\r\n\tEqually important are the consequences deriving from the extraordinary nature of the present times. The COVID-19 pandemic and the restrictive measures to contain the infection (lockdown and "physical distancing" in primis) have revolutionized the lives, and a distortion/modification of habits, rhythms, arrangements will continue to be necessary. \r\n\tGovernments have implemented a series of actions to mitigate the spread of infections and alleviate the consequent pressure on the hospital system. On the other hand, the Covid-19 pandemic has caused a series of other cascading effects that will probably be much more difficult to mitigate and which expose to complex consequences. The past two years have brought many challenges, particularly for healthcare professionals, students, family members of COVID-19 patients, people with mental disorders, the frail, the elderly, and more generally those in disadvantaged socio-economic conditions, and workers whose livelihoods have been threatened. Indeed, the substantial economic impact of the pandemic may hinder progress towards economic growth as well as progress towards social inclusion and mental well-being.
\r\n
\r\n\t \r\n\tAlthough in all countries the knowledge on the impact of the pandemic on mental health is still limited and mostly derived from experiences only partially comparable to the current epidemic, such as those referring to the SARS or Ebola epidemics, it is likely that the demand for intervention it will increase significantly in the coming months and years. The extraordinary growth of scientific research in the field of neuroscience now offers the possibility of a new perspective on the relationship between mind and brain and generates new scenarios in understanding the long wave of the pandemic and in the prospects for treatment. Moreover, the pandemic also has led to opportunities to implement remote monitoring and management interventions.
\r\n
\r\n\t \r\n\tOverall this volume will address the complex relationship existing between COVID-19, mental health, acquired knowledge, and possible interventions taking a highly multidisciplinary approach; from physiological and psychobiological mechanisms, and neuromodulation through medical treatment, psychosocial interventions, and self-management.
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1. Introduction
In the past few decades, works on technology acceptance research have always focused on cognitive instead of emotional factors to predict acceptance of technologies. The role of affect influence, state of mind, and feelings are not comprehended as comprehension and wordings utilized as a part of this range has dependably been utilized conversely by specialists. Numerous conflicting reports and clashing discoveries from past investigations that consider influence have brought about modest number of research endeavors here. Nonetheless, inquiry about them has demonstrated that reflexes, social judgment, discernment, and conduct [1, 2] are impacted by influence, mind-set, and feeling that constitute the major parts of individuals.
In the information systems’ (IS) area, client assessment or client acknowledgment of information technology (IT) is considered as a volitional conduct [3] and has been examined basically with an intellectual introduction [4–6]. Research in this area has dependably been vigorously affected by the insight state of mind conduct models, from Theory of Reasoned Action and the Theory of Planned Behavior [7]. Even though some works on affect, affectivity, playfulness, enjoyment, and emotion have been studied, the affective aspects are less central in most of these studies, with some exceptions, such as studies on aesthetics [8], computer playfulness [9], flow [10], and users’ experiences in technology acceptance [11]. Therefore, if the roles of affect indeed play a role in technology acceptance, what aspect of study should be examined and in what relationships of role of affect toward other constructs in the technology acceptance model.
2. Research gaps
Due to conflicting findings and inconsistent terminologies used in the research that considers affect, moods, emotions, and feelings, and the role of affect has been very much ignored by researchers in general. However, recent research has found that the inclusion of affective constructs is able to explain attitude and behavior more extensively in their models. Nevertheless, research that examines role of affect from the perception of the knowledge workers on the KS tools’ characteristics in terms of features and functions to induce positive or negative affective (PA and NA) states is lacking. This study extends technology acceptance model (TAM) with PA and NA on perceived ease of use (PEOU), perceived usefulness (PU), and BI to predict the behavioral intention to use KS tools by knowledge workers in MSC-status organizations.
3. Literature review
3.1. Related works on technology acceptance
Davis [4] develops technology acceptance model (Figure 1) to determine factors that influence the acceptance of technology. Two most important individual beliefs about using information technology are perceived usefulness (PU) and perceived ease of use (PEOU) that are able to explain individual’s intention to use the technology. Davis [4] concluded that perceived usefulness was the strongest predictor to one’s intention to use an information technology.
Figure 1.
Technology acceptance model [4].
In TAM, the goal is to utilize the primary determinant of use to accept or not to accept a new tool. The intention to utilize is controlled by the individual’s personality toward utilizing a specific tool. Perceived usefulness (PU) and perceived ease of use (PEOU) impact a person’s state of mind toward utilizing a specific tool. Perceived usefulness (PU) is characterized as how much individuals trust that utilizing a specific tool would improve his or her task execution [4]. Perceived usefulness is the key determinant that emphatically influences users’ convictions and expectation to utilize the innovation. Perceived ease of use (PEOU) is characterized as how much the user utilizes a specific tool, and it is free of effort [4]. Past research has demonstrated that perceived ease of use (PEOU) impacts aim in two ways: direct and indirect impact through usefulness of the tool [4]. As indicated by Davis [4], PEOU has no critical impact on behavioral expectation to utilize in light of the fact that PU intervened its impact. PEOU does not affect straightforwardly on user’s behavioral goal since it affects behavioral expectation through PU.
Venkatesh and Davis [12] extended TAM by calling it TAM2 with social influence and cognitive processes on the Perceived Usefulness and intention usage (Figure 2). In TAM2, subjective norm [7] is hypothesized to have a direct effect on the intention of an individual to choose to perform a certain behavior even if he/she is not favorable toward that behavior, but due to other referents think he/she should; hence, the individual complies with these referents. In mandatory system usage settings, subjective norms were found to have direct effect on intention over PU and PEOU. The model posits voluntariness as a moderating variable to distinguish between mandatory versus voluntary. Nevertheless, subjective norms can influence intention indirectly through perceived usefulness that is called internalization. Therefore, according to TAM2, the direct compliance-based effect of subjective norm on intention over PU and PEOU will occur in mandatory but not voluntary system usage settings [12]. Job relevancy, output quality, and result demonstrability are determinants for cognitive instruments on PU.
Figure 2.
Extended technology acceptance model (TAM 2) [12].
TAM2 proposes that individuals rely on the fit between their job and the performance outcomes of using the system. This will determine their perceived usefulness of the system based on the job relevancy. It was defined as an individual’s perception regarding the degree to which the target system is applicable to his or her job. Output quality is the quality of the end result produced by the system to the individual. An individual will take into account on how well the system performs those tasks. If the system does not produce any desirable output to enhance individual performance, it is deemed to believe that the user acceptance rate will drop. Therefore, TAM2 theorizes that result demonstrability defined by Moore and Benbasat [13] as “tangibility of the results of using the innovation” will directly influence perceived usefulness. TAM3 [12] is an extension of TAM where anchors and adjustments are hypothesized to influence PEOU in the model. Anchors are the degree to have general beliefs about computers and its usage, whereas adjustments are the degree of belief that is shaped based on direct experience with the target technology. The results indicate that there are strong correlations for these variables to PEOU. The antecedents for perceived ease of use include computer self-efficacy, perceptions of external control, computer anxiety, computer playfulness, perceived enjoyment, and objective usability. Unified theory of acceptance and use of technology (UTAUT) was introduced by Venkatesh in 2003. UTAUT was developed through the consolidation of various construct of eight models applied to IS usage behavior. These eight models are TAM, TRA, TPB, motivational model, integration of TAM and TPB, PC utilization model, innovation diffusion theory, and social cognitive theory. Behavioral intention and usage behavior were the two dependent variables. On the other hand, eight independent variables include performance expectancy, effort expectancy, social influence, facilitating condition, gender, age, experience, and voluntariness of use. Three main constructs are the determinants of the intention to use and behavior usage (Figure 3): performance expectancy, effort expectancy, and social influence. Performance expectancy was the strongest predictor among the eight factors. UTAUT theorizes that social influence holds significance only in mandatory technology use of situations.
Figure 3.
The unified theory of Acceptance and Use of Technology [6].
3.2. Affect, mood, emotion, sentiment, and feeling
Every single sociology shares an interest to attempt, to clarify, and to foresee individual’s behaviors, where these behaviors are impacted by subjective procedures. Most theories derived from behavioral often ignore role of affect factors. Role of affect refers to one’s feeling or how an individual feels when performing tasks [14, 15]. Affect also refers to one’s emotions, moods, and feelings, and they are used interchangeably [2, 16–18].
Dispositional affect is defined as a person’s affective predisposition toward perceiving the world around him or herself either positively or negatively [17, 19]. It has strong influences on individual behavior [20, 21]. Many related information systems research uses different terms to represent the role of affect such as “anxiety” when using computers, “computer playfulness,” “affect” toward computers, the influence of emotions toward users’ attitudes, and use of specific IT [9, 22–24]. Mood is an intra-individual change, generally nonintentional which is not associated with explicit intentions to act [25, 26]. Lazarus [17] defined mood as an affective state that comes and goes depending on particular conditions. Mood is low intensity, diffuse feeling states that usually do not have a clear antecedent [27]. Mood can be characterized as relatively unstable short term intra-individual changes [28]. Mood can be evoked by both dispositional affect and emotions. Unlike emotions, people may not realize that they are experiencing a “mood” and may also not realize that mood is influencing their behavior [27]. Emotions differ from both dispositional affect and mood. Emotions have a clear cause or object, usually are shorter in duration and more focused and intense [29]. Emotions are more likely to change beliefs than mood [30, 31]. Emotions are more likely to disrupt activity [17]. It is also said as an intense feeling; a complex and usually strong subjective response that typically accompanied by physiological and behavioral changes in body [32]. Emotions can occur during the impact period (i.e., when the new information technology (IT) had been deployed and was being used). In this period, emotions are generated based on individuals’ perceptions on the features of the new technology and on their usage of the new technology resources. Individuals will assess whether the technology constitutes a threat or an opportunity and how it can adapt into their daily tasks by changing their working behaviors [33]. Some specific emotion terms such as pleasure, arousal, and enjoyment are used to relate users’ attitude toward actual use of a technology [6]. Feelings are sensations perceived by the sense of touch; an affective state of consciousness that resulted from emotions, sentiments, or desires. On the other hand, cognition arises on the human beings’ perception toward using technologies [16, 34]. Behavioral aspect would be from the individual’s reactions toward using the information technologies [11]. Emotional Intelligence is a variable with a multifactor individual difference [35] that meets the traditional standards of intelligence. Being emotionally intelligent involves being actively able to identify, understand, process, and influence one’s own emotions and those of other to guide feeling, thinking, and action. Sentiments are valence appraisals of an object that involves evaluation of whether something is liked or disliked. These evaluations were evoked by phenomena. It can come from previous experience with the object or situation or through social learning [29]. Satisfaction has been the most widely studied sentiment. Most of the work conducted has focused on satisfaction at the individual level either because of workplace events or as a predictor of workplace outcomes [19].
Zhang and Li [36] examined the affects of emotional assessments of IT on IT utilized choices. Refer to Zhang and Li [36], two protest based full of feeling assessment builds: recognition on IT’s ability to incite positive affect and impression of the IT’s capacity to prompt negative affect able to influence. Their investigation demonstrated that positive affect and negative affect are particular ideas that affect perceived usefulness (PU), perceived ease of use (PEOU), and attitude toward utilizing IT tools. These impacts remain constant amid individuals in using and utilizing IT tools (ATT). Positive affect impacts PU, PEOU, and ATT, yet it turns out to be less critical to PU after some time, and positive affect just impacts PEOU; however, it turns out to be more vital to PEOU over the long run. Therefore, Zhang and Li [37] presumed that affect influence a key part in individuals’ connections in using IT tools.
Loiacono and Djamasbi [15] also found that positive mood played a significant role in the adoption of a new technology. Their study looked at the effects of positive mood, and to understand how individual’s characteristics affect an individual’s cognition and behavior on the acceptance of a Decision Support System. The objective of their research is to investigate how affect can be a vital component for technology acceptance to make rational decision making. Based on Isen et al. [38], qualities of task characteristics impact one’s certain state of mind particularly on tolerating another innovation, for example, Decision Support Systems (DSS) which requires subjective capacities to deal with troublesome/complex task. Association can control one’s state of mind by encouraging positive temperament inside the association, and it can enhance association’s results [16]. From their findings, Loiacono and Djamasbi [15] reported that positive mood could bring improvements in new technology acceptance.
4. The proposed affective technology acceptance (ATA) model
Based on the literature findings, affective technology acceptance model involves PA and NA that were used to induce positive and negative affect states on the individuals who uses the technology were proposed. Zhang and Li [36] adapted these constructs and defined them as the perception of IT’s capability to induce these feelings. It was said that the technology functions and features are capable of inducing these feelings in the individuals. Therefore, this research proposed an extension on the technology acceptance model by including this two affect states on the use of KS tools by the knowledge workers in the MSC-status organizations in Malaysia. Indication of the respondent’s feelings was recorded at eight different points in times on the instrument to gather the different affective states of the knowledge workers on using the knowledge sharing tools. The measurement scale was adapted from Perlusz [39]. Two groups of undergraduate students were used to validate the scale, and it was found that the technology affect scale were consistent and valid in Perlusz studies.
In this research, PA and NA are defined as the perception on KS tools’ characteristics in terms of features and functions to induce positive or negative affective states [36, 37, 40]. PA and NA were adapted from Zhang and Li [36], where they defined PA and NA as the perception of an IT’s capability to induce positive or negative affect. It is an individual’s perception or evaluation that an IT has the features and functions to induce positive or negative affect in him or her. In this study, the external stimulus is KS tools used by the knowledge workers in the MSC-status organizations in Malaysia. The respondents were asked to indicate the extent of how he/she feels on the usefulness, ease of use, and intention to use the KS tools in eight different points in times in the instrument. The different affective states of the knowledge workers were self-reported on the survey form. The measurement scale for PA and NA is adopted from Technology Affect Scale [39] where Perlusz [39] adapted the 10-item scale from Watson and Tellegen [41]. The scale was validated using two groups of undergraduate students who were exposed to several types of affects before interacting with mobile technologies. The Technology Affect Scale is found to be consistent and valid in his experiments.
4.1. PU, PEOU, ATT, and BI in technology acceptance model
The relationships among PU, PEOU, ATT, and BI are consistent with the literature. TAM originally included attitude as a mediator between the personal beliefs constructs, and behavioral intention [4]. Individual’s actual usage of the technology is dictated by behavioral goal, which is determined by perceived usefulness and perceived ease of use. The value of perceived usefulness is the degree to which an individual trusts that utilizing the innovation will upgrade his or her employment performance, and perceived ease of use is the degree to which individual trusts that utilizing the technology will be free of effort [4].
H7: There is a significant relationship between PEOU and PU.
H8: There is a significant relationship between PU and ATT.
H9: There is a significant relationship between PEOU and ATT.
H10: There is a significant relationship between ATT and BI.
4.2. PA and NA on the perceived usefulness, perceived ease of use, and behavioral intention to accept KS tools
This research considers PA and NA based on evidences obtained by Zhang and Li [36]. They found that PA strongly influences PEOU, PU, and ATT, while NA only influences PEOU at the initial stage of usage. In their work, BI is mediated by ATT, but the direct influence of PA and NA on BI was not being investigated (Figure 4). Isen [42] presented his findings by stating that positive affect state such as joy and elation will lead a person to be creative, playful, and explore innovative ideas and think broadly. Another piece of work conducted by Isen et al. [38] using four experiments on positive and negative affects induced by a series of activities such as watching comedy films for few minutes, receiving a small bag of candy, or showing film of unpleasant feelings. They found that positive affect induced by a comedy film or a small gift of candy facilitates creativity on tasks given. At the same time, activities that designed to induce negative affect using primitive arousal devoid of any affective tone (exercise) had no effect on these measures. In their findings, negative affect neither facilitates nor impairs creativity. However, they pointed out that one of their experiments showed that negative affect was only induced by showing subjects film that induces unpleasant feelings. The proposed work in this research hypothesized the extent of how a person feels in his perception on the KS tools’ features and functions (or characteristics) in their day-to-day tasks that induce positive or negative affect. This research fills the gap by examining the relationship of PA and NA and the behavioral intention to accept KS tools in the organizations. The affect induced by the perception toward how knowledge workers evaluate KS tools’ affective quality is believed to be able to influence an individual’s behavior and intention to accept a tool. Affect construct included in the proposed Affective Technology Acceptance Model, the hypothesis is as follow:
Figure 4.
ATA model.
H1: There is a significant relationship between PA and BI.
H2: There is a significant relationship between PA and PU.
H3: There is a significant relationship between PA and PEOU.
H4: There is a significant relationship between NA and PU.
H5: There is a significant relationship between NA and PEOU.
H6: There is a significant relationship between NA and BI.
5. Methods
5.1. Study contexts and samples
The population where sample will be drawn in this research consists of knowledge workers who work in MSC-status organizations in Malaysia. The samples are individuals who deal with information, require developing, or using knowledge to solve problems in their jobs. About 2500 MSC-status organizations from the MSC directory (http://www.mscmalaysia.my/company_directory) have been invited to participate in this research. Two thousands and five invitations were sent out to these organizations and 300 forms were received. Two hundred ninety-five forms were usable. A response rate of 11.87% was gathered from the self-administered questionnaire. Figure 5 illustrates KS tools that are highly utilized by the respondents, and Figure 6 presents those that are not used at all in the activities that are carried out by the respondents.
Figure 5.
KS tools with high usage frequency.
Figure 6.
KS tools not used at all among knowledge workers in MSC organizations.
Most of these organizations are in their initial stages of tool implementation or tools have been implemented but with very minimum tools usage among knowledge workers in these organizations. This rationalized the importance to carry out a research on their intention to use KS tools in their day-to-day jobs.
5.2. Instrument and measures
All the constructs in the research model were measured with items adapted from prior research. All the items in the questionnaire used a five-point Likert-type scale ranging from “Strongly Agree” to “Strongly Disagree” (Table 1).
Sections
No. of items
General information
9
KS tools behavioral intention
30
Role of affect
24
Table 1.
Instrument.
Respondents were asked to indicate to what extend one feels when one evaluates the KS tools when interacting and using the tools. The respondents were asked to record their feelings that were induced by the tools when they interacted with them. The positive and negative affect (PA and NA) are hypothesized to have an impact on PEOU, PU, and BI in the research model. Items for positive and negative affect (PANAS) were adapted from Perlusz [39], Tellegen [28], Watson [43], and Watson et al. [44]. Pre-test and pilot test were carried out before actual survey took place. A total of 30 respondents participated in these tests.
5.3. Data analysis
The proposed model and hypothesis testing was carried out using SmartPLS 3.0 software. The measurement and structural model analysis follows methodology described in Hair et al. [45]. In this research, a sample size of 295 is sufficient using G*Power software to examine the predictive accuracy of constructs and path coefficients of relations in the proposed model. The analysis on the years of experience of the knowledge workers in these MSC-status organizations highlighted that most of them have been in their industry more than 10 years. The preliminary analysis highlights that long service in the industry gives knowledge workers more domain knowledge where majority of them possess an undergraduate degree.
6. Results
6.1. Measurement model analysis
This section discusses the measurement model, which consists of several analyses. Table 2 illustrated the composite reliability on the results. Based on the analysis, it was shown that PU, PEOU, ATT, and BI all achieved the value of composite reliability higher than 0.90, which satisfy the threshold of composite reliability.
Constructs
Composite reliability (CR)
Cronbach’s alpha
AVE (Convergent validity)
Discriminant validity
Cross loading
Fornell-Larcker criterion
Perceived usefulness (PU_I)
0.945
0.932
0.710
Y
Y
Perceived ease of use (PEOU_H)
0.928
0.913
0.591
Y
Y
Attribute toward use of KS tools (ATT_G)
0.925
0.906
0.639
Y
Y
Behavioral intention to use KS tools (BI_J)
0.937
0.922
0.682
Y
Y
Table 2.
Composite reliability for reflective constructs.
Convergent validity looks at the extent to which a measure correlates positively with alternative measures of the same construct. In Table 2, it was found that all the constructs’ AVE are significant with at least 0.50 and above.
Discriminant validity is the extent to which a construct is truly distinct from other constructs by empirical standards. This means a construct has captured the phenomena not represented by other constructs in a model. Cross loading and Fornell-Larcker criterion discriminant validities are used in this analysis. The analysis indicates that AVE of all constructs has high correlation. Formative measurement analysis conducts a separate set of validity and consistency test. The formative constructs in the proposed model consist of positive and negative affect for PU (NA_PU and PA_PU), positive and negative affect for PEOU (NA_PEOU and PA_PEOU), and positive and negative affect for BI (NA_BI and PA_BI). Convergence validity is the extent to which a measure correlates positively with other measures or indicators of the same construct. A redundancy analysis is used to perform the convergence validity test by evaluating formative measurement models; one must test whether the formatively measured construct is highly correlated with a reflective measure of the same construct. A global indicator is designed for this test. To conduct the convergent validity, a separate model is created with the global indicator for each formative construct. From the outcomes of the redundancy analysis, negative affect on perceive usefulness, negative affect on perceive ease of use, negative affect on behavioral intention, positive affect on perceive ease of use and positive affect on behavioral intention are 0.8 or above. Their formative indicators are significant enough to capture content that these constructs want to capture.
For collinearity assessment, when collinearity has high correlations between two formative indicators in a formative construct, it is a problematic indicator and it is unwanted for a formative construct. VIF is used to assess collinearity. Once the collinearity of formative indicators has been treated, outer weights in formative measurement models can then be interpreted. All formative indicators satisfy the requirement of VIF values uniformly with values below the threshold value of 5. There are five items used to test PA → PU, PA→PEOU, and PA → BI. Similarly, five items were designed for NA → PU, NA → PEOU, and NA → BI. The items that are labeled as AA1A..E, BB1A..E, and CC1A..E are positive affect items whereas AA1F..I, BB1F..I and CC1F..I are negative affect items. There is no collinearity problem found in the model except for the items AA1G and AA1H from negative affect on perceived usefulness, BB1G and BB1H from negative affect on perceived ease of use and CC1F and CC1J from negative affect on behavioral intention. Based on items AA1G, AA1H, BB1G, BB1H, BB1J, CC1F, and CC1J being important questions to measure negative affect on perceived usefulness, perceived ease of use, and behavioral intention in the instrument, therefore, these items will be retained. A formative indicator of its relevance is analyzed based on the values of its outer weight as it is compared with others to determine its relative contribution to the construct.
To determine whether an indicator is significant or not, each indicator’s t-value must fulfill the critical value of l.65 for two-tailed tests at a significant level = 10%. The indicator significance level analysis for positive affect and negative affect on perceived usefulness is significant. Positive and negative affect on perceived ease of use has ten formative items that measure the construct. Five items were chosen to measure positive and negative affect, respectively. One negative affect item is not significant. Its t-value is less than 1.65, and outer weight and outer loading do not fulfill the criteria. However, BB1J was not considered to be deleted from this construct because this item has been validated and tested in the previous instrument. Positive and negative affect on behavioral intention has ten formative items that measure the construct. Five items were chosen to measure positive and negative affect, respectively. Negative affect has one item that is not significant. The outer loading value of 0.482 for CC1J is rounded up to be 0.5. Hence, all items are significant. In short, based on the theoretical model and measurement scale used for the proposed research model, the existing items for each construct will be kept.
6.2. Structural model analysis
Collinearity assessment on a structural model involves examination of each set of predictor constructs for each part of the structural model. Collinearity is assessed based on those constructs that have tolerance levels below 2.0 or VIF above 0.50. If such collinearity exists, one should consider eliminating the constructs, merging predictors into a single construct, or creating higher-order constructs to treat collinearity problem. Table 3 shows that there is no collinearity problem encountered in the research model.
Constructs
ATT_G
BI_J
PU_I
PEOU_H
ATT_G
2.326
NA_BI
1.075
PA_PU
1.307
NA_PU
1.062
PEOU_H
1.421
1.492
PU_I
1.421
PA_BI
1.371
PA_PEOU
1.211
NA_PEOU
1.051
Table 3.
Summary of VIF for collinearity analysis.
Structural model is used to calculate the estimates of the structural model relationships (path coefficient) that are represented as the hypothesized relationships among the constructs. For this research, we choose to take a significant level of 10% with a critical value of 1.65. Besides examining t-values, p-values are considered in this analysis. To obtain the t-values, a bootstrapping procedure with 5000 resamples was applied. Based on the analysis results, the hypothesis testing results are summarized as follows in Table 4.
No
Hypothesis
Results
1.
There is a significant relationship between PA and BI.
Supported
2.
There is a significant relationship between PA and PU.
Supported
3.
There is a significant relationship between PA and PEOU.
Supported
4.
There is a significant relationship between NA and PU.
Not supported
5.
There is a significant relationship between NA and PEOU.
Supported
6.
There is a significant relationship between NA and BI.
Supported
7.
There is a significant relationship between PEOU and PU.
Supported
8.
There is a significant relationship between PU and ATT.
Supported
9.
There is a significant relationship between PEOU and ATT.
Supported
10.
There is a significant relationship between ATT and BI.
Supported
Table 4.
Summary of the hypothesis testing results.
Another important measure is the total effect of each path. Direct effect for each path may not be very significant in some cases; hence, Total Effect is to assess the significant of paths in the model. The coefficient of determination is a measure of the model’s predictive accuracy using R2 where it represents the exogenous latent variables’ combined effects on the endogenous latent variables. R2 also represents the amount of variance in the endogenous constructs explained by all the exogenous constructs linked to it. In scholarly research that focuses on marketing issues R2 values of 0.75, 0.50, and 0.25 for endogenous latent variables can be described as substantial, moderate, and weak, respectively.
Attitude toward using KS tools can predict with an accuracy that is close to value 1. Followed by behavioral intention to use KS tools with a R2 value of 0.625 and Task Category-KS tools Fit of a R2 value of 0.593. As for perceived usefulness, it has a R2 value of 0.45 and perceived ease of use has the smallest R2 value of 0.360. By examining t-values based on the critical values 1.65 for two-tailed tests at a significant level = 10%, all the t-values in the table are significant. Hence, all the predictive accuracy values are significant (Table 5). Hence, ATT_G and BI_I are substantial and PU_I and PEOU_H are moderate endogenous latent variables in the proposed model.
Endogenous latent variable
R2
t-values
ATT_G
0.628542
14.3111
BI_J
0.625851
16.30823
PU_I
0.450406
6.329501
PEOU_H
0.360258
6.716182
Table 5.
R2.
7. Discussion and conclusion
Role of affect has been measured in this study to investigate on its relationship between positive and negative affect with knowledge workers’ behavioral intention to use knowledge-sharing tools. The results show that these two constructs have significant relationship on behavioral intention to use and this was also supported by Zhang and Li’s findings in 2007. Zhang and Li [36] pointed out that negative affect is easier to measure and investigate compared to positive affect. It was believed that negative affect creates impacts on knowledge worker’s performance and their intention to use a technology. However, this study outcome produces a new finding where the results show that negative affect has no impact on individuals’ perceived usefulness on the knowledge-sharing tools, whereas the results for attitude toward knowledge-sharing tools usage aligned with past literature works [4, 6]. Negative affect has a strong impact on behavioral intention usage of KS tools in the ATA model. From the findings, we know that knowledge workers use knowledge-sharing tools to perform their daily task in work, and the results gather their affect states after interacting with the tools. From the study, we conclude that if individuals have a strong negative influence on their behavioral intention, they will show less interest in the use of knowledge-sharing tools. Therefore, negative affect has the strongest influence on perceived ease of use and perceived usefulness of the tools. On the other hand, positive affect shows significant impact on perceived ease of use, perceived usefulness and behavioral intention. This implies that positive affect plays a great role in behavioral intention to use a technology; therefore, constant improvement on the tools is needed to induce positive affect on the individuals in using the tools.
Positive and negative affects are a major determining factor in technology acceptance. Past review works in information systems show that the outcomes were inconclusive and inconstant. Operationalization of affect and its related terms has been ambiguous. Many terms have been used interchangeably in a number of research; however, this is a growing field and interest among many researchers [12, 28, 37, 39, 40, 41, 46–56]. From the past related works, it has shown empirical evidence on the role of affect and it was used to explain better in a behavioral study. The proposed ATA model has hypothesized positive affect and negative affect in influencing PEOU, PU, and BI to use knowledge-sharing tools. Past research works has shown that affect has no significant impact on the usefulness of the tools. However, in this study, we found that positive affect has significant influence on the usefulness and ease of use on knowledge-sharing tools and subsequently influence individuals’ behavioral intention to use. These findings are a new contribution to the theoretical aspect of affect relating technology acceptance area of study.
Practitioners and business operators can then maximize these findings by knowing what to do to their tools in order to encourage more usage of the tools. Software designers can consider affect element as they design new tools for knowledge workers. Unpleasant and uncomfortable feelings at the first glance on the tools may induce negative affect on the individuals, hence, impact of affect must be considered while designing user interface of a technology. Technology that induces positive affect will increase the tools acceptance. This study brings new implications to the top management on the factors that impact the knowledge workers’ intention to use KS tools in their works. This study suggests that organizations should focus on knowledge workers’ affective aspects besides other factors before implementing any KS tools in their organizations. The affective aspects of knowledge workers induced by the tools are found to be significant in this research. Therefore, top management should pay attention while formulating their knowledge-sharing tools implementation strategies in their organizations.
\n',keywords:"positive affect, negative affect, TAM, knowledge sharing tools, knowledge workers, affective technology acceptance model",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/56731.pdf",chapterXML:"https://mts.intechopen.com/source/xml/56731.xml",downloadPdfUrl:"/chapter/pdf-download/56731",previewPdfUrl:"/chapter/pdf-preview/56731",totalDownloads:2322,totalViews:440,totalCrossrefCites:6,totalDimensionsCites:13,totalAltmetricsMentions:0,impactScore:12,impactScorePercentile:98,impactScoreQuartile:4,hasAltmetrics:0,dateSubmitted:"April 28th 2016",dateReviewed:"July 10th 2017",datePrePublished:null,datePublished:"November 21st 2017",dateFinished:"August 12th 2017",readingETA:"0",abstract:"Research works on TAM, TAM2, TAM3 and UTAUT has always focused on cognitive aspect of technology acceptance in the past two decades. Acceptance of technologies such as eCommerce, Mobile and ERP that considered emotion and affect are still less. This creates a gap in the technology acceptance research, which consider the role of affect into technology acceptance model. This study considers the role of affect of a knowledge worker that work in Multimedia Super Corridor (MSC)-status organizations in Malaysia on their behavioural intention to use knowledge sharing tools (KS tools) in their day-to-day tasks. Hence, Affective Technology Acceptance (A.T.A) model has been proposed. The behavioural intention on the acceptance of KS tools will be hypothesize in the Affective Technology Acceptance (A.T.A) model. Positive (PA) and Negative (NA) affect as the role of affect construct were introduce in this model to investigate its influence on KS tools usefulness and ease of use among employees in Multimedia Super Corridor organizations. The findings of this study highlighted that NA has no impact on perceive usefulness. The findings also showed that PA has very significant positive influence on PU, PEOU and BI with impact on PEOU being the greatest.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/56731",risUrl:"/chapter/ris/56731",book:{id:"5491",slug:"knowledge-management-strategies-and-applications"},signatures:"Angela Lee Siew Hoong, Lip Sam Thi and Mei-Hua Lin",authors:[{id:"190265",title:"Associate Prof.",name:"Angela",middleName:"Siew Hoong",surname:"Lee",fullName:"Angela Lee",slug:"angela-lee",email:"angelal@sunway.edu.my",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Sunway University",institutionURL:null,country:{name:"Malaysia"}}},{id:"195089",title:"Prof.",name:"Lip Sam",middleName:null,surname:"Thi",fullName:"Lip Sam Thi",slug:"lip-sam-thi",email:"thi@uum.edu.my",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"195090",title:"Prof.",name:"Mei Hua",middleName:null,surname:"Lin",fullName:"Mei Hua Lin",slug:"mei-hua-lin",email:"mhlin@sunway.edu.my",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Research gaps",level:"1"},{id:"sec_3",title:"3. Literature review",level:"1"},{id:"sec_3_2",title:"3.1. Related works on technology acceptance",level:"2"},{id:"sec_4_2",title:"3.2. Affect, mood, emotion, sentiment, and feeling",level:"2"},{id:"sec_6",title:"4. The proposed affective technology acceptance (ATA) model",level:"1"},{id:"sec_6_2",title:"4.1. PU, PEOU, ATT, and BI in technology acceptance model",level:"2"},{id:"sec_7_2",title:"4.2. PA and NA on the perceived usefulness, perceived ease of use, and behavioral intention to accept KS tools",level:"2"},{id:"sec_9",title:"5. Methods",level:"1"},{id:"sec_9_2",title:"5.1. Study contexts and samples",level:"2"},{id:"sec_10_2",title:"5.2. Instrument and measures",level:"2"},{id:"sec_11_2",title:"5.3. Data analysis",level:"2"},{id:"sec_13",title:"6. Results",level:"1"},{id:"sec_13_2",title:"6.1. Measurement model analysis",level:"2"},{id:"sec_14_2",title:"6.2. 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School of Science and Technology, Department of Computing and Information Systems, Sunway University, Malaysia
'},{corresp:null,contributorFullName:"Lip Sam Thi",address:null,affiliation:'
School of Business Management, Universiti Utara Malaysia, Malaysia
School of Science and Technology, Department of Psychology, Sunway University, Malaysia
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1. Definition and etiology
The modern definition of cerebral artery aneurysms began in 1874 with Duret’s description of the middle cerebral artery (MCA). It is known that 20% of all aneurysms are composed of MCA aneurysms and 90% of aneurysms originate from anterior circulation. It is more common in women aged 35–60 years [1]. Subarachnoid hemorrhage (SAH) is a major health problem worldwide with a high mortality rate. Despite a 17% decrease in case fatality in the last three decades associated with improved management strategies, 30-day mortality and sudden death rate unfortunately are still high, around 35 and 15%, respectively [2].
Cerebral arteriovenous malformations (AVM) are composed of a complexity of abnormal arteries and veins and are a major source of brain hemorrhage, resulting in morbidity and mortality, representing a diagnostic and therapeutic challenge in young adults. Cerebral AVM generally represents 1 and 3% of the total annual risk for epilepsy and bleeding in patients with AVM. The rate risk of bleeding in undamaged AVMs is 2.2% per year, and the rate of torn lesions is 4.5% per year. Important risk factors for the development of bleeding due to AVM include deep localization, deep venous drainage, associated aneurysms, pregnancy, age, and gender. Disconnection of arteriovenous malformations from circulation and prevention of epileptic seizures remain the mainstay of treatment. The size, location, and presence of deep venous drainage (using the Spetzler-Martin score) determine the mortality and management of the arteriovenous malformations.
The most common causes of aneurysm remain hemodynamic instability, degenerative changes, vascular injury, atherosclerosis, vasculopathy, high flow, arteriovenous malformation, and fistula. In addition, the important risk factors for the development of cerebral aneurysms are hypertension, smoking, chronic alcohol use, family history of intracranial aneurysms in first-degree relatives, and female sex. Autosomal dominant polycystic kidney disease is an inherited systemic disorder that is strongly associated with intracranial aneurysms. Autosomal dominant polycystic kidney disease has a prevalence rate 2–4 times higher than the general population. Other conditions such as Marfan syndrome, Ehler-Danlos syndrome type IV, neurofibromatosis type I, hereditary hemorrhagic telangiectasia, Moyamoya disease, pseudoxanthoma elastum, and fibromuscular dysplasia are weakly associated with intracranial aneurysms. Multiple aneurysms are detected in 10–30% of cases. Both localization and type of aneurysm are important considerations in describing the risk for rupture. Aneurysm rupture is directly proportional to size, and ruptured aneurysm causes subdural, subarachnoid, or intracranial hematoma. 25% of the cases with ruptured aneurysm are lost and 50% of them have partial or complete recovery. Overall incidence of mortality and complications in ruptured aneurysm is 80%. Risk factors for the formation of and rupture of intracranial aneurysms are shown in Tables 1 and 2 [1, 3, 4].
Formation of intracranial aneurysms
Hypertension Smoking Chronic alcohol use Family history Female sex Polycystic kidney disease Marfan syndrome Ehler-Danlos syndrome Fibromuscular dysplasia Neurofibromatosis type I
Table 1.
Risk factors for the formation of intracranial aneurysms.
Rupture of intracranial aneurysms
Female sex Smoking Hypertension Cocaine abuse Sympathomimetic drug use Posterior circulation aneurysms Type of aneurysms Giant aneurysms
Table 2.
Risk factors for the rupture of intracranial aneurysms.
Aneurysms are classified according to their shape or size.
Saccular berry aneurysms account for 90% of the total aneurysm morphology, and their rupture is the most common cause of SAH. Fusiform aneurysms account for the remaining 10%, and their most common location is posteriorly. Atherosclerosis and dissection are found to be responsible as possible mechanisms for formation of fusiform aneurysms.
2. Clinical presentation of subarachnoid hemorrhage
The most common clinical reflection of aneurysm is SAH; it can occur in several ways: headache, bilateral temporal hemianopsia and bilateral lower limb weakness, unilateral nerve palsy, facial or orbital pain, nosebleed, progressive vision loss and/or ophthalmoplegia, and symptoms of brain stem dysfunction. Patients with complex middle cerebral artery aneurysms may present with intracranial hemorrhage, mass effects, epilepsy, or cerebral ischemia; in addition, the aneurysm may be incidentally discovered. A high mortality rate of 65–85% within 2 years has been reported, and aneurysm rupture survivors are often left with severe neurological deficits [5, 6, 7, 8, 9].
In the presence of rupture, aneurysmal SAH may cause coma in 20–30% of patients. In “poor-grade” patients, neurologic findings may include extensor posturing and loss of upper brain stem reflexes, and further progression may occur in hours from the ictus. A wide light-fixed pupil may indicate oculomotor palsy from a ruptured posterior communicating aneurysm or lateral brain stem displacement from a hematoma in the temporal or frontal lobe. Pinpoint pupils may indicate the presence of an acute hydrocephalus with ventricles often filled with blood. The causes of coma after aneurysmal SAH are shown in Table 3.
Diffuse ischemic global cortical injury
Early cerebral edema
Acute hydrocephalus
Hematoma in the temporal lobe and brain stem shift
Hematoma in the pons
Nonconvulsive status epilepticus
Table 3.
Causes of coma in aneurysmal subarachnoid hemorrhage.
The severity of SAH is clinically assessed and graded using either the Hunt and Hess classification or the World Federation of Neurosurgeons (WFNS) scale (Tables 4 and 5). The WFNS, widely used, is a combination of focal neurological deficits and the Glasgow coma scale (GCS). Higher grades on both scales are associated with the worst outcomes. The WFNS classification provides a more objective assessment. The first computerized tomography scan uses the Fisher grading scale to determine the amount, localization, prognosis, and severity of bleeding (Table 6). The risk of vasospasm is high in patients with Grade III and IV SAH.
Grade
Clinical description
0
Unruptured aneurysm
1
Asymptomatic or minimal headache and slight nuchal rigidity
The overall mortality in patients with SAH is over 30%, and approximately 10–20% of survivors show functional dependence despite intensive neurological care. Several extensive studies have been conducted to improve intensive neurological care in patients with SAH [12]. Poor-grade aneurysmal SAH (WFNS Grades IV and V) reflect 20–30% of all aneurysmal SAH. Mortality is commonly associated with neurological injury resulting from the initial bleeding and rebleeding and from delayed cerebral ischemia (DCI). The volume of initial hemorrhage and initial neurological status following SAH remain major factors for mortality. Elderly patients and patients with coexisting medical conditions are at higher risk. The clinical goal is to prevent rebleeding and DCI [13, 14, 15].
In general, the prognosis of aneurysmal SAH is considered to be inversely related to grading at first presentation. Aggressive early interventions such as emergency surgical clip application or endovascular treatment of the aneurysm can lead to positive outcomes in poor-grade aneurysmal SAH patients. Subarachnoid hemorrhage patients can be followed with conservative treatment without invasive intervention. External ventricular drainage is a frequently preferred method in the case of hydrocephalus which can be observed during this clinical follow-up. In a multicenter, prospective observational study conducted with 324 patients, the relationship between the potential clinical risk factors and the prognosis of aneurysmal SAH in intracranial aneurysm patients was investigated. Results showed that age, female gender, ventilated respiratory status, pupil dilatation, low GCS, WFNS grade, intraventricular hemorrhage, higher Fisher grade, higher Modified Fisher grade, and a relatively poor outcome in aneurysmal SAH patients receiving conservative treatment play a major role. There are many studies showing that age has a strong relationship with clinical outcomes in aneurysmal SAH patients [16, 17, 18, 19, 20, 21, 22, 23]. Global cerebral edema occurs in up to 57% of patients suffering from subarachnoid hemorrhage and is associated with prolonged hospital stay and poor outcome. The pathogenesis of brain injury after intracerebral hemorrhage is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue. Typically, a sudden rise in intracranial pressure at the moment of rupture reduces cerebral perfusion globally in both hemispheres and results in marked ischemic changes. Intraventricular extension of the hemorrhage and hydrocephalus may be a cause of coma, and thus, an improvement may be seen after ventriculostomy [3, 24, 25].
3. Delayed cerebral ischemia
Rebleeding after SAH remains one of the most serious early complications; the reported incidence is up to 15% in the first 24 hours, and the mortality rate is approximately 70% [26, 27, 28]. Prognosis is closely related to initial bleeding, rebleeding, and DCI. The presence of intraventricular and intracerebral hemorrhage also adversely affects prognosis. Cardiac symptoms and neurogenic pulmonary edema are considered indicative of SAH severity. Hypernatremia after SAH is considered as a poor neurological marker. DCI generally begins approximately 3 days after bleeding, and its most severe presence is 1 week after bleeding. Smoking is considered as a risk factor for the development of DCI. The mechanism of DCI is not completely known, but the degree of initial bleeding is likely to be multifactorial with the severity of a function. It is also known that DCI occurs in cerebral regions without signs of angiographic vasospasm. The general recommendation is that angiographic vasospasm should not be treated in the absence of DCI.
DCI is usually treated by administration of nimodipine, via effect of maintenance of normal circulating blood volume and induced hypertension. Nimodipine is a calcium antagonist, and its oral administration is useful in the treatment of vasospasm and DCI. IV application of nimodipine is not recommended. High-dose IV nicardipine (0.15 mg/kg/hr for 14d) has been shown to reduce symptomatic vasospasm but not positively affect the 3-month neurological outcome in a prospective double-blind randomized controlled trial [4, 29, 30, 31, 32, 33, 34, 35].
The clinical goal is to prevent rebleeding and DCI, because, in patients with SAH, DCI is considered the most important preventable cause of death and poor neurological prognosis. Delayed cerebral ischemia affects up to 30% of patients and leaves the majority of survivors with motor deficits, cognitive dysfunction, and reduced quality of life. The risk of developing DCI is associated with the severity of initial bleeding [36].
In patients with GCS 8 or less with intracranial hemorrhage, endotracheal intubation should be considered to protect the airway or to clear tracheal secretions. Intubation should be performed with a rapid induction with minimal effect on hemodynamics and not increasing intracranial pressure. Drugs used in induction should be preferred accordingly (e.g., propofol). It should be remembered that propofol may cause a drop in blood pressure. Preventive isotonic liquid bolus should be applied if necessary. Post-expiratory positive pressure (PEEP) up to 12 mmHg is considered safe as long as the mean arterial pressure is maintained [37].
4. Factors determining prognosis in subarachnoid hemorrhage
The prognosis after SAH may vary from severe disability to death, depending on the complications usually seen in the first 2 weeks associated with the severity of bleeding.
Common causes of this deterioration include neurological events such as hydrocephalus, seizures, ischemia, and systemic conditions, such as fever and infections, respiratory failure, and electrolyte abnormalities. The level of consciousness is considered the most important early predictor of outcome. For these reasons, patients presenting with a GCS score of less than 13 have traditionally been defined as having poor-grade SAH (classified as grade 4 and 5 according to the Hunt and Hess or the WFNS grading scales 5 or more recently as VASOGRADE-Red 6). Brain injury refers to the acute consequences of SAH-associated sudden increase of intracranial pressure (ICP), which can cause decreased cerebral perfusion and transient global cerebral ischemia. The global cerebral ischemia can result in transient loss of consciousness or progressive intracranial hypertension [2, 38, 39, 40, 41].
5. Complications and current treatment approaches
During aneurysmal SAH, extravasation of high-pressure arterial blood in the subarachnoid space is associated with a sudden ICP increase that, if severe and sustained, may compromise cerebral perfusion, causing global cerebral ischemia and early brain injury. Recently, the treatment of hypertension in intracranial hemorrhage patients has been discussed with INTERACT and ATACH training. The American Heart Association/American Stroke Association and Neurocritical Care guidelines include mean arterial blood pressure monitor, unsafe aneurysm types, and 110 or 160 mm Hg (or both) of the systolic blood bridge. Remember to keep it below 180 mm Hg. After aneurysm treatment, these parameters should not be made in such a way that spontaneous high blood pressure may be beneficial [29, 42, 43, 44].
Intracranial hypertension (ICP of at least 20 mm Hg) is a relatively common complication of SAH, especially in patients presenting with poor neurological condition. Multiple factors such as cerebral edema, intraparenchymal hematoma, acute communicating hydrocephalus, intraventricular hemorrhage, aneurysm rerupture, complications related to aneurysm treatment, early brain injury, and DCI may contribute to the development of intracranial hypertension. High ICP is associated with severe regulation of brain metabolism, increased risk of neurological deterioration, and poor outcome, particularly in the absence of medical treatment. An ICP greater than 20 mm Hg is considered as an independent predictor of severe disability and death in aneurysmal SAH. Critical cerebral perfusion pressure levels (less than 70 mm Hg) are significantly associated with cerebral infarction after SAH [45, 46, 47, 48, 49, 50, 51].
If the autoregulation mechanism is intact when intracranial pressure rises, the body tries to keep the cerebral blood flow (CBF) constant. As the ICP rises, the brain perfusion pressure drops. Systemic vascular resistance decreases, and vasodilatation occurs at the limits of autoregulation to keep CBF stable. Cerebral blood flow is mainly regulated by arterial carbon dioxide tension (PaCO2). Abnormal PaCO2 levels are considered to cause major changes in CBF through vasoconstriction and vasodilation, respectively, possibly contributing to further brain injury [52, 53, 54, 55, 56].
Main management principles of intracranial hypertension after SAH are traditionally guided by the literature on traumatic brain injury, due to high numbers. It should be noted that pathophysiology is completely different in our scenario. The role of therapies such as hyperosmolar agents, hypothermia, barbiturates and decompressive craniotomy is not clear in SAH patients with intracranial hypertension resistant to first-line therapies. The first approach to elevated ICP is cerebral venous drainage, normoventilation (PaCO2: 35–40 mm Hg), and positioning bed height from 30° to 45°. During sedation and aspiration of tracheal secretions and physiotherapy, neuromuscular blocking agents should be added if necessary. However, the role of these drugs for ICP management has not been fully established, and some authors report that they may be more harmful than useful [57].
The use of hyperosmolar agents, such as mannitol and hypertonic saline, are current popular options in the treatment of high ICP in SAH.
Studies have shown that hypertonic saline is effective in controlling ICP and improving cerebral blood flow. The last treatment steps at highly resistant ICP include barbiturate, induced hypothermia, and decompressive craniectomy. Therapeutic hypothermia has been shown to be effective in controlling ICP in SAH but has not been shown to be associated with improved functional outcome and low mortality rates.
There are studies showing that hypertonic saline is more effective than mannitol in lowering ICP in traumatic brain injury. But however, there is no specific recommendation to select hypertonic saline or mannitol as the first line for patients with high ICP caused by traumatic brain injury [58, 59, 60, 61, 62, 63, 64, 65, 66]. Recent literature reports effectivity of hypertonic saline like mannitol in reducing of ICP in SAH. However further studies are needed to evaluate safest and optimal dose concentration and impact on improvement of outcomes.
Decompressive craniectomy, an important approach in refractory ICP in SAH patients, is often discussed in patients with poor prognosis. Decompressive craniectomy has been associated with decreased mortality, significant decrease in ICP, increased cerebral oxygenation, and increased cerebral metabolism in many studies. However, severe disability or death was also observed in patients undergoing decompressive craniectomy for refractory ICP [67, 68, 69, 70, 71, 72].
The hemodynamic approach, known as triple H therapy, has played a very important role in SAH treatment for many years. However, its safety and efficacy are discussed due to complications that may develop. In patients with SAH, a bolus normal saline fluid application is known to increase cerebral blood flow in areas of cerebral ischemia. The main purpose of fluid treatment in SAH is to maintain euvolemia and normal circulating blood volume. It should be noted that uncontrolled hypervolemia and hemodilution do not improve cerebral oxygen formation and may cause adverse events [73, 74, 75, 76, 77].
Noradrenaline perfusion may be added to the treatment to provide normotension in cases where appropriate blood pressure is not achieved despite fluid replacement or in conditions limiting fluid therapy such as heart failure. If the pathology persists after blood pressure therapy in neurological examination, intravenous angioplasty or salvage therapy with intravenous infusion may be helpful. Prophylactic use of angioplasty is not recommended. Cardiac complications after SAH may vary from benign electrocardiogram changes to cardiogenic shock. Positive troponin value is common after SAH and is considered a good indicator of left ventricular dysfunction, which increases the risk of hypotension, pulmonary edema, and cerebral infarction. Treatment is symptomatic and most patients have spontaneous recovery within 2 weeks. However, aggressive ICU management may be necessary for severely impaired left ventricular functions. Dobutamine, levosimendan, milrinone, and even an intra-aortic balloon pump may be added to the treatment to maintain cerebral blood flow. It is known that the risk of heart failure and pulmonary complications is much higher in patients with low-grade SAH. Hypovolemia and pulmonary edema are known to increase the risk of delayed cerebral ischemia in this patient group. Long-term intensive care hospitalization may be required in SAH patients. This may result in pulmonary complications such as hospital-acquired pneumonia, cardiogenic or neurogenic pulmonary edema, aspiration pneumonia, and pulmonary embolism, which occurs in approximately 30% of patients.
Acute respiratory distress syndrome occurs in 27% of SAH patients and is an independent predictor of outcome. However, diuretics can be dangerous because of the risk of brain ischemia caused by hypovolemia. Early pulmonary edema and late pulmonary edema after SAH are caused by heart failure and inflammatory (i.e., non-cardiogenic) conditions, respectively.
Measurement of extravascular lung water index, cardiac index, and pulmonary vascular permeability index with Pulse Contour Cardiac Output (PiCCO) is considered to be useful in the identification of pulmonary edema in SAH patients [78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95]. Neither statin therapy nor magnesium infusions should be initiated for delayed cerebral ischemia. Cerebral vasospasm is just one component of delayed cerebral edema.
Hyponatremia is common in subarachnoid hemorrhage and is associated with longer hospitalization time, but not increased mortality. Sodium abnormalities are common and carry a risk of poor prognosis in acute SAH patients. We performed a 10-year observational sodium study. Hyponatremia was defined as serum sodium (sNa) concentration below 135 mmol/L, whereas hypernatremia as sNa above 150 mmol/L. Our 10-year targeted sodium management regimen in acute SAH patients showed that dysnatremias were frequent, predominantly hyponatremic state, due to cerebral salt wasting syndrome (CSW) and not syndrome of inappropriate antidiuretic hormone secretion (SIADH). Hypernatremia was shown to be an independent risk factor for inpatient mortality and poor outcome. The standard sodium protocol lowered the frequency of SIADH, which was encountered in only one patient over 5 years. However, it did not significantly reduce the incidence and outcome improvement of hyponatremia. Hypernatremia occurred more often and had a higher mortality and worse outcome than hyponatremia, but these patients were neurologically worse upon its onset. Hyponatremia is the most common electrolyte imbalance that occurs in 50% of patients after SAH. Two mechanisms are accepted for hyponatremia after SAH: CSW and SIADH. Cerebral salt wasting syndrome and SIADH have different pathogenesis. However, it is not always easy to distinguish in the clinic, and they can be observed in the same patient [96, 97, 98, 99, 100].
\n',keywords:"aneurysmal subarachnoid hemorrhage, cerebral arteriovenous malformation, cerebral vasospasm, delayed cerebral ischemia, intracranial pressure",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/69659.pdf",chapterXML:"https://mts.intechopen.com/source/xml/69659.xml",downloadPdfUrl:"/chapter/pdf-download/69659",previewPdfUrl:"/chapter/pdf-preview/69659",totalDownloads:866,totalViews:0,totalCrossrefCites:0,dateSubmitted:"May 23rd 2019",dateReviewed:"September 13th 2019",datePrePublished:"November 27th 2019",datePublished:"March 11th 2020",dateFinished:"October 19th 2019",readingETA:"0",abstract:"Aneurysmal subarachnoid hemorrhage is an important group of intracranial hemorrhage with a high risk of disability and mortality. The initial amount of bleeding, rebleeding, and delayed cerebral ischemia are considered as the most important factors in determining the prognosis of aneurysm-induced bleeding. In arteriovenous malformations, its location and deep venous drainage play a role in the prognosis. Cardiac complications, neurogenic pulmonary edema, hypertension, hyperglycemia, infections, and prolonged mechanical ventilation in aneurysmal subarachnoid hemorrhage lead to morbidity and mortality. Aneurysm bleeding control, appropriate fluid replacement to ensure euvolemia, when necessary external ventricular drainage and/or decompressive craniectomy, mannitol or hypertonic saline application, and infection control are the main principles of treatment.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/69659",risUrl:"/chapter/ris/69659",signatures:"Sedef Tavukçu Özkan",book:{id:"8204",type:"book",title:"Vascular Malformations of the Central Nervous System",subtitle:null,fullTitle:"Vascular Malformations of the Central Nervous System",slug:"vascular-malformations-of-the-central-nervous-system",publishedDate:"March 11th 2020",bookSignature:"Bora Gürer and Pinar Kuru Bektaşoğlu",coverURL:"https://cdn.intechopen.com/books/images_new/8204.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-78985-712-2",printIsbn:"978-1-78985-711-5",pdfIsbn:"978-1-83880-146-5",isAvailableForWebshopOrdering:!0,editors:[{id:"95341",title:"Prof.",name:"Bora",middleName:null,surname:"Gürer",slug:"bora-gurer",fullName:"Bora Gürer"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Definition and etiology",level:"1"},{id:"sec_2",title:"2. Clinical presentation of subarachnoid hemorrhage",level:"1"},{id:"sec_3",title:"3. Delayed cerebral ischemia",level:"1"},{id:"sec_4",title:"4. Factors determining prognosis in subarachnoid hemorrhage",level:"1"},{id:"sec_5",title:"5. Complications and current treatment approaches",level:"1"}],chapterReferences:[{id:"B1",body:'Sarıhasan B. Nöroanestezi. Serebral Anevrizmalar ve AVM da Anestezi Yönetimi. In: Sarıhasan B, Madenoğlu H, Şatırlar ZO, Türe H, Karacalar KS, editors. Kayseri: M GrupMatbaacılık; 2017. pp. 235-247'},{id:"B2",body:'de Oliveira Manoel AL, Goffi A, Marotta TR, Schweizer TA, Abrahamson S, Macdonald RL. The critical care management of poor-grade subarachnoid haemorrhage. Critical Care. 2016;20:21'},{id:"B3",body:'Wıjdıcks EFM. The comatose patient. In: Comatose and Aneurysmal Subarachnoid Hemorrhage. New York: Oxford University Press; 2008. pp. 268-274'},{id:"B4",body:'D’Souza S. 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Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery. 1982;11:337-343'},{id:"B79",body:'Kimball MM, Velat GJ, Hoh BL, Participants in the International Multidisciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage. Critical care guidelines on the endovascular management of cerebral vasospasm. Neurocritical Care. 2011;15:336-341'},{id:"B80",body:'Zwienenberg-Lee M, Hartman J, Rudisill N, et al. Effect of prophylactic transluminal balloon angioplasty on cerebral vasospasm and outcome in patients with fisher grade III subarachnoid hemorrhage: Results of a phase ii multicenter, randomized, clinical trial. Stroke. 2008;39:1759-1765'},{id:"B81",body:'Mayer SA, LiMandri G, Sherman D, et al. Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. Journal of Neurosurgery. 1995;83:889-896'},{id:"B82",body:'Taccone FS, Lubicz B, Piagnerelli M, et al. Cardiogenic shock with stunned myocardium during triple-H therapy treated with intra-aortic balloon pump counterpulsation. Neurocritical Care. 2008;10:76-82'},{id:"B83",body:'Deibert E, Barzilai B, Braverman AC, et al. Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage. Journal of Neurosurgery. 2003;98:741-746'},{id:"B84",body:'Banki N, Kopelnik A, Tung P, et al. Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. Journal of Neurosurgery. 2006;105:15-20'},{id:"B85",body:'Levy ML, Rabb CH, Zelman V, et al. Cardiac performance enhancement from dobutamine in patients refractory to hypervolemic therapy for cerebral vasospasm. Journal of Neurosurgery. 1993;79:494-499'},{id:"B86",body:'Busani S, Rinaldi L, Severino C, et al. Levosimendan in cardiac failure after subarachnoid hemorrhage. The Journal of Trauma. 2010;68:E108-E110'},{id:"B87",body:'Lannes M, Teitelbaum J, Pilar Cortés M, et al. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: The Montreal neurological hospital protocol. Neurocritical Care. 2012;16:354-362'},{id:"B88",body:'Lazaridis C, Pradilla G, Nyquist PA, et al. Intra-aortic balloon pump counterpulsation in the setting of subarachnoid hemorrhage, cerebral vasospasm, and neurogenic stress cardiomyopathy. Case report and review of the literature. Neurocritical Care. 2010;13:101-108'},{id:"B89",body:'Yoneda H, Nakamura T, Shirao S, et al. Multicenter prospective cohort study on volume management after subarachnoid hemorrhage: Hemodynamic changes according to severity of subarachnoid hemorrhage and cerebral vasospasm. Stroke. 2013;44:2155-2161'},{id:"B90",body:'Hoff RG, Rinkel GJ, Verweij BH, et al. 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Journal of Neurosurgery. 2016;125(2):254-263'},{id:"B95",body:'Tagami T, Kuwamoto K, Watanabe A, et al. SAH PiCCO Study Group. Optimal range of global end-diastolic volume for fluid management after aneurysmal subarachnoid hemorrhage: A multicenter prospective cohort study. Critical Care Medicine. 2014;42(6):1348-1356'},{id:"B96",body:'Dority JS, Oldham JS. Subarachnoid hemorrhage: An update. Anesthesiology Clinics. 2016;34(3):577-600'},{id:"B97",body:'Spatenkova V, Bradac O, de Lacy P, et al. Dysnatremia as a poor prognostic indicator in patients with acute subarachnoid hemorrhage. Journal of Neurosurgical Sciences. 2017;61(4):371-379'},{id:"B98",body:'Spatenkova V, Bradac O, Skrabalek P. The impact of a standardized sodium protocol on incidence and outcome of dysnatremias in neurocritical care. Journal of Neurological Surgery Part A: Central European Neurosurgery. 2015;76(4):279-290'},{id:"B99",body:'Rabinstein AA, Bruder N. Management of hyponatremia and volume contraction. Neurocritical Care. 2011;15:354-360'},{id:"B100",body:'Audibert G, Steinmann G, de Talancé N, et al. Endocrine response after severe subarachnoid hemorrhage related to sodium and blood volume regulation. Anesthesia and Analgesia. 2009;108:1922-1928'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Sedef Tavukçu Özkan",address:"sedefto@gmail.com",affiliation:'
Department of Anesthesiology and Reanimation, İstinye University School of Medicine, Turkey
ICU, VM Medical Park Hospital Pendik, Turkey
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English language copyediting and proofreading, including the correction of grammatical, spelling, and other common errors
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XML Typesetting and pagination - web (PDF, HTML) and print files preparation
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Discoverability - electronic citation and linking via DOI
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Open Access Funding
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For Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
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Added Value of Publishing with IntechOpen
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Indexing and listing across major repositories, see details ...
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Live Performance Metrics to track readership and the impact of your chapter
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Dissemination and Promotion
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Optimized processes that assure your research is made available to the scientific community without delay
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+184,650 citations in Web of Science databases
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Applications",isOpenForSubmission:!1,hash:"a3479e76c6ac538aac76409c9efb7e41",slug:"neuroimaging-neurobiology-multimodal-and-network-applications",bookSignature:"Yongxia Zhou",coverURL:"https://cdn.intechopen.com/books/images_new/9347.jpg",editedByType:"Edited by",editors:[{id:"259308",title:"Dr.",name:"Yongxia",middleName:null,surname:"Zhou",slug:"yongxia-zhou",fullName:"Yongxia Zhou"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8938",title:"Inhibitory Control Training",subtitle:"A Multidisciplinary Approach",isOpenForSubmission:!1,hash:"bd82354f3bba4af5421337cd42052f86",slug:"inhibitory-control-training-a-multidisciplinary-approach",bookSignature:"Sara Palermo and Massimo Bartoli",coverURL:"https://cdn.intechopen.com/books/images_new/8938.jpg",editedByType:"Edited by",editors:[{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6998",title:"Synucleins",subtitle:"Biochemistry and Role in Diseases",isOpenForSubmission:!1,hash:"2b4b802fec508928ce8ab9deebd1375f",slug:"synucleins-biochemistry-and-role-in-diseases",bookSignature:"Andrei Surguchov",coverURL:"https://cdn.intechopen.com/books/images_new/6998.jpg",editedByType:"Edited by",editors:[{id:"266540",title:"Dr.",name:"Andrei",middleName:null,surname:"Surguchov",slug:"andrei-surguchov",fullName:"Andrei Surguchov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:65,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"46296",doi:"10.5772/57398",title:"Physiological Role of Amyloid Beta in Neural Cells: The Cellular Trophic Activity",slug:"physiological-role-of-amyloid-beta-in-neural-cells-the-cellular-trophic-activity",totalDownloads:5886,totalCrossrefCites:18,totalDimensionsCites:31,abstract:null,book:{id:"3846",slug:"neurochemistry",title:"Neurochemistry",fullTitle:"Neurochemistry"},signatures:"M. del C. Cárdenas-Aguayo, M. del C. Silva-Lucero, M. Cortes-Ortiz,\nB. Jiménez-Ramos, L. Gómez-Virgilio, G. Ramírez-Rodríguez, E. Vera-\nArroyo, R. Fiorentino-Pérez, U. García, J. Luna-Muñoz and M.A.\nMeraz-Ríos",authors:[{id:"42225",title:"Dr.",name:"Jose",middleName:null,surname:"Luna-Muñoz",slug:"jose-luna-munoz",fullName:"Jose Luna-Muñoz"},{id:"114746",title:"Dr.",name:"Marco",middleName:null,surname:"Meraz-Ríos",slug:"marco-meraz-rios",fullName:"Marco Meraz-Ríos"},{id:"169616",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Cardenas-Aguayo",slug:"maria-del-carmen-cardenas-aguayo",fullName:"Maria del Carmen Cardenas-Aguayo"},{id:"169857",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Silva-Lucero",slug:"maria-del-carmen-silva-lucero",fullName:"Maria del Carmen Silva-Lucero"},{id:"169858",title:"Dr.",name:"Maribel",middleName:null,surname:"Cortes-Ortiz",slug:"maribel-cortes-ortiz",fullName:"Maribel Cortes-Ortiz"},{id:"169859",title:"Dr.",name:"Berenice",middleName:null,surname:"Jimenez-Ramos",slug:"berenice-jimenez-ramos",fullName:"Berenice Jimenez-Ramos"},{id:"169860",title:"Dr.",name:"Laura",middleName:null,surname:"Gomez-Virgilio",slug:"laura-gomez-virgilio",fullName:"Laura Gomez-Virgilio"},{id:"169861",title:"Dr.",name:"Gerardo",middleName:null,surname:"Ramirez-Rodriguez",slug:"gerardo-ramirez-rodriguez",fullName:"Gerardo Ramirez-Rodriguez"},{id:"169862",title:"Dr.",name:"Eduardo",middleName:null,surname:"Vera-Arroyo",slug:"eduardo-vera-arroyo",fullName:"Eduardo Vera-Arroyo"},{id:"169863",title:"Dr.",name:"Rosana Sofia",middleName:null,surname:"Fiorentino-Perez",slug:"rosana-sofia-fiorentino-perez",fullName:"Rosana Sofia Fiorentino-Perez"},{id:"169864",title:"Dr.",name:"Ubaldo",middleName:null,surname:"Garcia",slug:"ubaldo-garcia",fullName:"Ubaldo Garcia"}]},{id:"58070",doi:"10.5772/intechopen.72427",title:"MRI Medical Image Denoising by Fundamental Filters",slug:"mri-medical-image-denoising-by-fundamental-filters",totalDownloads:2564,totalCrossrefCites:17,totalDimensionsCites:30,abstract:"Nowadays Medical imaging technique Magnetic Resonance Imaging (MRI) plays an important role in medical setting to form high standard images contained in the human brain. MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. Watt",authors:[{id:"145620",title:"Dr.",name:"Gina",middleName:null,surname:"Forster",slug:"gina-forster",fullName:"Gina Forster"},{id:"146553",title:"BSc.",name:"Andrew",middleName:null,surname:"Novick",slug:"andrew-novick",fullName:"Andrew Novick"},{id:"146554",title:"MSc.",name:"Jamie",middleName:null,surname:"Scholl",slug:"jamie-scholl",fullName:"Jamie Scholl"},{id:"146555",title:"Dr.",name:"Michael",middleName:null,surname:"Watt",slug:"michael-watt",fullName:"Michael Watt"}]},{id:"26258",doi:"10.5772/28300",title:"Excitotoxicity and Oxidative Stress in Acute Ischemic Stroke",slug:"excitotoxicity-and-oxidative-stress-in-acute-ischemic-stroke",totalDownloads:7157,totalCrossrefCites:6,totalDimensionsCites:25,abstract:null,book:{id:"931",slug:"acute-ischemic-stroke",title:"Acute Ischemic Stroke",fullTitle:"Acute Ischemic Stroke"},signatures:"Ramón Rama Bretón and Julio César García Rodríguez",authors:[{id:"73430",title:"Prof.",name:"Ramon",middleName:null,surname:"Rama",slug:"ramon-rama",fullName:"Ramon Rama"},{id:"124643",title:"Prof.",name:"Julio Cesar",middleName:null,surname:"García",slug:"julio-cesar-garcia",fullName:"Julio Cesar García"}]},{id:"62072",doi:"10.5772/intechopen.78695",title:"Brain-Computer Interface and Motor Imagery Training: The Role of Visual Feedback and Embodiment",slug:"brain-computer-interface-and-motor-imagery-training-the-role-of-visual-feedback-and-embodiment",totalDownloads:1439,totalCrossrefCites:13,totalDimensionsCites:23,abstract:"Controlling a brain-computer interface (BCI) is a difficult task that requires extensive training. Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192666,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. Vaccaro",authors:[{id:"91165",title:"Prof.",name:"Vafa",middleName:null,surname:"Rahimi-Movaghar",slug:"vafa-rahimi-movaghar",fullName:"Vafa Rahimi-Movaghar"}]},{id:"63258",title:"Anatomy and Function of the Hypothalamus",slug:"anatomy-and-function-of-the-hypothalamus",totalDownloads:4558,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"The hypothalamus is a small but important area of the brain formed by various nucleus and nervous fibers. Through its neuronal connections, it is involved in many complex functions of the organism such as vegetative system control, homeostasis of the organism, thermoregulation, and also in adjusting the emotional behavior. The hypothalamus is involved in different daily activities like eating or drinking, in the control of the body’s temperature and energy maintenance, and in the process of memorizing. It also modulates the endocrine system through its connections with the pituitary gland. Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3478,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3601,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:23,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81488",title:"Aggression and Sexual Behavior: Overlapping or Distinct Roles of 5-HT1A and 5-HT1B Receptors",slug:"aggression-and-sexual-behavior-overlapping-or-distinct-roles-of-5-ht1a-and-5-ht1b-receptors",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.104872",abstract:"Distinct brain mechanisms for male aggressive and sexual behavior are present in mammalian species, including man. However, recent evidence suggests a strong connection and even overlap in the central nervous system (CNS) circuitry involved in aggressive and sexual behavior. The serotonergic system in the CNS is strongly involved in male aggressive and sexual behavior. In particular, 5-HT1A and 5-HT1B receptors seem to play a critical role in the modulation of these behaviors. The present chapter focuses on the effects of 5-HT1A- and 5-HT1B-receptor ligands in male rodent aggression and sexual behavior. Results indicate that 5-HT1B-heteroreceptors play a critical role in the modulation of male offensive behavior, although a definite role of 5-HT1A-auto- or heteroreceptors cannot be ruled out. 5-HT1A receptors are clearly involved in male sexual behavior, although it has to be yet unraveled whether 5-HT1A-auto- or heteroreceptors are important. Although several key nodes in the complex circuitry of aggression and sexual behavior are known, in particular in the medial hypothalamus, a clear link or connection to these critical structures and the serotonergic key receptors is yet to be determined. This information is urgently needed to detect and develop new selective anti-aggressive (serenic) and pro-sexual drugs for human applications.",book:{id:"10195",title:"Serotonin and the CNS - New Developments in Pharmacology and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg"},signatures:"Berend Olivier and Jocelien D.A. Olivier"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"},{id:"80821",title:"Neuroimmunology and Neurological Manifestations of COVID-19",slug:"neuroimmunology-and-neurological-manifestations-of-covid-19",totalDownloads:41,totalDimensionsCites:0,doi:"10.5772/intechopen.103026",abstract:"Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Robert Weissert"}],onlineFirstChaptersTotal:17},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:99,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:289,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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He obtained a Master’s degree in Public Health and PhD in Public Health and Epidemiology. He has a background in Clinical Medicine and has taken courses at higher diploma levels in public health from University of Transkei, Republic of South Africa, and African Medical and Research Foundation (AMREF) in Nairobi, Kenya. Dr. Kasenga worked in different places in and outside Malawi, and has held various positions, such as Licensed Medical Officer, HIV/AIDS Programme Officer, HIV/AIDS resource person in the International Department of Diakonhjemet College, Oslo, Norway. He also managed an Integrated HIV/AIDS Prevention programme for over 5 years. He is currently working as a Director for the Health Ministries Department of Malawi Union of the Seventh Day Adventist Church. Dr. Kasenga has published over 5 articles on HIV/AIDS issues focusing on Prevention of Mother to Child Transmission of HIV (PMTCT), including a book chapter on HIV testing counseling (currently in press). 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