Orexin and cognitive functions.
\r\n\tTo viable rural development has a vital role for rural communities. In the design of policies to be successful that affect them rural people have to decide and implement. According to this, it is a critical point to involve the poor and disadvantaged, along with related stakeholders, agricultural and rural development. Hence, for the sustainable development by international initiatives and all other institutions were searched and to be present the agricultural and related research results. To help support the effort, various governmental and non-governmental agencies established fundings for sustainable rural development research and fostered the development of human well-being goals in rural areas via national and international initiatives. In this context, most efforts resulted in successful cases. This book will intend to provide the reader with a comprehensive overview of the theory, approaches, strategies, and cases, and key elements and challenges of sustainable development, and Bioeconomy, Green and Circular economy for sustainability, and UN SDGs-Agenda 2030 and EU Green Deal.
\r\n\r\n\tI believe that this work will be fundamental in the field of SDG, and it will be a guiding, idea-generating key for researchers, practitioners, rural community, and policy decision-makers, and I hope that together we will establish sustainable rural life and development around the world.
\r\n\t
Orexin, also known as hypocretin, is a neuropeptide that regulates arousal, wakefulness, and appetite. The most common form of narcolepsy, in which the sufferer experiences brief losses of muscle tone (cataplexy), is caused by a lack of orexin in the brain due to destruction of the cells that produce it. There are only 10,000–20,000 orexin-producing neurons in the human brain, located predominantly in the perifornical area and lateral hypothalamus. They project widely throughout the central nervous system, regulating wakefulness, feeding, and other behaviors. The orexin system was initially suggested to be primarily involved in the stimulation of food intake, based on the finding that central administration of orexin-A and orexin-B increased food intake. In addition, it stimulates wakefulness, regulates energy expenditure, and modulates visceral function [1, 2].
Two distinct types of orexin, orexin-A and orexin-B, were identified; they act on specific receptors called orexin receptor type 1 (OX1R) and orexin receptor type 2 (OX2R). Orexin-A activates both of these receptors equally, while orexin-B has a five times higher affinity to OX2R than OX1R. Upon activation, prepro-orexin will split to orexin-A and orexin-B, which act on their G protein-coupled receptors (Figure 1) [3].
Schematic representation of orexin system.
Orexin receptors are distributed mainly in the lateral hypothalamus and adjacent areas, and their nerve fibers project to multiple brain regions. Orexinergic neurons in the lateral hypothalamus group are closely associated with reward-related functions. These neurons preferentially innervate the ventral tegmental area and the ventromedial prefrontal cortex. In contrast, the perifornical-dorsal group of orexinergic neurons is involved in functions related to arousal and autonomic response. These neurons project inter-hypothalamically, as well as to the brainstem, where the release of orexin modulates various autonomic processes. Indeed, accumulating evidence shows that the orexin/receptor system is ectopically expressed in several neurological disorders, suggesting that it plays an important role in the incidence and pathogenesis of these diseases [4].
It has been verified that hypothalamic orexigenic neurons are involved in reward functions, while prefrontal orexigenic neurons are linked in the regulation of autonomic and arousal functions. Moreover, orexin provokes and stimulates food intake via inhibition of autonomic digestive feedbacks. Orexigenic neurons are inhibited by leptin and food intake, while hypoglycemia and ghrelin activate orexigenic neurons. Amino acid and high-protein diets paradoxically provoke the hyperpolarization of orexigenic neurons and block glucose-induced orexigenic neuron activations [5]. Animal model studies have shown that orexin is a very important link between sleep and body metabolism since sleep deprivation leads to higher food intake and induction of catabolism [6].
Additionally, orexin stimulates different neurotransmitters which are linked to the activation of the central nervous system, including acetylcholine, histamine, noradrenaline, and dopamine. Therefore, mutations of orexin receptors lead to sleep disorders. Mice with orexin knockout are subjected to narcolepsy and excessive daytime sleepiness [7]. Alizamini et al. study showed that central administration of orexin leads to stimulation of locomotion, psychomotor performance, body temperature, and energy expenditure. Furthermore, mice with orexin deficiency are subjected to obesity due to reduction of basal metabolic and energy expenditure rates. Beside, orexin knockout out mice is characterized by a reduction in brown adipose tissue thermogenesis with poor differentiation of pre-adipocyte into adipocytes in the adipose tissue [8]. Central and peripheral effects of orexin are illustrated in Figure 2.
Central and peripheral effects of orexin.
The aim of this study was to provide a narrative review of the neurobiological effect of orexin system and to examine the association between orexin neurotransmission and different psychoneurological disorders, including depression, schizophrenia, addiction, Parkinson’s disease, and dementia. Evidence from experimental, preclinical and clinical studies is evaluated for bidirectional relationships between orexin neurobiology and psychoneurological disorders. Given the nature of the subject area, it remains clear that this literature search cannot be regarded as a systemic review.
A diversity of search strategies was adopted and assumed which included electronic database searches of Medline and PubMed using MeSH terms, keywords, and title words. There is no limitation for publication year. The terms used for these searches were as follows: [orexin OR hypocretin] AND [cognitive function OR vigilance OR depression OR schizophrenia OR addiction OR Alzheimer dementia OR stroke OR sleep disorders]. [suvorexant OR orexin antagonists] AND [sleep disorders OR vigilance OR depression OR schizophrenia OR addiction]. Reference lists of identified and notorious articles were reviewed. Besides, only English articles were considered, and case reports were not involved in the review. The key features of recognized relevant search studies were considered, and the conclusions were summarized in a narrative review.
Orexin regulates behavioral and neuroendocrine response during stressful conditions as these events lead to the impairment of cognitive flexibility and function. Also, patients with psychiatric disorders such as panic disorder are associated with significant reduction of hypothalamic orexin activations [9].
It has been shown that stress improves male cognitive flexibility, but it worsens female cognitive flexibility due to gender differences in stress-induced orexin neuropeptide activations. Women are twice as likely as men to suffer from stress-related psychiatric disorders, such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD); however, the biological basis of these sex differences is not fully understood. Interestingly, orexins are known to be dysregulated in these disorders. Both preclinical and clinical studies have reported higher orexin system expression in females, which contributes to exaggerated neuroendocrine and behavioral responses to stress. Therefore, orexins may be important in the etiology of stress-related psychiatric disorders that present differently in men and women [10]. Piantadosi et al. illustrated that stimulation of prefrontal cholinergic neurons leads to the release of orexin from hypothalamic neurons, which play an important role in cognitive activation since high orexin activates the arousal state and executive functions via activation of cortical cholinergic neurons [11]. Chieffi et al. study reported the beneficial effects of exercise in stimulation of orexin release due to enhancement of hippocampal activity as exercise attenuates hippocampal deterioration and depressive symptoms in elderly persons through regulation of orexin release [12].
Notably, cognitive impairment is the main feature of neurological and neuropsychiatric disorders as in dementia and narcolepsy, which are linked to orexin dysfunction. Therefore, intranasal orexin peptide may be an effective agent for cognitive dysfunction [13]. Astonishingly, orexin plays a crucial role in activation of learning and memory, as orexin-A provokes memory acquisition and consolidation through activation of monoaminergic system. Consequently, orexin antagonist leads to significant memory dysfunction in the experimental rats [14]. Kim et al. study revealed that orexin is an important key factor of hippocampal neurogenesis as orexin-A participates in the hippocampal neuronal proliferation and neuroprotection following stroke; thus orexin agonist participates in prevention of negative stroke outcomes [15]. On the other hand, Uslaner et al. exhibited that dual orexin receptor antagonists (DORA-22) is an effective sedative agent, with less cognitive disability than GABA allosteric modulators, which cause significant cognitive dysfunctions [16, 17]. Therefore, orexin improves cognitive functions as illustrated in different human and animal studies (Table 1).
Species | Interventions | Results | References |
---|---|---|---|
Animals | Stimulation of prefrontal cholinergic neurons | ↑ orexin | Piantadosi et al. [11] |
Humans and animals | Exercise Orexin-A administration | ↑ orexin Provokes memory acquisition and consolidation | Chieffi et al. [12] |
Humans | Intranasal orexin-A administration | Improve cognition | Calva and Fadel [13] |
Mice | Orexin-A administration | Stimulates angiogenesis and neuroprotection | Kim et al. [15] |
Humans | Administration of orexin receptor antagonists | Stimulates angiogenesis and neuroprotection | Uslaner et al. [16] |
Orexin and cognitive functions.
Orexin is involved in the regulation of central and peripheral signals to regulate metabolic homeostasis. Alongside, orexin stimulates adrenocorticotrophin (ACTH) and corticosteroid secretions via activation of central corticotropin-releasing hormone (CRH) and vasopressin. Therefore, orexin through OX2R receptor controls the hypothalamic-pituitary-adrenal axis (HPA) [18]. Previously, Malendowicz et al. illustrated that chronic orexin administration led to dose-dependent increase in cortisol and aldosterone plasma levels independent of ACTH levels, indicating a direct stimulating effect of orexin on the adrenal cortex [19]. But in spite of these findings, Patel et al. study confirmed insignificant effect of orexin antagonists on ACTH and cortisol serum levels as well as on the markers of the sympathetic nervous system [20].
It has been reported that orexin administration leads to significant suppression of the hypothalamic prolactin release, which is not upturned by dopamine receptor antagonists like metoclopramide suggesting a novel pathway in controlling of prolactin secretion. The mechanism of prolactin inhibition may be through inhibition of prolactin-releasing factor or stimulation of prolactin-inhibiting factor. But previous study illustrated insignificant effect of orexin antagonist on prolactin plasma levels [21, 22].
Many studies showed that the blood glucose is regulated by central orexin through regulation of hepatic glucose production, skeletal glucose consumption and thermogenesis. High orexin or dysrhythmic in orexin secretion is linked with the development of obesity and insulin resistance [23, 24]. Thus, suvorexant and other orexin antagonists are effective in the management of obesity and insulin resistance via amelioration of body adiposity and augmentation of energy expenditure that improve glucose metabolism. Moreover, orexin-A has important roles in the regulation of pancreatic islet biology through activation of insulin secretion and prolongation of pancreatic islets life span [25].
Tsuneki et al. study illustrated that suvorexant improves glucose tolerance through inhibition of hepatic gluconeogenic factors, when administrated at resting time. However, administration of suvorexant at awaking time illustrates insignificant effect on glucose tolerance due to differential effects on the orexin sleep/wake operating system [26].
In addition, Flores et al. study illustrated an interaction between endocannabinoid and orexigenic neurons as there is a similarity between OX1R and CB1 receptors with diffuse overlapping in the anatomical distribution of these neurons. Therefore, the pharmacological effect of cannabinoid may be through orexigenic receptors [27]. The neuroendocrine effects of orexin are summarized in Table 2.
Species | Interventions | Results | References |
---|---|---|---|
Animals | Orexin administration | ↑ ACTH, cortisol | Czerwinska et al. [18] |
Animals | Orexin administration | ↑ cortisol, aldosterone | Malendowicz et al. [19] |
Humans | Orexin administration | No effect on ACTH and cortisol | Patel et al. [20] |
Humans and animals | Orexin administration | Inhibits prolactin | Lyons et al. [21], Samson et al. [22] |
Humans | High orexin levels | Insulin resistance and obesity | Gupta et al. [23], Cigdem et al. [24] |
Humans and animals | Orexin administration | ↑ insulin secretion | Mediavilla and Risco [25] |
Animals | Administration of orexin antagonists | Improves glucose tolerance | Tsuneki et al. [26] |
Neuroendocrine effects of orexin.
Among important etiological factors involved in the pathophysiology of depression, disturbances of monoamines and HPA are the main mechanistic pathways leading to functional disorders of neuroplasticity, which is regarded as a cardinal step in the onset of depression [28].
Diurnal variation in orexin serum levels revealed that high orexin levels are occurring at the middle of night. It has been reported that orexin level is significantly decreased in patients with depression in comparison with healthy subjects [29]. But paradoxical high orexin serum levels are seen in some depressed patients, which is normalized by selective serotonin reuptake inhibitors. Since, orexin-A CSF levels are negatively correlated with depressive symptoms [30].
Long-term antidepressant agents improve orexin serum levels regardless of the type of antidepressant medications [31]. Nevertheless, there are different findings concerning orexin levels in depression. Feng et al. reported that depression is linked to reduction of serotonergic neuronal activity which is responsible for modulation of orexinergic activity [32]. Thus reduction of serotonergic neuronal activity leads to activation of orexin neuroactivity leading to depression. However, orexin levels are significantly reduced in depression compared with healthy control [33].
The initial animal model study observed reduction in the orexinergic neurons by 18% with diminution in size of these neurons in comparison with normal rats. As well, prepro-orexin mRNA expression and orexin-A were reduced compared with control [34].
Previous preclinical study revealed a strong connection between low orexin and risk of depression which are inconsistent with previous studies that illustrated hypoactivity of orexinergic neurons in patients with depression since short-term antidepressant therapy improves sleep pattern through increasing and decreasing the expression of mRNA of orexin-A and orexin-B, respectively [35].
Ito et al. showed that administration of orexin-A leads to significant reduction of despair behavior in depression with important hippocampal neurogenesis via upregulation of neuropeptide Y (NPY). These changes are inhibited by co-administration of orexin-A antagonist [36].
Therefore, orexin levels are different according to the pathophysiology of depression. Low orexin in depressed patients is associated with hypersomnia, whereas high orexin in depressed patients is associated with insomnia and interrupted sleep [17]. Ji et al. illustrated that orexinergic neurons have direct connection to the ventral pallidum (VP) which is concerned with stress response and rewarding system. Orexin stimulates the VP and prevents depressive behavior. Therefore, high orexin in the VP is associated with elevated serum corticosterone serum levels during acute stress, which per se prevent a depressive reaction against stressful events through improvement of stress resilience [37].
The association between orexin and schizophrenia had not been previously explored precisely [38]. Clinical and preclinical findings proposed that orexin and orexin agonist are of great value and useful in treating cognitive deficit in schizophrenia [39]. There are widespread connection and interaction between orexin and dopaminergic neurons in midbrain, thalamocortical region, and amygdala suggesting the potential role of orexinergic neurons in schizophrenia [40].
Modafinil is an atypical dopamine reuptake inhibitor used in the treatment of narcolepsy and antipsychotic drug-induced sleep disorder (Figure 3) [41]. Modafinil has been revealed as a complement of drugs in therapy of schizophrenia, and it reduce negative symptoms with no effect on the positive symptoms. Modafinil improves locomotor and psychomotor performances through activation of orexinergic neurons [42].
Chemical structure of modafinil.
Therefore, activations of orexinergic neurons by modafinil may be an imperative step for future antipsychotic medications. These findings document that dopaminergic agonists mainly at D1 and D2 receptors modify orexinergic neurotransmissions [43]. Also, dopamine antagonists that cause weight gain lead to activation of orexin pathway, but dopamine antagonists which do not cause weight gain do not activate orexin pathway [44]. Nevertheless, amphetamine which indirectly activates dopamine leads to activation of orexinergic neurotransmission despite induction of weight loss. Moreover, clozapine activates only orexinergic neurons in the prefrontal cortex [45]. Similarly, orexin antagonists abolish olanzapine and haloperidol effect on midbrain dopaminergic neurons, suggesting that orexin is an important neurotransmitter mediates the action of antipsychotic drugs [46]. As well, Chen et al. illustrated that orexin-A is stimulated and upregulated by non-obesegenic antipsychotic drugs [47]. Also, the high orexin level in patients with schizophrenia treated with antipsychotic drugs is regarded as a protective factor against the development and risk of drug-induced metabolic syndrome [48]. Furthermore, orexin agonist like modafinil ameliorates cognitive function, attention, and antipsychotic-induced sedation.
The orexinergic system has broad projections and connections to different brain area which are concerned with drug-induced neuro-adaptation, including midbrain dopaminergic neurons, ventral tegmental area (VTA), nucleus accumbens (NA), amygdala, and medial prefrontal cortex (mPFC). Drug abuse leads to augmentation of dopaminergic activity in NA through activation of orexinergic neurons at mesocorticolimbic pathway [49]. Correspondingly, experimental studies illustrated that OX1R and OX2R are highly expressed in the NA leading to inhibitory effect instead of excitatory effects seen on the VTA, amygdala, and mPFC. Therefore, a differential effect of orexin is receptor type dependent [50].
Acute administration of addicting drugs such as methamphetamine, nicotine, and amphetamine leads to activation of orexinergic neurons at the lateral hypothalamus. However, acute administration of cocaine and morphine does not affect orexinergic neurons. Besides, chronic administration of addict drugs causes activation of orexinergic neurons mainly at OX2R receptors, but chronic increasing dose of addict drugs leads to downregulation of orexinergic receptors [51]. Carr and Kalivas reported that orexin is an important mediator which enables cocaine to induce addiction-like behavior in rats due to dopaminergic neuronal changes [52]. Also, James et al. verified that orexinergic neurons at the lateral hypothalamus play a vital role in expression of addiction-like phenotype [53]. Thus, the orexinergic system is regarded as an important novel target for drug therapies to treat addiction.
Orexin serum level in chronic smoker subjects is related to craving in the phase of abstinence since it increased during addiction phase and reduced during withdrawal phase. This reduction leads to increase in craving and risk of relapse [54]. Therefore, orexin serum level is regarded as a potential biomarker predicts time and risk of smoking relapse.
Furthermore, Tsai and Huang reported that the orexin serum level is increased in heroin addicts who shifted to methadone maintenance therapy compared with controls suggesting that methadone increases orexin serum levels [55]. Similarly, orexin serum level is increased in chronic alcoholism, which is positively correlated with the severity of alcohol withdrawal. Alleviation of alcohol withdrawal syndrome is linked with reduction of the orexin serum level, which monitors the status of alcoholic patients during the abstinence period [56].
Narcolepsy is a sleep disorder that causes excessive daytime sleepiness or an intractable urge to sleep in, in which duration of rapid eye movement sleep (REM) is reduced. Cataplexy is a sudden reduction in muscle tones with preserved consciousness. Narcolepsy is commonly associated with cataplexy, which is triggered by emotional stimuli [57]. Methylphenidate, modafinil, and other psychostimulants are effective in the management of these sleep disorders [58]. Dysregulation of NREM sleep leads to narcolepsy only, whereas dysregulation of REM sleep leads to combined narcolepsy with cataplexy [59]. It has been reported that orexin increases vigilance through increasing awaking time and decreasing REM and NREM sleep periods. Both OX1R and OX2R are involved in the maintenance of arousal state directly or indirectly through the activation of monoaminergic neurons (noradrenalin, dopamine, histamine, and serotonin). Also, orexin activates cholinergic neurons in the basal forebrain, which is also important for arousal statues [60]. Yamanaka et al. study illustrated that activation of OX2R by orexin leads to wakefulness which is mediated by a histamine neurotransmitter since antihistamine blocks the excitatory effect of orexin, while activation of OX1R by orexin leads to wakefulness, through noradrenalin neurotransmitter [61]. Reduction of orexin level in the cerebrospinal fluid was documented in patients with narcolepsy and nowadays is regarded as one of the diagnostic criteria in the diagnosis of narcolepsy. Likewise, human postmortem study found that orexin peptide and prepro-orexin mRNA are deficient in the pons and cerebral cortex [62]. Therefore, these findings unveil that orexin is an important neuropeptide in the regulation of sleep and consolidated wakefulness. Table 3 summarized the potential role of orexin in common psychiatric disorders.
Psychiatric disorders | Species | Orexin levels | References |
---|---|---|---|
Depression | Human | Decreased | Kok et al. [29] |
Human | Increased | Grady et al. [30] | |
Schizophrenia | Human | Decreased | Mereu et al. [42] |
Patel et al. [20] | |||
Chronic smoking | Animals | Increased | Al’Absi et al. [54] |
Drug addictions | Human | Increased | James et al. [53] |
Alcoholism | Human | Increased | Pan et al. [56] |
Narcolepsy | Human | Decreased | Gabelle et al. [62] |
Orexin and psychiatric disorders.
Orexinergic neurons are severely affected in Parkinson’s disease (PD); previously Fronczek et al. confirmed that orexinergic neuron density was reduced in the prefrontal cortex by 40% with significant reduction in CSF orexin levels in PD patients compared to the healthy control [63].
Furthermore, animal model study illustrated that 15% damage to the orexinergic neurons did not affect CSF orexin, while damage more than 70% leads to 50% decline in the CSF orexin [64]. These findings may explain the association of narcolepsy with PD since both dopamine and orexin interplay in the regulation of sleep pattern through activation of midbrain and thalamocortical pathway [65]. Feng et al. illustrated that in PD, there is a deficiency in hypoxia inducible factor 1 alpha (HIF1-α) due to mitochondrial dysfunction and the administration of orexin-A leads to significant neuroprotective effect on the dopaminergic neurons through the activation of HIF-α [66].
Moreover, orexin-A improves dopaminergic neurons in PD through the reduction of tyrosine hydroxylase (TH) and activation of brain-derived neurotrophic factor (BDNF) in the substantia nigra [43]. Therefore, orexin antagonist may increase risk of PD due to reduction of the neuroprotective and stimulating effects on the dopaminergic neurons at substantia nigra [67]. Sheng et al. found that orexin plays important roles in activation of the subthalamic nucleus which may give a new evidence for the participation of the subthalamic orexinergic system in PD. Importantly, orexin-A increased the protein level of brain-derived neurotrophic factor in dopaminergic neurons of the substantia nigra. The upregulation of BDNF is mainly via OX1R [68]. Long-term therapy with ropinirole in PD leads to significant reduction in the orexin activity which might explain the adverse effect of ropinirole-induced sleep disorder through inhibition of glutamatergic excitatory effect on the orexinergic neurons. Therefore, pharmacotherapy of PD should be re-evaluated in this context [69].
Alzheimer’s disease (AD) is a neurodegenerative disease affecting different brain areas characterized by cognitive deficit and progressive memory loss [70]. AD also affects hypothalamic orexinergic neurons leading to excessive daytime sleepiness, which is correlated with low orexin CSF levels, as reduction 40% of the brain cell number is linked with a 14% reduction in orexin CSF levels [71]. Normally, orexin regulates cholinergic and monoaminergic neuron firing during sleep and wakefulness. In AD a reduction in the cholinergic pathway leads to disturbance in sleep patterns leading to daytime sleepiness and insomnia at night which are a hallmark of sleep rhythm in AD [72]. Besides, reduction of cholinergic activity causes overactivity of orexinergic neurons, which causes abnormal sleep and cognitive functions. These changes lead to an elevation of the orexin CSF level, which is linked with reduced REM sleep [73].
Dementia with Lewy bodies is characterized by an elevation in α-synuclein level, which is accumulated in orexin-containing neurons at the hypothalamus causing interference in orexin axonal transport. This effect leads to a reduction in the activity of the orexinergic system in dementia with Lewy bodies but not in AD [74]. Therefore, there are complexities in the orexinergic system according to the clinical presentation and sleep pattern in patients with AD.
Huntington’s disease (HD) is a hereditary neurodegenerative disorder characterized by personality changes, motor disturbances, cognitive decline, and weight loss [75]. HD is caused by a defect in the gene encoding huntingtin, a protein with unclear function, which is essential for cell survival during development and in adult life [76]. In HD there is neurodegeneration involving the neostriatum and cerebral cortex, with the manifestation of intraneuronal aggregates of misfolded huntingtin. Moreover, in patients with end-stage HD, there is about 90% of neuronal loss in the tuber nucleus of the lateral hypothalamus. Orexin-A and orexin-B are synthesized from the same precursor gene and are expressed in the same neurons with their cell bodies concentrated to the lateral hypothalamus [77]. Preclinical and clinical studies observed that orexin serum and CSF levels are decreased by 72% in HD. In healthy subjects, orexin CSF level is >200pg/ml, but in HD and narcolepsy, this level is decreased below 110 pg/ml, due to degeneration of orexinergic neurons in the lateral hypothalamus. Therefore, CSF orexin level is regarded as a biomarker to evaluate the disease progression and usefulness of therapeutic intervention in patients with HD [78, 79]. However, Meier et al. illustrated that CSF and serum orexin levels are of no diagnostic value in prediction and follow-up of HD [80].
Recently, Cabanas et al. observed that orexin in HD has aberrant effects leading to abnormal sleep pattern, and thus orexin antagonist suvorexant may be of great value in restoring normal sleep and behavioral disturbance in HD [81] in addition, these neurons remain functional and illustrate paradoxical effect, it become more modifiable and affect by serotonine and noradrenaline, and less sensitive to the effect of suprachiasmatic nucleus (the master clock of the brain) causing abnormal biological circadian rhythm [81, 82].
Therefore, orexin level in HD is reduced, but the remaining functional orexinergic neurons lead to abnormal circadian biological rhythm causing behavioral, motor, and sleep disturbances.
Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to transmit signals, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. Specific symptoms can include double vision, blindness in one eye, muscle weakness, and trouble with sensation or coordination. MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). Between attacks, symptoms may disappear completely; however, permanent neurological problems often remain, especially with the advancement of the disease [83, 84].
The three main characteristics of MS are the formation of lesions in the central nervous system, inflammation, and the destruction of myelin sheaths of neurons. These features interact in a complex and not yet fully understood manner to produce the breakdown of nerve tissue and in turn the signs and symptoms of the disease. Cholesterol crystals are believed to both impair myelin repair and aggravate inflammation. MS is believed to be an immune-mediated disorder that develops from an interaction of the individual’s genetics and as yet unidentified environmental causes. Damage is believed to be caused, at least in part, by attack on the nervous system by a person’s own immune system [85].
Considering the multiplicity of symptoms associated with multiple sclerosis (MS), there is possibility that hypocretin system function might be involved in the pathogenesis of the disease. Papuc et al. showed that high orexin CSF level in patients with MS as compared with healthy controls, but it positively correlated with fatigue level, suggesting a compensatory mechanism for the production of orexin in MS [86]. On the other hand, Nozaki et al. illustrated that orexin CSF level is reduced and correlated with symmetrical hypothalamic lesion and spinal cord damage in MS. Therefore, low orexin level was implicated in the pathogenesis of hypersomnia and cognitive deficit in patients with MS [87]. Recently, Pallais et al. confirmed that orexin has a neuroprotective effect in MS through inhibition of inflammatory and proinflammatory mediators mainly matrixmetaloproteinases (MMP-3, MMP-9) which are involved in damage of neuronal matrix proteins. Consequently, low CSF orexin level indicates underlying active disease [88].
Therefore, CSF orexin level is a valuable biomarker in the diagnosis and prediction of the severity of MS.
Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is a disease that leads the death of neurons controlling voluntary muscles. The underlying mechanism involves damage to both upper and lower motor neurons. ALS is characterized by stiff muscles, muscle twitching, and muscle weakness is still unknown. The cause of ALS is not known in 90% of cases but is believed to involve both genetic and environmental factors. The remaining 10% of cases is inherited [89]. Previously, Van Rooij et al. illustrated that CSF orexin level was normal in patients with ALS and not correlated with age and gender. However, a disturbance in the orexinergic system is involved in the pathogenesis of ALS [90]. Moreover, the pathogenesis of ALS is associated with lateral hypothalamic lesions, a site of the orexinergic system leading to sleep disturbances and hypersomnia [91].
Despite different and large body of literature survey, little is known about CSF orexin levels, in clinical and preclinical studies in ALS.
Therefore, orexin CSF level and orexinergic activity in different neurodegenerative diseases are summarized in Table 4.
Psychiatric disorders | Species | CSF orexin levels | References |
---|---|---|---|
Parkinson’s disease | Human | Decreased | Fronczek et al. [63] |
Alzheimer’s disease | Human | Increased | Liguori et al. [73] |
Huntington’s disease | Human | Decreased | Mignot et al. [78] |
Animals | Normal | Papuc et al. [86] | |
Multiple sclerosis | Human | Decreased | Nozaki et al. [87] |
ALS | Human | Normal | Van Rooij et al. [90] |
Orexin and neurodegenerative diseases.
Regarding orexin antagonists, suvorexant is a dual orexin receptor antagonist was approved by the Food and Drug Administration (FDA) on 13 August 2014 [92]. Other orexin antagonists are almorexant, lemborexant, and filorexant are used in the management of insomnia and other sleep disorders. Also, these drugs may be of great value in the control of depressive disorders and peripheral diabetic neuropathy [93].
Suvorexant (Figure 2) is the first orexin antagonists approved in the United States for treatment of insomnia, which is effective in reduction of time to sleep onset and increase of total sleeping time [94]. Moreover, administration of SB-33867 which is an orexin antagonist leads to significant reduction of sympathetic tone causing a reduction in blood pressure, heart rate, and plasma noradrenalin. These findings suggest that orexin through OX1 receptor regulates sympathetic tone since intravenous administration of orexin leads to parallel increases in noradrenalin plasma levels [95].
Hatta et al. study confirmed the significant effect of suvorexant in the management of delirium in elderly patients in acute care units. The anti-delirium effect is due to the regulation of circadian biology [96]. Delirium is proposed to be related of suvorexant to disturbances and disorders in sleep pattern in critically ill patients in the intensive care unit. Also, attention disorders are caused by disturbances in the ascending reticular activating system (ARAS) which is responsible for maintenance of human arousal. Normally, the arousal state is regulated and stimulated by ARAS neurotransmitters and by hypothalamic orexin [97]. Therefore, orexin receptor antagonists may play important role in the regulation of hypothalamic and brain stem stress during acute injury. Moreover, a recent study by Kawada et al. illustrated that suvorexant add-on therapy to ramelteon in the management of sleep disorders in patients with acute stroke is more effective than when combined with benzodiazepines [98].
It has been verified that prolonged alcohol consumption is associated with sleep disturbance which is a powerful factor for relapse and setback to alcohol use. Suvorexant reduces the motivation properties of alcohol, so it plays a crucial role in the prevention of alcoholism [99].
Beside, Gentile et al. study revealed the possible role of suvorexant in reduction of motor impulsivity of cocaine-induced psychostimulant effects. Thus suvorexant may be effective in attenuation of cocaine withdrawal syndrome [100].
As well, suvorexant had placebo-like effect on EEG in comparison with zolpidem which has a significant reduction in the spectral density of rapid eye movement and non-rapid eye movement sleep (NREM) pattern [101].
In spite of the wide uses of suvorexant in the management of sleep disorders and controlling insomnia, it did not reduce the psychomotor performances as documented by Vermeeren et al. study [102].
Orexin-A is involved in regulation of feeding; it stimulates nocturnal feeding through OX1 receptor. Therefore, OX1 receptor antagonist regulates feeding and reduced nocturnal feeding; thus, orexin antagonist could be useful in the treatment of obesity [103]. Orexin-A is implicated in the pathogenesis of obesity; it promotes hyperphagia through central activation of cannabinoid receptors and inhibition of melanocyte-stimulating hormone [104]. Both orexin-A and endocannabinoid increases glucose response of neuronal excitability in the arcuate nucleus leading to induction of feeding and obesity [104].
In summary, more research is required to reinforce the extant information on the importance of the limited number of factors studied to date and provide data on additional potentially relevant effects. Similarly, rubric for such research should shift from preclinical and animal model studies to clinical studies to illustrate disease progression and treatment effects in relation to orexin neurobiology. This study suggests that orexin system is a future target in the management of different psychoneurological disorders after delineating the specific role of orexin receptor agonists and antagonists. Moreover, measurement of orexin serum level which is an easy method may be of great value in evaluation and assessment of different neurological disorders. Also, ratio of orexin serum level/CSF orexin level may reflect the activity of endogenous orexinergic system.
Orexin system is regarded as a potential novel target in the management of schizophrenia, depression, addiction, and sleep disorders. Orexin serum level might predict relapse and withdrawal of addict patients.
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Mixed methods research (MMR) is defined as the collection, analysis, and integration of both quantitative data (e.g., RCT outcome) and qualitative data (e.g., observations, semi-structured interviews) to provide a more comprehensive understanding of a research problem than might be obtained through quantitative or qualitative research alone [1, 2]. Relevant strategies for the use of mixed methods in health services research include adding qualitative interviews to follow up on the outcomes of intervention trials, gathering both quantitative and qualitative data to assess patient reactions to a program implemented in a community health setting, or using qualitative data to describe or explain the mechanism of a study correlating behavioral and social factors to specific health [3]. We want to find out if this is important in the field of counseling.
I want to start this chapter with the “Classification”, the “five purposes for mixing in mixed-methods research”:
Triangulation seeks convergence, corroboration, and correspondence of results in different ways.
Complementarity seeks elaboration, enhancement, illustration, and clarification of the results from one method with the results from the other method.
Development seeks to use the results from one method to help develop or inform the other method, where interpretation includes sampling and implementation, as well as measurement decisions.
Initiation seeks the discovery of paradox and contradiction, new perspectives of frameworks, and the recasting of questions or results from one method with questions or results from the other method.
Expansion seeks to extend the breadth and range of inquiry by using different methods for different inquiry components [4, 5].
Next to the five purposes MMR has five essential characteristics: (1) the collection and analysis of both quantitative and qualitative data, (2) the use of rigorous procedures in conducting quantitative and qualitative research, (3) the integration of the findings, (4) the use of mixed method designs and (5) the use of a conceptual framework [6]. By “Integration”, we mean integrating quantitative and qualitative research through our research teams, philosophies, research process, and research methods.
A mixed methods research project provides more insight than qualitative or quantitative data alone by greater mining data depth. The different perspectives from linking enable the databases to “talk” to each other. We can compare the two database results and follow up quantitative results with qualitative data collection.
There are three different core designs: convergent design, explanatory sequential design, and exploratory sequential design. A plan’s importance is: identifying a theoretical framework, writing a mixed methods question, and writing a mixed method study aim, composing the study using a writing structure that matches the design, developing a joint display for integration, identifying the methodological/validity issues in design, drawing a diagram of configuration, identifying the type of mixed methods design and creating a title for the project.
The convergent design qualitative interviews, analysis, quantitative survey, and analysis stand alone in the first phase. Then they are merged and an interpretation follows. You should choose a convergent design when your mixed method project intends to compare results, develop broader products, validate data, and build cases. It can be helpful when you need rapid data collection. It is also beneficial when you have equal emphasis on both quantitative and qualitative data (Figure 1).
The convergent design [
The explanatory sequential design has three phases. In the first phase, the quantitative survey and analysis of the qualitative interviews and comments will be explained in the second phase. In the third, an interpretation follows (Figure 2).
The explanatory sequential design [
The explanatory sequential design starts with collecting quantitative data through a cross-sectional web-based survey, which delivers numeric data. It follows an analysis of the data through data screening, providing descriptive statistics and factor loadings. In the case selection, an interview protocol will be developed, participant dorm will be selected and interviewed.
The collection of qualitative data happens through documents and telephone interviews. It makes up the text and image data. Lastly, the qualitative data analysis follows a cross-thematic study and delivers a cross-thematic matrix and a visual model of multiple case analyses.
You should choose an explanatory sequential design when your mixed method project intends to explain surprising, contradictory, outlier results or results that do not match theory or form groups/cases for further analysis. Other reasons could be when you have time to conduct your study in phases or emphasize starting a project from a quantitative perspective.
The third core design is the exploratory sequential design.
As illustrated in Figure 3 this design has three phases. In the first phase, interviews, observations, and other qualitative methods are conducted and analyses are made. The analysis of qualitative data leads to the development of a quantitative device.
Exploratory sequential design [
The second phase is the quantitative phase, which includes an instrument design or intervention design. Then follows a quantitative test of an instrument or intervention in phase 3, which leads to an interpretation. “We can first explore qualitatively, and then test out the ideas quantitatively” [6]. Afterward, quantitative data will be collected and analyzed and an interpretation follows.
An exploratory sequential design should be chosen when your mixed methods project intends to build and test an intervention, instrument, survey, app or website, or new variables. Other reasons could be when you emphasize starting your project qualitatively or when you have time to collect in phases over time.
Lastly, a short comment about complex designs. Typically, complex applications are used when researchers have multiple research phases, multiyear research projects, large funded projects, multiple researchers, or the inclusion of mixed methods core designs within different phases of research [7].
Marte Meo is a video-based counseling method founded by Maria Aarts in the Netherlands and is now in worldwide use [8]. Marte Meo has been adopted and put into practice by a large and diverse network of trained and certified counselors worldwide.
With the help of a model of beneficial interaction behavior, Marte Meo aims to support personal development. In this respect, it stands in tradition with the humanistic approach. It was founded with the aim of reducing symptomatology. However, we found that in practice, more Marte Meo counselors aim for personal growth. The focus is on relationships that exhibit “complementarity”. This is mostly given in a dyad relationship, where one person is responsible, supports, cares educates, etc. (e.g., parents, educators, teachers, careers), and another person needs this support (e.g., infant, child, adolescent, sick, disabled, dementia sufferer [8, 9].
In our research, we choose an integrated exploratory sequential design [6], which seems to be best suited to our purposes. It enabled us to discover in detail how a selected group of experts and parents applied for the Marte Meo program, and we then tested out the ideas culled from that process quantitatively with a large convenience sample.
The exploratory sequential design of the Marte Meo project has five phases as illustrated in Figure 4. A systematic literature review is carried out in the first phase, which builds into qualitative interviews and analysis in the second phase. The third phase builds an analysis of videotaped observations. A fourth quantitative phase with an online survey follows and in the last step, the fifth phase follows an interpretation.
Exploratory sequential Design of the Marte Meo Project.
The staged qualitative research consisted of designing, conducting, and analyzing semi-structured interviews with parents and Marte Meo Counselors and then using that analysis to inform the design, the conduct, and analysis of videotaped observations of everyday situations for example in day-care centers to examine the process and effects of Marte Meo interaction elements on children.
Combining these qualitative analyses then became the basis for developing an online questionnaire that could enable us to collect quantitative data on the current use of Marte Meo in practice by experts. As a result of this design, four phases of analysis will be carried out: after the two qualitative phases, after the quantitative phase, and during the integration phase, which will connect the data strands and expand the initial qualitative exploratory results.
With the aim of obtaining more meaningful results on the application of Marte Meo in counseling and therapy, it would be desirable to collect an international and generally more heterogeneous sample that includes various groups of people (clients, other affected persons, or experts in other methods, etc.).
In response to the question “What further development does the method need?”, the experts’ statements strongly pointed to the desire for a scientific foundation for the Marte Meo method. The respondents hoped that increased scientific research on the effectiveness of the method in various fields of application would lead to greater acceptance and consequently to the method being financed by public bodies. The fitting of the effect factors according to Grawe [10] to the basic principles of Marte Meo suggests further follow-up studies are needed to make statements about the effectiveness of Marte Meo. For example, it would be interesting to correlate the experts’ self-declarations of the benefits of Marte Meo with objective behavioral data of the clients and to secure them by means of inference statistics. A concrete criterion for this could be the increased rate of observable Marte Meo elements (beneficial interaction) applied visibly and audibly in video recordings over several counseling sessions [11]. Marte Meo seems to fit different approaches. Possible moderators for the effectiveness of Marte Meo could therefore be the experience, knowledge, or skills of the expert. More than one-fifth of respondents stated that they had children themselves. This factor, too, could be a moderator for the effect of the Marte Meo consultancy services used. Overall, although Marte Meo is often used in combination with other methods in a wide variety of contexts, there seems to be little research on the effect of combined use. Here, it would be interesting to get context-specific information about which combinations of methods are effective for which concerns and contexts.
At the time of research, no study could be found that describes the current status of the nationwide application of Marte Meo in practice, counseling and therapy. The results indicate a high degree of diversity in the use of Marte Meo with a high overall satisfaction among experts. Almost one-third of Marte Meo usage takes place in everyday teaching, followed by counseling, exchange with colleagues, teaching, supervision, and therapy. Marte Meo is often combined with the systemic approach, among other things, because it is flexible enough and allows the experts a lot of leeway in their approach, depending on their individual personalities.
The results of the work show that Marte Meo is perceived as beneficial by its implementers. The experts reported more joy and success in their work. In particular, in the pedagogical context, the daily, resource-oriented “Marte Meo view”, which has been sharpened by the training, seems to be essential, as it allows for an awareness of the needs of the interaction partners and the beneficial interaction elements. Moreover, for some respondents, the use of Marte Meo seems not to be limited to professional practice but is expressed in a general humanistic attitude towards interpersonal relationships of all kinds.
Regarding various application contexts and concrete advisory procedures, well-founded insights into the benefits and effectiveness of Marte Meo could be found in the future, thus ensuring increasing quality assurance or control and the institutional establishment of the method. In order to consider the diversity in the application of Marte Meo, future research can make use of the results of the qualitative and quantitative studies and derive specific questions. It was discussed that a potential benefit of Marte Meo could be based on the fact that central premises or principles of Marte Meo can be applied to the four impact factors according to Grawe [10]. Thus, in order to advance the application of Marte Meo in the future, scientific studies on this point seem promising.
There are still questions about how competently Marte Meo is performed in practice; that is, how much is supervision prescribed so that there is more reason to infer fidelity to the method than with most other interventions. If fidelity is not something that the Marte Meo process itself effectively ensures (especially when it is integrated into other methods that are part of the systemic approach), then implementation studies should be built into outcome/impact studies, so that one can distinguish whether objective results vary depending on the level of fidelity of different practitioners. Implementation studies utilizing the Consolidated Framework for Implementation Research (CFIR) might be highly worthwhile.
In our reflections, our decision to utilize an exploratory sequential design was a useful one. In particular, the enhancements of including the systematic literature research (phase 1) and two different qualitative methods (interviews (phase 2) and observations (phase 3) seemed to be a good choice—and might be a recommendation for other similar research projects.
The second project is one concerning genograms. Genograms are an integral part of therapy and counseling (Figure 5).
Example genogram created with the InGeno app.
The study investigated the meaning and functions of genograms in the professional practice of counselors.
The article of Rohr et al. [12] presents partial results of the research project InGeno, in which—on the basis of the “actual” use of genograms to be researched—a user-friendly software for genogram creation is being developed. 108 counselors participated in the quantitative online questionnaire study. The data were analyzed descriptively and summarized together with the qualitative results of Rohr’s [13] preliminary study. The results show: Genograms are of central importance for those counselors who use them in their counseling practice: they are an integral part of their counseling work, are used in a variety of counseling situations together with the clients, and are further used and processed throughout the counseling process. In this context, genogram work fulfills a variety of functions, such as gaining information about the clients, recognizing transgenerational patterns and relationship dynamics, strengthening the identity of the clients, and uncovering their resources. The advantages and disadvantages of standardization and creativity are discussed.
Overall, the present study confirmed and extended the results of Rohr [13] to a large extent.
“Genograms are visualizations of the bio-psycho-social situation of the family and enable clients to recognize patterns of behavior—and thus to get to know themselves better” [13]. They consist of objective data (analogous to the family tree) and subjective meanings. “The task in genogram work in the context of counseling and therapy is to work out the structures of the social matrix (the social field).” Further, Hildenbrand [14], a pioneer in the use of genograms in German-speaking countries, writes: “Instead, I separate between the given and the given-up in human action [15] and find the actor in the distance between the two: The latter becomes an actor by making the given into the given up, i.e., by shaping his or her life”.
The article does not describe normatively and ideally how genograms ‘should’ be created. There is no single case study described, as this would not be helpful for our research questions. Our questions are discussed based on an elaborate research design. Based on the results we describe in this article descriptively: How do experienced counselors and therapists actually work with genograms, what advantages and disadvantages, limits, and possibilities (modes of action) do they find?
The questionnaire used here was created, among other things, based on the evaluation of twenty qualitative expert interviews. It is part of the interdisciplinary research project “InGeno”. A research team from the Department of counseling Research at the University of Cologne is developing a software (app) to create genograms with Computer Science Professor Dr. Mario Winter, B.Sc. Sven Kullack from the Cologne University of Applied Sciences (Figure 6) [13, 15].
Exploratory sequential design of the Genogram Project.
Based on a systematic literature review [16] our project provides a comprehensive overview of genograms’ current research literature. In addition to a detailed account of developed extensions of the standard genogram for specific target groups and counseling settings, research findings on the utility of genograms in training and supervision and the need for discussing psychometric testing of genograms. The presented systematic literature review method aims to invite researchers to “underpin” their future counseling and therapy research with this approach. In this case, it will inspire counselors and therapists to test different extensions of genogram work depending on the target group and setting in practice.
The systematic literature search done on 05/09/2018 returned 348 hits. Thirty publications from other sources supplemented these. After removing duplicates, we checked the remaining 277 publications for thematic fit based on the titles or abstracts. Here, 112 publications were excluded as they did not fit in terms of content or were not available in English, German, or Spanish. The remaining 165 publications were checked for their suitability in the full text. In this step, a further sixty publications were excluded because they did not contribute to the genograms’ role in counseling practice.
The date of publication was not an exclusion criterion; also included were publications before 1990. A total of 105 publications were included in the systematic literature review and were analyzed concerning their empirical content.
Against the background of the quantitative results presented in this article, the systematic literature research [12], and the preceding qualitative interviews with experts the question of the significance and function of genograms in counseling practice can be answered as follows: For those counselors who use genograms in their counseling practice, they are of central importance and an integral part of the counseling process. They are very likely to be used in a large number of counseling situations, whereby most of the time this is done together with the clients. The genogram work is not a one-time activity, but the genogram is used and processed again and again during the counseling process. This leads to the conclusion that for many counselors the genogram fulfills the function of a common thread that runs through the counseling process and can be referred to again and again. The willingness to supplement central and well-known basic functions with further elements that make sense for individual counseling practice is great so that a great heterogeneity in the presentation of the genograms is to be expected. The goals of genogram work are to gain information about the clients, to recognize transgenerational patterns and relationship dynamics, to strengthen the clients’ identity—or their own appreciative understanding—and to uncover their resources. According to this, the genogram fulfills a variety of important functions in the counseling process—as well as within training and supervision: almost all respondents experienced the creation of their own genogram as very or mostly helpful.
The counseling and therapeutic work with genograms are very diverse. This is evident from both the systematic literature review (Phase 1) presented in the previous article [12] as well as from the results presented in this article. This is followed by open, fundamental questions: Are we even talking about the same “thing” when we use the term genogram—or genogram work? Bruno Hildenbrand [14] propagates to call “genogram work” only what aims at case reconstruction based on objective data. This could be called an extreme pole of answers to the question: “How are genograms used?”
For us, genograms are semi-standardized “visualizations of the family’s bio-psycho-social situation and enable clients* to recognize patterns of behavior—and thus to get to know themselves better” [13]; “semi-standardized” because it became clear in the study presented that the use of the symbols proposed by McGoldrick et al. [17] varied significantly in practice. Despite the advantages of standardization, e.g., the majority use of one and the same software, we believe that the focus should be on the common process of genogram use—and not on the genogram as a means of pure information retrieval.
Maybe the question of standardization or creativity is not relevant for individual counselors and therapists, but undoubtedly for the “scientific community”: If professional communication is to be done or if genograms are integrated into therapy applications, standardization is helpful for transparent communication. And if this communication will be digital in the near future (keyword “digital file”), a digitalization of genograms (beyond photos of paper-and-pencil drawings) will be necessary. And yet working with genograms is always an idiographic procedure, i.e., case-oriented, not standard, and developing or progressing from hour to hour. Especially “relationship lines” with double or jagged lines are not “set in stone” from a constructivist-systemic understanding, should not be the basis for “hard diagnostics” (said Tom Levold in the second phase of our project, the qualitative data collection). They are perspectives, circular, they may be experienced quite differently after a few weeks and serve only as hypotheses.
In conclusion, this chapter presents an outlook on an elaborate research project which I have started on behalf of the DGfB, the German National Association for Counseling (member of EAC and IAC). Together with Marc Weinhardt (Universität Trier), Cornelia Maier-Gutheil (Evangelische Hochschule Darmstadt), Tim Stanik (Hochschule der Bundesagentur für Arbeit, Schwerin) and Marc Höcker (Universität zu Köln und Universität Mainz) I work on the development of a German qualifications framework for Counseling—in the context of the European Qualifications Framework (EQF).
It is a particular challenge due to the specific conditions in non-formal learning. It requires a well-considered, staged, and explorative approach because it is impossible to fall back on already established procedures for the allocation and reference competencies of the DQR (The German Qualifications Framework) from other fields. The DQR is a mixture of Mixed Methods Program Evaluation Design and Mixed Methods Participatory Design.
In a first step, a multi method approach triangulates a systematic literature review with a quantitative expert survey.
Here, the competencies and competence facets defined in the academic discourse and the competencies and competence facets depicted in counseling curricula are recorded to secure and further explore these in a Delphi study with one hundred experts’ participation. The experts were selected in close consultation with the client to adequately reflect the counseling landscape’s diversity and consider a cross-school perspective.
The Delphi study (100 experts will fill in the questionnaire) aims to check and supplement the literature review results and weighting concerning the Qualifications Framework for Counseling. It is to ensure that a methodically supported and intersubjectively comprehensible consensus is found within the member associations.
At the same time, we will analyze procedures and instruments for competence assessment, examinations, and certification procedures of the DGfB member associations with regard to their outcome and competence orientation in order to systematize their adaptation possibilities for the project context. Evaluating both partial studies’ results (qualification framework for counseling and synopsis of competence assessment procedures). In the course of qualitative group discussions with representatives of the DGfB member associations, proposals for certification criteria and practices will be derived and, in the course of the project, acceptance for the project results will be created in the DGfB member associations. The entire application’s orientation follows a research concept oriented towards impact factors. It is thus natively connectable to competence-oriented discourses and aims at theoretical and empirical modeling of successful counseling actions.
This project is a so-called complex design—an intersection of core designs with complex applications (see Figure 7).
Process model embedding mixed methods into complex designs [
They are used when researchers have multiple research phases, multiyear research projects, large funded projects, multiple researchers, and inclusion of mixed methods core designs within different phases of research [6]. In this case, it is a mix of a “Mixed Methods Program Evaluation Design” (see Figure 8) and a “Mixed Methods Participatory Design” which is used when you want to involve stakeholders or participants in your design, when you want to bring about change and when you understand participatory approaches [6].
Mixed methods program evaluation design [
In general, this article can be understood as a plea for mixed methods research. We agree with Teddlie and Tashakkori [18]: “We believe that divergent thought will always be a part of MMR (…), but that it is now time for greater convergence on some basic characteristics and principles” and with Symonds and Gorard [19]: “Death of mixed methods?: Or the rebirth of research as a craft”. Considering the limitations of the quantitative and qualitative paradigms and current definitions of mixed methods, we advocate the development of a research community where ‘all methods have a role, and a key place in the full research cycle from the generation of ideas to the rigorous testing of theories for amelioration’ and do not believe in “oppositional components of paradigms” [20].
This text is a “plea for mixed methods research in the field of counseling” by explaining three empirical examples. Timothy C. Guetterman did a meta-analysis together with my mentor Charles Deutsch from the Harvard School of Public Health and other colleagues [3]. Their goal was to understand how reviewers evaluate mixed methods research by analyzing reviewer comments for grant applications that were submitted primarily to the National Institutes of Health. They asked Mixed Methods Research Training Program (MMRTP) health sciences researchers and consultants to send them summary comments on their mixed methods grant applications and received 40 summary comments on funded (40%) and unfunded (60%) mixed methods grant applications [3]. They conducted a document analysis with a coding rubric based on NIH Best Practices for Mixed Methods Research in the Health Sciences and allowed inductive codes to emerge. Reviewers positively evaluated mixed methods applications that demonstrated coherence between goals and research design elements, detailed methods, plans for integrating mixed methods, and use of theoretical models. Reviewers identified weaknesses in mixed methods applications that lacked methodological detail or rationale, had a high participant load, and did not delineate investor roles. Successful mixed methods applications convey assumptions behind the methods chosen to achieve specific goals and clearly describe the procedures to be followed. Investigators planning to use mixed methods should remember that reviewers are looking for both points of view [3].
Mixed methods approaches are well suited to achieving the goals of health and implementation research. Nonetheless, applicants should be careful to explain the proposed methods based on underlying assumptions so that referees trained in the former methods from disciplines such as epidemiology and statistics will be able to understand the connection between the specific goals and the mixed methods. The reviewers pay attention to details about the samples, the plans for data collection and analysis, and the data integration procedures. Applicants should anticipate and dispel the concerns of the evaluators about possible disadvantages of mixed methods in terms of participants, time and resource expenditure, and generalizability of results [3]. The study of Guetterman et al. provides some empirical evidence for researchers keen to take full advantage of mixed methods to address pressing clinical and health care issues [3]. Therefore, it fits perfectly into this “plea for mixed methods research in the field of counseling”.
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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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Among these heavy metals, a few have direct or indirect impact on the human body. Some of these heavy metals such as copper, cobalt, iron, nickel, magnesium, molybdenum, chromium, selenium, manganese and zinc have functional roles which are essential for various diverse physiological and biochemical activities in the body. However, some of these heavy metals in high doses can be harmful to the body while others such as cadmium, mercury, lead, chromium, silver, and arsenic in minute quantities have delirious effects in the body causing acute and chronic toxicities in humans. The focus of this chapter is to describe the various mechanism of intoxication of some selected heavy metals in humans along with their health effects. Therefore it aims to highlight on biochemical mechanisms of heavy metal intoxication which involves binding to proteins and enzymes, altering their activity and causing damage. More so, the mechanism by which heavy metals cause neurotoxicity, generate free radical which promotes oxidative stress damaging lipids, proteins and DNA molecules and how these free radicals propagate carcinogenesis are discussed. Alongside these mechanisms, the noxious health effects of these heavy metals are discussed.",book:{id:"7111",slug:"poisoning-in-the-modern-world-new-tricks-for-an-old-dog-",title:"Poisoning in the Modern World",fullTitle:"Poisoning in the Modern World - New Tricks for an Old Dog?"},signatures:"Godwill Azeh Engwa, Paschaline Udoka Ferdinand, Friday Nweke Nwalo and Marian N. Unachukwu",authors:[{id:"241837",title:"Mr.",name:"Godwill Azeh",middleName:null,surname:"Engwa",slug:"godwill-azeh-engwa",fullName:"Godwill Azeh Engwa"},{id:"274194",title:"BSc.",name:"Paschaline Ferdinand",middleName:null,surname:"Okeke",slug:"paschaline-ferdinand-okeke",fullName:"Paschaline Ferdinand Okeke"},{id:"286975",title:"Dr.",name:"Friday",middleName:null,surname:"Nweke Nwalo",slug:"friday-nweke-nwalo",fullName:"Friday Nweke Nwalo"},{id:"286976",title:"Dr.",name:"Marian",middleName:null,surname:"Unachukwu",slug:"marian-unachukwu",fullName:"Marian Unachukwu"}]},{id:"27687",doi:"10.5772/29869",title:"Heavy Metals and Human Health",slug:"heavy-metals-and-human-health",totalDownloads:18956,totalCrossrefCites:84,totalDimensionsCites:192,abstract:null,book:{id:"1012",slug:"environmental-health-emerging-issues-and-practice",title:"Environmental Health",fullTitle:"Environmental Health - Emerging Issues and Practice"},signatures:"Simone Morais, Fernando Garcia e Costa and Maria de Lourdes Pereira",authors:[{id:"13875",title:"Prof.",name:"Simone",middleName:null,surname:"Morais",slug:"simone-morais",fullName:"Simone Morais"},{id:"79715",title:"Prof.",name:"Maria De Lourdes",middleName:null,surname:"Pereira",slug:"maria-de-lourdes-pereira",fullName:"Maria De Lourdes Pereira"},{id:"87294",title:"Prof.",name:"Fernando",middleName:null,surname:"Garcia E Costa",slug:"fernando-garcia-e-costa",fullName:"Fernando Garcia E Costa"}]}],mostDownloadedChaptersLast30Days:[{id:"64851",title:"Herbal Medicines in African Traditional Medicine",slug:"herbal-medicines-in-african-traditional-medicine",totalDownloads:14207,totalCrossrefCites:30,totalDimensionsCites:52,abstract:"African traditional medicine is a form of holistic health care system organized into three levels of specialty, namely divination, spiritualism, and herbalism. The traditional healer provides health care services based on culture, religious background, knowledge, attitudes, and beliefs that are prevalent in his community. Illness is regarded as having both natural and supernatural causes and thus must be treated by both physical and spiritual means, using divination, incantations, animal sacrifice, exorcism, and herbs. Herbal medicine is the cornerstone of traditional medicine but may include minerals and animal parts. The adjustment is ok, but may be replaced with –‘ Herbal medicine was once termed primitive by western medicine but through scientific investigations there is a better understanding of its therapeutic activities such that many pharmaceuticals have been modeled on phytochemicals derived from it. Major obstacles to the use of African medicinal plants are their poor quality control and safety. Traditional medical practices are still shrouded with much secrecy, with few reports or documentations of adverse reactions. However, the future of African traditional medicine is bright if viewed in the context of service provision, increase of health care coverage, economic potential, and poverty reduction. Formal recognition and integration of traditional medicine into conventional medicine will hold much promise for the future.",book:{id:"6302",slug:"herbal-medicine",title:"Herbal Medicine",fullTitle:"Herbal Medicine"},signatures:"Ezekwesili-Ofili Josephine Ozioma and Okaka Antoinette Nwamaka\nChinwe",authors:[{id:"191264",title:"Prof.",name:"Josephine",middleName:"Ozioma",surname:"Ezekwesili-Ofili",slug:"josephine-ezekwesili-ofili",fullName:"Josephine Ezekwesili-Ofili"},{id:"211585",title:"Prof.",name:"Antoinette",middleName:null,surname:"Okaka",slug:"antoinette-okaka",fullName:"Antoinette Okaka"}]},{id:"76640",title:"Control of Clinical Laboratory Errors by FMEA Model",slug:"control-of-clinical-laboratory-errors-by-fmea-model",totalDownloads:1131,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Patient safety is an aim for clinical applications and is a fundamental principle of healthcare and quality management. The main global health organizations have incorporated patient safety in their review of work practices. The data provided by the medical laboratories have a direct impact on patient safety and a fault in any of processes such as strategic, operational and support, could affect it. To provide appreciate and reliable data to the physicians, it is important to emphasize the need to design risk management plan in the laboratory. Failure Mode and Effect Analysis (FMEA) is an efficient technique for error detection and reduction. Technical Committee of the International Organization for Standardization (ISO) licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. FMEA model helps to identify quality failures, their effects and risks with their reduction/elimination, which depends on severity, probability and detection. Applying FMEA in clinical approaches can lead to a significant reduction of the risk priority number (RPN).",book:{id:"9808",slug:"contemporary-topics-in-patient-safety-volume-1",title:"Contemporary Topics in Patient Safety",fullTitle:"Contemporary Topics in Patient Safety - Volume 1"},signatures:"Hoda Sabati, Amin Mohsenzadeh and Nooshin Khelghati",authors:[{id:"340486",title:"M.Sc.",name:"Hoda",middleName:null,surname:"Sabati",slug:"hoda-sabati",fullName:"Hoda Sabati"},{id:"348872",title:"M.Sc.",name:"Amin",middleName:null,surname:"Mohsenzadeh",slug:"amin-mohsenzadeh",fullName:"Amin Mohsenzadeh"},{id:"348874",title:"MSc.",name:"Nooshin",middleName:null,surname:"Khelghati",slug:"nooshin-khelghati",fullName:"Nooshin Khelghati"}]},{id:"64762",title:"Mechanism and Health Effects of Heavy Metal Toxicity in Humans",slug:"mechanism-and-health-effects-of-heavy-metal-toxicity-in-humans",totalDownloads:10236,totalCrossrefCites:100,totalDimensionsCites:229,abstract:"Several heavy metals are found naturally in the earth crust and are exploited for various industrial and economic purposes. Among these heavy metals, a few have direct or indirect impact on the human body. Some of these heavy metals such as copper, cobalt, iron, nickel, magnesium, molybdenum, chromium, selenium, manganese and zinc have functional roles which are essential for various diverse physiological and biochemical activities in the body. However, some of these heavy metals in high doses can be harmful to the body while others such as cadmium, mercury, lead, chromium, silver, and arsenic in minute quantities have delirious effects in the body causing acute and chronic toxicities in humans. The focus of this chapter is to describe the various mechanism of intoxication of some selected heavy metals in humans along with their health effects. Therefore it aims to highlight on biochemical mechanisms of heavy metal intoxication which involves binding to proteins and enzymes, altering their activity and causing damage. More so, the mechanism by which heavy metals cause neurotoxicity, generate free radical which promotes oxidative stress damaging lipids, proteins and DNA molecules and how these free radicals propagate carcinogenesis are discussed. Alongside these mechanisms, the noxious health effects of these heavy metals are discussed.",book:{id:"7111",slug:"poisoning-in-the-modern-world-new-tricks-for-an-old-dog-",title:"Poisoning in the Modern World",fullTitle:"Poisoning in the Modern World - New Tricks for an Old Dog?"},signatures:"Godwill Azeh Engwa, Paschaline Udoka Ferdinand, Friday Nweke Nwalo and Marian N. Unachukwu",authors:[{id:"241837",title:"Mr.",name:"Godwill Azeh",middleName:null,surname:"Engwa",slug:"godwill-azeh-engwa",fullName:"Godwill Azeh Engwa"},{id:"274194",title:"BSc.",name:"Paschaline Ferdinand",middleName:null,surname:"Okeke",slug:"paschaline-ferdinand-okeke",fullName:"Paschaline Ferdinand Okeke"},{id:"286975",title:"Dr.",name:"Friday",middleName:null,surname:"Nweke Nwalo",slug:"friday-nweke-nwalo",fullName:"Friday Nweke Nwalo"},{id:"286976",title:"Dr.",name:"Marian",middleName:null,surname:"Unachukwu",slug:"marian-unachukwu",fullName:"Marian Unachukwu"}]},{id:"65467",title:"Anesthesia Management for Large-Volume Liposuction",slug:"anesthesia-management-for-large-volume-liposuction",totalDownloads:5965,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The apparent easiness with which liposuction is performed favors that patients, young surgeons, and anesthesiologists without experience in this field ignore the many events that occur during this procedure. Liposuction is a procedure to improve the body contour and not a surgery to reduce weight, although recently people who have failed in their plans to lose weight look at liposuction as a means to contour their body figure. Tumescent liposuction of large volumes requires a meticulous selection of each patient; their preoperative evaluation and perioperative management are essential to obtain the expected results. The various techniques of general anesthesia are the most recommended and should be monitored in the usual way, as well as monitoring the total doses of infiltrated local anesthetics to avoid systemic toxicity. The management of intravenous fluids is controversial, but the current trend is the restricted use of hydrosaline solutions. The most feared complications are deep vein thrombosis, pulmonary thromboembolism, fat embolism, lung edema, hypothermia, infections and even death. The adherence to the management guidelines and prophylaxis of venous thrombosis/thromboembolism is mandatory.",book:{id:"6221",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery"},signatures:"Sergio Granados-Tinajero, Carlos Buenrostro-Vásquez, Cecilia\nCárdenas-Maytorena and Marcela Contreras-López",authors:[{id:"273532",title:"Dr.",name:"Sergio Octavio",middleName:null,surname:"Granados Tinajero",slug:"sergio-octavio-granados-tinajero",fullName:"Sergio Octavio Granados Tinajero"}]},{id:"30178",title:"Chest Mobilization Techniques for Improving Ventilation and Gas Exchange in Chronic Lung Disease",slug:"chest-mobilization-techniques-for-improving-ventilation-and-gas-exchange-in-chronic-lung-disease",totalDownloads:31193,totalCrossrefCites:0,totalDimensionsCites:5,abstract:null,book:{id:"648",slug:"chronic-obstructive-pulmonary-disease-current-concepts-and-practice",title:"Chronic Obstructive Pulmonary Disease",fullTitle:"Chronic Obstructive Pulmonary Disease - Current Concepts and Practice"},signatures:"Donrawee Leelarungrayub",authors:[{id:"73709",title:"Associate Prof.",name:"Jirakrit",middleName:null,surname:"Leelarungrayub",slug:"jirakrit-leelarungrayub",fullName:"Jirakrit Leelarungrayub"}]}],onlineFirstChaptersFilter:{topicId:"3",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82507",title:"Use of Computed Tomography in the Assessment of Severity of Aortic Valve Stenosis",slug:"use-of-computed-tomography-in-the-assessment-of-severity-of-aortic-valve-stenosis",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105644",abstract:"The workhorse in the diagnosis of aortic stenosis (AS) has been transthoracic echocardiography (TTE) with clear-cut validated threshold values for grading it mild, moderate, or severe. However, up to one-third of patients may present with discordant findings on echo sonogram and may need further evaluation with other imaging modalities such as computed tomography (CT). CT is useful in determining aortic valve area (AVA) by planimetry and outperforms TTE in identifying severe AS in bicuspid aortic valve (BAV), but it is not routinely ordered for those purposes. It has been widely used in helping, determining, and grading the severity of AS by calculating aortic valve calcium (AVC) load with a scoring system. AVC scores of 2000 AU or more for men and 1300 AU for women are highly indicative of severe AS and have been associated with the poor outcomes. AVC score will underestimate AS in a minority of circumstances where the process is driven more by fibrosis than calcification. CT use is limited by its recent adoption into medical practice and, therefore, is still not universally available in every center. It requires additional training for providers and low-dose radiation exposure may be a concern for some patients.",book:{id:"11221",title:"Aortic Stenosis - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11221.jpg"},signatures:"David Weininger Cohen and Wilbert S. Aronow"},{id:"82509",title:"Role of Sociodemographic and Economic Variables in Predisposition to Vaso-Occlusive Crisis and Mortality in Patients with SCD: Case Study of Sub-Saharan Africa",slug:"role-of-sociodemographic-and-economic-variables-in-predisposition-to-vaso-occlusive-crisis-and-morta",totalDownloads:0,totalDimensionsCites:null,doi:"10.5772/intechopen.105685",abstract:"Sickle cell disease (SCD) is a major public health challenge. It is a common cause of acute and chronic illness and death, which results from a single amino acid substitution (glutamic acid to valine) at position 6 of the beta (β) chain of the hemoglobin molecule. The pathophysiology is based on the polymerization of deoxygenated hemoglobin S (HbS) and production of irreversibly sickled red cells and vaso-occlusive crisis (VOC). The disease is associated with recurrent episodes of acute pain and organ damage. This chapter highlights the role of SES on the predisposition to VOC and mortality among SCD patients. Findings from this review will enable the development and implementation of policies that can facilitate the effective management of SCD in the region. More awareness and education of parents of children and adults living with SCD are needed to identify factors that predispose patients to VOC and common-sense measures to prevent these triggers. SCD patients should be protected against malaria. The need for nutritional intervention, proper hydration, avoidance of dietary intake of sodium, strenuous physical activity, and extreme weather to reduce the incidence of VOC cannot be overemphasized. Protective immunization and access to effective prophylactic and therapeutic agents should be implemented.",book:{id:"11293",title:"Sickle Cell Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11293.jpg"},signatures:"Osaro Erhabor, Teddy Charles Adias, Tosan Erhabor, Osaro Mgbere, Sadiya Usman and Bibiana Nonye Egenti"},{id:"82513",title:"Neurological Effects of COVID-19 and Its Treatment/Management",slug:"neurological-effects-of-covid-19-and-its-treatment-management",totalDownloads:0,totalDimensionsCites:null,doi:"10.5772/intechopen.105730",abstract:"The impact of COVID-19 is significant in the body system, one of which is the central nervous system (CNS) involved in controlling all aspects of human behavior and coordination. This shows the need to assess from various studies in human and animal models the neurological effects of this virus. Some of the reported effects include loss of taste and smell, headaches, delirium, dizziness, ischemic stroke, and brain inflammation. It is essential to review the acute, chronic or transient neurological effects. This will enhance and/or improve treatment designs and management modalities for the COVID-19. We critically revise the literature and contribute to the body of knowledge in this line of research. Here in this chapter, we highlighted the various neurological disorders caused by COVID-19 and examined the relationship between the neurological systems and COVID-19. As well as evaluate current treatment/management modalities including vaccines and prospects for the future.",book:{id:"11592",title:"COVID-19 Pandemic, Mental Health and Neuroscience - New Scenarios for Understanding and Treatment",coverURL:"https://cdn.intechopen.com/books/images_new/11592.jpg"},signatures:"John Teibo, Abolaji Olagunju, Festus Atiba, Olabode Omotoso, Titilade Teibo, Ahmad Babalghith and Gaber Batiha"},{id:"82511",title:"Outcomes of Bariatric Surgery",slug:"outcomes-of-bariatric-surgery",totalDownloads:1,totalDimensionsCites:null,doi:"10.5772/intechopen.105734",abstract:"The prevalence of obesity has increased globally. Management of obesity consists of medical and surgical interventions. The results of bariatric surgery are consistently more significant than medical therapy. Importantly, bariatric surgery achieves durable weight loss in more patients than medical therapy. Moreover, studies have reported improvement in most obesity-related complications after bariatric surgery. Improvement or remission of type 2 diabetes mellitus, hypertension and dyslipidemia is noteworthy. Due to better outcomes, the indications of bariatric surgery are expanding. In conclusion, bariatric surgery is a cost-effective and safer alternative for morbidly obese patients who fail to respond to non-surgical treatments. Some studies have raised concerns about the worsening of mental health problems after bariatric surgerys. It requires careful management of high-risk patients and further research.",book:{id:"11687",title:"Bariatric Surgery - Past and Present",coverURL:"https://cdn.intechopen.com/books/images_new/11687.jpg"},signatures:"Asad Ullah"},{id:"82321",title:"Noncanonical (Non-R132H) IDH-Mutated Gliomas",slug:"noncanonical-non-r132h-idh-mutated-gliomas",totalDownloads:4,totalDimensionsCites:0,doi:"10.5772/intechopen.105469",abstract:"Mutations in IDH1 or IDH2 confer a significant survival advantage compared to their isocitrate dehydrogenase (IDH) wild-type counterparts and, as such, are the most significant prognostic factors in this group. The mutations in the IDH1 gene are heterozygous and almost always involve only a single residue (arginine 132), which is replaced by histidine in roughly 90% of tumors. Regardless, the non-p.R132H (noncanonical) mutations in the IDH1 gene were also documented in around 20% of mutated glioma. The noncanonical IDH mutations have distinguishing radiological and histological features. The existence of such tumors seems to be associated with a genetic predisposition to cancer development.",book:{id:"11597",title:"Glioblastoma - Current Evidences",coverURL:"https://cdn.intechopen.com/books/images_new/11597.jpg"},signatures:"Tariq D. Al-Saadi and Roberto J. Diaz"},{id:"82492",title:"Treatment of Patients with Newly-Diagnosed Multiple Myeloma",slug:"treatment-of-patients-with-newly-diagnosed-multiple-myeloma",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105774",abstract:"Multiple Myeloma is an incurable disease. It is responsible for 1.8% of all cancers. The median age is 69–71 years. The treatment of MM is challenging and is affected by several factors such as the patient’s age, comorbidity index, and fitness. The main combination regimen consists of the addition of proteasome inhibitors and IMIDs to steroids. In all studies conducted to date, the results obtained in transplanted patients are better than in patients who did not proceed into transplantation. Before starting treatment, risk stratification should be performed for all patients, and they should be treated accordingly. 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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. 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He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. 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He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. 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In 1992, Dr. Babinszky obtained a Ph.D. in Animal Nutrition from the University of Wageningen. His main research areas are swine and poultry nutrition. He has authored more than 300 publications (papers, book chapters) and edited four books and fourteen international conference proceedings.",institutionString:"University of Debrecen",institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"201830",title:"Dr.",name:"Fernando",middleName:"Sanchez",surname:"Davila",slug:"fernando-davila",fullName:"Fernando Davila",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201830/images/5017_n.jpg",biography:"I am a professor at UANL since 1988. My research lines are the development of reproductive techniques in small ruminants. We also conducted research on sexual and social behavior in males.\nI am Mexican and study my professional career as an engineer in agriculture and animal science at UANL. Then take a masters degree in science in Germany (Animal breeding). Take a doctorate in animal science at the UANL.",institutionString:null,institution:{name:"Universidad Autónoma de Nuevo León",country:{name:"Mexico"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",slug:"miguel-quaresma",fullName:"Miguel Quaresma",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309250/images/9059_n.jpg",biography:"Miguel Nuno Pinheiro Quaresma was born on May 26, 1974 in Dili, Timor Island. He is married with two children: a boy and a girl, and he is a resident in Vila Real, Portugal. He graduated in Veterinary Medicine in August 1998 and obtained his Ph.D. degree in Veterinary Sciences -Clinical Area in February 2015, both from the University of Trás-os-Montes e Alto Douro. He is currently enrolled in the Alternative Residency of the European College of Animal Reproduction. He works as a Senior Clinician at the Veterinary Teaching Hospital of UTAD (HVUTAD) with a role in clinical activity in the area of livestock and equine species as well as to support teaching and research in related areas. He teaches as an Invited Professor in Reproduction Medicine I and II of the Master\\'s in Veterinary Medicine degree at UTAD. Currently, he holds the position of Chairman of the Portuguese Buiatrics Association. He is a member of the Consultive Group on Production Animals of the OMV. He has 19 publications in indexed international journals (ISIS), as well as over 60 publications and oral presentations in both Portuguese and international journals and congresses.",institutionString:"University of Trás-os-Montes and Alto Douro",institution:{name:"University of Trás-os-Montes and Alto Douro",country:{name:"Portugal"}}},{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",country:{name:"Portugal"}}},{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/283019/images/system/283019.png",biography:"Dr. Kerro Dego is a veterinary microbiologist with training in veterinary medicine, microbiology, and anatomic pathology. Dr. Kerro Dego is an assistant professor of dairy health in the department of animal science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. He received his D.V.M. (1997), M.S. (2002), and Ph.D. (2008) degrees in Veterinary Medicine, Animal Pathology and Veterinary Microbiology from College of Veterinary Medicine, Addis Ababa University, Ethiopia; College of Veterinary Medicine, Utrecht University, the Netherlands and Western College of Veterinary Medicine, University of Saskatchewan, Canada respectively. He did his Postdoctoral training in microbial pathogenesis (2009 - 2015) in the Department of Animal Science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. Dr. Kerro Dego’s research focuses on the prevention and control of infectious diseases of farm animals, particularly mastitis, improving dairy food safety, and mitigation of antimicrobial resistance. Dr. Kerro Dego has extensive experience in studying the pathogenesis of bacterial infections, identification of virulence factors, and vaccine development and efficacy testing against major bacterial mastitis pathogens. Dr. Kerro Dego conducted numerous controlled experimental and field vaccine efficacy studies, vaccination, and evaluation of immunological responses in several species of animals, including rodents (mice) and large animals (bovine and ovine).",institutionString:"University of Tennessee at Knoxville",institution:{name:"University of Tennessee at Knoxville",country:{name:"United States of America"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón",slug:"juan-carlos-gardon",fullName:"Juan Carlos Gardón",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:"Catholic University of Valencia San Vicente Mártir, Spain",institution:null},{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/125292/images/system/125292.jpeg",biography:"Katy Satué Ambrojo received her Veterinary Medicine degree, Master degree in Equine Technology and doctorate in Veterinary Medicine from the Faculty of Veterinary, CEU-Cardenal Herrera University in Valencia, Spain. She is a Full Professor at the Department of Medicine and Animal Surgery at the same University. She developed her research activity in the field of Endocrinology, Hematology, Biochemistry and Immunology of horses. She is a scientific reviewer of several international journals : American Journal of Obstetrics and Gynecology, Comparative Clinical Pathology, Veterinary Clinical Pathology, Journal of Equine Veterinary Science, Reproduction in Domestic Animals, Research Veterinary Science, Brazilian Journal of Medical and Biological Research, Livestock Production Science and Theriogenology. Since 2014, she has been the Head of the Clinical Analysis Laboratory of the Hospital Clínico Veterinario from the Faculty of Veterinary, CEU-Cardenal Herrera University.",institutionString:"CEU-Cardenal Herrera University",institution:{name:"CEU Cardinal Herrera University",country:{name:"Spain"}}},{id:"309529",title:"Dr.",name:"Albert",middleName:null,surname:"Rizvanov",slug:"albert-rizvanov",fullName:"Albert Rizvanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309529/images/9189_n.jpg",biography:'Albert A. Rizvanov is a Professor and Director of the Center for Precision and Regenerative Medicine at the Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU), Russia. He is the Head of the Center of Excellence “Regenerative Medicine” and Vice-Director of Strategic Academic Unit \\"Translational 7P Medicine\\". Albert completed his Ph.D. at the University of Nevada, Reno, USA and Dr.Sci. at KFU. He is a corresponding member of the Tatarstan Academy of Sciences, Russian Federation. Albert is an author of more than 300 peer-reviewed journal articles and 22 patents. He has supervised 11 Ph.D. and 2 Dr.Sci. dissertations. Albert is the Head of the Dissertation Committee on Biochemistry, Microbiology, and Genetics at KFU.\nORCID https://orcid.org/0000-0002-9427-5739\nWebsite https://kpfu.ru/Albert.Rizvanov?p_lang=2',institutionString:"Kazan Federal University",institution:{name:"Kazan Federal University",country:{name:"Russia"}}},{id:"210551",title:"Dr.",name:"Arbab",middleName:null,surname:"Sikandar",slug:"arbab-sikandar",fullName:"Arbab Sikandar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210551/images/system/210551.jpg",biography:"Dr. Arbab Sikandar, PhD, M. Phil, DVM was born on April 05, 1981. He is currently working at the College of Veterinary & Animal Sciences as an Assistant Professor. He previously worked as a lecturer at the same University. \nHe is a Member/Secretory of Ethics committee (No. CVAS-9377 dated 18-04-18), Member of the QEC committee CVAS, Jhang (Regr/Gen/69/873, dated 26-10-2017), Member, Board of studies of Department of Basic Sciences (No. CVAS. 2851 Dated. 12-04-13, and No. CVAS, 9024 dated 20/11/17), Member of Academic Committee, CVAS, Jhang (No. CVAS/2004, Dated, 25-08-12), Member of the technical committee (No. CVAS/ 4085, dated 20,03, 2010 till 2016).\n\nDr. Arbab Sikandar contributed in five days hands-on-training on Histopathology at the Department of Pathology, UVAS from 12-16 June 2017. He received a Certificate of appreciation for contributions for Popularization of Science and Technology in the Society on 17-11-15. He was the resource person in the lecture series- ‘scientific writing’ at the Department of Anatomy and Histology, UVAS, Lahore on 29th October 2015. He won a full fellowship as a principal candidate for the year 2015 in the field of Agriculture, EICA, Egypt with ref. to the Notification No. 12(11) ACS/Egypt/2014 from 10 July 2015 to 25th September 2015.; he received a grant of Rs. 55000/- as research incentives from Director, Advanced Studies and Research, UVAS, Lahore upon publications of research papers in IF Journals (DR/215, dated 19-5-2014.. He obtained his PhD by winning a HEC Pakistan indigenous Scholarship, ‘Ph.D. fellowship for 5000 scholars – Phase II’ (2av1-147), 17-6/HEC/HRD/IS-II/12, November 15, 2012. \n\nDr. Sikandar is a member of numerous societies: Registered Veterinary Medical Practitioner (life member) and Registered Veterinary Medical Faculty of Pakistan Veterinary Medical Council. The Registration code of PVMC is RVMP/4298 and RVMF/ 0102.; Life member of the University of Veterinary and Animal Sciences, Lahore, Alumni Association with S# 664, dated: 6-4-12. ; Member 'Vets Care Organization Pakistan” with Reference No. VCO-605-149, dated 05-04-06. :Member 'Vet Crescent” (Society of Animal Health and Production), UVAS, Lahore.",institutionString:"University of Veterinary & Animal Science",institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311663/images/13261_n.jpg",biography:null,institutionString:null,institution:{name:"National Dairy Research Institute",country:{name:"India"}}},{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",country:{name:"United Kingdom"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",biography:"Samir El-Gendy is a Professor of anatomy and embryology at the faculty of veterinary medicine, Alexandria University, Egypt. Samir obtained his PhD in veterinary science in 2007 from the faculty of veterinary medicine, Alexandria University and has been a professor since 2017. Samir is an author on 24 articles at Scopus and 12 articles within local journals and 2 books/book chapters. His research focuses on applied anatomy, imaging techniques and computed tomography. Samir worked as a member of different local projects on E-learning and he is a board member of the African Association of Veterinary Anatomists and of anatomy societies and as an associated author at local and international journals. Orcid: https://orcid.org/0000-0002-6180-389X",institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"246149",title:"Dr.",name:"Valentina",middleName:null,surname:"Kubale",slug:"valentina-kubale",fullName:"Valentina Kubale",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246149/images/system/246149.jpg",biography:"Valentina Kubale is Associate Professor of Veterinary Medicine at the Veterinary Faculty, University of Ljubljana, Slovenia. Since graduating from the Veterinary faculty she obtained her PhD in 2007, performed collaboration with the Department of Pharmacology, University of Copenhagen, Denmark. She continued as a post-doctoral fellow at the University of Copenhagen with a Lundbeck foundation fellowship. She is the editor of three books and author/coauthor of 23 articles in peer-reviewed scientific journals, 16 book chapters, and 68 communications at scientific congresses. Since 2008 she has been the Editor Assistant for the Slovenian Veterinary Research journal. She is a member of Slovenian Biochemical Society, The Endocrine Society, European Association of Veterinary Anatomists and Society for Laboratory Animals, where she is board member.",institutionString:"University of Ljubljana",institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",biography:"Dr. Fonseca-Alves earned his DVM from Federal University of Goias – UFG in 2008. He completed an internship in small animal internal medicine at UPIS university in 2011, earned his MSc in 2013 and PhD in 2015 both in Veterinary Medicine at Sao Paulo State University – UNESP. Dr. Fonseca-Alves currently serves as an Assistant Professor at Paulista University – UNIP teaching small animal internal medicine.",institutionString:null,institution:{name:"Universidade Paulista",country:{name:"Brazil"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",biography:"María de la Luz García Pardo is an agricultural engineer from Universitat Politècnica de València, Spain. She has a Ph.D. in Animal Genetics. Currently, she is a lecturer at the Agrofood Technology Department of Miguel Hernández University, Spain. Her research is focused on genetics and reproduction in rabbits. The major goal of her research is the genetics of litter size through novel methods such as selection by the environmental sensibility of litter size, with forays into the field of animal welfare by analysing the impact on the susceptibility to diseases and stress of the does. Details of her publications can be found at https://orcid.org/0000-0001-9504-8290.",institutionString:null,institution:{name:"Miguel Hernandez University",country:{name:"Spain"}}},{id:"350704",title:"M.Sc.",name:"Camila",middleName:"Silva Costa",surname:"Ferreira",slug:"camila-ferreira",fullName:"Camila Ferreira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/350704/images/17280_n.jpg",biography:"Graduated in Veterinary Medicine at the Fluminense Federal University, specialist in Equine Reproduction at the Brazilian Veterinary Institute (IBVET) and Master in Clinical Veterinary Medicine and Animal Reproduction at the Fluminense Federal University. She has experience in analyzing zootechnical indices in dairy cattle and organizing events related to Veterinary Medicine through extension grants. I have experience in the field of diagnostic imaging and animal reproduction in veterinary medicine through monitoring and scientific initiation scholarships. I worked at the Equus Central Reproduction Equine located in Santo Antônio de Jesus – BA in the 2016/2017 breeding season. I am currently a doctoral student with a scholarship from CAPES of the Postgraduate Program in Veterinary Medicine (Pathology and Clinical Sciences) at the Federal Rural University of Rio de Janeiro (UFRRJ) with a research project with an emphasis on equine endometritis.",institutionString:null,institution:null},{id:"41319",title:"Prof.",name:"Lung-Kwang",middleName:null,surname:"Pan",slug:"lung-kwang-pan",fullName:"Lung-Kwang Pan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41319/images/84_n.jpg",biography:null,institutionString:null,institution:null},{id:"201721",title:"Dr.",name:"Beatrice",middleName:null,surname:"Funiciello",slug:"beatrice-funiciello",fullName:"Beatrice Funiciello",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201721/images/11089_n.jpg",biography:"Graduated from the University of Milan in 2011, my post-graduate education included CertAVP modules mainly on equines (dermatology and internal medicine) and a few on small animal (dermatology and anaesthesia) at the University of Liverpool. After a general CertAVP (2015) I gained the designated Certificate in Veterinary Dermatology (2017) after taking the synoptic examination and then applied for the RCVS ADvanced Practitioner status. After that, I completed the Postgraduate Diploma in Veterinary Professional Studies at the University of Liverpool (2018). My main area of work is cross-species veterinary dermatology.",institutionString:null,institution:null},{id:"291226",title:"Dr.",name:"Monica",middleName:null,surname:"Cassel",slug:"monica-cassel",fullName:"Monica Cassel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/291226/images/8232_n.jpg",biography:'Degree in Biological Sciences at the Federal University of Mato Grosso with scholarship for Scientific Initiation by FAPEMAT (2008/1) and CNPq (2008/2-2009/2): Project \\"Histological evidence of reproductive activity in lizards of the Manso region, Chapada dos Guimarães, Mato Grosso, Brazil\\". Master\\\'s degree in Ecology and Biodiversity Conservation at Federal University of Mato Grosso with a scholarship by CAPES/REUNI program: Project \\"Reproductive biology of Melanorivulus punctatus\\". PhD\\\'s degree in Science (Cell and Tissue Biology Area) \n at University of Sao Paulo with scholarship granted by FAPESP; Project \\"Development of morphofunctional changes in ovary of Astyanax altiparanae Garutti & Britski, 2000 (Teleostei, Characidae)\\". She has experience in Reproduction of vertebrates and Morphology, with emphasis in Cellular Biology and Histology. She is currently a teacher in the medium / technical level courses at IFMT-Alta Floresta, as well as in the Bachelor\\\'s degree in Animal Science and in the Bachelor\\\'s degree in Business.',institutionString:null,institution:null},{id:"442807",title:"Dr.",name:"Busani",middleName:null,surname:"Moyo",slug:"busani-moyo",fullName:"Busani Moyo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Gwanda State University",country:{name:"Zimbabwe"}}},{id:"423023",title:"Dr.",name:"Yosra",middleName:null,surname:"Soltan",slug:"yosra-soltan",fullName:"Yosra Soltan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"349788",title:"Dr.",name:"Florencia Nery",middleName:null,surname:"Sompie",slug:"florencia-nery-sompie",fullName:"Florencia Nery Sompie",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sam Ratulangi University",country:{name:"Indonesia"}}},{id:"208123",title:"Dr.",name:"Mari-Carmen",middleName:null,surname:"Uribe",slug:"mari-carmen-uribe",fullName:"Mari-Carmen Uribe",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"345713",title:"Dr.",name:"Csaba",middleName:null,surname:"Szabó",slug:"csaba-szabo",fullName:"Csaba Szabó",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"345719",title:"Mrs.",name:"Márta",middleName:null,surname:"Horváth",slug:"marta-horvath",fullName:"Márta Horváth",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"420151",title:"Prof.",name:"Novirman",middleName:null,surname:"Jamarun",slug:"novirman-jamarun",fullName:"Novirman Jamarun",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Andalas University",country:{name:"Indonesia"}}}]}},subseries:{item:{id:"91",type:"subseries",title:"Sustainable Economy and Fair Society",keywords:"Sustainable, Society, Economy, Digitalization, KPIs, Decision Making, Business, Digital Footprint",scope:"\r\n\tGlobally, the ecological footprint is growing at a faster rate than GDP. This phenomenon has been studied by scientists for many years. However, clear strategies and actions are needed now more than ever. Every day, humanity, from individuals to businesses (public and private) and governments, are called to change their mindset in order to pursue a virtuous combination for sustainable development. Reasoning in a sustainable way entails, first and foremost, managing the available resources efficiently and strategically, whether they are natural, financial, human or relational. In this way, value is generated by contributing to the growth, improvement and socio-economic development of the communities and of all the players that make up its value chain. In the coming decades, we will need to be able to transition from a society in which economic well-being and health are measured by the growth of production and material consumption, to a society in which we live better while consuming less. In this context, digitization has the potential to disrupt processes, with significant implications for the environment and sustainable development. There are numerous challenges associated with sustainability and digitization, the need to consider new business models capable of extracting value, data ownership and sharing and integration, as well as collaboration across the entire supply chain of a product. In order to generate value, effectively developing a complex system based on sustainability principles is a challenge that requires a deep commitment to both technological factors, such as data and platforms, and human dimensions, such as trust and collaboration. Regular study, research and implementation must be part of the road to sustainable solutions. Consequently, this topic will analyze growth models and techniques aimed at achieving intergenerational equity in terms of economic, social and environmental well-being. 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