The National Center for Complementary and Alternative Medicine (NCCAM) complementary and alternative treatments [87].
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"2244",leadTitle:null,fullTitle:"Photonic Crystals - Innovative Systems, Lasers and Waveguides",title:"Photonic Crystals",subtitle:"Innovative Systems, Lasers and Waveguides",reviewType:"peer-reviewed",abstract:"The second volume of the book concerns the characterization approach of photonic crystals, photonic crystal lasers, photonic crystal waveguides and plasmonics including the introduction of innovative systems and materials. Photonic crystal materials promises to enable all-optical computer circuits and could also be used to make ultra low-power light sources. Researchers have studied lasers from microscopic cavities in photonic crystals that act as reflectors to intensify the collisions between photons and atoms that lead to lazing, but these lasers have been optically-pumped, meaning they are driven by other lasers. Moreover, the physical principles behind the phenomenon of slow light in photonic crystal waveguides, as well as their practical limitations, are discussed. This includes the nature of slow light propagation, its bandwidth limitation, coupling of modes and particular kind terminating photonic crystals with metal surfaces allowing to propagate in surface plasmon-polariton waves. The goal of the second volume is to provide an overview about the listed issues.",isbn:null,printIsbn:"978-953-51-0416-2",pdfIsbn:"978-953-51-4988-0",doi:"10.5772/2632",price:139,priceEur:155,priceUsd:179,slug:"photonic-crystals-innovative-systems-lasers-and-waveguides",numberOfPages:360,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"4b76d54a6aa8ed0a8b5a798f280e48d5",bookSignature:"Alessandro Massaro",publishedDate:"March 30th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/2244.jpg",numberOfDownloads:43850,numberOfWosCitations:36,numberOfCrossrefCitations:7,numberOfCrossrefCitationsByBook:3,numberOfDimensionsCitations:33,numberOfDimensionsCitationsByBook:5,hasAltmetrics:1,numberOfTotalCitations:76,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 6th 2011",dateEndSecondStepPublish:"May 4th 2011",dateEndThirdStepPublish:"September 8th 2011",dateEndFourthStepPublish:"October 8th 2011",dateEndFifthStepPublish:"February 7th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"89960",title:"Dr.",name:"Alessandro",middleName:null,surname:"Massaro",slug:"alessandro-massaro",fullName:"Alessandro Massaro",profilePictureURL:"https://mts.intechopen.com/storage/users/89960/images/2512_n.jpg",biography:"Alessandro Massaro received the Laurea degree in electronic engineering and the Ph.D. degree in telecommunication engineering from the Università Politecnica delle Marche, Ancona, Italy, in 2001 and 2004, respectively. From 2004 to 2006 he worked as Research Scientist (post-doc) in the Department of Electromagnetism and Bioengineering at Università Politecnica delle Marche. In 2006, he spent one year in Research and Development at medical and industrial optics industry (endoscope design and optical systems). He worked for two years with National Nanotechnology Laboratory of CNR-INFM, Università del Salento, as principal investigator. He was team leader in Robotics Lab. platform of the Center for Bio-Molecular Nanotechnology of Italian Institute Technology (IIT), Arnesano, Lecce, Italy. He is currently team leader in Smart Materials platform of the Center for Bio-Molecular Nanotechnology of Italian Institute Technology (IIT), Arnesano, Lecce, Italy. 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Tinnitus is a symptom that can be defined as the perception of noise without any external sound source [1]. It is estimated that around 5–15% of the population have a form of tinnitus, and tinnitus may occur at any age. It is more common in elderly individuals (particularly those aged between 60 and 69) than young adults [2]. Many people with tinnitus appear to overcome this situation; nevertheless, tinnitus becomes a serious condition for a 1% minority [3].
However, the physiopathological mechanisms of tinnitus are not well-defined, and this has so far been the biggest challenge in treatment. Broad etiological diversity and symptom subjectivity in the same patient often make it difficult to achieve good results [4]. Moreover, no specific treatment, including drug therapy, is currently accepted as being effective in the treatment of tinnitus symptoms [5].
It is for this reason that patients with tinnitus continue to look for new and more effective treatments. Many of them have turned their attention to complementary and alternative therapies [3].
Complementary and alternative medicine is now frequently being used in the treatment of tinnitus [6].
The increasing popularity of complementary drugs in the treatment of tinnitus requires meticulous assessment and testing of the studies [7].
In this section, we aim to review complementary and alternative treatments that are being used for tinnitus.
Complementary medicine is defined as being a medical practice, or as an intervention, that is sufficiently documented to demonstrate its safety and efficacy in specific diseases and conditions [3]. The standard treatments accepted for tinnitus are as follows: psychotherapeutic interventions such as white noise generators, behavioral/cognitive therapy, hearing aids, benzodiazepines, tricyclic antidepressants, eighth nerve section, and vascular decompression [8].
A range of complementary treatments, such as acupuncture, yoga, homeopathy, hyperbaric oxygen therapy,
Complementary and alternative medicine is often used in the treatment of tinnitus, and acupuncture is one of used options [10]. Acupuncture is a method of treatment in which needles are inserted into the body and manipulated. Acupuncture (synonyms: reflexotherapy, sensory stimulation) is defined as the practice of inserting needles into the skin and underlying tissues at precise areas known as points. This is done for therapeutic or preventive purposes. Chinese texts from the first-century BC describe the treatment in systematic detail [11]. The treatment of tinnitus through acupuncture is documented in some books [12, 13]. However, there is still a lack in scientific literature of evidence to support the therapeutic efficacy of acupuncture. Studies have shown that needle stimulation creates an electric charge that has the potential of triggering a rebalancing of the system [14]. Chinese scalp acupuncture is a contemporary acupuncture technique that has been around for just 40 years. It combines traditional Chinese insertion methods with Western medical knowledge of the cerebral cortex. The treatment not only alleviates the signs of tinnitus [15, 16] but also has been proven to be a very effective technique in the treatment of various central nervous system disorders [4].
Studies show that acupuncture enhances tinnitus perception, decreases the intensity of the condition, and improves the quality of life of sufferers. Only a few studies report that acupuncture has a significant effect on the treatment of tinnitus, and these reported effects only provided brief respites of relief [4]. Some study participants demonstrated improvements in sleep quality, blood circulation, and muscle relaxation. After treatment with acupuncture, the subjects demonstrated reductions in the interference of the condition in their quality of life, easy masking by the environment, and forgetting the tinnitus in the presence of normal sounds during daily life more easily [6].
The Chinese scalp acupuncture technique, associated with bilateral electroacupuncture (EA), provided statistically significant improvements in decreasing the intensity level of the tinnitus and also improving a tinnitus patient’s quality of life over the short term [6].
A few studies reported that acupuncture could provide immediate relief from both the loudness and discomfort of tinnitus and could thus enable a significant improvement in the patient’s quality of life [4]. Other studies failed to demonstrate the efficacy of this approach [17].
Manual acupuncture, electroacupuncture (EA), scalp acupuncture, and ear acupuncture treatments will also be considered as part of the term “acupuncture.”
Consequently, in clinical applications, acupuncture treatment applied by experienced and licensed practitioners can be an option for patients with tinnitus. This is especially the case for patients who reject psychosocial behavior therapy, which is the only treatment of which there is clinical evidence of an improvement in the quality of life in tinnitus patients. Additionally, as acupuncture is a safe procedure and there is no current treatment with clinically evidenced efficacy for specific tinnitus symptoms, it is an option for treating tinnitus symptoms in patients who apply to clinics for this procedure [5].
Certain mechanisms of subjective tinnitus are not known, and therefore various treatment modalities are useful in some patients, while they are not used in others. Feelings of depression, a poor quality of life, nervousness, hopelessness, and insomnia in patients are reported, and this situation may change depending on the severity and frequency of the condition. A relationship between tinnitus and the prefrontal cortex and limbic system should be stressed. This part of the brain is linked to emotions. Therefore, when tinnitus is severe, a connection can be made between depression, anxiety, and other psychological disorders [18].
Originating in India, yoga is an ancient and holistic system that includes physical postures (asanas), breathing exercises (pranayama), and meditation (shavasana and yoga nidra). Its name is derived from the Sanskrit word “Yuj,” which means to unite, to join, or to add. Yoga is now thought to be the science of existence. The aims of the practice are inner peace and the union of mind, body, and soul. In addition to Ashtanga, Hatha, Karma, Jnana (Gyana), Bhakti, and Kundalini, there are various forms of yoga that enable progress toward these aims. Each discipline is a specific branch of a comprehensive system. Yoga has been reported to decrease sympathetic hormones, stimulate the limbic system, and activate antagonistic neuromuscular systems. Meditation is a hypometabolic state that enables relaxation and reduces the stress caused by sympathetic overactivity. Yoga is reported to play an effective role in reducing stress and anxiety, supporting general health and improving the quality of life [19]. Yoga can reduce stress by certain poses relaxing the muscles of the body and allowing the control of autonomous nervous activity through deep breathing. During meditation, the individual begins a journey toward the inner self. Adopting certain postures allows the body to completely relax, and this helps achieve a higher state of body consciousness.
There are several studies about the therapeutic effects of yoga in cases of conditions such as anxiety, stress, depression, sleep disorders, and stress-related insomnia, as well as hypertension [20].
However, there are few studies in the literature which examine the effect of yoga on tinnitus. Of the studies that do exist, results have shown that yoga exercises performed once a week over 3 months do improve the symptoms of tinnitus. In various studies, yoga has been associated with low levels of stress and anxiety and a high quality of life [21, 22].
Consequently, the findings of studies assert that yoga therapy may play a role in reducing the symptoms of tinnitus [23].
Biofeedback is a process of learning that influences the individual’s physiological processes and aims to provide the best improvements in health [24, 25]. Biofeedback provides information regarding the current state of an individual’s physiological process. This allows the individual to learn to appreciate their individual status. The purpose of biofeedback is to allow the individual more control or influence over the progression of that system [24, 25]. One of the unique characteristics of biofeedback is that the process establishes a connection between the individual’s mind and body [24, 26]. Individuals are usually unaware of the status of their physiological systems.
However, through biofeedback, individuals are given the opportunity of learning how cognitive and emotional processes affect their physiological functions. When individuals realize that they are nervous, they then can influence this physiological system. For instance, during biofeedback, the instance of muscle strain might be used to help individuals recognize that they are nervous or stressed. Thanks to biofeedback, the individual who requests feedback has the opportunity of seeing the effect of relaxation techniques on muscle strains.
Being able to affect the progress of a physiological system is called “self-regulation” [25, 26]. Learning how to affect one’s own physiological functions encourages the individuals to play a more active role in their own healthcare and maintaining a healthy life [24, 26].
Biofeedback is used in the treatment of medical and mental disorders such as anxiety, hypertension, and headache. Additionally, biofeedback is sometimes used as an adjuvant to drug therapy and alcohol treatment. Furthermore, biofeedback techniques are used to not only improve sports performance but also increase optimal functionality [24, 26]. Studies conducted by Sherma (2004) support the activity of biofeedback in many medical and mental disorders [25].
Tinnitus is a subjective auditory perception without any physical external source. While it is known that there is a correlation between tinnitus and cochlear damage, its neurophysiology is not currently known, despite the demonstration of some correlations [27]. Damaged hair cells in the cochlea may cause an absence of neurons in the auditory system and the rearrangement of cortical maps [28, 29]. Cortical neurons, which lack certain frequencies, might become more sensitive to close frequencies [30]. Because of this hypothesis, Dohrmann et al. used auto-activity models of the brain’s non-auditory and noncellular regions for testing. They did this by using magnetoencephalography (MEG) and electroencephalography (EEG) in patients with chronic tinnitus [31]. They found that the reduced power within the delta interval (1.5–4 Hz) and the alpha frequency band (8–12 Hz) was most distinct in the brain’s temporal region. They therefore referred to 8–12 Hz activity as tau activity [32].
Modification of the electrophysiological properties of brain activity may actually affect tinnitus. Neurofeedback has been shown to lead to such electrophysiological modifications [33]. Biofeedback-relaxation training has been assessed for chronic tinnitus [34], and a recent study reports significant improvements in tinnitus distress following a biofeedback-based behavioral treatment [35]. These results might be attributable to biofeedback treatment as electromyography (EMG) parameters remain stable for a period of 3 months [36]. Also, some authors used the relationship between stress, the reduced alpha band, and increased beta band in terms of neurofeedback [37, 38]. It was seen that neurofeedback again increased alpha rhythm and decreased beta rhythm in tinnitus patients.
Similar results were found also in a recent study [39]. A distinct decrease in alpha band (8–12 Hz) and a significant increase in gamma frequency (48–54 Hz), compared to controls, were seen in tinnitus patients [40].
According to a study, tinnitus-related problems in patients decreased following training and in the following months, despite a negligible increase in the tau/delta ratio. It can be concluded that the effects of neurofeedback treatment on tinnitus are enabled by other factors such as placebo, distraction from tinnitus through neurofeedback, etc. However, contrary to the placebo hypothesis in this study, significant results were achieved with patients who received up to 6 months post-treatment, indicating that the results should decrease over time. Stable long-term results for both tinnitus disorder and tinnitus-related problems were also reported in a randomized controlled study of biofeedback-based behavioral treatment [35]. The authors reported improvements in self-efficacy and coping abilities. The effects of neurofeedback on tinnitus comorbidities are therefore seen to be important.
As suggested by Weise et al., a decrease in tinnitus discomfort may be associated with control and emotional control created by neurofeedback [35]. The positive effect of neurofeedback may also be related to the rearrangement of cortical maps [41].
Hypnotherapy is an altered state of consciousness that allows the subconscious mind to be more open to selective and positive suggestion. It can be very effective in coping with the psychological aspects of tinnitus such as anger, stress, and anxiety.
Hypnotherapy is able to involve various techniques by helping patients feel more comfortable with noise. In order to process tinnitus sounds, the subconscious is able to use sounds produced through hypnosis to make tinnitus less threatening and easier to live with by directing the mind in the same way as background noise does.
By working with the mind (particularly with the part of the subconscious that stores memory, imagination, and behaviors), hypnotherapy may help train the brain and change patients’ reactions to tinnitus. An improvement can be achieved in other healthcare problems related to tinnitus by changing the way the mind reacts to tinnitus sounds [42].
This therapy aims to create a deep state of relaxation while protecting normal mental activity. It also allows for better implementation of cognitive-behavioral therapy and some psychological techniques. Modern practice focuses on the studies of Milton Erickson [43], who, derived from many practical techniques, was a keen advocate of the superiority of indirect over direct suggestion. Its efficacy has been evidenced in a series of clinical cases for various conditions, ranging from irritable bowel syndrome [44] to preoperative anxiety [45]. Meta-analysis demonstrates enhanced results for cognitive-behavioral therapy when it is used as a supporting treatment [46].
Auditory cores of the midbrain receive a significant amount of afferents from high centers [47], and subjective experiences of sensory phenomena are modulated to produce striking effects that may cause changes in the levels of auditory cortex activity [48]. Also, as in all chronic disorders, personal perceptions of tinnitus by the affected patient have a strong influence on his/her life. In the light of these two ideas, it can be expected that tinnitus would be suitable for a psychological approach, and indeed, most hypnotherapists consider tinnitus as a treatable condition.
Using hypnosis in the management of tinnitus is not a new concept. Some techniques and case reports which have been debated for over 30 years were published in the literature 20 years ago. Despite hypnosis having quite a long history, few peer-reviewed studies have been conducted on the suitability of various techniques and even the validity of hypnosis as a management strategy. In cases where such a study is present, it is difficult to make a comparative evaluation as there is no standard agreed treatment method. While some individuals assert that tinnitus might be related to chronic pain and treated this way, others use time regression to take the patient back to a time before the onset of tinnitus. Other approaches are to emphasize a session-based approach or the use of self-hypnosis [49].
Hypnotic inner absorption involves concentration and focused attention. When the mind is engaged and focused in this way, it can lead to changes through the use of mind power. The use of hypnosis and self-hypnosis may allow people to gain more control over their behaviors, thoughts, emotional reactions, and even their physiological reactions and physical health.
One study shows that although tinnitus was not altered in 5 of 14 patients, hypnosis did lead to lead to slight relief and reports of the noise being more bearable in the others. There was no improvement in tinnitus matching levels or visual analogue scales in one patient. In another study by Mason, there was no difference between two groups in terms of tinnitus loudness, tinnitus severity, linear analogue scale, and the need for further treatment. The main benefit of hypnotherapy is the fact that it can provide relief and sense of relaxation, making tinnitus more bearable [3].
Tinnitus is the perception of sound in the absence of evident acoustic stimulation. There are traditional medical treatments for tinnitus; however, they have not proven to be satisfactory. As an alternative therapy, hyperbaric oxygen (HBO2) treatment may improve tinnitus, but benefits provided are not clear [50].
Hyperbaric oxygenation permits a controlled increase in the partial oxygen pressure of the blood. This technique can be used for tinnitus and sudden deafness, which has been caused by the development of a lack of oxygen in the inner ear and brain, and the resulting limited energy supply. Current results support the implementation of hyperbaric oxygen treatment as an alternative therapy when standard treatments fail. Some studies have reported an improvement of 60–65% in tinnitus with hyperbaric oxygen treatment. HBO treatment should be initiated at the earliest opportunity, particularly in tinnitus cases that are accompanied by a sudden loss in hearing. Treatment success in case of sudden deafness depends on the rapid application of HBO. HBO treatment extends the range of treatment possibilities for tinnitus and sudden deafness [51].
Tinnitus is a common condition that lacks a practical and effective pharmacological treatment. When tinnitus cannot be overcome through traditional means, patients increasingly turn toward “alternative” or “complementary” drugs [52].
Through the use of a “satisfying dose” for treatment purposes, homeopathic principles may use large “homeopathic” doses of a substance that triggers a symptom in order to stimulate a physiological reaction against the symptoms, thereby eliminating the discomfort. Substances in “active” homeopathic (D60) tablets include pharmacological doses of tinnitogenic medicines such as sodium salicylate, ascaridole, conine, and quinine [3].
In a study, despite survey results showing the preference of homeopathic preparations over placebo in 14 of 28 subjects, a variance analysis showed that neither VAS scores nor audiological measurements could provide significant improvements in tinnitus symptoms as a response to tinnitus. It could not be shown that homeopathy was more effective than the equivalent placebo in the treatment of tinnitus [52].
In another work, results of a placebo-controlled randomized study were published. A study by Simpson on tinnitus disorder, awareness, loudness, and audiological measurements (narrow-band masking) did not show any difference between the groups treated with homeopathic preparations, including sodium salicylate, ascaridole, conine, and quinine and placebo [3].
A low-power laser (LPL), with the power of around 1% of a surgical laser, has been reported to be able to accelerate the healing of injured peripheral nerves and soft tissues and to reduce inflammation and pain [53]. Many studies have revealed that the primary absorption area of LPL within a neuron was probably mitochondrion. When laser light is absorbed, protons are released from the mitochondrion to the cytoplasm. It is thought that protons suppress the permeability of sodium and potassium channels that decrease the frequency of nerve action potential. In animal experiments, the compound action potential of the eighth nerve was suppressed by the irradiation of LPL, through a round window directly to the cochlea [53]. The wavelengths used are between 810 and 890 nm within the interval of 40–60 mW. They are passed through the external auditory canal toward the cochlea.
Three studies have failed to demonstrate a significant response to low-power laser [54].
In a study conducted in 2002, active or placebo laser treatment was transmissionally applied for 6 minutes once a week to 68 ears in 45 patients with unilateral or bilateral tinnitus. Laser was applied four times for a period of 4 weeks. A survey was conducted to evaluate the loudness, duration, quality, and discomfort of tinnitus before and after irradiation. Loudness and pitch match were obtained for tinnitus, and auto-acoustic emissions were also examined. No significant difference was observed between active and placebo laser groups in terms of loudness, duration, quality, and the level of discomfort of tinnitus. One patient had acute hearing loss after the third irradiation of active laser treatment. In consequence, transmeatal low-power laser irradiation with 60 mW is not as effective in tinnitus treatment [54].
Another study was conducted to evaluate the efficacy of 5 mW laser irradiation in the treatment of chronic tinnitus, and 66 ears of 45 patients with chronic unilateral or bilateral tinnitus were treated in these studies. Transmeatal low-power (5 mW) laser irradiation was found to be beneficial in the treatment of chronic tinnitus [55]. Many other studies achieved the same results [56].
According to Takeda, previous studies on the ionization fluctuation of the inner ear on the proteins and phospholipids of hair cell membranes have revealed a potential relationship between ion disorders and tinnitus [57]. Apparently, satisfactory outcomes were achieved with the use of rare-earth magnets in affecting ion disorders and in the treatment of tinnitus. However, it seems that references to these claims do not support them. Takeda’s methods include placing a 4 mm diameter circular 1800 G samarium-cobalt magnet between two thin pieces of cotton and against a tympanic membrane 2 mm thick. An uncontrolled, prospective observational study conducted with 50 patients reported an improvement in the ears of 66% of tinnitus patients [57]. This study was not able to demonstrate any beneficial effect on tinnitus with the use of ear canal magnets. No improvement was seen in either minimum loudness match, minimal masking level changes, or subjective changes in tinnitus severity [3, 57]. In a double-blind study by Takeda on tinnitus treatment in 50 patients that involved the placement of rare-earth magnets, no evidence of significant benefits could be provided with this form of treatment [58].
Using ultrasound for treating tinnitus was found inadvertently. A patient who underwent ultrasonic examination of the maxillary antrum claimed to have had their tinnitus relieved during the process. Improvement is short term but repeatable. It is known that some types of ultrasound might alter cell morphology, biochemistry, or behavior through hydrodynamic shearing forces produced by characterization activity, or typically, by a significant increase in the temperature [59]. However, the exact mechanism which provides benefits for tinnitus is not known. In a study by Rendell et al., there was no significant difference in the loudness match of tinnitus, grading scales analysis, and the verbal reports of the placebo group and the group treated with ultrasound.
Another study by Carrick et al. demonstrated a distinctly more frequent sense of improvement in patients who have used active devices [3]. This study aimed to determine whether or not a low-dose ultrasound applied to mastoid bone provided subjective improvements in the tinnitus levels of long-term patients.
In another study, 40 patients volunteered to enroll in a double-blind study. They received 10-minute treatment with an ultrasound generator, and then the same placebo device, in two separate visits. Devices were separated randomly during the first visit. In every visit, the patients stated whether tinnitus was completely healed, slightly healed, did not change, or was made worse by the treatment. Forty percent of the patients who completed the study were healed through ultrasound, and 7% through placebo. Low-power ultrasound provided a greater improvement when compared to placebo [60].
The suppressive effect of electromagnetic stimulation on tinnitus was observed in patients with cochlear implants. Other studies have found a suppressive effect on tinnitus by using direct current stimulation of the cochlea. Stimulation via the round window membrane is the most effective method; however, the suppression lasts only throughout the current flow, and only anodal stimulation is effective. Risks of this treatment include tissue damage and surgery. The three studies conducted have not demonstrated significant benefits over electromagnetic stimulation. Another study by Roland revealed that the active device provided a significant improvement in the symptom score and tinnitus match, and a 9% improvement was seen in the placebo group when compared to 45% of patients treated with electromagnetic stimulation [61].
Results of another study conducted to determine whether or not pulsed electromagnetic stimulation on mastoid bone provided an improvement in tinnitus level of patients with long-standing tinnitus were reported. Fifty-eight patients volunteered for a double-blind, placebo-controlled study. Active and placebo devices were separated randomly in these patients’ first visit. At the end of the 1-week treatment, each patient stated whether tinnitus was completely removed, healed, did not change, or was made worse by the treatment. Forty-five percent of the patients who completed the trial showed improvement with the active device. Furthermore, 9% of them reported improvement with the placebo. It is therefore thought that electromagnetic stimulation could be an effective treatment with some tinnitus patients [62].
Ginkgo is a tree that grows in China. The first publication on the use of
Reports such as these assert that
Zinc is an important trace element present in all organs, tissues, fluids, and secretions of the body. It is distributed throughout the central nervous system, including the auditory pathway in synapses from the cochlea to the eighth cranial nerve [67]. Zinc is the fundamental component of Cu/Zn superoxide dismutase (SOD). It is important for the proper functioning of more than 300 enzymes, as well as the synthesis and stabilization of deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and proteins. It also plays a structural role in the function of ribosomes and membranes. Otolaryngology-related studies were used to examine the effects of abnormal zinc levels as a cause of anosmia [68] and burning mouth syndrome [69]. Three potential mechanisms relating to tinnitus are linked to zinc [70]: Cochlear Cu/Zn SOD activity, synaptic transmission, and depression. The literature suggests that the prevalence rates of zinc deficiency are more suitable for elderly individuals and individuals with a tinnitus range from 2–69% [70, 71]. Even though not all studies have shown clinically significant results [72, 73], a limited number of studies point to the beneficial effects of zinc on tinnitus [67, 71, 74]. It is possible to improve the overall effect of treatment by classifying tinnitus patients through the measurement of their serum zinc levels.
Melatonin is a hormone produced at night by the pineal gland. Its main function appears to be regulating the sleep–wake cycle. However, not all effects of melatonin have been completely defined [75]. It is readily available as a nonprescription remedy and is widely used to help patients with sleep disorders. Many studies have examined whether or not its use can be connected with tinnitus. In a randomized, prospective, double-blind, placebo-controlled study conducted with 23 patients, melatonin was subjectively reported to be beneficial in tinnitus treatment. Greater benefits were observed with patients with sleep disorders. Other studies have revealed similar results [76, 77, 78, 79].
There are some reports that show a relationship between vitamin B12 deficiency and auditory pathway disorders. In a study, it was observed that vitamin B12 replacement treatment provided an improvement in the tinnitus of some patients. It was also concluded that vitamin B12 serum levels should be monitored routinely while evaluating chronic tinnitus patients. A potential mechanism in a few cases of severe vitamin B12 deficiency is increased cardiac output, arterial pressure, and anemia caused by vitamin B12 deficiency. This increased flow is perceived as a ringing in the ear. Vitamin B12 deficiency is a potentially treatable cause of pulsatile tinnitus. As another potential mechanism, vitamin B12 is required for the mutase activation of methylmalonyl coenzyme A, which is necessary for myelin synthesis [63]. In this way, cobalamin deficiency may lead to combined peripheral and central nervous system dysfunction.
Connections have been made between garlic and some lipid-lowering effects. A few studies have revealed some potential effects of garlic in increasing fibrinolytic activity and lowering blood pressure [80]. It is believed that the main effects of garlic on tinnitus are due to its potential of improving blood flow to the cochlear artery by reducing plaque formation, stabilizing blood pressure, and increasing the antioxidant capacity of the blood. This effect is only theoretical, and there are therefore no scientific studies which examine the potential effects of garlic on tinnitus.
The diversity and lack of standardization in terms of the preparation of herbal treatments’ diversity make it almost impossible to come to a meaningful conclusion regarding their efficacy. No study has yet been conducted using scientific methodology, and so any claims about the benefits of herbal treatments are merely anecdotal.
The use of the herbal medicines bojungikgitang and banhabaekchulchonmatang in the treatment of tinnitus has its origins in the principles of traditional Korean medicine. Generally, tinnitus is thought to develop due to dysfunctional irregularities in the intestines and visceral organs. Bojungikgitang is used in the treatment of chi energy deficiency, and banhabaekchulchonmatang is used to treat gallbladder problems, which are thought to be associated with tinnitus. These two remedies are very common in Korea and have been approved by the Korea Food and Drug Administration as herbal medications in adults for the treatment of tinnitus.
Despite the lack of scientifically solid studies, there are anecdotal reports that suggest that traditional Chinese medicine is successful in relieving tinnitus. Er Ming Fang (EMF01) is a Chinese herbal mixture that contains various different herbs. Research studies have not demonstrated any benefits with salicylate-induced tinnitus in rats [81].
Yokukansan is an herbal medicine used in traditional Japanese medicine. It is thought to be an effective treatment for undifferentiated somatoform tinnitus [82].
Tinnitus patients are sometimes attracted to nontraditional or alternative treatments. However, there is no convincing evidence of the efficacy of any complementary therapy in the treatment of tinnitus [83]. However, considering the lack of traditional treatment options, and the placebo reaction which is observed with tinnitus, low-risk therapies such as aromatherapy should not be dismissed, and they are often sought by patients.
The basis of holistic and complementary treatments is primarily the fact that they reduce the symptoms of patients or minimize the discomfort associated with such symptoms. Aromatherapy, which is the most common alternative approach, requires a combination of essential oils and massage to reduce the symptoms of the disorder and make the patient feel better.
Aromatherapy uses frankincense, which dates back to ancient Babylon, and various oil groups (e.g., rowan, chamomile, frankincense, lavender, and mint) [84]. Hippocrates suggested that the way to health was to have aromatic baths and massages. It is known that virgin cedarwood oil was used for hygienic purposes 5000 years ago by the Egyptians [85]. Both the lavender plant and its essential oil were used by abbess Hildegard of Bingen at the beginning of the twelfth century. It is thought that the essential oils of turpentine, cinnamon, frankincense, juniper, rose, and sage were known and used in the fifteenth century [84].
According to the results of this study, it is considered that the majority of patients benefited from aromatherapy, while the benefits were shown to be non-specific rather than directly associated with tinnitus. Patients reported that the aromatherapy helped them to relax and that other somatic symptoms were eased.
Even though aromatherapy has a negative effect on being able to ignore tinnitus, relaxation was also seen to be advantageous in other studies on relaxation approaches [86].
A list of The National Center for Complementary and Alternative Medicine (NCCAM) complementary and alternative treatments can be found inTable 1.
NCCAM classifications | CAM therapies | |
---|---|---|
Alternative medical systems | Acupuncture | Acupuncture by experienced and licensed practitioners might be an option for tinnitus patients, which can help decrease the intensity of tinnitus and improve the quality of life for patients. This treatment tends to only be for the short term. Nonetheless, it remains a possible treatment for patients and is a relatively safe procedure for patients to consider |
Homeopathy | In homeopathy, through the use of a “satisfying dose” for treatment purposes, homeopathic principles may use large “homeopathic” doses of a substance that triggers a symptom in order to stimulate a physiological reaction against the symptoms, thereby eliminating the discomfort. This remedy may be beneficial to a person who has tinnitus with associated deafness | |
Hyperbaric oxygen treatment | Hyperbaric oxygen (HBO) treatment as an alternative therapy when standard treatments fail. HBO treatment should be initiated at the earliest opportunity, particularly in tinnitus cases that are accompanied by a sudden loss in hearing. Treatment success in case of sudden deafness depends on the rapid application of HBO | |
Mind–body medicine | Yoga, hypnosis, biofeedback, neurofeedback, imagery | Mind–body medicines have been associated with low levels of stress and anxiety and a high quality of life. These therapies can be very effective in coping with the psychological aspects of tinnitus such as anger, stress, and anxiety. The main benefit of mind–body treatments is the fact that they can provide relief and sense of relaxation, making tinnitus more bearable |
Biologically-based therapies | Dietary and herbal supplements Aromatherapy Chinese herbal medicine Chinese medicine Dietary medicine Clinical nutrition including multivitamins and minerals Western herbal medicine | The use of biologically based therapies to treat tinnitus is common, particularly with |
Manipulative and body-based methods | Magnet/laser therapy | Application of magnets and ultrasound has been found to be placebo therapies for tinnitus or to have limited scientific supports for their effectiveness. Additional studies are needed |
Energy therapies | Bioalan (Bioelectromagnetics) | Recent and ongoing research studies have attempted to assess whether transcranial magnetic stimulation could be an effective tinnitus treatment. This application is based on the thought that tinnitus is associated with an irregular activation of the temporoparietal cortex (a part of the brain) and thus that disturbing this irregular activation could result in transient reduction of tinnitus |
The National Center for Complementary and Alternative Medicine (NCCAM) complementary and alternative treatments [87].
Tinnitus does not have an established treatment as its pathophysiology has not been completely understood. Patients who cannot sufficiently benefit from medical treatments often try complementary and alternative treatments. In the studies conducted, it was demonstrated that such approaches provided benefits for some tinnitus patients. Through a holistic approach combined with medical know-how, patients can gain control over their problems, decrease, or even eliminate the effects of these problems. For that reason, the prevalence and acceptance of nontraditional approaches for tinnitus have increased among both patients and practitioners. Consequently, it is recommended that patients who cannot sufficiently benefit from medical treatments be referred to acknowledged experts for complementary and alternative treatments.
Formal education in Oman could be said to have started in the 1930s, under the reign of Sultan Said bin Taimur who is the father of the current Sultan of Oman (Sultan Qaboos); one of the teachers of Sultan Said bin Taimur is known by Sheikh Ahmed bin Sulaiman bin Zahran al-Riyami. He taught the Holy Quran, Arabic and arithmetic, and is known as the “father” of education in Oman [1]. Education was predominantly imputed by the Islamic establishment where religion, Arabic language, and arithmetic were taught in mosques and private homes. One of the first schools in Oman was established in Muscat in 1871 (now the capital of Sultanate of Oman) known by the Al Zawawi School in Al-Khor Mosque next to Al Jalali Fort. The school was run by the Imam of the Mosque, who taught the Holy Quran, the fundamentals of religion, and Arabic language including reading, writing, grammar, and rhetoric. Other well-known schools which opened their doors to Omani students were the Alrahyal School established by Mahnon Ben Alrahyal in Sohar and the Bayada Balrstak mosque and Aldharh School in Bahla and the Alqalah School in Nizwa. Formal education started to take shape [1].
\nThe earliest school was the Masjid Al-Khor in Muscat which opened in 1871 and closed its doors in 1988. There was also Beit Al-Wakeyel School, and the Sheikh Rashid Bin Aziz Alkasibi School was one of the oldest schools that opened in 1888 for government employees. Later in 1914 came the Bothiynah School which carried the name after Mohamed Ali Bouzaiene, who came from Tunisia to Oman under the reign of Sultan Said bin Taimur. The school was open for girls and boys and attended in a rented house in Muscat. The school taught the Quran, Arabic language, history, geography, and arithmetic. The school also adopted a study plan that included six classes per day, and its student enrollment did not exceed 120 students; most of the students were accommodated in common and large rooms for males and females [1].
\nThe semi-formal schooling started in the mid-1930s, with the first known by Nader Ben Faisal School which opened its doors in 1932; at the same time, many nonformal schools were opened which taught the Holy Quran, Arabic, and arithmetic. Beginning of the last century, the Al-Saidiyyah School in Muscat opened in 1940 as a semi-public school. The Al-Saidiyyah School included classrooms, administration, and teachers’ rooms. It consisted of two stages: the first was a two-year primary school and the second was a six-year primary school. Al-Saidiyyah schools were very popular in which they accommodated for a large student body and had a curriculum attuned with the national educational goals. The school was staffed by teachers from Arab countries and some Omani teachers. The Al-Saidiyyah schools were limited to the study of the Quran and teaching matters of religion, as well as reading, writing, and arithmetic (collection, subtraction, multiplication, and division). The mathematics, science, history, geography, and Arabic language curriculum they used was available from Lebanon. The second and third Al-Saidiyyah schools where in the Muttrah region, administratively located in the Muscat province and Salalah (further point in the south of the country), respectively [2]. The school and its branches continued to grow substantially and developed in 1955, to be able to relocate to its own premises. The large part of schooling was driven by an Islamic educational framework fathered by the likes of Al-Sahabi Al-Jalil Mazin Bin-Ghodouba and Al-Jalandi Bin Masoud—these schools mainly taught the Koran with classical subjects as arithmetic, Arabic, and geography. There were also religious schools in Muscat such as Masjed Al-Khod and Madrasat Al-Zwawiah—both schools taught religion and Arabic [3].
\nThe Al-Saidiyyah School in Muttrah moved to its own building in 1960; in the same year two other third and fourth primary schools were opened. Within 2 years, the primary level was completed until the sixth grade and the graduates obtained the primary certificate. Despite the school’s modest and limited resources, they have been credited being citadels of cultural and intellectual movements in the Sultanate and enriching the Omani heritage and culture. The educational development in Oman was centered around population centers with critical masses and mostly around Muscat. Not later than the 1970s had Oman experienced substantive growth in the development of the educational sector with the discovery the oil and gas (which drives the modern day economy). The development was mostly located around the center of commerce of the Muscat region as well as Muttrah which has now the largest sea port in the region [4].
\nThe growth in the educational sector started in 1970 at that time the number of students did not exceed 900 and in mere 5 years there were 207 schools with 55,752 students [5]. In 1986, there were 588 schools and 218,914 students enrolled; at the end of 2015, there were 56,211 teachers and 523,522 students. Till today, Oman had provided free education and encouraged every child to enroll in a school. As of 2017, there were 565,184 students in schools; there were also 1091 schools offering what is currently known as the basic education programs and post-basic education of grade 11 and 12 programs. The school staff serving these schools amounted to 60,165 [1, 6, 7]. Added to that, the private education sector has also grown tremendously with over 486 private schools in 2015, serving more than 97,465 students [7].
\nThe major educational challenges in Oman were several, among the first was the long distances between population densities. The country was geographically spread over thousands of miles apart with two population centers one in the North (Muscat—now capital) and the second in the South (Salalah region, respectively) and small villages spread across Oman’s mountainous terrain. It was thus hard to provide the basic infrastructural services as roads and electricity; it was also hard to find the human resources to support teachers and administrators in distant villages. The challenges were concrete and tangible particularly in improving the quality of the teaching and learning process as well as the quality of student outcomes in an information-driven world [8].
\nSecond, with Oman being linguistically, ethnically, and religiously diverse; preservation of tradition, culture and language and concomitantly to move forward in its educational mission in face of a fast changing world was a major challenge. Thus, in unifying the country as an Arab speaking and part of the Islamic world, the reform has stressed and celebrated its cultural heritage, its diverse cultural tradition, religion and languages. Third, on seeing the changes the world has gone through in the last decade, particularly in the integration of technology in education, and the way technology has changed the school, curriculum, or even the delivery of instruction, schools in many parts of Oman were left behind to deal with the technological changes. The reform thus, stressed on modernizing the school infrastructure and technological practices.
\nOman’s national strategy was to establish a modern society having a solid infrastructure for education and economy, being able to engage with the technological advances in an advanced and technologically driven world. The Ministry of Education also underlined and stressed on the scientific approach in teaching and in the acquisition of knowledge to move society forward, innovate, and reproduce itself scientifically. Thus, education was seen to have a perennial purpose in instilling the intellectual skills and knowledge acquisition of life skills for citizenship and life-long learning. The objective of these strategies was to build a holistic Omani character, able to deal with the current and future challenges, and engage in the making of important—objective and scientific approaches to deal with the modern and the technological age [8].
\nFourth, a major challenge facing Omani graduates from secondary schools was their inability to deal with the complexity of everyday life. Thus, this included the ability to analyze and solve problems and being flexible, accommodative, and self-directed [9]. Also, alluding to the work of Wagner, Kegan, Lahey, Lemons, Garnier, Helsing, Howell, and Rasmussen [10], it was suggested the three Rs, rigor, relevance, and respect, were generally missing in Omani schools. Rigor means the ability to do and be able to perform due to their learning, relevance as it relates to what they learn for the future. Respect means the ability to deal with others and adequately respect one another in different context. This has also imputed a new way of thinking and seeing of the new curriculum and how teachers deal with knowledge, the curriculum, and how it is translated to students. It also allowed for the reconceptualization of what school outcomes fit with twenty-first century goals, as to reflect on programs that can prepare students and make them understand the world around them. The impetus also suggested that education is tied to social change, reaching beyond the limits attained by a process in which teachers and students transform their work into productive elements in society and also engage in the social or economic transformation of the nation.
\nFifth, Oman like other Gulf states relies heavily on an expatriate work force. With low levels of Omani human capacity, fulfilling jobs in brick and mortar industries, Omanis on a general level have greater reliance on “external-foreign”—cheap labor. A national strategy was put in place to train and sustain a large local unskilled labor force [11]. The goals set are still unreachable; challenges abound on the social level. Omanis vie for administrative nontechnical government jobs, and the large private sector shuns Omanis from its workforce. Even many employers feel that students once graduated from school or completed some level of tertiary education lacked “soft skills” and the ability to develop these skills, such as team work, public speaking, problem solving, critical thinking, and a strong work ethic in the public or private sectors [12].
\nSixth, while Oman has a large cadre of teachers, many of these teachers according to the World Bank had little training in pedagogical practices. There was also limited practical and applied school training due to a lack of trained trainers. It was also emphasized that teachers were doing significant administrative duties, and added to that, there was increased working hours and a higher number of working days for administrators and teachers [8]. The recent literature specifically by Darling-Hammond [13] suggests that teacher quality is one of the most important factors for student achievement and draws on such factors as teacher training and further professional development. Oman’s large teaching-work force reported by the World Bank lack the practical and pedagogical skills needed to operate in modern institutions. Many teachers in the area of expertise have little opportunities to undergo the needed training. There was also a lack of focus on the process of teacher practice, to deal with classroom initiatives and classroom orientations. It was apparent there was a complete alienation between teacher practice, peer activities, and student learning; thus, in many schools in-service training should focus on teaching skills for quality learning [14].
\nIn face of the ever-changing global world, leadership believed that a strategy be in place where technology management, integration, and usage appeared to be a challenge among Omanis as they still abound to compete in a global world. It also appeared that new educational goals prepared Omanis for life and work; the new ecosystem required greater integration of technology in their daily lives. Still, Oman’s adaptability was challenged in a rapidly changing technological world and a global world [2].
\nLastly, challenges appeared in the preparedness of children entering early-years education. Preschool appeared to be missing and nonexistent especially for the majority of publicly funded schools. It is only recent that early education started taking shape as a precursor to primary education. Also, appetite for investment in private schools and international schools lacked the funding needed to accommodate for the majority of the population as they could not afford school fees [15]. Other important elements were the complete absence of special needs, early childhood education centers, and particularly the establishment of schools for special needs [8].
\nThe challenges were considerable in the trajectory of Oman’s development of the educational system which took a great quantitative leap firstly in the development of the educational infrastructure and the second phase, a qualitative impetus, to fit the local and basic education needs of Omani society [9].
\nThe first reform that took place in Oman was in 1976, during which a development plan emphasized a quantitative increase in infrastructure and teacher development. In 1978, the first white paper underlined the national and global changes, linking education to the development of Omani citizens. More significantly, it stressed on the Omani identity and the ability of the large populace to modernize, think rationally and scientifically, be able to assimilate knowledge using modern tools, and acquire the needed thinking skills, as well as become self-effective learners [16]. During the development plan, emphasis was placed on the development of the educational services and the diversification of education by establishing two preparatory schools and professional-technical institutes specialized in technical education to accommodate the intermediate certificate holders. Among these institutes were the Nizwa Agricultural Institute, Teachers Institutes, and the Commercial Secondary School [17]. Initiatives were taken for school improvements in laboratories, resource rooms or workshop facilities, technology and other building amenities. At the same period, the establishment of the first school for people with special needs known by the Al Amal School for the deaf and mentally challenged. Since its inception, Al Amal School reached 309 students in the academic year 2005/2006. The need for such schools remains to be high to this date [18].
\nThe second Five-Year Plan 1981–1985 was a period known by the educational renaissance which continued in two directions: the spread of education through out of Oman and in parallel a qualitative leap in the improvement of the teaching and learning process. The strategy established was to spread education to the remotest areas of the Sultanate and on the other hand, a qualitative initiative that attempted to enrich the schools with the needed services and resources. The creation of the alternative primary schools known by the integrated schools continued to expand creating an integrated curriculum across subjects. The integrated school combined the two stages which supposedly had a purpose to increase the learning process. The preparatory schools were provided with the laboratory, library, and family education room for girls’ school. At the same period, the teachers’ institutes were established and known mostly as the “intermediate colleges”; the duration of the programs in these college was for 2 years and prepared teachers to practice teaching in schools [19].
\nIn the academic year 1983/1984, the Ministry embarked on opening specialized schools, including the industrial school in Al Batin area which enrolled male students. In the following school year, the “rational school” was opened in Muscat to accommodate students with mental disabilities, rehabilitation, and providing services for students with special needs. In the academic year 1984/1985, the educational system in Oman introduced cycle 1 and cycle 2; added to that, a two-year secondary school comprising of grade 11 and 12. In the year 2001/2002, Omar bin Khatab, a privately funded institute for speech and the blind, opened its doors for students with special needs. The number of students in the academic year 1999/2000 was 11, while in 2006/2007, it reached 115; its growth reflects the greater needs for such institutes in Oman and in the Gulf. Part of the higher education development plans was a number of educational establishments to train in trade, technical, agricultural, and education which included the establishment of the Education, Institute of Justice, Institute of Health Sciences, Institute of Finance, Professional Training Institute, Institute of Public Administration, Oman College of Industrial Arts, and the Police and Internal Security Training Centers [20].
\nDuring the period between 1985 and 1990, the scaling of educational infrastructure became more apparent with the growth of the schooling system. In line with national strategic development was promoting principles of quantitative expansion of the education sector, especially in infrastructure projects and programs. During this phase, there was also a scaling up of the educational services and educational infrastructure projects, in parallel to qualitative improvement in the educational processes. Education was seen within the macro-economic scheme, thus linking educational costs to returns in terms of building human capacity. The plan was to support young Omanis to take a greater initiative in seeking the training and eventually provide the supply for the needed human resources to serve the public and private-industrial sector with the increase in student enrollment and by encouraging every child to seek an education especially in the remotest areas of the country. It was thus necessary to find some suitable educational outposts in the rural areas of the Sultanate to serve students across Oman. Compounded with the rush to improve teacher quality, the Ministry extended and stressed on the development of education in the Sultanate in terms of quality and quantity, through teacher development and infrastructure of schools, respectively. It also took a challenge where it began to train Omani teachers to obtain the pedagogical skills in subject specialization.
\nIn the academic year 1991/1992, the Ministry made substantial changes to expanding the system and moved to eradicate illiteracy among adults; also the beginning of afternoon schools started the adult education programs. At the same period, the Ministry of Education increased the number of teacher training colleges and other specialized colleges as the Institute of Educational Rehabilitation. The establishment of the teaching colleges allowed Omanis to obtain the pedagogical training having subject specializations to reach teaching qualifications for those whose first degrees were in subject specialization [4].
\nThe period from 1991 to 1995 included infrastructure developments and aimed at continuing the achievement of educational outcomes by balancing between quantity and quality. More accountable measures were in place to balance between spending and the educational returns produced. In the period between 1996 and 2000, Oman set goals to modernize all aspects of Omani life with the desire to achieve self-sufficiency, economic diversification, and sustenance to keep abreast with the global and technological advancement [21].
\nIn the same period between 1991 and 1995, the Ministry of Education had embarked on the establishment of the basic education system which was later implemented in 1998/1999 academic year, which aimed to develop the educational infrastructure to improve the quality and reduce its cost. The Ministry was also able to instill and prepare students to deal with twenty-first century skills, building on soft skills by encouraging the learner to deal with the necessary aspects to better develop the communication skills, self-learning, and the ability to think critically and thus adapt to the latest developments [22]. In the late 1990s and at the beginning of the new century, the implementation of the basic education system came to replace the primary, preparatory, and secondary school; it aimed to develop programs that were centered around twenty-firstst century skills. From 2001 to 2005, the same level of development and growth continued the previous stage [23]. Specifically, from 2006 to 2010, the period was characterized mostly by scaling the implementation of the basic and post-basic education system. In addition to expanding the application of the latter to all schools, the years 2006–2010 were dedicated to the development of post-basic education in addition to the development and application of the basic education in the lower classes. It became apparent that educational change focused on the content and linked the theoretical applications with practical applications. The approach was also to develop a research initiative allowing greater insight and curriculum revision. It also stressed on the post-basic education system, in line with international experience and benchmarking.
\nThe period between 2010 to the present experienced substantive initiative in the improvement of teaching practices, creation of forums, and teaching collaboratives. Increasingly, schools were given the autonomy to run their own training programs, and this included the development of curriculum, collaborative initiatives that draw on their own capacity of local teacher trainees, and training programs. Many public schools were in line with national and strategic initiatives, an overall initiative stressed on self-sufficiency initiatives with a general aim to sustain Omani teachers and develop effective teacher training programs. A broad aspect of this project was the assessment of school and teachers’ needs in the newly educational structure established, keeping in mind that few studies or reports have emerged addressing the training programs and the kind of teacher training needed. Nor was there an assessment of the educational facilities, teaching styles, or learning styles within schools. Also, many schools started to share expertise with each other and initiated the collaborative communities between and within schools [24].
\nAt the same period, the Ministry of Education was interested in assessing school supervisors as well as teachers. Assessment took a 360-degree approach in which it covered all aspects of the school system; concurrently, great strides were taken to improve the quality of teachers especially in providing continuous professional development, instilling research capacity and action research as a necessary element for teacher development to improve classroom practices and teaching quality. The Ministry also encouraged schools to improve practices by creating collaborative communities where teachers and staff would share expertise.
\nThe reform established the basic and the post-basic education system in 2007/2008. The basic education system extended from grade 1 to 10. The structure was divided into two cycles; the first cycle consisted of four years (grades 1–4) and cycle two consisted of 6 years (grades 5–10). These two cycles are considered as the basic education; the post-basic education students enter into secondary education made of grades 11 and 12, or otherwise join vocational training institutions. The new post-basic education system organized on a “core plus electives” model for grades 11 and 12 was introduced in 2007. This gradually replaced the existing system of 6 years of primary, 3 years of preparatory, and 3 years of secondary schools, but the range from beginning to completion has remained the same. The basic and guiding principles of the basic education included the stress on structural and system wide changes in the schools as in (1) the development of a philosophy of education; (2) establishment of a set of objectives compatible with student needs; (3) restructuring of the school and educational system through delegation of responsibilities, policies, rules, and regulation; (4) reinforcement of teaching mathematics and science in the English Language; (5) population of students to enter the higher education system; (6) stress on life skills throughout the curriculum; (7) allow for project-based learning; (8) provide students the autonomy to choose from different courses; (9) development of life skills as needed; (10) creation of teaching strategies and methods that integrate technology; (11) effective professional development for all school staff; (12) continuous infrastructure development in technology; and (13) quality assurance and improvement initiatives.
\nThe foreseen outcomes of the basic education system were to bring the work experience into the educational system. Its intent was to replace expatriate labor force with highly qualified Omani citizens which would have the advanced training before they enter the workplace and thus compete with the large expatriate one. This was also a way to entice and encourage Omanis to have a greater role in the labor market, and in particular emphasize and entice women to take part in the labor market [12]. The other and main focus was on the post-basic education reform which focused on grade 11 and 12. The Ministry of Education attempted to impute the educational process and reinforce the educational reform by stressing on reshaping the last two grades of 11 and 12 of secondary schools. It also attempted to reexamine the content and how it could be translated into practical terms to the lives of students. The stress on the last two grades after the basic education had students relate their education to the real world. The new initiative also stressed on the curriculum and teacher training to emphasize critical thinking, long-life learning, citizenship of the world, and global issues, as well as humanity, cultural diversity, instances, and context which make them value the contextual richness. The post-basic framework drew on three important frames in the hope that it reflects on the outcomes that embody the latter dispositions and include the theoretical knowledge, research, community service, and overall excellence.
\nWhile the basic and post-basic education system of grade 11 and 12 began in 2007 and scaled to all public schools in Oman, it completed the transformation of all public schools. Couched within new educational philosophies, the Ministry dedicated a large part of its resources to train and retrain teachers and school staff on the curriculum and teacher training [25]. Today, the educational system is well under way and draws on those elements of continuous improvement, benchmarked along international standards allowing for involvement and awareness by the public.
\nThe educational reform that took place in the 1970s, was not evaluated until 1994. The initiative involved a collaboration between the Ministry of Education and the Scottish Qualification Authority, and collaboration between their evaluation summed the educational conditions in Oman. The educational system was traditional, curricula were rather generalized, and education was content-centered as opposed to student centered. Schools and the Ministry lacked a clear vision and mission. Books were outdated, and the educational process was mainly driven by tests and centered around the dense curriculum [25]. Teachers also lacked the skills needed to transform schools into places of learning or made initiatives to face the challenges to advance the needs of the Sultanate of Oman. The initiative envisioned to produce high-quality graduates of general education geared toward skills in problem-solving, critical thinking, and analytical skills [26]. A later study came from the World Bank and the Ministry of Education with two main recommendations in their assessment: creating a culture of excellence and making and developing strong pedagogical skills among teachers [27].
\nThe leadership had also invested interest in education and made great strides in the improvement of quality of education for the development of high-quality human resources imputed by the Oman’s economic future in vision 2020 [1]. The Vision 2020 of Oman was a landmark document and provided a frame to move the Omani economy forward. The document also served as a framework of the country’s educational system. The Vision 2020 aimed to achieve the status of a “Newly Industrialized Economy,”, lowering the disparities between Oman and Oil-rich countries in its surrounding. In vision 2020, Oman attempted to build a solid foundation for human resource development, to offset dependency on Oman’s limited oil reserves. The blueprint document was both to move the educational strategy forward among Oman’s other economic, social, and human resource developments.
\nThrough the Vision 2020, several educational recommendations were made to the Ministry of Education; among those suggestions was to create a basic education road map that can prepare students to continue their education or join the work force. Mainly the five-year plan between 1996–2000 focused on the development of human capacity [23]. Educational training was one of the key pillars through the improvement of the curriculum that focused on two main aspects. Firstly, the content of the curriculum and secondly, teaching methods. In terms of the curriculum and subject matter, the attempt was to reduce the theoretical parts and connect the material to lives of students and the real world. In addition, teachers were required to align the curriculum to student abilities at each educational phase. Teachers were to reduce the reliance on rote learning and memorization and move forward through constructivist approaches with focus on problem-solving, critical thinking skills, and cooperative work, with the assumptions that students were inclined to move away from rote learning and teacher practices centered on classrooms around student initiatives and learning [24]. In parallel to the changes in the system, the initiative was to write a new curriculum supported by teacher guides. The new material was gradually implemented in the schools starting 1998/1999 and continued to date.
\nThe basic education was different from the general education in that it integrated between theory and applications, developing the individual character. The basic education curriculum aimed at providing the learners with the required life skills and preparing them for the work place through life skills, independence, and values embedded in the curricula. Given the challenges of English language proficiency [24] and likewise competencies in mathematics and science, a curricular review was eminent. More so the Ministry was intent on developing a curricula and methods for the two subjects of mathematics and science [25].
\nA major benchmark in Omani educational history was in 1997 right after the Vision 2020 publication; a clear agenda was put in place which outlined the strategic plan for the next two decades. Its main goals were to equip students with the technological, scientific, and advanced knowledge to move the country’s educational system as well as its economic development along twenty-first century skills. The plan was to improve the educational system as a whole which included teacher qualifications, changing the way assessment was performed, closing the afternoon school system and lastly but not least, extending the school day and year.
\nSignificant challenges were seen in how teachers undertook the classroom teaching. Many instructional practices have been pervasive and centered on the traditional rote methods, away from the more substantive and deep approaches to learning. In addition, the alignment of content, sequence, and teacher practices appeared to be unaligned to grade level. While faced with substantive barriers for the improvement of schools, the Ministry of Education has been unable to provide the required resources for the realization of the comprehensive initiatives to improve the quality of education of the required level. But initiatives for improvement has been widespread, this including the process of decentralization as a policy which provided administrative and financial autonomy, giving regional authorities jurisdiction in making administrative and budgetary decisions to state directories. The Ministry of Education lacked the capacity to provide training programs for Omani teachers and management of human resources. Added to the fact that a great number of teachers were migrating from the rural areas to urban areas, leaving many rural schools understaffed [2], it was also not easy to also distribute teachers to all areas and to keep a balance of teachers in rural and urban areas.
\nSystem wide changes appeared in the integration of content subject matter, which included the integration bundle subjects as Islamic Studies, Arabic and Social Studies and in another, Mathematics and Science. Each field had the same teacher who teaches the bundle subjects which insured to some extent the integration of the material. Other new subjects were introduced in the curriculum as information technology and environmental life skills. While curriculum changes were done gradually, the adaptation was done in stages. To allow for school staff to deal with the major changes to the curriculum methodology for basic education, the new system was first introduced to 17 schools in the 1998/1999 academic year and 25 schools the next academic year, having been delivered to all schools in 2006/2007. In addition, the teaching of mathematics and science in English and teaching of English needed a major overhaul, which suggested these subjects to be more attuned to life and communication skills, public speaking, problem solving, and critical thinking [24].
\nAnother significant change in the system has been the extension of the school year. Oman had one of the lowest numbers of school days when compared to some of the industrialized countries whose students had scored in the upper first quartile in the world on the Trends in International Mathematics and Science Study (TIMSS). Further, many school graduates were challenged by English and had to repeat at least a year of English, mathematics, and information technology to be able to enroll into a regular university program. While several reasons have been attributed to the poor academic outcomes, it was believed that teaching days were lost due to examinations, special events, and other missed holidays. To keep in line with international norms, as an example, Japan (240 days) or Singapore (200 days), extending the school year meant that students would be more at task and would have better performance results. The Ministry decided to extend the school year to 180 days to bring it more into line with hours of schooling in other countries. The school-day increased to 8 periods per day and each period to 40 min per day, which resulted in an overall 60% increase in hours compared to the old system [2].
\nEnglish was stressed and started to be taught from grade one of the first cycle. The Ministry also implemented a procedure for curriculum and new teaching approaches, for instance, the teaching of the mother tongue by integrating with other subjects as Islamic studies, geography, and history. It also attempted to adopt international curriculum in the first cycle to keep in par with international benchmarked curriculum. The Ministry of Education also started a comprehensive quality approach to the educational system including the education board (region) and schools. Such approaches included the data-driven performance measure which increased efficacy of decisions along administrative operations. Administratively, three major offices have been established and included the Directorate General of Human Resources Development and Curriculum Evaluation Department and the Directorate General of Planning and Quality Assurance Office all working to support one another in the process of deliberation and evaluation of programs and systems [3].
\nOther initiatives were made in the improvement of teaching quality, whereby a reconceptualization of the pedagogical approaches was made in the way teachers were asked to give feedback to students and change the way the assessments were applied in the teaching and learning process [28]. The reconceptualization of the pedagogical approaches shifted in the way school instruction could be a predictor of school success. Suggestions were also made in regard to how the assessments were taking place in class. Teachers drew on new concepts of continuous assessment where students could be given continuous feedback in ways to overcome the challenges and provide teachers an understanding of where students could face difficulties in their lessons or concepts. Also, the Ministry of Education and the World Bank suggested that these assessments need also to identify male students to face most of the difficulties because many of them tended to discontinue and dropout from school.
\nIn parallel to system and structural wide improvements made in schools and the Ministry, teacher practice was an important and significant element to the overall improvement of schooling. The preparation institutes were established which gave qualification programs and the start of vocational, industrial, and agricultural schools. The creation of the National Center for Vocational Orientation allowed a different qualification and tracks; it made it permissible for parents to enroll their children and tell parents about available educational and training opportunities. The attempt was to establish a linkage of the general education, university education, and the job market. Within the Ministry of Education, the Department of Schools Performance Development was established for school administrators to help them set strategies to reach their targets, apply their plans, and raise capacity among school staff. The department instated regulatory guidelines and policies, thus creating an accountable system for the schools. Another role taken by the latter department has been to train teachers in all facets of basic education. The training assured that basic education program effectively trained in the philosophy, methodology, and curriculum material of the basic education. At the center of the training was the Teacher Training Center in Muscat and later instituted in all the Ministry of Education Directories moved to all out regions in Oman [27].
\nTeachers Institutes were the only organizations training teachers which later in 1970s became Colleges of Education and integrated in a larger university system, eventually offering a bachelor’s degree. The Ministry of Education in fact established the Directory General for Evaluation and Development, and as part of the higher education development, Sultan Qaboos University was established in 1986 with five colleges were established. This included Education and Islamic studies, Agriculture, Sciences, Medicine, Engineering, and Humanities. In addition, there were a number of educational establishments to train in trade, technical, agricultural, and education teacher training, in addition to the Institute of Justice, Institute of Health Sciences, Institute of Finance, Professional Training Institute, Institute of Public Administration, Oman College of Industrial Arts, and Police and Internal Security Training Centers [20]. As with the Sultan Qaboos University, the Ministry of Education made an initiative by drawing upon practices of educational systems as that of the United Kingdom, United States of America, Canada, Australia, and Malaysia, taking into account Omani values and traditions. The intention was to build a citizen whose strong faith in God, loyalty to the nation, is disposed with intellectual, spiritual, emotional, and social qualities amicable with Oman’s culture and tradition.
\nAnother step forward was the initiation of the National Forum on the Development of Secondary Education of grade 11–12 held in 2002; it linked closer higher education with the secondary education, and it was apparent with a global world moving to an age of connectedness. Thus, as social systems change all the artifacts around, human functioning and interconnectedness must also change. It is thus within those changes that Oman positioned itself in a global context [29].
\nThe Ministry of Education in Oman had administrative and legal jurisdiction of all public schools from grade 1 to grade 12. The Ministry had gone through several restructuring initiatives, the most significant has been the impetus to decentralize the educational system and give autonomy to the directories in the different regions in Oman. The reform was also significant because it drew upon policies which allowed autonomy to the different directories (Ministry of Education Centers) around the country working within a total quality framework and implementing a new curriculum, student assessment, and pedagogical implementation. The directories which spread all over Oman were responsible for evaluating and assessing the educational planning, collecting data from students, teacher training, and the development of the educational sector as well as coordinating with other ministries to address student needs. The central offices in the different regions of Oman were mainly responsible for the implementation of policies established by the Ministry of Education. The different directories within the Ministry of Education also encouraged schools to take up new initiatives and proposals for the improvement of the educational system. The most striking change was to provide teacher autonomy to cover the curriculum with any content they may provide and see fit for the educational purpose of their classes.
\nIn the past decade (2000 to the present), the Ministry of Education has reoriented its approach in dealing with educational problems and issues through data-driven approach and reliance on empirical evidence and data driven information. Three important initiatives were implemented: (1) provide support to school administrators with important training to develop the educational skills, knowledge, and capacities; (2) the elimination of the two track system (Arts track versus Science track), which came as a result of the study carried out in 1993, to provide equal and equitable opportunities for all; and (3) the implementation of the e-government learning system network, to reach all areas in the Sultanate. The e-government process was appealed as a major tool in the development of public services and in the contribution of the knowledge-based economy, for instance, the development of the educational portal and scaling it to all schools, planned and implemented by 2016 to cover all schools in Oman. The management system, however, has been used only for administrative purposes. More recently, it has extended to reach parents and students, which included data of teachers and administrative staff as well as student’s achievement. It had the capabilities to have parents check on their children’s work and progress. In addition, the Internet Protocol (IP) was introduced to facilitate the communication between the units of the Ministry and regional educational offices. The intent of the Ministry was to initiate the process to allow the technology to be used by teachers, students, and stakeholders [7].
\nFuture endeavors ensued the development of the creation of interactive electronic curricula of English language from grade one to grade 12 as well as mathematics and science being electronically mediated in Arabic and English. The flagship project was to build a digital model equipped with the latest educational and technological equipment. The Ministry intention was also in its awareness of the technology teachers and school administrators as well as students and parents. The technological endeavor and importance of engaging stakeholders in the educational process are mostly overcoming the digital gap to raise the technological know-how [30].
\nThe Ministry of Education has also stressed on the importance of the private sector and other stakeholders on the improvement and development of the educational program. The Ministry of Education signed a number of partnership agreements with Oman International Bank which financed the printing of textbooks, conferences, and resource centers in schools as the Dawhat Al-Adab General Education School. The partnership between Oman International Bank and the Ministry of Education spearheaded an initiative as part of the social responsibility initiatives that went beyond the concept of commercial sponsorship. It aimed at creating a culture of citizenship where students could experience their responsibilities and prerogatives, thus creating individuals with moral, cultural, and national aspirations that could provide the best of their abilities inside an institution or in the public. Other important players have been the Omantel and Oman Mobile, two telecommunication giants; both companies have made great efforts to provide excellent services to support activities and improve the educational process. Omantel provided the infrastructure resources to establish the Educational Portal project designated for the public schools in Oman, and it also provided a bundle of low price Short Message Service (SMS) to enable parents to keep in touch with schools and be updated continuously with their children’s academic performance. In consortium with the latter, the ministry also implanted a number of initiatives in science and mathematics and their interrelation with economy and sustainable social development. Not the least, the ministry also stressed on the significance of data-research-driven policy and that such research is grounded from the field rather from some theoretical and western model. It also appeared that the Ministry made substantial effort to draw on the different stakeholders whether the ministries, the public sector, or non-profit organizations. The ministry also stressed on parent involvement and businesses to provide support and involvement in the school [7].
\nAnother important restructuring initiative focused on the assessment and evaluation in the belief that students and teachers, even administrative-staff, have substantive responsibilities including curriculum development and evaluation.
\nThe philosophical position of the Ministry of Education was published 1978, in a white paper which tied the educational curriculum to human development, citizenship, and society. Education was seen as couched in strong cultural traditions and Islamic values were thought to build on the Omani character, a character open to society as a whole, able to deal with the technological advances to modernize society. It also stressed on the individual to develop holistically, including physically, intellectually, and spiritually. With overemphasis on the Omani identity extending from its Islamic roots and Arab background, education was also thought to modernize society, especially the technological advancement of society. Four main frames that this philosophy drew upon are (1) teaching couched within a strong cultural tradition and Islamic values; (2) education being able to live within a social and natural world; (3) teaching the individual to learn; and (4) teaching the individual to learn about his identity and citizenship.
\nThe two-cycle structure from grade 1 to grade 10 was believed to improve mathematics, science, English, and computers which were introduced early in the first cycle. The approach was also to allow students within the system and reduce attrition or school leavers. The new structure also helped to rewrite the curriculum and to align the way it was taught. The approach was to rethink the “old” focus on content and curriculum and teaching method centered around student activities in the classroom [31]. The approach was to make the curriculum more engaging to student lives where classroom instruction teachers relied less on rote learning and memorization in their teaching and more effort was given to student-centered activities. No doubt, this has come with new teaching method, using concrete material improved strategies for student assessment and evaluation. Thus, the new curriculum stressed on five main objectives:
Developing critical thinking skills
Developing problem solving skills
Developing collaborative and cooperative work
Building positive attitudes of pupils toward their subjects and schooling
Encouraging independence
The main challenge was to keep pace with the technological change and new educational methods required to prepare Omani children for life and work with new conditions created by the present modern global economy. These required a high degree of adaptability and a strong background in science and mathematics curricula being designed to achieve the knowledge, skills, and attitudes that Omanis will need.
\nThe basic education approach reduced the theoretical and abstract concepts in the curriculum, and through relevance to the material, whether in mathematics and science, there was stress on applications and problem-solving. There was also greater stress on higher-ordered thinking, compatible with ways that assessed individual levels as well as innovative use of technologies. School teachers were drawn to scientific thinking approaches in dealing with knowledge, away from the stress on the subject matter and theoretical component.
\nTeacher methodologies were also key to the new challenges, while the classroom teaching was assessed to be old and outdated to the knowledge available, classroom environments, and teaching approaches. The new teaching methods shifted from teacher-centered to student-centered where students were given greater responsibility for their own learning. The shift was to move away from a lecture but to organize and simulate activities having relevance to real-life applications. Teachers were encouraged to inform the students of the objectives, what is to be learned and what has been learned. Continuously, teachers discussed with students what they have discovered in the classroom as a group. Further, the structure of the classroom was reorganized to accommodate for group work and collaborative learning.
\nAt the juncture of the reform a philosophical turn took place in the conceptualization of how assessment was being used in schools. Philosophically, the assessment was not simply to draw out the mistakes and weaknesses, but also to improve the educational practice and develop the whole educational process, as in providing appropriate classroom environment in which students can successfully demonstrate their abilities across a wide range of skills. To achieve this, the ministry prepared the document underpinning the principles of assessment and evaluation and how to put them in practice through planning, teaching, recording, and reporting. Thus, teachers in the classroom take the responsibility for student assessment, whether in observation performance-based assessment, projects, paper-and-pencils, tests and quizzes, interview and student presentations, and portfolios. Thus, in assessments which are multifaceted, there might be no one way to assess the teachers who were given the opportunity to select their curriculum and to align with their teaching styles.
\nAssessment started being applied in the teaching learning cycle which stressed on the teaching of students. To measure success, teacher class practices shifted from assessing how much the curriculum has covered to whether students learned and whether the learning was meaningful [18]. This approach also allowed for teachers to know their students and draw on devising curriculum and learning exercise suitable for student ability level, specifically, the new assessment methods: (a) evaluation through the collection of information and student interest in the subject; (b) planning based on student interest; and (c) teaching based on student interest [32].
\nTeachers were required to use continuous assessment methods with their pupils and work every day by using assessment instruments such as checklists and recording sheets of student development. Assessments were no more used to see where students are but to see if they could face the challenges and what improvements they could make. Focus of assessment shifted from being seen as end of the course element, but as being part of the educational process where students and teachers can draw on such elements in form of instructional strategies as student oral works, projects, reports, quizzes, short tests, examinations, homework, practical performance, and portfolios. Assessments did not stop there; the ministry wanted a 360-degree approach that involved also teachers, administrators, and school staff. In terms of teacher assessment, its use was thought to understand what actions teachers were taking in the classroom. The ministry assigned a four-tear system in which assessors are known as supervisors in the school. The school had established three layers: the first supervisory level was at the school, the second at the state level, and lastly Ministry of Education. The goal of the school assessment was mainly to see whether the national objectives have been achieved and created three layers of checks and balances. The assessment philosophy drew on basically whether students have used knowledge and critical thinking skills that allowed them to move forward in learning [33].
\nCertainly, teachers were more likely to be effective in their approaches as in doing more critical thinking and problem-solving. Teachers paradigmatically shifted from rote to higher ordered thinking. Teachers were trained to provide more opportunities for classroom activities to take place with students leading the classroom or through active learning opportunities. With that came the change in the assessments inside the class and outside; rather than stress on the final summative assessments, there was greater weightage put on class assignments and continuous assessments with applications to real world problems that integrate technology in the learning and assessments [24].
\nThe assessments were also conceptualized not only to address the learning outcome through the delivered curriculum but were individualized to fulfill the needs of students to address the challenges and strength of each student.
\nWith the speed of the reform, there has been a great impetus to assess whether the changes brought to the educational system was significant to the extent that it provided the needed changes conceptualized by the leadership in Oman. It was important also to address the feedback from stakeholders, the changes, and whether they have materialized into successful outcomes. In 2004, the ministry started to evaluate the new program, and this was done through the different directorships in the different regions. Important challenges were pointed out. First since 1970, great and tremendous infrastructure development was materialized [8]. However, like many Gulf Arab countries (for example Nasser [34]) on International scores as the Trends in International Mathematics and Science Study, Oman had scores below many countries and boys scoring well below girls. School graduates lacked critical skills, particularly in English and other subjects. Thus, for Oman’s education system needing to improve, standards needed to be raised.
\nThe establishment of the basic and post-basic education was a significant signpost in the Omani educational reform particularly in structural and system wide changes [35]. The establishment of year 11 and year 12 was a bundle aligned with the curriculum and the workplace, drawing on broader and integrated curriculum with linking learning outcomes to the workplace.
\nTeachers were trained at writing objectives and aligning to content and learning outcomes. Teachers continued to write objectives in the scope and sequence of the curriculum material. They were required to develop their educational curriculum and activities that suit the environment of the school and change the teaching approach, with greater autonomy given to schools and community of learning [36].
\nThe main challenge facing Oman was a need to keep pace with technological change and new educational methods required to prepare Omani children for life and work in the new conditions created by the present modern global economy. Charged with an appetite for change and high degree of adaptability, Oman thought to advance in those critical subject areas as in science and mathematics in order to apply such knowledge and skills to the technology that Oman needs. New and redeveloped science and mathematics curricula and the scientific approaches in school learning were being designed to achieve the knowledge, skills, and attitudes that young Omanis may need to learn and adapt to the very different future they will face. New methods of teaching, using concrete artifacts, improved strategies for student assessment, and evaluation will all be aspects of the curriculum reform. Underlying the educational reform pillars and frame was an integrated development which included physical, intellectual, social, and individual attributes. Thus, the philosophy stressed on the collective formation in line, and compatible with individual needs.
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Given knowledge of human limitations, strategies for real-time on board monitoring of the “human system” may be employed to increase the safety of the pilot and aircraft.",book:{id:"6399",slug:"aircraft-technology",title:"Aircraft Technology",fullTitle:"Aircraft Technology"},signatures:"Douglas Summerfield, David Raslau, Bruce Johnson and Lawrence\nSteinkraus",authors:[{id:"161053",title:"Dr.",name:"Bruce",middleName:null,surname:"Johnson",slug:"bruce-johnson",fullName:"Bruce Johnson"},{id:"216519",title:"Dr.",name:"Douglas",middleName:null,surname:"Summerfield",slug:"douglas-summerfield",fullName:"Douglas Summerfield"},{id:"231816",title:"Dr.",name:"David",middleName:null,surname:"Raslau",slug:"david-raslau",fullName:"David Raslau"},{id:"231819",title:"Dr.",name:"Lawrence",middleName:null,surname:"Steinkraus",slug:"lawrence-steinkraus",fullName:"Lawrence Steinkraus"}]},{id:"61403",title:"Aircraft Gas-Turbine Engine with Coolant Injection for Effective Thrust Augmentation as Controlled Object",slug:"aircraft-gas-turbine-engine-with-coolant-injection-for-effective-thrust-augmentation-as-controlled-o",totalDownloads:1390,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"This chapter deals with some intensive methods regarding aircraft gas-turbine-engine performance enhancement, which are suitable alternatives for the most common temporarily thrust increasing method—the afterburning. Coolant injection method, into the compressor or into the combustor, realizes the desired thrust increase for a short period, when the flight conditions or other aircraft necessities require this. Both methods were studied from aircraft engine’s point of view, considering it as controlled object. New engine’s mathematical model was built up, following the thermo- and gas-dynamics changes and some quality studies were performed, based on engine’s time behavior simulations; some control options and schemes were also studied. Quantitative studies were based on the model of an existing turbo-engine; mathematical model’s coefficients are both experimentally determined (in the Aerospace Engineering Division labs) as well as estimated based on graphic-analytic methods. This approach and the presented methods could be applied to any other turbo-jet engine and used even in the stage of pre-design of a new engine, to estimate its stability and quality.",book:{id:"6399",slug:"aircraft-technology",title:"Aircraft Technology",fullTitle:"Aircraft Technology"},signatures:"Alexandru Nicolae Tudosie",authors:[{id:"30042",title:"Dr.",name:"Alexandru Nicolae",middleName:"Nicolae",surname:"Tudosie",slug:"alexandru-nicolae-tudosie",fullName:"Alexandru Nicolae Tudosie"}]},{id:"58067",title:"Cassini Spacecraft-DSN Communications, Handling Anomalous Link Conditions, and Complete Loss-of-Spacecraft Signal",slug:"cassini-spacecraft-dsn-communications-handling-anomalous-link-conditions-and-complete-loss-of-spacec",totalDownloads:1338,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Once spacecraft are launched, it is impossible for engineers to physically repair anything that breaks onboard the vehicle. Instead, remote solutions must be employed to address spacecraft anomalies and fault conditions. To achieve this goal, telemetered data from the spacecraft are collected and assess by ground personnel to resolve problems. However, if the ground-to-spacecraft communication system breaks down, or the vehicle delivers an anomalous signal, a rigorous protocol must be employed in order to re-establish or fix the telecommunications link. There are several factors that can contribute to link problems, such as malfunctions or mishandling of the ground station equipment, onboard failures of the spacecraft’s flight software coding, or even mishaps caused by the space environment itself. This chapter details the anomaly recovery protocols developed for the Cassini Mission-to-Saturn project, to resolve anomalous link problems as well re-acquisition of the spacecraft should a complete Loss of Signal (LOS) condition occur.",book:{id:"6350",slug:"space-flight",title:"Space Flight",fullTitle:"Space Flight"},signatures:"Paula S. Morgan",authors:[{id:"110221",title:"Dr.",name:"Paula",middleName:"Suzanne",surname:"Morgan",slug:"paula-morgan",fullName:"Paula Morgan"}]},{id:"72323",title:"Research in Microgravity in Physical and Life Sciences: An Introduction to Means and Methods",slug:"research-in-microgravity-in-physical-and-life-sciences-an-introduction-to-means-and-methods",totalDownloads:1032,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Microgravity is the state encountered in a vehicle in free fall, whether on Earth, in low Earth orbit or in deep space. 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Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}]},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",slug:"current-topics-in-neglected-tropical-diseases",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Alfonso J. 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He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. 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