Other disciplines

The detailed characteristics of these studies, including the study design, sample, intervention, statistical methods, and outcome measures, are presented in Table 4 .

Of the 22 final literature selections in other disciplines, there were 20 randomized controlled trials [B1] [B2] [B3] [B5] [B6] [B7] [B8] [B9] [B10] [B11] [B12] [B13] [B14] [B15] [B16] [B17] [B18] [B20] [B21] [B22], one pre- and post-hoc comparative study [B4], and one scoping review [B19]. The detailed characteristics of these studies, including the study design, sample, intervention, statistical methods, and outcome measures, are presented in Table 4 . Regarding the country of the study's publication, there were seven studies from the United States of America and the United Kingdom, three studies from China, two studies from the Netherlands, and one study each from Germany, India, and Hong Kong. As for the statistical techniques that appeared with high frequency, there were 10 studies that used independent t-test [B2] [B3] [B5] [B6] [B8] [B11] [B13] [B15] [B18] and one-way ANOVA [B3] [B6] [B7] [B9] [B11] [B14] [B18] [B21] [B20] [B22], while seven studies used repeated measures ANOVA [B2] [B4] [B10] [B11] [B15] [B20] [B22]. All studies for the literature review were conducted on patients. The most common intervention used was auricular acupressure, which was applied on patients with Parkinson’s disease [B11], poststroke depression [B6] [B14], insomnia and depression [B20] [B21], carpal tunnel syndrome [B7], soldiers with PTSD [B19], migraine [B15], pelvic organ prolapse [B8], and gallbladder stones [B22]. The second most common intervention used was yoga therapy, and the subjects were those with active arthritis [B18], generalized anxiety disorder [B17], hemodialysis [B4], and hypertension [B2]. Other subjects and interventions shown in the studies were the following: irritable bladder syndrome patients treated with cinnamon patch [B13]; depression patients treated with bouldering psychotherapy [B12]; dementia patients treated with aromatherapy [B10]; insomnia patients treated with Tai-chi and meridian pressure [B9]; Crohn’s disease patients treated with moxibustion [B3]; HIV patients treated with green tea [B5]; and peripheral arterial disease patients treated with laser acupuncture [B1]. On the other hand, the following were identified as the measurement variables for yoga intervention: level of depression, arthritis stage, anxiety level, quality of life, treatment response rate, sleep, and autonomic function [B2] [B4] [B16] [B17] [B18]. Measurement variables for auricular acupressure included level of depression, sleep quality, level of pain, physical and psychological symptoms, severity of depressive symptoms pelvic organ prolapse, and gastrointestinal symptoms [B3] [B6] [B7] [B8] [B11] [B14] [B15] [B19] [B20] [B21] [B22].

In the study conducted using cinnamon patches, the overactive bladder symptom scores and residual urine volume after urination were identified [B13]. In the study which used green tea, the level of depression was assessed while measuring the severity of depressive symptoms through bouldering [B12]. In the study that used aromatherapy, the behavior, psychology, daily living ability, and cognitive function of the patients with dementia were also assessed [B10].

The present study employed text mining techniques to analyze the literature on CAM published over the past five years and identify trends in nursing research. The text network analysis revealed keywords with high TF-IDF and degree centrality, such as 'cell', 'patient', 'treatment', 'cancer', 'study', and 'effect', suggesting a strong focus on cellular mechanisms, patient-centered approaches, and treatment effects, particularly in the context of cancer [ 22 , 23 ]. The high centrality of these keywords indicates their importance and influence within the broader network of CAM research [ 24 , 25 ]. The topic modeling approach identified 15 major topics, providing a comprehensive overview of the key areas of focus in recent CAM research. This data-driven method offers a more nuanced understanding of research trends compared to previous studies that relied on arbitrary searches or focused on narrow populations or interventions [ 27 , 28 , 29 , 30 , 31 ]. By employing this systematic approach, the present study captures the breadth and diversity of CAM research, overcoming the limitations of previous nursing studies.

An expert panel of 9 individuals (3 doctors, 3 nurses, and 3 pharmacists), each holding a master's or doctoral degree, conducted a survey to classify topics based on keywords. According to the expert classification results shown in Table 2 , Topics 1–3, 5–6, and 9–15 were classified as Medicine, Topics 4 and 7 as Nursing, and Topics 8 and 10 as Pharmacology. While Topics 4 and 7 were found to be nursing-related, closer examination revealed the presence of literature from other medical disciplines within these topics. To address this issue and clarify the nursing-specific research, a further refinement of the literature search was conducted using the PICO framework. The keywords from Topics 4 and 7 were used to formulate a focused research question and search strategy, yielding a final selection of 34 articles, with 12 nursing-specific articles and 22 articles from other disciplines. Analyzing trends in nursing and interdisciplinary studies within the context of the existing literature provides a more comprehensive understanding of CAM research trends. From a nursing perspective, the identification of topics related to patient care, such as symptom management, quality of life, and patient education, highlights the potential for CAM interventions to improve patient outcomes and experiences. The prominence of keywords such as 'patient', 'treatment', and 'effect' highlights the need for evidence-based practice and the need for rigorous studies to evaluate the efficacy and safety of CAM interventions in nursing care. Furthermore, the expert panel's validation of Topics 4 and 7 as relevant to nursing research emphasizes the relevance of these areas within the nursing discipline. Topic 4, which includes keywords such as 'trial', 'effect', 'yoga', 'anxiety', and 'depression', suggests a focus on the psychological benefits of CAM interventions, particularly in the context of clinical trials. This aligns with the growing recognition of the importance of holistic, patient-centered care in nursing practice [ 3 , 4 ]. Topic 7, which includes keywords such as 'practice', 'evidence', 'education', 'knowledge', and 'attitudes', highlights the importance of evidence-based practice and the need for nurse education and training in CAM. As CAM interventions become increasingly popular among patients, it is crucial for nurses to have the knowledge and skills needed to provide safe and effective care [ 5 , 6 ]. The insights gained from this study highlight the potential of text mining and topic modeling techniques for investigating research trends in various fields [ 11 , 12 , 13 ]. By leveraging these methods, researchers can systematically analyze large volumes of literature, identify key areas of focus, and uncover patterns and trends that may not be apparent through traditional review methods [ 14 , 15 ]. This approach can lead to a more comprehensive understanding of the current state of research and inform future directions for investigation.

In conclusion, the present study demonstrates the value of text mining and topic modeling techniques in analyzing research trends, particularly in the field of CAM [ 9 , 10 ]. The systematic approach employed in this study allowed for a more comprehensive and data-driven exploration of the research landscape, overcoming the limitations of previous studies and providing valuable insights into the trends in nursing research on CAM. The findings of this study have significant implications for nursing practice, highlighting the need for evidence-based approaches, patient-centered care, and the integration of CAM interventions into nursing education and training. Future studies should consider adopting similar methodological approaches to investigate research trends in other fields, as this can lead to a more complete understanding of the current state of research and inform future directions for investigation.

The trends analysis of nursing and interdisciplinary studies on CAM revealed notable differences in research design, subject characteristics, intervention types, and assessment methods. Nursing studies exhibited a more balanced distribution of research designs, including randomized controlled trials [A2, A4, A7, A8], non-randomized comparative trials [A3, A5, A6], descriptive survey studies [A1, A9-A11], and a qualitative study [A12]. In contrast, other disciplines predominantly utilized experimental designs, with 95.2% of the studies being randomized controlled trials [B1-B3, B5-B18, B20-B22]. This disparity suggests that nursing research on CAM should expand its focus on experimental studies to enhance the evidence base and align with the methodological approaches of other disciplines.

The subject characteristics of nursing studies differed significantly from those of other disciplines, with nursing research primarily focusing on healthcare professionals and students [A1, A3, A6, A9-A12], while other disciplines exclusively studied patient populations [B1-B22]. This highlights the need for nursing research to diversify its study subjects and investigate the effects of CAM interventions on patients and healthcare providers [ 28 , 29 ], as well as broader community and general health populations [ 3 , 6 ]. By expanding its scope, nursing research can provide valuable insights into the effectiveness and applicability of CAM interventions in promoting health and well-being across diverse settings and populations [ 4 , 5 , 7 , 8 ]. Nurses, as frontline healthcare providers, are uniquely positioned to bridge the gap between healthcare settings and the community, engaging with patients and community members to assess their health needs and provide evidence-based recommendations for CAM interventions [ 1 , 2 ]. This expanded focus, coupled with interdisciplinary collaboration and knowledge exchange [ 9 , 10 ], can lead to the development of innovative, culturally sensitive, and evidence-based CAM interventions that address the complex health needs of individuals and communities alike.

A closer examination of the intervention types in nursing studies reveals that although they focused on a relatively limited range of CAM modalities, such as yoga [A2, A5, A8] and auricular acupressure [A7], these interventions demonstrated promising potential for managing various symptoms and conditions. For instance, yoga was found to be effective in reducing psychological symptoms and cortisol levels in college students [A2], alleviating chemotherapy-related symptoms in cancer patients [A5], and improving post-traumatic stress disorder among traffic accident survivors [A8]. Similarly, auricular acupressure was shown to help decrease angina symptoms in hypertensive patients [A7]. These research findings suggest that even though the scope of CAM interventions in nursing research may be limited, they can provide significant benefits to diverse patient populations [ 2 , 4 , 22 ]. In contrast, the wide array of CAM interventions investigated in other disciplines, such as aromatherapy for dementia [B10], green tea for depression in HIV patients [B5], laser acupuncture for peripheral arterial disease [B1], cinnamon patch for irritable bladder syndrome [B13], bouldering psychotherapy for depression [B12], Tai-chi and meridian pressure for insomnia [B9], and moxibustion for Crohn's disease [B3], demonstrates the potential for nursing research to explore and apply new therapies. The safety, efficacy, and potential of these diverse CAM modalities, as evidenced in other disciplines [ 23 , 24 ], should encourage nursing researchers to investigate their applicability in patient care. By conducting rigorous studies on the safety and efficacy of various CAM interventions, nursing research can provide valuable evidence to support the integration of complementary therapies into nursing practice [ 2 , 4 , 22 ]. Moreover, this trends analysis emphasizes the importance of studying CAM interventions for chronic disease management. With the increasing prevalence of chronic conditions [ 1 , 9 , 10 ], nursing research can play a pivotal role in evaluating the effectiveness of CAM for managing these diseases. Studies on yoga for hypertension [B2] and arthritis [B18], auricular acupressure for insomnia and depression [B20, B21], and moxibustion for Crohn's disease [B3] demonstrate the potential of CAM in improving patient outcomes and quality of life. As nurses have more direct and prolonged contact with patients compared to other healthcare professionals, they are well-positioned to assess the effectiveness of CAM interventions in both clinical and community settings [ 3 , 5 ]. By conducting well-designed studies on the safety and efficacy of various CAM modalities, nursing research can provide the necessary evidence to support the integration of complementary therapies into chronic disease management plans, ultimately enhancing patient care and outcomes across diverse settings. Leveraging their unique role in patient care and conducting rigorous studies on the safety and efficacy of various CAM interventions, particularly for chronic disease management, can enable nursing research to make significant contributions to the integration of complementary therapies into nursing practice. This approach has the potential to not only improve patient outcomes and experiences but also strengthen the evidence base for CAM in healthcare, fostering interdisciplinary collaboration in CAM research and advancing the field of nursing.

The analysis of assessment methods revealed that nursing studies heavily relied on self-developed measurement instruments (58.3%) [A3, A5, A6, A9-A12], while other disciplines predominantly used previously validated tools [B1-B22]. Furthermore, nursing studies rarely incorporated physiological indicators (8.3%) [A2], in contrast to the more frequent use of such measures in other disciplines (36.3%) [B1-B22]. These findings underscore the importance of utilizing validated assessment tools and physiological indicators in nursing research to enhance the reliability and validity of study results [ 31 ]. By incorporating these objective measures, nursing research can more clearly identify significant factors and strengthen the level of evidence, ultimately improving the credibility and applicability of the results.

The trends analysis of statistical techniques revealed a higher prevalence of independent t-tests in nursing research (83.3%) [A1-A5, A7-A11], while other disciplines showed a more balanced use of various techniques, including one-way ANOVA (45.5%) [B3, B6, B7, B9, B11, B14, B18, B20-B22] and repeated measures ANOVA (31.8%) [B2, B4, B10, B11, B15, B20, B22]. This difference can be attributed to the nature of the dependent variables assessed in each field, with nursing studies primarily focusing on single assessments of knowledge, attitudes, education, beliefs, and symptoms [A1, A3-A11], whereas other disciplines frequently employed repeated measures of pain, depression, response rate, serum levels, and neurological outcomes [B2-B4, B6-B8, B10, B11, B14-B22]. These findings underscore the importance of aligning the choice of statistical techniques with the nature of the outcome measures to ensure the validity and reliability of the research findings.

In conclusion, the trends analysis of nursing and interdisciplinary studies on CAM highlights the need for nursing research to expand its focus on experimental designs, diversify study subjects, explore various CAM interventions, utilize validated assessment tools and physiological indicators, and employ robust statistical techniques. By addressing these methodological considerations, nursing research can strengthen the evidence base for CAM interventions, facilitate their integration into nursing practice, and contribute to interdisciplinary dialogue in the field of CAM research [ 11 , 12 , 13 ]. As CAM use becomes increasingly prevalent among patients, particularly those with chronic conditions [ 1 , 9 , 10 ], nursing research has a crucial role to play in investigating the safety and efficacy of various CAM modalities [ 2 , 4 , 22 ]. This approach not only has the potential to improve patient outcomes and experiences but also enables nursing research to make valuable contributions to interdisciplinary collaboration in the field of CAM [ 3 , 5 ]. By embracing the diversity of CAM interventions and fostering interdisciplinary interactions, nursing research can broaden its scope, enhance the efficiency of patient-focused care, and move closer to providing truly holistic care that addresses the multifaceted needs of patients. Also, the integration of CAM into nursing practice, supported by robust research evidence, has the power to transform healthcare delivery and improve the lives of patients, particularly those with chronic conditions who stand to benefit greatly from a more comprehensive and individualized approach to care.

The trends analysis of nursing and interdisciplinary studies on CAM highlights the potential for nursing research to draw inspiration from the diverse CAM interventions studied in other disciplines and adapt them for nursing practice. For example, the use of aromatherapy for dementia [B10], green tea for depression in HIV patients [B5], and cinnamon patch for irritable bladder syndrome [B13] could be explored in nursing research to assess their feasibility and effectiveness in nursing care settings. By learning from the experiences of other disciplines and adapting promising CAM interventions for nursing practice, researchers can expand the scope of nursing research on CAM and contribute to the development of innovative, evidence-based complementary therapies for various patient populations. Given the current trends in nursing research on CAM, it is essential for future studies to consider the research directions and methodologies employed in other disciplines to guide the advancement of nursing science in this field. In summary, this trends analysis emphasizes the need for nursing research to embrace a more diverse and rigorous approach to CAM research, drawing inspiration from the methodologies and interventions studied in other disciplines. By expanding the focus on experimental designs, diversifying study subjects, exploring novel CAM interventions, utilizing validated assessment tools and physiological indicators, nursing research can strengthen the evidence base for CAM interventions, facilitate their integration into nursing practice.

Limitations

This study aimed to identify research trends in CAM through text network analysis and to analyze nursing research trends based on the findings. The use of text mining and big data analysis allowed for a more comprehensive and less biased approach to data collection and processing compared to arbitrary search strategies. However, there were still limitations in defining each field intuitively due to the diverse and wide-ranging areas of CAM used in different disciplines. Future studies should focus on analyzing overall topics across various fields as well as keyword extraction through text mining to gain a more holistic understanding of CAM research trends. Another limitation of this study is that the search languages were restricted to Korean and English. This may have excluded relevant studies published in other languages and might limit the generalizability of the findings. As CAM is rooted in diverse cultures and traditions worldwide, it is important to include studies conducted in various languages for a comprehensive understanding. Future research should incorporate more languages to provide a global perspective on CAM research trends.

Despite these limitations, this study offers a novel methodological strategy for trend analysis by combining keywords extracted using big data rather than relying on researchers' arbitrary settings. The keyword-based classification and literature analysis provide a new approach to identifying research trends and directions. The trends analysis between nursing literature and other disciplines revealed differences in subject selection, study design, statistical techniques, and measurement of dependent variables, highlighting the need for nursing research to broaden the range of subjects and measurement tools while considering randomization and generalization in experimental designs. Furthermore, this study emphasizes the importance of using design techniques that facilitate the sharing of research results beyond the nursing community.

Conclusions

This study significantly advances CAM research in nursing by providing a comprehensive, data-driven overview of research trends. We have identified key areas for improvement, such as the need for more randomized controlled trials and broader subject diversity, and have proposed innovative methodological strategies. Our findings underscore the importance of interdisciplinary collaboration and the adoption of diverse, rigorous research approaches. By addressing these gaps, nursing research in CAM can be strengthened, ultimately enhancing the integration of evidence-based CAM practices in nursing care and improving patient outcomes.

Availability of data and materials

The data and materials of this study are available from the corresponding author upon reasonable request.

Abbreviations

Complementary and Alternative Medicine

World Health Organization

National Center for Complementary and Integrative Health

Research Information Sharing Service

Korean studies Information Service System

Cumulative Index to Nursing and Allied Health Literature

Term Frequency-Inverse Document Frequency

Latent Dirichlet Allocation

Markov Chain Monte Carlo

Document Term Matrix

Mixed Methods Appraisal Tool

Institutional Review Board

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The authors thank all participants who accepted to be part of this work.

This study was supported by the National Research Foundation of Korea (NRF-2022R1F1A1071533)

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Study design: JN, HP, and HL; Data collection and Data analysis : JN and HL ;Study supervision: HP; Manuscript writing: JN, HL, and SL Critical revisions for important intellectual content: HP. All authors reviewed and approved the final manuscript.

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Nam, J., Lee, H., Lee, S. et al. Literature review of complementary and alternative therapies: using text mining and analysis of trends in nursing research. BMC Nurs 23 , 526 (2024). https://doi.org/10.1186/s12912-024-02172-9

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Share and Cite

Muhammad, N.A.G.; Orejudos, J.N.; Aniñon, M.J.C. A Compendium of Research, Tools, Structural Analysis, and Design for Bamboo Structures. Buildings 2024 , 14 , 2419. https://doi.org/10.3390/buildings14082419

Muhammad NAG, Orejudos JN, Aniñon MJC. A Compendium of Research, Tools, Structural Analysis, and Design for Bamboo Structures. Buildings . 2024; 14(8):2419. https://doi.org/10.3390/buildings14082419

Muhammad, Nurwin Adam G., Jerson N. Orejudos, and Mary Joanne C. Aniñon. 2024. "A Compendium of Research, Tools, Structural Analysis, and Design for Bamboo Structures" Buildings 14, no. 8: 2419. https://doi.org/10.3390/buildings14082419

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• Case Report
• Open access
• Published: 10 August 2024

Chrysosporium articulatum mimicking Trichophyton spp. infection in a cat: a case presentation and literature review

• Magdalena Kizerwetter-Świda 1 ,
• Iwona Bąk 1 ,
• Małgorzata Justyna Biegańska 1 ,
• Kourou Dembele 2 &
• Dorota Chrobak-Chmiel 1  

BMC Veterinary Research volume  20 , Article number:  359 ( 2024 ) Cite this article

Metrics details

Dermatophytosis is a common skin infection of cats and many other animals. A reliable diagnosis is crucial because of the zoonotic potential of dermatophytes. The routine mycological diagnostic procedures for dermatophytosis are widely known, but in the case of some isolates, identification based on phenotypic characteristics may be incorrect. Infections caused by Chrysosporium spp. are usually described in reptiles, but in other animals they are uncommon.

Case presentation

This study presents a description of a cat with dermatological lesions, that was mistakenly diagnosed with Trichophyton spp. dermatophytosis. Clinical material for mycological examination was collected from alopecic areas on the back of the neck, the ventral abdomen, and the hindlimbs. The initial identification based on phenotypic properties indicated Trichophyton spp. The result of the MALDI-ToF MS allowed the exclusion of the Trichophyton genus. Ultimately, the correct identification as Chrysosporium articulatum was obtained based on the sequencing of ribosomal genes.

Conclusions

Interpretation of the results of the mycological examination of samples collected from animals’ skin or hair shafts is always challenging. Thus, careful consideration of the primary cause of the clinical lesions observed on the skin is mandatory, and the culture results are worth supporting by molecular methods.

Peer Review reports

Dermatophytosis is a common fungal infection in veterinary and human medicine. Dermatophytes are filamentous fungi that may cause superficial infections of keratinized tissues such as skin (stratum corneum of the epidermis), hairs and claws in different animal species, including dogs and cats. The vast majority of dermatophytoses in pets are caused by Micropsorum spp. and Trichophyton spp. [ 1 , 2 , 3 , 4 ]. The pathogenicity of these fungi is related to their ability to degrade keratin found in superficial tissues, typically viable tissues are rather not invaded. However, sporadic invasive infections have been reported in immunocompromised or elderly human patients [ 5 ]. Dermatophytes belong to a group of keratinophilic and keratinolytic fungi. In addition, many keratinophilic environmental fungal species can use pre-digested keratinaceous debris or by-products of keratin degradation. These are: Chrysosporium spp., Psuedogymnoascus spp., Geomyces spp., Pectinotrichum spp., Renispora spp. and others. In general, these non-dermatophytes keratinolytic fungi are saprophytes, engaged in the decomposition of keratinized residues in the soil. However, Chrysposporium spp. strains with kertinolytic properties have been described, with positive results in hair perforation test [ 6 , 7 ].

Chrysosporium genus is classified in the family Onygenaceae , Onygenales order, Eurotiomycetes class and Ascomycota phylum. This genus includes about 100 species [ 8 ], commonly found in the environment, soil, and water sediments, but also on the skin and hairs of animals and humans. The taxonomical classification is often based on the fungal morphology. However, when sexual states and macroconidia are not present, the microconidia-producing fungi are clustered in polyphyletic genera, such as the genus Chrysosporium . Recent research results based on genetic properties have allowed the updating of the Chryspsporium spp. taxonomy [ 9 ]. Moreover, Kendemir et al. (2022) have shown 100% ITS sequence identity in C. articulatum UAMH 4320 with Aphanoascus reticulisporus [ 10 ]. Colonies formed by Chrysosporium are white or pale with septate hyphae producing pyriform or obovate to ellipsoidal microconidia [ 6 ]. The appearance of these powdery colonies as well as micromorphology resembles some dermatophytes, e.g. Trichophyton mentagrophytes [ 11 ]. Fungi classified in the genus Chrysosporium are regarded as non-pathogenic. However, there has been an increasing number of infections caused by these fungi in recent years. Most of the documented cases involve immunocompromised humans [ 12 , 13 ]. Infections of this etiology also occur in animals, mainly in reptiles, most often as cases of dermatitis, but also as life-treating infections [ 14 , 15 ]. Chrysosporium tropicum was described as a causative agent for dermatomycosis in chickens [ 16 ]. Additionally, Chrysosporium spp. is often isolated from feathers [ 17 ].

The clinical manifestations of dermatophytosis in cats are variable and related to the dermatophyte species involved [ 18 ]. Typically, single or several alopecic areas with scaling, crusting and erythema are observed. However, other clinical presentations are also possible, like a matted coat, seborrhea, miliary dermatitis, the presence of pustules, papules, macules, nodules, hyperpigmentation, kerions, and onychomycosis. Infected animals may show symptoms of pruritus. The variable clinical appearance of dermatophytosis can be explained by differences in the composition and structure of keratin, the specificity of enzymes produced by particular fungi, and the defence mechanisms of host organisms [ 18 , 19 ]. Moreover, any other dermatoses may cause similar clinical manifestations. Thus, differential diagnosis including, among others food allergy, hormonal disorders, atopic dermatitis, autoimmune dermatoses, bacterial dermatitis, or infestation with skin parasites should always be performed. Hence, the diagnostic procedures must be accurate and carried out step-by-step. Apart from mycological examination, the results of additional tests such as parasitic, bacteriological, histopathology of biopsy material and allergy tests should also be performed [ 19 ]. Of note, the reliable diagnosis of dermatophytosis in dogs and cats is also essential because of the zoonotic potential of most of the species isolated from pets [ 20 ]. Moreover, cats may be asymptomatic carriers of M. canis or they may have a subclinical infection, which further complicates the diagnosis [ 3 ].

In this study we present a case of a cat with dermatological lesions, initially diagnosed with Trichophyton spp. infection. Ultimately, the cultured fungi were identified by sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry method (MALDI-ToF MS) as C. articulatum , which is usually regarded as a non-pathogenic fungus. Moreover, we present a review of diagnostic procedures used in dermatophyte identification and the literature data on infections caused by Chrysosporium spp.

A 7-year-old an outdoor, neutralized male European shorthair cat weighing 6 kg showing dermatological lesions was admitted to the Small Animal Clinic at the Institute of Veterinary Medicine, Warsaw University of Life Sciences. Clinical findings included: intense pruritus and alopecia on the back of the neck, on the ventral abdomen, and the hindlimbs (Fig.  1 ). At the visit, flea dermatitis was excluded. Wood’s lamp examination was performed, and no fluorescence was observed. The cat was diagnosed with dermatitis miliaris. To reduce intense itching, the cat was treated with dexafort (0,9 mg i.m.). Plucked hairs and scraped scales were collected for mycological examination.

Pruritic self-inflicted alopecic areas on the back of the neck (left) and the hindlimb (right)

Direct microscopic examination of collected hairs and scales was performed with KOH, but wet-mounts failed to detect any spores or other fungal elements in both examined samples. Sabouraud dextrose agar (SDA), Sabouraud dextrose agar supplemented with 0.05% cycloheximide and 0.005% chloramphenicol, and dermatophyte test medium (DTM) were used for fungal culture. All plates were incubated aerobically, at 25 °C for four weeks. The colonies appeared on SDA and DTM medium after five days of incubation. Colonies were flat, white in colour, with a powdery surface (Fig.  2 ). DTM medium turned red, as is observed when dermatophytes grow. Colony morphology resembled colonies of Trichophyton spp. (Fig.  3 ). The isolate was examined for microscopic morphology using lactophenol cotton blue staining. Conidia were smooth and thin-walled, pyriform, one-celled, and sessile, usually on side branches or at the ends of long narrow stalks (Fig.  4 ). Additionally, a hair perforation test was performed following standard mycological procedures, and no keratinolysis was noted. The isolate was identified based on the colony morphology on SDA, DTM medium and micromorphology as Trichophyton spp. Thus, topical and systematic antifungal therapy was prescribed.

The fungal isolate was further identified using MALDI Biotyper (Bruker Daltonics, Billerica, MA, USA) according to the manufacturer’s instruction at the Jagiellonian Centre of Innovation (Kraków, Poland). The identification of our isolate with the MALDI-ToF MS method revealed Chrysosporium keratinophilum with a score value of 2.11. The identification score ranging 2.00–3.00 was considered as a high-confidence identification to the species level.

Ultimately, molecular biology methods were used for identification. Genomic DNA was extracted from five-day-old colonies using the method described by Brillowska-Dabrowska et al. [ 21 ]. Briefly, a fragment of a colony was mixed with 100 µl of extraction buffer (60 mM sodium bicarbonate, 250 mM potassium chloride and 50 mM Tris, pH 9.5, Sigma Aldrich) and incubated at 95 °C for 10 min. Then, 100 µl of 2% bovine serum albumin was added and after vigorous vortexing for 5 s, the obtained solution was used for PCR. Amplification of the internal transcribed sequence (ITS) region of ribosomal RNA was used with conserved primers ITS4 and ITS5 described by White et at. [ 22 ], with the following thermal-cycling conditions: initial denaturation for 3 min at 94 °C, followed by 35 cycles of 30 s at 94 °C, 30 s at 50 °C, 45 s of at 72 °C, and final elongation for 6 min. The obtained product was verified by agarose gel electrophoresis and subjected to sequencing with the same primers. Finally, the sequence was analyzed with BLAST software using the National Center for Biotechnology Information (NCBI) database. GenBank BLAST analysis of the obtained sequence of the internal transcribed sequence region of ribosomal RNA indicated 99.27% identity to a sequence of Chrysosporium articulatum deposited in the NCBI database.

Finally, the isolate obtained from a cat was recognized as C. articulatum , which was considered an environmental isolate contaminating the fur. Based on the verified identification dermatophytosis was ultimately excluded, allowing to avoid unnecessary implementation of antifungal therapy to the patient. The final diagnosis was a food allergy, with the recommendation of an elimination diet. After four weeks, a follow-up visit took place, during which the veterinarian confirmed that the cat’s condition improved, in alopecic areas, fur started to regrow and the itching had stopped. During the follow-up visit, hair samples were collected for mycological culture, which gave a negative result.

Colony morphology on SDA medium supplemented with chloramphenicol and cycloheximide (front and back of the plate) - flat, white colonies, with a powdery surface on the front and pale brown on the reverse

Colony morphology on DTM medium - colour change from yellow to red (five days of incubation on the left and four weeks of incubation on the right)

Morphology of septate hyphae and microconidia – light microscope examination under 400x magnification with lactophenol cotton blue staining

Veterinary mycological diagnostics encounter certain difficulties in identifying unusual, less frequently isolated species. The positive fungal culture results in invasive infections or disseminated cutaneous infections and does not pose any problems in interpretation because the clinical samples are collected from tissues and should not contain any fungal elements, including saprophytes. The cultivation of fungi commonly considered environmental saprophytes from superficial skin lesions is more challenging in interpretation. It may be difficult to assess whether these fungi caused the infection (in some immunocompromised patients) or whether they were cultivated accidentally. Moreover, in some cases, the differentiation of dermatophytes and other non-dermatophytic fungi may be more demanding than it seems. Incorrect identification of pathogenic fungi as saprophytes may result in the omitting of necessary antifungal therapy despite the medical indications. Alternatively, therapy may be introduced for patients that do not require such treatment, because only environmental saprophytic fungi were cultured from samples collected superficially. The treatment of dermatophytosis in dogs and cats may be topical or quite often requires systemic administration of antifungals [ 23 ]. Topical therapy is used to minimize disease transmission and environmental contamination, while systemic antifungal therapy eradicates the infection within the hair follicle [ 24 ]. Treatment of dermatophytosis may be associated with side effects, such as liver toxicity or vasculitis, and it may lead to an increase in fungal resistance. Unnecessary antifungal treatment, which is usually long-term, causes an imbalance in natural microbiota.

Fungi classified in the genus Chrysosporium are regarded as non-pathogenic, non-dermatophyte keratinolytic fungi. Recently, the number of cases of human infections caused by Chrysosporium spp. described in the literature is increasing, especially in immunocompromised human patients. Chrysosporium zonatum and Chrysosporium tropicanum are most commonly reported [ 25 ]. The clinical presentation includes respiratory allergic reactions, pulmonary invasive infections and skin infections. There is only one documented case of Chrysosporium articulatum invasive pulmonary infection in human, 16-year-old man diagnosed with lymphoblastic leukemia [ 12 ].

In veterinary medicine infections caused by Chrysosporium spp. are rarely described, and mostly are reported in reptiles. In recent years, Chrysosporium anamorph of Nannizziopsis vriesii (CANV) has become the leading fungal agent of dermatitis in reptiles. The lesions initially involve the skin, and the presence of hyperkeratosis, necrosis, vesicles, crusts, and ulceration may be observed. Progress to fatal systemic disease often occurs [ 14 , 15 ].

We have gathered here five literature reports concerning Chrysosporium spp. infections in dogs and cats. Of note, publications describing the isolation of these fungi from before 1990 have been omitted due to the unreliable identification methods used at that time. The first is a review study concerning 157 cases of disseminated canine mould infections demonstrated that the majority (59,3%) was caused by Aspergillus spp. Chrysosporium spp. was identified as the etiological agent only in two cases, which corresponds to only 1,3% of incidence [ 26 ]. One of the publications included in the review mentioned above was a case report concerning disseminated infection in German shepherd dog in Australia. Fungal hyphae were observed in needle aspirates of the iliac lymph nodes and spleen. The fungal culture from these materials was positive and was diagnosed as Chrysosporium spp. [ 27 ]. An earlier publication also from Australia described disseminated opportunistic fungal infections among 10 dogs, of which, in one case, Chrysosporium spp. was found to be the etiological agent [ 28 ]. In another review study describing fungal keratitis in 11 dogs, the presence of Chrysosporium spp. was confirmed in one patient [ 29 ]. Moreover, the literature provides one description of superficial skin lesions in two Persian cats and their owner caused by Chrysosporium spp. These two cats lived in the same household. Moreover, Chrysosporium spp. was also isolated from its owner, who was undergoing chemotherapy for mammary cancer. Fungal culture from hairs and skin scrapings revealed the presence of Chrysosporium spp. in both cats. Unfortunately, the authors did not verify the identification with molecular biology methods, however, effective antifungal treatment proved, that the isolated fungi were the etiological agent involved in the observed clinical changes [ 30 ]. Additionally, in 2011 Pin et al. described well-documented onychomycosis caused by C. keratinophilum in seven captive Bennett’s wallabies [ 31 ].

Diverse fungal species may occur on the skin and hairs of cats, which may be either pathogens or contaminating saprophytes. Thus, veterinary mycological diagnostics encounter dilemmas, such as contamination of superficial clinical samples by saprophytic fungi, which is most probable when the samples of hair, skin scrapings or claws are collected. Chrysosporium spp. is one of many saprophytic fungi that can contaminate the animal’s haircoat or skin and thus contribute to the contamination of clinical samples. Chrysosporium spp. has been most commonly isolated (25%) from healthy dogs and cats in Mexico [ 32 ]. This creates a challenge for veterinary laboratory diagnostics because Chrysosporium spp. shows similar characteristics to dermatophytes [ 7 ]. These fungi may have macromorphology and micromorphology similar to some Trichophyton spp., thus may be easily misidentified. Additionally, Chrysposporium spp. can grow on the DTM agar, causing pH change and redness of the medium while showing morphological characteristics corresponding to dermatophytes [ 30 ]. Furthermore, a positive hair perforation test was observed for Chrysosporium species. isolated from the environment, confirming their keratinolytic properties. Mitola et al. have described positive results of a hair perforation test for Chryspsporium georgii , Chrysosporium keratinophilum , and Chrysosporium lucknowense isolates obtained from environmental samples [ 7 ]. Likewise, Gurung et al. observed keratinolytic activity in soil isolates identified as Chrysosprium indicum and Chrysosporium fluviale [ 6 ].

A common opinion is that dermatophytes may be easily discriminated with DTM agar plate. However, literature data indicate that other fungi can also produce a positive reaction in this medium. These include Chrysosporium spp., as confirmed by Dokuzeylul et al. [ 30 ] and Jang et al. [ 33 ]. Jang et al. (2007) found that 63% of moulds isolated from dogs produced colour changes to red on DTM medium, including Chrysosporium , as well as some isolates of Aspergillus , Penicillium and others. Thus, as mentioned before, the color change of DTM agar is not sufficient to confirm the presence of dermatophytes.

The identification of our isolate with MALDI-ToF MS showed Chrysosporium keratinophilum with a high score value of 2.11. However, the sequencing of ribosomal genes indicated Chrysosporium articulatum . While performing MALDI-ToF MS analyses, the manufacturer’s Brucker database included protein spectra from only two species of this genus ( C. keratinophilum and Chrysosporium shanxiense ). Therefore, we were unable to obtain correct species identification with this method. Nevertheless, the high score value of C. keratinophilum allows us to exclude Trichophyton spp. Similar difficulties in the identification of filamentous fungi were described by Normand et al. [ 34 ] and Wilkendorf et al. [ 35 ]. The explanation for this situation is that proteomic profiles of unusual, saprophytic, filamentous fungi are currently not included in available databases, also indicating the need to expand and update these databases.

Our report describes a case of a cat with dermatological lesions initially misdiagnosed as dermatophytosis caused by Trichophyton spp. The initial identification of DTM-positive isolate as Trichophyton spp. was confirmed by colony morphology on Sabouraud agar as well as its micromorphology. Nevertheless, correct identification to the species level was obtained after sequencing of ribosomal genes. The identification using the MALDI-ToF MS technique was not possible because the available database does not include this species. Although this method allowed for the recognition of the genus Chrysosporium . Results presented in this study indicate that interpretation of the results of the mycological examination in all cases of culturing saprophytic fungi, growing from superficial samples is always challenging. Thus, careful consideration of the primary causative agent of the clinical lesions observed on the skin is mandatory. Moreover, DTM medium should be used only as a screening method, and the identification of DTM-positive isolates as dermatophytes must be confirmed by other tests.

Data availability

The dataset generated and analyzed during the current study is available in the NCBI GenBank repository, under the accession number: PP758650.

Abbreviations

Matrix assisted laser desorption ionization-time of flight mass spectrometry

Sabouraud dextrose agar (SDA); DTM - Dermatophyte test medium

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Acknowledgements

The authors would like to thank Beata Kowalkowska for her excellent technical assistance.

Studies were partially financed by the Science Development Foundation – Warsaw University of Life Sciences.

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DCC obtained all clinical samples, prepared all photographs, and provided contact with the cat’s owner and a veterinarian. DCC and MKŚ performed phenotypic identification, DNA isolation, PCR and sequencing analysis. MJB and IB were involved in mycological consultation. IB provided valuable comments regarding PCR and sequencing. KD conducted the clinical examination and differential diagnosis. All authors have read, critically discussed the results, and approved the manuscript.

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Kizerwetter-Świda, M., Bąk, I., Biegańska, M.J. et al. Chrysosporium articulatum mimicking Trichophyton spp. infection in a cat: a case presentation and literature review. BMC Vet Res 20 , 359 (2024). https://doi.org/10.1186/s12917-024-04185-7

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MINI REVIEW article

Assessment of the economic viability, environmental, and social impacts of green hydrogen production: an algerian case study.

• 1 African Membrane Society (AMSIC), a Ecole Nationale d’Ingénieurs du Mali Abderhamane Baba Touré, Bamako, Mali
• 2 i2i Innovation MegaHub (“i2iMegaHub”), Accra, Ghana
• 3 Agence Nationale de la Valorisation des Résultats de la Recherche et du Développement Technologique (ANVREDET), El Djazair, Algeria

The impacts of climate change are real and in many parts of the world testify to its harsh reality, including rampant extreme weather events, droughts, heat, wildfires, and flooding which have recorded in places which have not experienced them in recent memory. In the quest to avert such events, there is a growing awareness and demand for sustainable processes and operations. Today, sustainability encompasses a balance between ecological footprint and human development index, taking into consideration economics, the green environment, safety, quality, ethics, diversity and inclusion (D&I), and communities. This article presents some steps that have been taken by Algeria to balance energetic autonomy and sustainable development, and a case study on green hydrogen production employing membrane processes. Algeria’s objective to join the global fight against climate change is to develop its green hydrogen base. Given its resources, including available solar and wind power, seawater desalination plants, building capacity, and its favorable location, it is developing its green hydrogen economy to supply hydrogen, especially to Europe. This presents an opportunity for other developing nations, especially in Africa, to gain from this experience.

1 Introduction

Hydrogen by nature is a green fuel and produces little to no toxic emissions if used effectively ( Wang et al., 2023 ; Anwar et al., 2021 ). Hydrogen is projected to be the clean energy of the future and it is expected that green hydrogen will be a decarbonization substitute for much of the fossil fuel energy used today, hence reducing the impacts posed by non-green fuels ( Al-Zareer et al., 2018 ; Lee et al., 2018 ; Anwar et al., 2021 ; Nasser and Hassan, 2023 ).

Hydrogen as a fuel is fundamentally green; however, it is the means of its production that classifies it as green, grey, blue, red/pink, cyan/turquoise, brown and black, green, yellow, and white ( Lubbe et al., 2023 ; Chaudhary et al., 2024 ). A fully green production process is preferable given the increasing requirements to reduce environmental impacts and decarbonization ( Chi and Yu, 2018 ; Lubbe et al., 2023 ).

This study will share some of the different non-green and green hydrogen production technologies and color codes. Algeria currently produces grey hydrogen and is investigating ways to change to green hydrogen to tap into the European market. Algeria now is considering strategies to move into this space to reduce environmental impacts.

Here we will discuss the global demand trends for hydrogen, the types of hydrogen, and their production sources. The focus will be on green hydrogen, various technologies used to produce it, its drawbacks, the various cost contributors, and future research focuses.

Most hydrogen currently produced comes from the natural gas or coal industry, as well as steam reforming of natural gas; in general, these are not fully green ( Wang et al., 2023 ). There is, however, a drive to boost green hydrogen production despite its challenges.

The different color coding categorization of produced hydrogen is generally based on the energy source, carbon emission associated with the production process, the overall environmental impacts, and the specific production process ( Arcos and Santos, 2023 ).

Membrane science and technology have and will have a significant role to play in renewable and non-renewable hydrogen production as far as electrolyzers, water treatment, and separation and purification are involved.

2 Literature

2.1 current uses of hydrogen.

Industrial processes that use hydrogen include: hydrodesulfurization, where sulfur is removed from fuels in the petroleum refining industry ( Lee et al., 2018 ); the metal industry for treatment such as sintering, brazing, annealing, powder coating, and metal injection modeling; in the fertilizer industry for ammonia-based fertilizer production ( Chaudhary et al., 2024 ); in the food industry for oil hydrogenation for margarine production ( Puprasit et al, 2022 ). Hydrogen has the potential to replace or supplement natural gas for cooking and heating; hydrogen-powered fuel cells provide the energy to power vehicles, maritime vessels, and aviation, as well as devices such as cell phones, laptops, and back-up and emergency power in buildings and military applications ( Chaudhary et al., 2024 ). More areas of interest are emerging for hydrogen application ( Agyekum et al., 2022 ; Osman et al., 2022 ; Chaudhary et al., 2024 ).

2.2 Global demands for hydrogen

Hydrogen Insight projects that the global demand for hydrogen in 2050 is expected to more than triple. This will mainly be driven by aviation, power generation/energy storage, heavy industry ( E1A, 2019 ; Otto et al., 2022 ; Dally, 2024 ), water and road transport, and residential/commercial heating. S&P Global Commodity Insights projects that by mid-century, the total global hydrogen produced (249.5 MT) will comprise 67% green hydrogen, 16% blue hydrogen fossil fuel with carbon capture and storage (CCS), and the remaining 17% produced from unabated gas or coal without carbon capture and storage (CCS) technology ( Collins, 2023 ).

Moreover, it is expected that 17% of total global hydrogen produced will be traded across borders from areas with abundant wind and solar power, including Australia, Chile, North Africa, and the Middle East, to carbon conscious regions such as the Europeans Union and East Asia ( Collins, 2023 ).

2.3 Global projection for green hydrogen production

Rystad Energy through Hydrogen Insight projects the top ten green hydrogen producing nations for 2023–2030 to be Australia, the United States, Spain, Canada, Chile, Egypt, Germany, India, Brazil, and Morocco, with Australia, the US, and Spain in the lead ( Klevstrand, 2003 ). Table 1 shows some of the companies in the individual top ten (10) hydrogen producing countries projected for 2023–2030.

Table 1 . Some companies in the projected top ten hydrogen producing countries 2023–2030.

2.4 Hydrogen type color coding and production technologies

Several technologies are involved in the production of renewable and non-renewable hydrogen ( Anwar et al., 2021 ; Hydrogen Technologies, 2023 ). Table 2 shows hydrogen color codes assocaited with the different hydrogen production processes. Ambiguities exist in the literature on hydrogen color coding, highlighting the need for a global uniform color coding.

Table 2 . Hydrogen color codes associated with different hydrogen production processes.

Figure 1 shows the various non-renewable and renewable hydrogen production technology relative positions on technology maturation versus readiness ( Hydrogen Technologies, 2023 ).

Figure 1 . Hydrogen production technology maturation versus technology readiness level ( Hydrogen Technologies, 2023 ).

The demand for green hydrogen is focused the on the four promising electrolyzer types: alkaline (ALK), polymer electrolyte membrane (PEM), anion exchange membrane (AEM), and solid oxide electrolyte (SOE) ( Chi and Yu, 2018 ; Lu et al., 2023 ). They have advantages and disadvantages, challenges they face and expected future research and development directions ( Kumar and Lim, 2022 ).

2.5 Green hydrogen production technologies involving electrolyzers

Green hydrogen production involves electrolyzers, which use electrodes, membranes, electrolytes, water, and renewable energy, comprising ALK, PEM, AEM, and SOE mentioned above ( Chi and Yu, 2018 ; Kumar and Lim, 2022 ; Lu et al., 2023 ). Both ALK and PEM are commercialized while SOE and AEM are still in the pre-commercialization stage, with SOE ahead of AEM in development ( Patonia and Poudineh, 2022 ; Franco and Giovannini, 2023 ; Hydrogen Technologies, 2023 ).

Figure 2 shows the operation mechanisms of these four. Each has advantages and disadvantages that need to be understood and explored for their proper selection, application, and operation ( Franco and Giovannini, 2023 ).

Figure 2 . Promising electrolyzer types ( IRENA, 2020 ; El-Shafie, 2023 ).

2.6 A basic water electrolyzer–green hydrogen production system

A basic water electrolyzer–green hydrogen production system consists of feed water into a gas separator to remove all gases including oxygen (O 2 ) produced from the electrolyzer stack(s) on the input end, and an electrolyzer stack(s) where renewable electricity is supplied to split the feed water. The output end has another gas separator to enhance hydrogen purification, a deoxo unit to further purify the hydrogen produced, and a unit to dry the hydrogen for compression to storage ( IRENA, 2020 ; El-Shafie, 2023 ).

2.7 Global demand for green hydrogen production electrolyzers and the companies involved

The increasing demand for hydrogen, specifically green hydrogen, has led to an increasing demand for electrolyzers. For the United States and Europe, ALK is dominant and will remain so into the near future, then PEM followed by SOE and then AEM. For manufacturers outside the United States and Europe, a twelve-fold growth (i.e. 1000E to 12,000E) is expected by 2030, driven by ALK, PEM, and SOE. The total global demand for electrolyzers is expected to see a six-fold growth by 2025 and a ten-fold growth by 2035, also mainly driven by ALK, PEM, and SOE ( Ernst and Young LLP, 2023 ).

2.8 Various electrolyzers: advantages, disadvantages, and challenges

These electrolyzers have different electrodes and electrolyte materials, construction, installation, feedwater requirements, and associated operational costs. The electrolyte carries the created chemical charges from one electrode to the other.

From a general and simplistic standpoint, an electrolyzer system is composed of water and electrical supply systems, electrodes comprised of an anode (positive) and cathode (negative), membrane(s), and a separation system for the gases produced.

A general electrolyzer operational flow process is depicted in Figure 3 . With the electrical system turned on, (1) the water supplied to the electrolyzer at the anode side undergoes oxidation where both O 2 and positively charged hydrogen ions (H + ) are produced alongside the release of electrons, and (2) the membrane(s) selectively transport H + to the cathode to be reduced to hydrogen gas ( US Department of Energy, 2024 ).

Figure 3 . Electrolyzers operational flow process ( US Department of Energy, 2024 ).

Figure 2 shows the various reactions at the anodes and cathodes for the individual PEM, ALK, AEM and SOE electrolyzers.

Both ALK and AEM electrolyzers are considered alkaline systems while PEM as acidic and SOE is a solid oxide or ceramic ( IRENA, 2020 ; Patonia and Poudineh, 2022 ).

The alkaline systems use liquid electrolytes such as potassium hydroxide (KOH) and sodium hydroxide (NaOH), while PEM uses acids such as perflurosulfonated acids (PFSA) ( El-Shafie, 2023 ). Both AEM and PEM use solid polymers, and SOE uses solid oxide or ceramic. The alkaline systems(i.e., ALK and AEM) are involved in the transport of anions—hydroxide or hydroxyl ions (OH − )—through the electrolyte from the cathode to the anode, while the acidic system (i.e., PEM) selectively transports cations—protons or H + —through the solid polymer electrolyte from the anode to the cathode. SOE selectively transports anions—charged oxygen ions (O 2- )—through the solid oxide or ceramic electrolyte from the cathode to the anode. For all four electrolyzers, hydrogen is generated on the cathode side. ALK is the most mature, durable, and cheapest ( Simoes et al., 2021 ; Nasser and Hassan, 2023 ; Yang, et al., 2023 ).

However, the drawbacks of ALK include only pressurized versions being compatible with renewable electricity and having lower purity hydrogen than PEM ( Nasser and Hassan, 2023 ) While AEM could compete with ALK from a cost perspective and better compatibility with renewable electricity, it has lower degradation rates ( Miller, 2022 ; Yang, et al., 2023 ).

Commercialized PEM, while compatible with renewable electricity, has high material costs ( Wang et al., 2023 ). SOE, the most efficient and compatible with renewable electricity, is associated with very high operating temperature and lower durability ( Nasser and Hassan, 2023 ) and is still in development.

PEM requires the use of pure water while ALK uses a variety of water sources, including seawater and wastewater. PEM’s pure water requirement could make it expensive and, in some cases, limit its use. Similarly, the pressurized ALK version for renewable energy compatibility makes it less efficient than PEM and could limit its use. ALK electrode material includes nickel and iron, making it more durable and less sensitive to feedwater impurities ( Hydrogen Newsletter, 2022 ).

Generally, AEM requiring drinking quality water ( Du et al., 2022 ) produces better results with similar PEM iridium anode ( Miller, 2022 ) while SOE is exploring the use of a wide range of water qualities, especially impure water sources ( Maddaloni et al., 2023 ).

ALK, PEM, and AEM, which operate at lower temperatures compared than SOE, have improved performance, longer device lives, and produce higher quality hydrogen with quality feedwater water. However, quality feedwater adds to the costs, process complexities, and design limitations ( Becker et al., 2023 ).

2.9 Environmental and social impacts of green hydrogen production

Green hydrogen is considered a potential fuel to reduce the overall global carbon footprint; however, the green hydrogen industry is associated with some environmental and social impacts and risks ( Vernick, 2024 ). The hydrogen industry production, storage, and utilization is associated with environmental and social risks and impacts ( Vernick, 2024 ).

However, the resultant impact is expected to be lower. Green hydrogen production involves the use of energy, water, and land. The land acquisition and clearing for green hydrogen production plants is associated with both environmental and social risk and impacts. Environmental risk and impacts include deforestation and habitat loss ( Tolba and El-Kholy, 1992 ), soil erosion and degradation ( Lal, 2001 ), water pollution and decreased water quality ( Camara et al., 2019 ), loss of biodiversity and ecosystem disruption ( Mullu, 2016 ), and increased greenhouse emissions ( Romijn, 2011 ).

Social risks and impacts include displacement of indigenous communities and loss of traditional lands ( Moreda, 2017 ), conflict and human violation ( Grant and Das, 2015 ), economic impacts on local communities, particularly loss of livelihood ( Hufe and Heuermann, 2017 ), cultural heritage destruction ( Pankaj et al., 2023 ), and health impacts, including increased respiratory problems ( Myers et al., 2013 ).

Moreover, energy is required to split water to produce green hydrogen, and the energy source needs to be green ( Osman et al., 2022 ). The equipment used in green hydrogen production itself could be associated with a significant carbon footprint ( Hurwitz et al., 2023 ). Additionally, the production process requires a significant quantity of water which could lead to water scarcity ( Vernick, 2024 ). The different electrolyzers require different water quality, which in turn demands different treatment methods with different environmental or social impacts. Hydrogen stored in high pressure containers and pipelines can leak and cause explosions ( Vernick, 2024 ). Ensuring both environmental and safety integration will lower overall environmental and safety impacts and risks. Moreover, the proper integration of land, energy, and water alongside the selection of a production process and storage systems reduces overall impacts and risks.

3 Green hydrogen production cost and economic viability

There is a general drive to increase green hydrogen adoption, partly due to lower environmental impacts and costs, while driving favorable policies over its non-green hydrogen counterparts ( Ishaq et al., 2022 ).

The electrolyzers and renewable electricity costs ( Badgett et al., 2022 ) are among the factors which may be hindering green hydrogen growth and adoption. Hence, as costs reduce, green hydrogen will be able to compete with the dominant fossil fuel hydrogen.

The total cost of ownership (TCO) of green hydrogen mostly includes the costs of electrolyzers, ancillary equipment, installation, and operational costs. Ancillary equipment to electrolyzers includes cooling equipment, compression, electricity sources, water treatment, purification, dryers, and power electronics ( IRENA, 2020 ).

There are costs associated with installing a complete system, while operating costs involve consumable and unit costs involved in the production process, including the electricity consumption rate and cost, water quality and consumption rate, and stack degradation and replacement rates. Other factors affecting overall production costs include operational efficiency, economy of scale, increasing automation, and design complexities. A large capacity system operating close to maximum capacity for longer hours is preferred for reducing costs and improving return on investment from an operational efficiency standpoint. Improving electrolyzers and their electrical efficiency are expected to reduce electrical consumption and costs. Generally, increasing module and manufacturing plant sizes can all significantly reduce costs in addition to automation ( Corbeau and Merz, 2023 ). Each of the above factors could impact the overall cost differently, given that all the electrolyzers have some distinct differences.

From 2019 to 2022, electrical efficiencies generally improved for each type of electrolyzer. Electrolyzers improved in the following order: SOE > PEM > ALK > AEM. In 2050, system electrical efficiencies expressed in kilowatt-hours per kilogram of green hydrogen produced are expected to be lowest for SOE (<40) and similarly for ALK, PEM and AEM (<45) ( IRENA, 2020 ; Patonia and Poudineh, 2022 ).

Generally, ALK requiring the use of low-cost steel or nickel alloy-plated material has the lowest cost ( Miller et al., 2020 ). However, costs are associated with controlling the hydroxide electrolyte solution concentration, temperature, corrosion ( Lohmann-Richters et al., 2021 ), and hydrogen produced needing further purification to meet some requirements.

PEM requires the use of expensive platinum-group metals, mostly iridium, to withstand the corrosive acid operating environment. The high voltage applied for high hydrogen production rates results in higher initial costs ( Corbeau and Merz, 2023 ). This restricts opportunities for cost reduction.

SOE, still in development, has the flexibility of being constructed from a variety of materials including steel, nickel, and zirconia ( Hauch et al., 2020 ). This offers some advantages in reducing costs. However, in the current developmental stages, manufacturing process complexities mean that it is more expensive than ALK and PEM. The expectation is that SOE still will implement cost reduction opportunities ( Minary-Jolandan, 2022 ).

AEM is a better alternative to ALK for easy renewable energy compatibility, costs the same as ALK, and performs like PEM. Moreover, AEM is being explored as an alternative to PEM but with lower overall costs. AEM performance with PEM iridium anodes has returned the best AEM results ( Miller, 2022 ; Yang, et al., 2023 ).

In conclusion, selection of any of these electrolyzers depends on the specific application, availability of resources and infrastructure, and expected project viability ( Hydrogen Newsletter, 2022 ).

While green hydrogen production using an electrolyzer is driven by many factors, available electricity and costs are among the most critical. Industry guides suggest that economic viability could favor higher efficiency and higher capex electrolyzers such as SOE, which may be applicable to areas with a scarcity of renewable electricity, while lower efficiency and lower capex electrolyzers such as ALK may be suitable for areas with sufficient renewable electricity. Driving green hydrogen production costs down depends on the upfront investment, electricity availability and cost, efficiency, stack degradation, and replacement rates. Other considerations include the effects of module size, manufacturing economy of scale, hydrogen produced for specific applications, feed water quality, and the integration of an electrolyzer of interest with intermittent renewable energy operation ( Corbeau and Merz, 2023 ).

Remarkably, some of these parameters may be coupled such that an improvement in any of the parameters could adversely impact the others. This requires making a conscious decision on selection. The ALK, AEM, PEM, and SOE electrolyzers operate differently, hence entailing different cost implications, effectiveness, and production system designs ( Kumar and Lim, 2022 ).

Furthermore, the fast-paced industrial innovation occurs behind closed doors, so up-to-date information is lacking in the public domain. This lack of access to new information means that outdated information is available to academia and the public ( Corbeau and Merz, 2023 ).

The role of membrane science and technology in green hydrogen production using electrolytic splitting of water cannot be overstated, from transporting ionic species from one electrode to the other in electrolyzers, treating the different water sources to meet electrolyzers’ feed water quality to ensure improved productivity and system lives, and producing hydrogen purification.

Increasing use of green hydrogen over established fuels will not only lead to decarbonization of the energy system but a revolution in the water industry, leading to improved water treatment technologies and water use strategies in the face of dwindling clean water resources. The water industry is and will play a vital role in electrolytic green hydrogen production given that water is one of the key raw materials. Hence, countries seeking to adopt net zero strategies should consider a more integrated approach to renewable electricity, water, and green hydrogen ( Newborough and Cooley, 2021 ).

Future green hydrogen development includes increasing adoption of renewable hydrogen by lowering costs and instituting favorable policies to promote it over non-green hydrogen ( Kumar and Lim, 2022 ).

SOE, still in development, is expected to emerge as the best electrolytic solution with lower costs and high efficiency ( Miller, 2022 ). Other green hydrogen developments include exploring (1) photolytic means, where sunlight is directly used to split water into hydrogen and oxygen, (2) thermochemically converting biomass into liquid or gas and separating hydrogen, and (3) biological production of hydrogen by microbes ( EIA, 2023 ).

Growing infrastructure demands include hydrogen refueling stations, storage, and transportation which are crucial for the industry’s success and growth. Economic opportunities associated with green hydrogen include the growth of new industries, job creation, and economic expansion ( Hassan et al., 2024 ; Jones, 2024 ). The future of hydrogen as part of the global energy mix will depend on continued investment, improvement, lowering of costs, increasing adoption, and policy direction.

4 The Algerian case study: existing capabilities and preparation for its green hydrogen economy

Algeria is a motivated player in the hydrogen industry given that is has many assets for becoming a regional and international player. Currently, Algeria is involved in the blue hydrogen industry. However, it wants to join the fight against climate change and plans to become a leading green hydrogen production country. The road map towards this includes (1) regulatory and institutional adaptation, (2) human capital development, (3) industrial integration and growth, (4) financing mechanisms and incentives, (5) international cooperation and technology transfer, and (6) deployment of the hydrogen sector. The road map involves the following actionable phases with objectives and timelines. (1) Start-up phase (2023–2030) focusing on start-up activities and training, laying the groundwork for building projects and expertise, and initiating pilot projects to explore hydrogen production and utilization. (2) Market expansion and creation phase (2030–2040) that emphasizes the shift to market expansion and creation, scale-up, and the establishment of markets for the applications. (3) Industrialization and export phase (2040–2050) that prioritizes the export of hydrogen derivatives and contributing to global energy markets. ( National Hydrogen Development Strategy in Algeria, 2023 ).

Algeria’s energy transition quest will promote energy transition, innovation, and efficiency ( ITA, 2023 ). Moreover, Algeria seeks to establish a supportive hydrogen sector framework by 2050 dubbed the “The Algerian Strategy on Green Hydrogen 2050”. Algeria’s ambitious target includes reducing its greenhouse gases (GHG) and petroleum products consumption. Algeria projects to export 30–40 TWh of gaseous, liquefied, and derived green hydrogen by 2040 ( Stambouli et al., 2024 ).

Algeria is taking the necessary steps in developing strategies and policies. It is forming internal and external alliances and dealing with some of the existing challenges to make it align with the needs of a green hydrogen economy. Algeria’s plans to appeal to the European market across the Mediterranean. It has acquired land and solved its water scarcity issues by building desalination plants as well as boosting green energy resources with solar and wind energy systems. Moreover, Algeria is considering ways to reduce the impacts of its blue hydrogen industry amid its pursuit of green hydrogen production. Furthermore, it is collaborating with local energy clusters to build and sustain the overall energy ecosystem ( National Hydrogen Development Strategy in Algeria, 2023 ).

Algeria’s Sonatrach state-owned oil company signed a memorandum of understanding (MoU) with Hecate Energy Global Renewables (HGR Energy) to explore both renewable energy and green hydrogen projects in Algeria ( Djunisic, 2024 ).

One of Algeria’s local energy clusters is the Green Energy Cluster Algeria (GEC) which is a collaborative organization including industries, universities, research centers and institutes, and representatives from key government ministries. Its main goal is to foster synergies among its members, promote competitiveness, contribute to sector-specific training to add to its human resource capacity to develop and transfer the knowledge base to support Algeria’s hydrogen economy ( Green Energy Cluster Algeria, 2024 ).

5 Conclusion and directions

Algeria is on track with the start-up phase of its roadmap, building more capability as it positions itself, including lowering costs and moving in the right direction to grow its green hydrogen base. Currently, it is addressing challenges to its water supply by installing desalination plants, designating land, building more solar energy plants, collaborating with local energy clusters, signing MoUs with major global companies for hydrogen projects, and pilot projects to build expertise and training ( National Hydrogen Development Strategy in Algeria, 2023 ).

The above review presents some information on renewable hydrogen production strategies and Algeria’s plans so that other developing nations can decide whether to replace existing non-renewable hydrogen production with renewable hydrogen.

Author contributions

AA-M: Writing–original draft, Writing–review and editing, Formal Analysis, Investigation, Methodology. ND: Conceptualization, Investigation, Methodology, Project administration, Resources, Supervision, Writing–review and editing. WB: Conceptualization, Investigation, Methodology, Project administration, Resources, Supervision, Writing–review and editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: hydrogen, electrolyzers, renewables, energy, sustainability, decarbonization, membranes, clean-fuel

Citation: Anim-Mensah A, Drouiche N and Boulaiche W (2024) Assessment of the economic viability, environmental, and social impacts of green hydrogen production: an Algerian case study. Front. Membr. Sci. Technol. 3:1382651. doi: 10.3389/frmst.2024.1382651

Received: 06 February 2024; Accepted: 17 June 2024; Published: 07 August 2024.

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*Correspondence: Alexander Anim-Mensah, [email protected]

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