Sleep disturbances in ALS.
\r\n\t
",isbn:"978-1-80355-220-0",printIsbn:"978-1-80355-219-4",pdfIsbn:"978-1-80355-221-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"56a4bfdf71363b77f6fed81f28e5acb6",bookSignature:"Dr. Venkata Krishna Parimala",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10962.jpg",keywords:"WSN Architectures, Models and Systems, Quality of Service, Performance Analysis, QoE, Energy Management, Protocols, Systems, Algorithms, IoT Enabled Applications, Trust Models, Data Visualization",numberOfDownloads:162,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"August 27th 2021",dateEndSecondStepPublish:"September 24th 2021",dateEndThirdStepPublish:"November 23rd 2021",dateEndFourthStepPublish:"February 11th 2022",dateEndFifthStepPublish:"April 12th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"9 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Dr. P. Venkata Krishna is a pioneering researcher in Wireless Networks and IoT and he has authored over 200 research papers in various national and international journals and conferences. Dr. Krishna has an h index of 23 and is the editor for the ObCom series of International conference proceedings and a founding member of the ObCom International Conference. Dr. Krishna is also a senior member of several professional societies such as IEEE, ACM, CSI, and IE(I).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"234338",title:"Dr.",name:"Venkata Krishna",middleName:null,surname:"Parimala",slug:"venkata-krishna-parimala",fullName:"Venkata Krishna Parimala",profilePictureURL:"https://mts.intechopen.com/storage/users/234338/images/system/234338.jpg",biography:"Dr. P. Venkata Krishna is currently a Professor of Computer Science and a Director at Sri Padmavati Mahila University, Tirupati, India. He received his B. Tech in Electronics and Communication Engineering from Sri Venkateswara University, Tirupathi, India, M. Tech in Computer Science & Engineering from REC, Calicut, India, and he received his Ph.D. from VIT University, Vellore, India. Dr. Krishna has several years of experience working in academia, research, teaching, consultancy, academic administration and project management roles. His current research interests include Mobile and wireless systems, cross-layer wireless network design, QoS, and Cloud Computing. He was the recipient of several academic and research awards such as the Cognizant Best Faculty Award for the year 2009-2010 and the VIT Most Active Researcher Award for the year 2009-2010. His biography was also selected for inclusion in the 2009-2010 edition of Marquis Who’s Who in Science and Engineering and the Marquis Who’s Who in the World, California, USA. He is the editor for the ObCom series of International conference proceedings and he is a founding member for ObCom International Conference. He has authored over 200 research papers in various national and international journals and conferences. He has produced 10 Ph.D.’s and 1 MS by research degree under his guidance and has guided several masters and bachelor's projects. Dr. Krishna has authored 15 books on Computer Networks and Programming Languages. He has delivered several keynote addresses and chaired sessions in reputed conferences. He is currently serving as editor in chief for the International Journal of Smart Grid and Green Communications, Inderscience Publishers, Switzerland, and also the editor for the International Journal of Systemics, Cybernetics and Informatics, and Journal of Advanced Computing Technologies. He is an Associate Editor for the International Journal of Communication Systems, Wiley. He is senior member of several professional societies such as IEEE, ACM, CSI, IE(I), etc.",institutionString:"Sri Padmavati Mahila Visvavidyalayam",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Sri Padmavati Mahila Visvavidyalayam",institutionURL:null,country:{name:"India"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:[{id:"81946",title:"Energy Management in Wireless Sensor Network",slug:"energy-management-in-wireless-sensor-network",totalDownloads:6,totalCrossrefCites:0,authors:[null]},{id:"81473",title:"IoT-Based Decision Support System for Health Monitoring of Induction Motors",slug:"iot-based-decision-support-system-for-health-monitoring-of-induction-motors",totalDownloads:19,totalCrossrefCites:0,authors:[null]},{id:"81385",title:"Localization Context-Aware Models for Wireless Sensor Network",slug:"localization-context-aware-models-for-wireless-sensor-network",totalDownloads:18,totalCrossrefCites:0,authors:[null]},{id:"80499",title:"Network Slicing for Industrial IoT and Industrial Wireless Sensor Network: Deep Federated Learning Approach and Its Implementation Challenges",slug:"network-slicing-for-industrial-iot-and-industrial-wireless-sensor-network-deep-federated-learning-ap",totalDownloads:48,totalCrossrefCites:0,authors:[null]},{id:"80045",title:"Resource Allocation in Wireless Body Area Networks: A Smart City Perspective",slug:"resource-allocation-in-wireless-body-area-networks-a-smart-city-perspective",totalDownloads:72,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"441704",firstName:"Ana",lastName:"Javor",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/441704/images/20009_n.jpg",email:"ana.j@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors, and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"10198",title:"Response Surface Methodology in Engineering Science",subtitle:null,isOpenForSubmission:!1,hash:"1942bec30d40572f519327ca7a6d7aae",slug:"response-surface-methodology-in-engineering-science",bookSignature:"Palanikumar Kayaroganam",coverURL:"https://cdn.intechopen.com/books/images_new/10198.jpg",editedByType:"Edited by",editors:[{id:"321730",title:"Prof.",name:"Palanikumar",surname:"Kayaroganam",slug:"palanikumar-kayaroganam",fullName:"Palanikumar Kayaroganam"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"314",title:"Regenerative Medicine and Tissue Engineering",subtitle:"Cells and Biomaterials",isOpenForSubmission:!1,hash:"bb67e80e480c86bb8315458012d65686",slug:"regenerative-medicine-and-tissue-engineering-cells-and-biomaterials",bookSignature:"Daniel Eberli",coverURL:"https://cdn.intechopen.com/books/images_new/314.jpg",editedByType:"Edited by",editors:[{id:"6495",title:"Dr.",name:"Daniel",surname:"Eberli",slug:"daniel-eberli",fullName:"Daniel Eberli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"76675",title:"Introductory Chapter: Studies on Cucumber",doi:"10.5772/intechopen.97360",slug:"introductory-chapter-studies-on-cucumber",body:'Cucumber (
Cucumber is an annual climbing herbaceous plant. The root system is shallow and mainly distributes in the cultivated land layer of 30 cm. The stem is vine with different degree of apical dominance. The cross section of the stem is rhombus, and the epidermis of the stem has burrs. The axillae on the stem have the ability of branching, and the number of branching varies greatly among varieties. The cotyledons of cucumber are opposite and long elliptic; euphylla are alternate, simple, pentagonal palmate or cordate in outline, and the blades are 3–7 lobed. The flower is axillary, unisexual and occasionally hermaphrodite. The calyx is green with bristles, and the corolla is yellow. The colour of young fruit changes from white to pale green, while mature fruit is yellow or brown when ripened. The shape of the fruit is diverse, such as clublike, cylindrical and spherical. Each fruit has 100–400 seeds. The weight of 1000 seeds is about 20–40 g.
At present, cucumber is the fourth most widely cultivated vegetable after tomato, cabbage and onion [8]. Cucumber has versatile uses in culinary, therapeutic and cosmetic purposes [5, 6]. Nutritional and epidemiological researches have shown various benefits of cucumber. For example, cucumber contains abundant nutrients and has crunchy texture and unique flavor, so it is a quintessential vegetable used for a variety of dishes, and it is also indispensable for salad, soup and smoothie. Cucumber is rich in superior hydration and phytochemicals, which have diverse health benefits including weight loss, anti-inflammation, remedy for multiple diseases of eczema, constipation, hypertension, atherosclerosis, cancer, etc. [9]. Recent studies found that the presence of kaempferol in cucumber is an important antidiabetic agent [10]. Furthermore, cucumber is popularly used for natural beautification and for skin treatments [11].
Cucumber pickles are most commonly fermented vegetable and widely consumed throughout the world [12]. Good fermentation depends on the proper combinations and interactions of multiple physical, chemical and microbiological factors [13]. Brine storage and process operations are susceptible to oxidation reactions during the fermentation process, and this has adverse influence on the quality property of cucumber pickles. To control the influence factors of cucumber fermentation, researchers have done many efforts on modern and advanced technologies, such as reducing the concentration of brining sodium chloride, developing the brining properties using lactic acid bacteria cultures, developing an anaerobic tank system, preventing cucumber gaseous deterioration by pouring of CO2 from fermentation brines [13]. After storing the brine, excess salt and organic wastes need to be leached to complete the product processing, and these wastes are sources of serious environmental concern. Thus, the waste disposal needs to be solved in the cucumber pickle industry.
Marketing is vital for linking production and consumption and facilitating agricultural productivity and employment [14]. Market performance is the ultimate result of various market activities, and market structure is the organization characteristics of the market that influence the nature of competition and pricing [15]. Both male and female participate in cucumber marketing, and the male–female rate has great differences in different regions. The wholesalers are older than the retailers. In Ibadan, most of the retailers were within 31–40 years age, whereas most of the wholesalers were within 41–50 years age. It’s gratifying that cucumber marketing is usually profitable for the retailers and wholesalers at both peak and lean seasons of cucumber production. However, the cucumber market is competitive, and inequality exists in the market. Commodity perishability is an important constraint in cucumber market. Thus, it is indispensable to reduce perishable degree and prolong storage time after post-harvest.
Inappropriate farming systems and poor agronomic management are responsible for low yield of cucumber. The quality/fertility status of soils is essential for growth and development for cucumber [16]. With good moisture and fertilizer management, optimum yield of cucumber might be attained. The conventional irrigation methods including flooding irrigation, furrow irrigation and drip irrigation have been widely applied for a long time in cucumber cultivation because of their low cost or simple operation [17, 18]. However, these irrigation methods are surface irrigation and are driven by positive pressure, which may cause low water use efficiency, water wastage and nutrient loss [16, 19]. To solve these problems, new irrigation technique such as negative pressure irrigation that controls automatically water release based on the soil water potential difference should be encouraged [16]. Inadequate fertilizer use causes low soil fertility that cannot provide sufficient nutrients for the normal growth of cucumber. The integration application of inorganic and organic fertilizer is more beneficial than the sole use of inorganic fertilizer or organic manures in cucumber production [20]. Moreover, fertilizer sources need to dissolve or decompose to make nutrients available for cucumber plants, so soil fertility also depends on soil water, temperature and density. Consequently, the soil management strategies such as negative pressure irrigation, seasonable fertilization, application of organic mulches and conservation tillage should be appropriately applied for sustainable production of cucumber.
Soilless cultivation in substrate culture is an important cultivation pattern for cucumber in greenhouses. The substrates should have specific physical properties including pore volume, air and water capacity, and density of substrates. Studies indicate that biostimulators can stabilize the production process to enhance plant growth under stress conditions. For instance, humate can increase vitality and growth of plants, improve seed germination, promote nutrient uptake, enhance transport and availability of micronutrients, and increase ion-exchange capacity. Lactates can produce bioregulatory effects to improve nutrient balance and plant vitality [21].
During growth process, cucumber might be affected by multiple insect pests and diseases, resulting in decrease of yield and quality. The major insect pests in cucumber including
Plant secondary metabolites play important roles in adapting to various environments and defensing against biotic and abiotic stresses. Cucumber is a rich source of phenolic compounds that are important secondary metabolites [30, 31]. The antioxidant capacity of cucumber seems to be attributing to polyphenols that scavenge singlet oxygen, hydroxyl and lipid peroxyl radicals to prevent lipid oxidation. Better understanding of the molecular regulation of polyphenols biosynthesis is crucial to increase the production of polyphenols. Polyphenols are derivatives of phenylpropanoid pathway which involves an array of enzymes. Among these, phenylalanine ammonia lyase, chalcone synthase, cinnamate 4-hydroxylase and dihydroflavonol reductase play important roles [32]. In-depth study of these key enzymes in cucumber will facilitate to reveal the molecular mechanism of polyphenol synthesis, which is helpful for advancement in biotechnological and industrial applications.
In the past decades, traditional breeding has played essential roles in cultivar innovation of cucumber. Some superior varieties with early maturity, high yield and high resistance have been developed through hybridization and mutagenesis [33]. However, this progress is slow because of the long cycle and difficulty in selection of stable genetic characters or genotypes. To overcome the obstacle of traditional breeding, molecular breeding technologies including molecular marker assisted breeding, genome-wide design breeding and genetic engineering have been applied in cucumber to accelerate the breeding cycle and select desirable traits. Molecular breeding of cucumber has made some progress and achievements on completion of genomics, genetic architecture and molecular mechanism underlying important traits, and creation of high quality and multi-resistant varieties [7, 34, 35, 36]. With increasing consumption demand of cucumber, more new varieties with excellent comprehensive properties are in need, and we might make some efforts from the following aspects: (i) expanding collection and utilization of cucumber germplasm resources; (ii) establishing highly efficient gene editing and genetic transformation technologies in cucumber; (iii) identifying new loci or genes associated with key agronomic traits of cucumber and combining multiple molecular markers of excellent traits into one variety; (iv) realizing rapid accumulation of omics genotypes and phenomics [37].
Given the effect of neuromuscular disease on respiratory muscle strength (including the diaphragm, upper airway and accessory muscles), it is an undeniable fact, that neuromuscular disease can cause disruption of sleep. In general, sleep disorders are underrecognized in this population, as their secondary effects can mimic symptoms of the underlying disease. Recognizing sleep-related disorders in patients with neuromuscular disease such as Amyotrophic Lateral Sclerosis (ALS) is of utmost importance, as they are potentially treatable problems and their correction can improve quality of life and even increase survival time [1].
ALS is an incurable neurodegenerative disorder of upper and lower motor neurons, which is characterized by degeneration of the corticospinal tracts, resulting in loss of motor neurons in the brain, brainstem and anterior horn cells of the spinal cord. Age of onset of disease is in the sixth decade of life and is usually sporadic, though a minority of patients have familial disease. Numerous abnormalities exist in cellular and molecular function in ALS, including protein aggregation, mitochondrial dysfunction, DNA and RNA processing and central nervous system inflammation [2].
The hallmark of clinical disease is the presence of both upper and lower motor neuron signs. Weakness in ALS starts as asymmetrical or focal, and then progresses to generalized weakness, ultimately affecting all skeletal muscles. Loss of motor neurons in the brainstem and spinal cord causes weakness of the pharyngeal, laryngeal, intercostal and diaphragmatic muscles. This predisposes patients with ALS to respiratory dysfunction (the physiology behind this to be detailed below). When respiratory dysfunction becomes severe, tracheostomy and permanent ventilation are required. From the time of the diagnosis the median survival time is 3 to 5 years. The most common cause of death in ALS is respiratory failure [3, 4].
There are two FDA approved medications for ALS. Riluzole was approved in 1997 and provides a modest survival benefit of 3 months. A second medication, Edaravone, a free radical scavenger, was approved in 2017, but is only approved for use in ALS patients without respiratory insufficiency, and is controversial for clinical use due to its burdensome administration schedule and questionable clinical efficacy [5]. Numerous clinical drug trials have failed to demonstrate marked clinical benefit in ALS. However, provision of non-invasive ventilation has shown survival benefit in some ALS patients [6]. The dearth of effective treatment options for ALS underscores the importance of modifying those factors that optimize quality of life and extension of survival, particularly sleep and respiration.
Adequate involuntary ventilation is essential for effective sleep. The pathway by which voluntary ventilation occurs involves the cerebral cortex, brainstem and corticospinal tracts to motor neurons in the C3-C5 spinal segments which supply the phrenic nerve. The phrenic nerve innervates the diaphragm. In the state of wakefulness (in which both voluntary and involuntary ventilation persists), the diaphragm is the major inspiratory muscle and is assisted by accessory muscles. The accessory inspiratory muscles include the intercostals, trapezius, scalenes, sternocleidomastoid and pectoralis major muscles. Involuntary or automatic breathing involves the respiratory centers in the brainstem (pons and medulla). This is the central respiratory drive. Oxygen and carbon dioxide levels sensed by chemoreceptors (peripheral and central) directly influence automatic breathing (which is then carried out through the spinal segments formerly mentioned innervating the diaphragm through the phrenic nerve). During non-REM sleep, muscle tone is decreased and during REM sleep muscle tone is almost completely lost. Automatic ventilation during sleep is almost completely dependent on the diaphragm (particularly in REM sleep) therefore diaphragmatic dysfunction (such as that seen in ALS) can predispose to hypoventilation and nocturnal hypoxemia. The sensitivity of chemoreceptors is also reduced during sleep [1].
Effective sleep also depends on maintaining a patent upper airway. Patency of the upper airway is dependent on secondary muscles of respiration, which include the muscles of the pharynx. Pharyngeal muscle tone is maintained by trigeminal sensory afferents during inspiration, when negative pressure is generated. This prevents upper airway collapse. Weakness of pharyngeal muscles (such as in ALS) leaves one susceptible to airway collapse and the upper airway resistance seen in obstructive sleep apnea [1].
Sleep disorders are quite prevalent in patients with ALS, but often underreported, misdiagnosed, and undertreated. It has been shown that the onset of nocturnal breathing abnormalities often precedes the onset of overt daytime respiratory dysfunction [3]. A recent study showed that sleep disorders occur in 70 percent of patients with ALS, where 65 percent have insomnia, 50 percent have sleep-breathing disorders including hypoventilation, and 85 percent suffer from night-time awakening related to ALS symptoms [7].
The most common form of sleep disturbance encountered in ALS is due to hypoventilation, rather than obstructive nocturnal events [8]. As ALS progresses, the involvement of the respiratory muscles is unavoidable; this results in nocturnal hypoventilation [9, 10]. Hypoventilation is the primary etiology of nocturnal oxygen desaturation (hypoxemia) in patients with ALS. This is due to bilateral phrenic nerve dysfunction resulting in diaphragmatic weakness or paralysis [11]. Nocturnal hypoventilation is first present when supine, as this is where the diaphragm is put at its worst mechanical disadvantage resulting in a drop in lung volumes [3, 12]. Diaphragmatic dysfunction in ALS is of particular concern in regard to sleep-disordered breathing as the diaphragm is the sole active respiratory muscle during REM sleep (where accessory and intercostal muscles are naturally inhibited) [13]. For this reason, nocturnal hypoventilation is especially worse during REM sleep [12, 14].
Quality of sleep in those without advanced disease can be normal (although quality of life is impacted by respiratory muscle weakness) [11]. As the disease progresses fragmentation of stage N3 of sleep occurs due to loss of circadian rhythms [13]. All stages of sleep are eventually affected resulting in daytime hypercapnia which is defined as an elevated CO2 > 45 mm Hg. Hypoxemia and hypercapnia result from respiratory failure and the hypoventilation syndrome caused by restrictive thoracic disease from weakness of respiratory muscles. This hypoventilation syndrome results in a decrease in sensitivity of chemoreceptors due to chronic hypercapnia [15]. Hypoventilation is further complicated with the co-existence of sleep-breathing disorders.
Sleep-breathing disorders are common in ALS. Oropharyngeal weakness affecting dilatory muscles leads to obstructive sleep apnea that presents like in non-ALS OSA patients with snoring, snorting, apneas, and frequent nocturnal arousals [16]. In a study of 18 patients with ALS, it was found on polysomnography that total sleep time was decreased, and frequency of sleep-disordered breathing and arousals were higher than in age-matched controls. Eight of these patients were found to have periods of hypoventilation (most often during REM sleep). There were no recorded apneas. Bulbar involvement did not show a significant association with degree of sleep-disordered breathing [2]. Bulbar weakness does however predispose to obstructive sleep apnea due to weakness of tongue protrusion and palatal control. Bulbar weakness is also associated with increased secretions and weak cough [13]. That being said, since patients with bulbar ALS have tongue atrophy, they have less prevalence of OSA [17, 18]. Central sleep apneas in ALS patients may result from central motor neuron impairment, though they are less frequent than OSA [15].
Particular importance should be placed on addressing respiratory muscle weakness (hypoventilation) rather than the number of apneas or hypopneas on polysomnography in ALS patients [11]. OSA is common in ALS and if untreated shortens the survival of ALS patients [3, 12]. Non-invasive positive pressure ventilation can prolong time to tracheostomy and provide benefit in regard to quality of life in the setting of respiratory muscle weakness and sleep-disordered breathing [11]. Therefore, when OSA is suspected a polysomnogram should be requested to confirm its diagnosis.
In regard to the effects of sleep-disordered breathing on quality of life, ALS patients often complain of excessive daytime sleepiness resulting from nocturnal sleep fragmentation and insomnia. Nocturnal hypoventilation results in orthopnea, morning headaches, excessive daytime sleepiness, and cognitive dysfunction [12, 17]. A study showed the most common nocturnal complaints in ALS patients were nocturia, sleep fragmentation, and cramps (each seen in about half of the patients) [19]. Table 1 shows the common sleep disturbances seen in ALS.
Insomnia Excessive daytime sleepiness Sleep fragmentation Sleep related hypoventilation Sleep breathing disorders |
Sleep disturbances in ALS.
Nocturnal restlessness, sleep fragmentation with multiple awakening, snoring, and apneas leads to excessive daytime sleepiness, difficulties to arouse in the morning, difficulties to arouse from sleep, cognitive problems and poor work performance. In severe cases when insomnia and sleep continuity is severely impaired patients develop lethargy, cyanosis, early morning headaches, nausea and vomiting and leg edema. Table 2 shows the most common sleep features in ALS patients.
Nocturnal features | Daytime features |
---|---|
Nocturnal restlessness Sleep fragmentation Increase WASO Insomnia Apneas/hypopneas Snoring/snorting Orthopnea Respiratory interruptions Difficulty to aroused in the morning Nocturnal cyanosis Choking Nocturia Nocturnal cramps Nightmares | Excessive daytime sleepiness Increase daytime napping Fatigue Poor concentration Poor work performance Morning lethargy Morning headaches Cognitive dysfunction |
Sleep-related features in ALS.
WASO: wake after sleep onset.
Patients with ALS suffer from other conditions that also affect the sleep such as restless leg syndrome (RLS), REM-sleep behavior disorder (RBD), cramps, immobility-associated discomfort, pain, depression-related sleep disorders and dementia-related sleep disorders which may affect the sleep continuity. Even patients newly diagnosed with ALS have shown poor sleep quality related to depression and poor nocturnal mobility [12, 17, 19].
There are important secondary cardiopulmonary effects of chronic nocturnal hypoxemia that should not be overlooked. These include pulmonary hypertension, right heart failure and arrhythmia. There is also an increased risk of stroke, myocardial infarction and lethal cardiac arrhythmias. This highlights the critical need to diagnose and treat sleep-disordered breathing early particular in ALS where lifespan is devastatingly shortened [20].
Essential to the identification of ALS patients with sleep abnormalities is maintaining a high index of suspicion and taking a detailed sleep history. This ideally takes place with a family member or caregiver present (or anyone who may share a bed with the patient). This second party can provide history regarding the patient’s behaviors during sleep and functioning in the daytime (some of which the patient himself/herself may not be aware of). Specific questions regarding the presence of excessive daytime sleepiness, cognitive dysfunction, orthopnea, apneas and snoring are essential. Frequent awakenings, snoring and choking are clues for suspecting obstructive sleep apnea. Nocturnal orthopnea is often an early sign of respiratory dysfunction causing hypoventilation. Commonly used screening tools for sleep disorders include STOP-BANG, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index Scale [3]. All patients with respiratory dysfunction or bulbar weakness should be screened for sleep disorders. Close attention should be placed on examining for signs of respiratory dysfunction such as accessory muscle use (particularly when supine). Increased work of breathing can result in weight loss and cachexia. Patients with bulbar dysfunction progressively develop changes in their voice, difficulty clearing secretions, weak cough and difficulty swallowing [21].
There are multiple modalities that can be utilized in the diagnostic evaluation of respiratory muscle weakness and sleep disorders in ALS. The use of more than one modality increases the precision and accuracy of the diagnosis and prevents over- or underestimation of respiratory muscle strength [20]. Table 3 outlines the different laboratory investigations used to diagnose sleep disorders in ALS.
Arterial Blood Gas (ABG) Pulmonary Function Tests
Overnight Pulse Oximetry Polysomnography (PSG) |
Investigations commonly used to detect sleep disorders in amyotrophic lateral sclerosis.
If hypoventilation is suspected, then spirometry should be requested. Clinical indicators include excessive daytime sleepiness, morning headaches, frequent nocturnal waking, and vivid dreams [22]. Forced vital capacity (FVC) has long been used to predict survival and disease progression in ALS patients. Faster progression of disease has been associated with FVC < 75 percent of predicted value. A more accurate measure of weakness of the diaphragm is supine FVC however this can be difficult to evaluate [21, 22]. The difference between standing and supine FVC correlates with orthopnea and a fall from sitting to supine >20 percent has a sensitivity of 90 percent for identifying diaphragmatic weakness [12], whereas sitting FVC < 50 percent has only a sensitivity of 58 percent. Despite wide availability in obtaining FVC it is not as sensitive for early respiratory dysfunction and values may be inaccurate in patients with bulbar dysfunction who cannot maintain a tight seal on the mouth piece [21].
The sniff nasal transdiaphragmatic pressure (SNIP) is a strong predictor of diaphragmatic muscle strength. It is a non-invasive inspiratory volitional test. It can also be used to monitor progression of disease [21]. In addition, SNIP testing is not limited by the requirement of securing an adequate seal over the instrument’s mouthpiece, rendering it advantageous for evaluation of patients with prominent cranio-bulbar weakness. The sniff test has a sensitivity of 97 percent for a sniff value <40 cm H2O for predicting six-month mortality, compared to 58 percent sensitivity of VC < 50 percent [23, 24]. SNIP value <40 cm H2O is strongly correlated with nocturnal hypoxemia in ALS patients [24] (see Figure 1). This predictive value for nocturnal hypoxemia was not seen with other measures of respiratory sufficiency such as MIP and FVC [24].
Scatterplot of the proportion of the night spent with nocturnal hypoxemia (defined as oxygen saturation < 90 percent) in ALS patients with SNIF <40 cm H2O compared to those with SNIF >40 cmH2O [
Maximal inspiratory pressure (MIP) and maximal expiratory pressures (MEP) are useful for predicting early respiratory muscle weakness. MIP is done by inspiring from residual lung volume. MEP is done by having the patient maximally expire against a closed airway. MIP > 80 cm H2O or MEP > 90 cm H2O excludes significant respiratory muscle weakness [21]. MIP < 40 cmH2O also identifies people at risk of hypoventilation. This test may underestimate the degree of respiratory muscle weakness as it involves a mouthpiece and those with facial or bulbar weakness may not form a tight seal around it. This test does require effort on the part of the patient [21].
Nocturnal pulse oximetry and capnography can also be used for screening for hypoventilation. Nocturnal pulse oximetry is often the first test ordered when sleep disturbance is suspected as it is inexpensive and non-invasive [20]. Nocturnal desaturation <90 percent for >5–10 percent of the time may suggest hypoventilation [23]. A nocturnal desaturation to less than 90 percent for one minute is also helpful to diagnose hypoventilation [22]. Patterns seen in early disease suggestive of hypoventilation are cyclical desaturations with low baseline oxygen saturation. This pattern is also seen in COPD or interstitial lung disease and nocturnal pulse oximetry cannot distinguish between these conditions. There are also some technical problems with nocturnal pulse oximetry as the oximeter can become dislodged or readings can be inaccurate in the setting of anemia. [20] Capnography is utilized in diagnosing hypoventilation by measuring a nocturnal transcutaneous carbon dioxide [PtcC02] increment of >10 mm Hg above 50 mm Hg for >10 min. This is performed with simultaneous pulse oximetry recording to compensate for possible aberrant valuates seen at times with PtCO2 [25].
Nocturnal and daytime arterial blood gases (ABG) is another tool that can be used to predict nocturnal hypoventilation resulting in hypoxia (PaO2 < 60 mm Hg) and hypercapnia (PaCO2 > 45 mm Hg). Nocturnal hypoventilation is suggested by an increase of PaCO2 by 10 mm Hg when comparing nocturnal to daytime values. This method is more invasive, and disparities can sometimes only be seen late in the disease [20]. Hypoventilation can also be diagnosed by ABG with hypercapnia defined as a cut off of PCO2 > 45 mm Hg while resting in a seated position for 15 min [26].
In-laboratory overnight polysomnography is the gold standard for the diagnosis of hypoventilation and OSA. At home tests are not recommended for patients with neuromuscular disease as these are limited studies. The standard polysomnogram consists of at least 3 electroencephalography (EEG) channels, chin and leg electromyography (EMG), 2 eye (electrooculogram) leads, effort channels, flow channels, electrocardiography and SaO2. This allows for tracking and monitoring the stages of sleep, SaO2 abnormalities and any abnormal movements [20]. Polysomnography [PSG] with capnography [transcutaneous PCO2] detects sleep-related hypoventilation [PCO2 increment more than 10 mmHg during sleep versus wakefulness, especially during REM] and is more sensitive than oximetry. One third of the patients with confirmed sleep hypoventilation have normal oxygenation [12, 19]. Using PSG, the etiologies of sleep disturbances can be distinguished using analysis of this multimodal test and patterns of SaO2 abnormalities. This allows for recognition of hypoxemia that is event related (obstructive sleep apnea) or due to hypoventilation (or a combination of both) [20].
The measurement of diaphragmatic thickening using ultrasound is a new developing technique that predicts hypoventilation, though no cut off value has been established [19].
Basic sleep hygiene should always be emphasized with the patient and family as the usefulness of these interventions is often overlooked. Treatment of comorbid conditions that may be contributing to sleep disorders or fatigue such as hypothyroidism, depression or obesity should also be addressed.
The mainstay of treatment of sleep-disordered breathing in ALS is through assistance of the weakened respiratory muscles with positive upper airway pressurization [20]. Non-invasive positive pressure upper airway ventilation [NIV] should be considered when hypoventilation is clinically suspected and confirmed with spirometry [19]. Practice parameters recommend initiation of NIV when SNIP falls below 40 cm H2O, FVC < 50%, or in the setting of abnormal nocturnal oximetry [22].
It is well established, that NIV improves symptoms of sleep disturbance, quality of life and cognitive function and is primarily indicated in sleep-disordered breathing and inspiratory muscle dysfunction. NIV may also prolong tracheostomy -free survival [19]. Studies have shown a slower rate of decline of FVC and pulmonary function with use of NIV in ALS patients. Benefit in survival correlated with at least 4 hours of NIV use at night [20]. Most patients with ALS will need NIV at first while sleeping, but later as symptoms progress with more dyspnea and hypercapnia/hypoxemia-related-symptoms NIV will be required for longer periods of ventilation and then continuously [12, 19]. They are at first treated with NIV and finally with tracheostomy with total ventilator support, if elected by the patient, or with supportive measures in hospice until death.
The aim of NIV is normalization of hypercapnia, hypoxia, and the apnea-hypopnea index. This results in improvement of the sleep architecture and prolonged survival up to one year [19]. NIV is divided in pressure-assisted control where partial pressure is provided and volume-assisted control where the patient receives a predefined gas volume. Volume-assisted control has the advantage of overcoming airflow obstruction and being effective in obstructive events, but it has the disadvantage of an uncomfortable feeling caused by the ventilation and no compensation for leaks [27]. The pressure assisted control is more comfortable and it compensates for leaks. One study showed greater survival with pressure-assisted over volume-assisted ventilation [28]. NIV using nasal ventilation is preferred because it allows speech and induces a lower rate of OSA. Patients require close surveillance in the first few days of use to determine proper the settings and then monthly or quarterly evaluations thereafter. NIV failure is most commonly caused by leaks [29] and the coexistence of untreated OSA that increases mortality.
Bronchial congestion caused by weak coughing and excessive sialorrhea may also cause failure of NIV therapy. Sialorrhea may be treated with drugs [atropine, scopolamine, belladone tincture], and if these drugs fail with salivary glands radiation; Botox injections are not recommended. Keeping the head up to avoid supine position, cervical collars, or mandibular advancement may also be helpful in addition to NIV [19].
To assist cough, mechanical insufflation-exsufflation (MI-E) devices can be prescribed to patients in order to clear airway secretions and prevent development of pneumonia. These devices administer pressure (both positive and negative, as might be done in a voluntary cough) artificially and can be used via face mask or tracheostomy [30].
It is important to mention, that bulbar dysfunction poses some management challenges in regard to the use of NIV. Compliance with use of NIV in these patients is lower due to decreased tolerance. As previously mentioned, hypersalivation in these patients worsens prognosis with NIV and requires symptomatic treatment. The initial study that showed increased survival with use of NIV [31] in patients with ALS did not show benefit in patients with severe bulbar symptoms however more recent studies have contradicted this. For this reason, treating symptoms that limit NIV usage in these patients is essential. Full face masks rather than the nasal mask are necessary for patients with bulbar dysfunction due to incomplete mouth closure [32].
Parkinson Disease [PD] is the second most common neurodegenerative disorder after Alzheimer’s disease [33]. PD occurs as a result of chronic, progressive decrease in dopamine levels of the substantia nigra, secondary to loss of dopaminergic neurons in the pars compacta and the occurrence of Lewy bodies in the cytoplasm of remaining neurons [34]. It is primarily diagnosed clinically and patients may present with the characteristic motor deficits, which include the resting tremor, bradykinesia, rigidity and postural instability. However, most will have both motor and nonmotor symptoms. The nonmotor symptoms cause disturbances, which affect sleep, mood, cognition, sensation and autonomic function. Among the nonmotor symptoms in PD, sleep disorders are second in frequency only to neuropsychiatric disorders [35]
It is estimated that between 55 to 80 percent of PD patients suffer from sleep disorders [SD] [36, 37]. Sleep can be affected in a multitude of ways with the most common SD displayed inTable 4. Some disturbances will precede the disease, while others are indicators of disease progression. In many cases, more than one sleep disorder may coexist in the same patient. Poor sleep, particularly if chronic, will have an impact on daily activities causing excessive daytime sleepiness [EDS] and sleep attacks [SA]. The neurodegenerative process caused by PD itself will exacerbate daily drowsiness, as well as certain medications [38]. Therefore, a detailed sleep history in a patient with PD is imperative to identify symptoms in order to treat accordingly and monitor their progression. There is evidence to suggest that improving a patient’s quality of sleep not only will improve their quality of life, but can also lead in an improvement of their motor symptoms.
Nocturnal sleep disorders | Diurnal sleep disorders |
---|---|
Insomnia Circadian rhythm disorders Sleep breathing disorders Restless leg syndrome Periodic limb movements of sleep Rapid Eye Movement (REM) sleep behavior disorder Nocturia | Excessive daytime sleepiness Sleep attacks |
Sleep disorders in PD.
Another important consideration for patients with bradykinesia and rigidity, who may have trouble turning in bed at night or getting to the bathroom - is using an extended release formulations as their last dose of the day that might disrupt their sleep or, even worse, lead to falls.
Two validated scales were created to assess the severity of the impact of PD [Parkinson Disease Sleep Scale (PDSS) and Scales for Outcome in PD Sleep [SCOPA-S] [39, 40].
Patients with PD often have many sleep architecture changes, the most common ones are shown in Table 5. The sleep architecture abnormalities include intrinsic brain changes caused by the underlying neurodegenerative disorder, co-existent sleep disorders, nocturnal motor symptoms, and dopaminergic medications.
Decreased total sleep time Increased sleep latency Increased sleep fragmentation Increase WASO Decreased sleep efficiency Decreased spindles Decreased N3 stage Decreased REM stage |
Insomnia affects approximately 50 to 60% of patients with PD, making it the most common sleep disorder and perhaps the most complex to treat given its multifaceted basis [42]. When it lasts for more than three months, it is considered chronic insomnia [43].
It can be further classified into the following patterns:
Sleep-onset insomnia: when the patient has difficulty falling asleep
Sleep-maintenance insomnia, also referred as sleep fragmentation: when the patient has difficulty staying asleep
Terminal insomnia: when the patient awakens involuntarily earlier than usual
The most common insomnia is sleep-maintenance insomnia seen in 80 percent of patient with PD, whereas sleep onset and terminal insomnia are seen in 18 percent and 40 percent of the PD patients, respectively [36, 37, 44, 45]. Insomnia is more prevalent in women, those with longer PD duration, and those with depression or anxiety. The causes of insomnia is multifactorial and includes the neurodegenerative process of PD itself, co-morbid sleep disorders, nocturia, cramps, limitation in mobility (i.e. difficulty turning in bed), early morning leg dystonia, pain, confusion, urinary dysfunction, sleep breathing disorders [SBD], and drugs [36, 42, 45, 46, 47]. Circadian rhythm disorders and psychiatric disorders [depression, anxiety, hallucinations, etc.] may also contribute in the genesis of insomnia [45, 46, 47].
Before deciding on a treatment option for insomnia, it is important to establish the specific pattern of insomnia and other risk factors that may be contributing to the condition. For example, addressing motor symptoms and/or obstructive sleep apnea may significantly improve insomnia therefore reducing or even eliminating the need for pharmacological interventions.
Almost half of patients with PD take medications for insomnia [36, 37, 42]. The use of levodopa-carbidopa controlled release [LD-CD] at bedtime may reduce motor bradykinesia/akinesia with improvement in total sleep time [48]. Dopamine agonists [DA] such as ropinirole-24 hour prolonged release (2-24 mg/day) [49], pramipexole (up to 4.5 mg/day) and transdermal rotigotine patch (up to 16 mg/day) [50] can be used as adjuncts to LD-CD. This combination has shown to improve both nocturnal motor activity and sleep symptoms. Two trials with transdermal rotigotine patch demonstrated improvement not only nocturnal motor symptoms but also wake time after sleep onset [WASO], nocturia, pain, RLS with reduced daily sleep episodes and overall improved quality of life in PD patients [51, 52]. MAO-inhibitor rasagiline has shown to improve total sleep time and reduce sleep latency when used in combination with LD-CD compare to when LD-CD is used alone [53]. Rasagiline’s beneficial effects on insomnia are likely related to an increment in melatonin levels.
After motor impairment and co-existent sleep disorders are identified and treated, insomnia can further be managed with cognitive behavioral therapy utilizing sleep hygiene techniques, stimulus control, sleep restriction, relaxation techniques, and cognitive therapy [53, 54]. Soporific drugs such as eszopiclone, zolpidem, doxepin, trazodone, ramelteon, and melatonin have been used with various success in the therapy of insomnia in PD patients [44]. Melatonin at very high doses (50 mg) at bedtime was compared with 5 mg/day at the bedtime in the treatment of insomnia in PD patients. Melatonin 50 mg dose showed a statistical significant improvement in total sleep time compared to lower doses, however melatonin at 5 mg improved subjective sleep disturbance, sleep quantity, and daytime drowsiness compared to placebo. Melatonin may be associated with morning headaches, hallucination, and daily drowsiness [55].
Nocturia is defined as an increase in the frequency of nocturnal urination. About one third of PD patients suffer from nocturia [56]. Nocturia in PD is most likely a result of autonomic dysfunction caused by detrusor hyperreflexia from lack of dopamine which decreases the inhibition of micturition. However, it is important to rule out secondary organic causes of nocturia (such as urinary tract infections, prostrate disorders, anxiety, congestive heart failure, etc.) before altering anti-Parkinson medication doses [45, 48].
Subcutaneous apomorphine at a dose of 3-8 mg at bedtime has been used to treat nocturia as it reduces the hyperreflexia in the detrusor muscles [57]. Rasagiline at a dose of 1 mg/day can increase bladder capacity and decreases residual volume [58]. Intranasal desmopressin and botulinum toxins in the detrusor muscles may be beneficial. Anticholinergic drugs [oxybutynin, solifenacin, darifenacin, tolterodine], can potentially help with nocturia, although the side effects of these drugs (drowsiness and cognitive impairment) might be an impediment [35].
Restless leg syndrome [RLS] is a sensorimotor disorder characterized by an unpleasant leg sensation associated with an urge to move the legs, relieved by leg movement, worsen by inactivity and worse at night [43]. RLS is seen in about 20% of patients with PD, which is a higher rate than in the general population [59]. Primary RLS is a genetic disorder, whereas secondary RLS results from other conditions such as renal disease, iron deficiency, co-existence of neuropathies, medications, etc. [43, 60]. PD patients who develop RLS tend to have later PD onset, poor sleep quality and more cardiovascular and anxiety disorders [45, 59]. RLS need to be differentiated from common complain seen in PD patients such as uncomfortable nocturnal motor symptoms secondary to immobility, akathisia and dystonia. The treatment of RLS in PD patients is similar to the treatment for non-PD patients. Identify and treat any underlying secondary causes of RLS first. Iron supplementation is required when ferritin levels are below 50 microg/ml. Antidepressants may worsen RLS symptoms therefore adjustment in dosage or replacement with bupropion with dopaminergic effect is warranted [60, 61]. Antidopaminergic and antihistaminic medications can also worsen RLS [45]. L-dopa-carbidopa is no longer recommended to treat RLS due to the high risk of augmentation (treatment complication from dopaminergic drug with worsening of the RLS symptoms [45, 60, 61]. Dopamine agonists (ropinirole, pramipexole, transdermal rotigotine patches) and GABAergic products (pregabalin, enacarbil, gabapentin) can be used as first line of therapy. The latter being particularly useful in patients with a coexistent neuropathic pain [60, 61]. Other drugs as clonazepam and opioids may be used to induce sleep and treat pain, respectively. New devices that apply pressure to the legs may also relieve RLS symptoms [62].
Periodic leg moment of the sleep [PLMS] is a sleep disorder characterized by repetitive leg movements while patient is asleep that result in sleep fragmentation and daily drowsiness. Whereas the diagnosis of RLS is clinical the diagnosis of PLMS is polysomnographic. A PLMS index [leg movements per hour of sleep] of 15 or more is considerate abnormal [43]. PLMS is seen in 80% of patients with RLS [43] and the incidence of PLMS is 30–80% of patients with Parkinson disease [45, 63]. Age and dopamine loss may contribute to PLMS [64]. The mainstay treatment for PLM is the use of dopamine agonists [65].
REM Behavior Disorder (RBD) is a REM-parasomnia characterized by the ability of the patient to reenact the content of his dreams with complex and violent motor behaviors which varies from vocalization, throwing punches, kicking, flailing, screaming, to jumping from the bed and running. This can cause injuries to the patient and/or to the bed partners [43]. RBD is commonly seen in PD [66] and is more prevalent in the second half of the night when REM sleep occurs [43]. Studies have demonstrated that RBD may manifest years prior to the development of PD symptoms with an estimated 75–90% of RBD patients developing PD after 10 to 14 years from onset [43]. RBD may precede the onset of others alpha-synucleinopathies such as Lewy Body dementia and multiple system atrophy [43]. RBD should be considered in patients presenting with history of “acting out their dreams or motor activation while sleeping” and confirm it with video polysomnography, though not require for its diagnosis. Creating a safe sleeping environment is the first step in management. This condition responds to low dose of clonazepam [0.25-2 mg qhs]. Clonazepam improves total sleep time, sleep efficiency, increase in NREM sleep, and decrease WASO [67, 68]. However, this medication was associated with sedation, cognitive deficits, and increments in falls [45]. Melatonin 3 to 12 mg at night or at higher doses is also helpful in RBD and can be used with dementia and obstructive sleep apnea where clonazepam is not recommended. Melatonin may be used as solo or co-adjuvant therapy for insomnia and at high doses may be associated with morning headaches, sedation, or delusion/hallucinations [45, 69]. Patients who failed clonazepam and melatonin may respond to rivastigmine [70] or ramelteon [71] at night.
Obstructive sleep apnea (OSA) is the most common sleep breathing disorder (SBD). Other forms of SBDs are also seen in PD such as snoring, central and mixed apneas [43]. OSA is characterized by intermittent and repetitive events of pharyngeal airway collapse with complete upper airway obstruction (apnea) or partial upper airway obstruction (hypopneas) during sleep, especially during REM sleep when the effect of the atonia is more pronounced. Patients present with nocturnal snoring, snorting, sleep fragmentation, insomnia, and daily consequences of daytime sleepiness, fatigue, poor concentration, poor memory, and mood changes. If severe, it is associated with sleep attacks [spells of sudden sleepiness] [43]. The prevalence of OSA in PD varies between 20–60% depending on the methodology used to score respiratory events [45] and according to two recent studies it is more common in PD patients than in the general population [72, 73]. An additional study showed that SBDs are also more common in other forms of parkinsonism such as vascular parkinsonism than controls [74]. From all forms of SBDs [snoring, central sleep apneas and obstructive sleep apneas] OSA is the most common form in PD [74]. This is likely related to multiple factors seen in patients with PD: most PD patients are elders [advanced age is a risk factor for OSA], PD present with autonomic dysfunction [autonomic dysfunction increases the risk for OSA], PD patients share loss of motor neurons from brainstem involved in respiration [reduced respiratory drive] and control oropharyngeal muscles [fluctuating respiratory muscle coordination increases risk for OSA], PD patients have restrictive lung disease caused by chest wall rigidity and upper airway abnormalities as shown spirometry abnormalities in up 65% patients with PD [75]which increased the risk for upper airway obstruction [42, 74]. The diagnosis of OSA is suspected through history and specific screening questionnaires such as STOP-BANG and Berlin’s questionnaire. In PD, STOP-BANG has a high sensitivity, but low specificity in the diagnosis of OSA, whereas the Berlin’s Questionnaire has a higher sensitivity in the diagnose of PD, but it sensitivity declines as the severity of PD declines [76]. And it is confirmed with polysomnography at a sleep center or level III portable monitoring at home [77, 78]. OSA may worsen PD as it worsens sleep fragmentation and causes intermittent hypoxia [45, 79, 80] which is associated with worsening in the cognitive function [81, 82]. Sleep disorders are considered one of the most disabling of the non-motor symptoms of PD [83]. The treatment of OSA with PD is the same than in patients without PD: body weight loss, positional therapy, continuous positive airway pressure (CPAP), and surgery [45, 84]. The cognitive impairment often reported in patient with Parkinson disease [81, 82] also improves with positive airway pressure therapy [85].
Circadian rhythm disorders (CRD) are implicated in the pathophysiology of PD [86], but their real prevalence in PD patients remains unknown [87]. Motor and non-motor features [autonomic function, visual performance, sleep-awake cycles, and response to dopaminergic drugs] experienced a diurnal fluctuation from the circadian system [88]. Dopamine is an intermediary of light providing input to the retinal circadian clock which provides a direct input to the suprachiasmatic nuclei (SCN). Thereby, via retinal dopamine-containing amacrine cells, information is conveyed across a series of clock genes that control the circadian rhythm. Dopamine deficiency, seen in Parkinson disease, affects specific clock genes (dysregulation of Bmal gene expression) resulting in dysfunction of the central sleep–wake cycle control [86, 87]. Studies using actigraphy to record times of wrist motor activity [wakefulness] and times of motor inactivity [sleepiness] showed lower peaks of physical activity during rest time and higher levels of activity at night compared with control [89, 90]. Motor symptoms in Parkinson disease worsen in the afternoon and evening in stable patients and patients with wearing off [advanced PD] indicating that the response to dopaminergic drugs declines throughout the daytime [91]. This decrease in diurnal activity and increase in nocturnal activity observed in PD patients is influenced by dopaminergic drugs [86]. A variability in the pharmacokinetics of levodopa, i.e. faster during daytime and while standing compared with being supine at night, play the role in levodopa variability [92]. Patient with PD with hallucinations show more fragmentation of the rest activity with more unpredictability in the circadian pattern [93].
Autonomic dysfunction, a common feature in PD, also follows a circadian pattern with a nocturnal blood pressure reversal pattern i.e. blood pressure equal or higher than daytime blood pressure as demonstrated in most of the patients in one study [94]. An attenuation of sympathetic nervous system activity in PD patients was demonstrated by a heart rate variability study where power spectral analysis using a 24-hour ambulatory EKG revealed a decrease in total frequency component and low frequency/high frequency ratio [86, 94]. Studies in PD patients have shown a reduction in core body temperature. This reduction in core temperature correlated with higher rates of self-reported RBD symptoms, reduction in percentage of REM sleep, and prolonged latency compared with controls [95].
Hormonal changes are also affected by circadian rhythms in PD. PD patients have shown elevated serum cortisol levels and reduced serum melatonin levels compared with controls [96, 97]. Furthermore, melatonin diurnal fluctuations are blunted in PD patients [98] which correlates with the self-reported symptoms of EDS [97]. The amplitude in melatonin decreases and melatonin phase advanced in PD treated patients compared with non-treated patients indicating that as PD progresses melatonin decreases with a phase advancement [99]. Dopamine drugs affect the regulation of melatonin circadian pattern and sleep onset patients in PD patients [100].
Circadian rhythm changes affect also visual performance in PD [101] most likely caused by impairment in retinal dopamine content that follows a circadian rhythm independent of light/dark cycles [102] Dopamine agonists may regulate the rhythmic expression of melanopsin in retina ganglion cells [88].
In summery the causes of CRD in PD are multifactorial and some are included below list:
Disorders of the sleep-awake neuronal circuity controlling the circadian rhythm.
Hypothalamic dysregulation with a decline of the SCN that lead to reduction in melatonin production and sleep-awake disruption.
Dysregulation of the genes that control the awake-sleep cycles such as Bmal1 gene and clock genes expression [dopamine regulates the Bmal1/clock activity]
Disconnection of SCN with neuronal circuitries and hormonal signals
SCN degeneration associated with clock gene dysregulation
Striatum dysregulation [dopamine controlled clock proteins Per1/Per2 gene expression]
Decrease rhythmic expression of retinal melanopsin [regulated by dopamine] that affect the entrainment of diurnal circadian rhythm
Animal models of PD revealed changes in the neurons firing pattern of the SCN associated with changes in the circadian rhythm amplitude [86, 87, 103]
Light therapy is a non-invasive technique proven to be safe, well tolerated, and effective on the treatment of daily drowsiness and impair alertness in PD [104, 105, 106].
Excessive daytime sleepiness (EDS) involves symptoms of frequent napping, feeling abnormally sleepy and sleep attacks. It is seen in 33–76% of patients with PD [100, 107] and is likely a result of damaged to the orexin-producing neurons from the posterior lateral hypothalamus involved in the wakefulness [108]. Other brainstem stimulating monoaminergic neurons are also implicated in promoting wakefulness in damaged in PD [109]. EDS is common in advanced PD and is a marker of dopamine loss [110, 111]. Table 6 display the condition more commonly associated with EDS in PD.
Severe PD PD-related disability Cognitive decline Frequent hallucinations Dementia Depression Polypharmacy Co-existence sleep disorders High comorbid disease burden High doses of antiparkinsonian Drugs |
Cause of excessive daytime sleepiness in PD.
Sleep attacks, which are defined as sudden irresistible drowsiness without awareness of falling sleep, are seen in 21% of PD patients. These are particularly concerning as they can cause serious injuries or even death, for example, as a result of a car accident when the patient falls asleep while driving [45, 55]. The Inappropriate Sleep Composite Score (ISCS) have a high specificity to detect the risk of car accidents related to EDS while driving [112]. A study with drug-naïve patients with early PD showed that patient who developed EDS after 5 years of treatment had higher baseline levels of drowsiness [113].
Management of EDS includes improving sleep hygiene, daytime regular exercises, avoid strenuous exercises a few hours before bedtime, reducing sedating medications both psychiatric (i.e. antidepressants, benzodiazepines, antipsychotics, etc.) as well as anti-Parkinson medications (particularly dopaminergic medications and levodopa), especially when used in combination [45, 114]. Stimulating anti-Parkinson medication earlier into the day such as amantadine and selegeline may help with EDS and if appropriate may be used instead of DAs [115]. If above plan fails, consider starting stimulants such as:
Caffeine at a dose of 200 mg twice a day [116]
Methylphenidate at a dose of 1 mg/kg TID [119]
Sodium oxybate at a dose of 3–9 grams per night at bedtime and 4 hours later [120].
Treatment of co-existent sleep disorders is essential.
Deep brain stimulation (DBS) is the most common surgical intervention for the treatment of PD. The procedure involves the surgical placement of electrodes, either unilaterally or bilaterally, in certain target areas in the brain. Most commonly placed in the subthalamic nucleus (STN) or the internal globus pallidus (GPi). The electrodes are then connected to a pulse generator implanted in the chest. DBS is known to improve motor symptoms and overall quality of life however we have only recently established that it also improves non-motor symptoms, including sleep [121]. STN DBS especially has shown significant improvement in sleep quality, sleep efficiency and sleep duration [121].
The beneficial effect on sleep architecture and sleep disorders [45] are displayed Table 7.
Increase total sleep time Increase sleep efficiency Reduce sleep fragmentation Decrease WASO Increased slow wave sleep Increase REM sleep Improve insomnia Improve restless leg syndrome Improve daytime sleepiness |
Deep brain stimulation, sleep architecture and sleep disorders.
IntechOpen's Authorship Policy is based on ICMJE criteria for authorship. An Author, one must:
',metaTitle:"Authorship Policy",metaDescription:"IN TECH's Authorship Policy is based on ICMJE criteria for authorship. In order to be identified as an Author, one must:",metaKeywords:null,canonicalURL:"/page/authorship-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"All contributors who meet these criteria are listed as Authors. Their exact contributions should be described in the manuscript at the time of submission.
\\n\\nConversely, all contributors who do not meet these criteria should be listed in the Acknowledgments section of the manuscript, along with a short description of their specific contributions.
\\n\\nCHANGES IN AUTHORSHIP
\\n\\nIf it is felt necessary to make changes to the list of Authors after a manuscript has been submitted or published, it is the responsibility of the Author concerned to provide a valid reason to amend the published list. Additionally, all listed Authors must verify and approve the proposed changes in order for any amendments to be made.
\\n\\nAFFILIATION
\\n\\nAuthors are responsible for ensuring all addresses and emails provided are correct. Under affiliation(s) all Authors should indicate where the research was conducted. Please note that no changes to the affiliation(s) can be made after the chapter has been published.
\\n\\nPolicy last updated: 2017-05-29
\\n"}]'},components:[{type:"htmlEditorComponent",content:"All contributors who meet these criteria are listed as Authors. Their exact contributions should be described in the manuscript at the time of submission.
\n\nConversely, all contributors who do not meet these criteria should be listed in the Acknowledgments section of the manuscript, along with a short description of their specific contributions.
\n\nCHANGES IN AUTHORSHIP
\n\nIf it is felt necessary to make changes to the list of Authors after a manuscript has been submitted or published, it is the responsibility of the Author concerned to provide a valid reason to amend the published list. Additionally, all listed Authors must verify and approve the proposed changes in order for any amendments to be made.
\n\nAFFILIATION
\n\nAuthors are responsible for ensuring all addresses and emails provided are correct. Under affiliation(s) all Authors should indicate where the research was conducted. Please note that no changes to the affiliation(s) can be made after the chapter has been published.
\n\nPolicy last updated: 2017-05-29
\n"}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[],filtersByRegion:[],offset:0,limit:12,total:null},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{hasNoEditors:"0",sort:"dateEndThirdStepPublish",topicId:"8,9,10,11,14,15,20,22,24"},books:[{type:"book",id:"11124",title:"Next-Generation Textiles",subtitle:null,isOpenForSubmission:!0,hash:"093f9e26bb829b8d414d13626aea1086",slug:null,bookSignature:"Dr. Hassan Ibrahim",coverURL:"https://cdn.intechopen.com/books/images_new/11124.jpg",editedByType:null,editors:[{id:"90645",title:"Dr.",name:"Hassan",surname:"Ibrahim",slug:"hassan-ibrahim",fullName:"Hassan Ibrahim"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11561",title:"Zeolite From Wastes - New Perspectives on Innovative Resources and Their Valorization Process",subtitle:null,isOpenForSubmission:!0,hash:"3ed0dfd842de9cd1143212415903e6ad",slug:null,bookSignature:"Dr. Claudia Belviso",coverURL:"https://cdn.intechopen.com/books/images_new/11561.jpg",editedByType:null,editors:[{id:"61457",title:"Dr.",name:"Claudia",surname:"Belviso",slug:"claudia-belviso",fullName:"Claudia Belviso"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11762",title:"Characteristics and Applications of Boron",subtitle:null,isOpenForSubmission:!0,hash:"611776f7f3cc9951a8956d2e3d535a8e",slug:null,bookSignature:"Associate Prof. Chatchawal Wongchoosuk",coverURL:"https://cdn.intechopen.com/books/images_new/11762.jpg",editedByType:null,editors:[{id:"34521",title:"Associate Prof.",name:"Chatchawal",surname:"Wongchoosuk",slug:"chatchawal-wongchoosuk",fullName:"Chatchawal Wongchoosuk"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11910",title:"Frontiers in Voltammetry",subtitle:null,isOpenForSubmission:!0,hash:"fc53a7599a61ed04a0672a7bca81e9c2",slug:null,bookSignature:"Dr. Rajendrachari Shashanka, Dr. Kiran Kenchappa Somashekharappa, Dr. Sharath Peramenahalli Chikkegouda and Dr. Shamanth Vasanth",coverURL:"https://cdn.intechopen.com/books/images_new/11910.jpg",editedByType:null,editors:[{id:"246025",title:"Dr.",name:"Shashanka",surname:"Rajendrachari",slug:"shashanka-rajendrachari",fullName:"Shashanka Rajendrachari"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11922",title:"Watermarking - Recent Advances, New Perspectives and Applications",subtitle:null,isOpenForSubmission:!0,hash:"9843dc1d810407088ed9eef10768a64b",slug:null,bookSignature:"Prof. Joceli Mayer",coverURL:"https://cdn.intechopen.com/books/images_new/11922.jpg",editedByType:null,editors:[{id:"110638",title:"Prof.",name:"Joceli",surname:"Mayer",slug:"joceli-mayer",fullName:"Joceli Mayer"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11517",title:"Phase Change Materials - Technology and Applications",subtitle:null,isOpenForSubmission:!0,hash:"1b7a5f2631db5e49399539ade1edf264",slug:null,bookSignature:"Dr. Manish K Rathod",coverURL:"https://cdn.intechopen.com/books/images_new/11517.jpg",editedByType:null,editors:[{id:"236035",title:"Dr.",name:"Manish",surname:"Rathod",slug:"manish-rathod",fullName:"Manish Rathod"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11451",title:"Molecular Docking - Recent Advances",subtitle:null,isOpenForSubmission:!0,hash:"8c918a1973786c7059752b28601f1329",slug:null,bookSignature:"Dr. Erman Salih Istifli",coverURL:"https://cdn.intechopen.com/books/images_new/11451.jpg",editedByType:null,editors:[{id:"179007",title:"Dr.",name:"Erman Salih",surname:"Istifli",slug:"erman-salih-istifli",fullName:"Erman Salih Istifli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11932",title:"New Materials and Enhanced Performance of Sodium-Ion Batteries",subtitle:null,isOpenForSubmission:!0,hash:"75c27a6f2739e8af817bace95b0e50d6",slug:null,bookSignature:"Ph.D. Fatma SARF",coverURL:"https://cdn.intechopen.com/books/images_new/11932.jpg",editedByType:null,editors:[{id:"245850",title:"Ph.D.",name:"Fatma",surname:"SARF",slug:"fatma-sarf",fullName:"Fatma SARF"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11528",title:"Maintenance Management - Current Challenges, New Developments, and Future Directions",subtitle:null,isOpenForSubmission:!0,hash:"a3e4ad5806a77b0e930fbd4cb191bee2",slug:null,bookSignature:"Prof. Germano Lambert-Torres, Dr. Erik Leandro Bonaldi and Dr. Levy Ely Oliveira",coverURL:"https://cdn.intechopen.com/books/images_new/11528.jpg",editedByType:null,editors:[{id:"112971",title:"Prof.",name:"Germano",surname:"Lambert-Torres",slug:"germano-lambert-torres",fullName:"Germano Lambert-Torres"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11486",title:"Climate Change - Recent Observations",subtitle:null,isOpenForSubmission:!0,hash:"741543ff220f5cf688efbf12d3e2f536",slug:null,bookSignature:"Assistant Prof. Terence Epule Epule",coverURL:"https://cdn.intechopen.com/books/images_new/11486.jpg",editedByType:null,editors:[{id:"348146",title:"Assistant Prof.",name:"Terence Epule",surname:"Epule",slug:"terence-epule-epule",fullName:"Terence Epule Epule"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11509",title:"Wireless Power Transfer - Perspectives and Application",subtitle:null,isOpenForSubmission:!0,hash:"f188555eee4211fc24b6cca361983149",slug:null,bookSignature:"Dr. Kim Ho Yeap",coverURL:"https://cdn.intechopen.com/books/images_new/11509.jpg",editedByType:null,editors:[{id:"126825",title:"Dr.",name:"Kim Ho",surname:"Yeap",slug:"kim-ho-yeap",fullName:"Kim Ho Yeap"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11760",title:"Applications and Use of Diamond",subtitle:null,isOpenForSubmission:!0,hash:"2edcf9a24450d8655e756e1080defe32",slug:null,bookSignature:"Mr. Evgeniy Lipatov",coverURL:"https://cdn.intechopen.com/books/images_new/11760.jpg",editedByType:null,editors:[{id:"21254",title:"Mr.",name:"Evgeniy",surname:"Lipatov",slug:"evgeniy-lipatov",fullName:"Evgeniy Lipatov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:38},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:13},{group:"topic",caption:"Business, Management and Economics",value:7,count:7},{group:"topic",caption:"Chemistry",value:8,count:23},{group:"topic",caption:"Computer and Information Science",value:9,count:24},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:15},{group:"topic",caption:"Engineering",value:11,count:65},{group:"topic",caption:"Environmental Sciences",value:12,count:10},{group:"topic",caption:"Immunology and Microbiology",value:13,count:16},{group:"topic",caption:"Materials Science",value:14,count:25},{group:"topic",caption:"Mathematics",value:15,count:11},{group:"topic",caption:"Medicine",value:16,count:116},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:6},{group:"topic",caption:"Neuroscience",value:18,count:4},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:9},{group:"topic",caption:"Physics",value:20,count:9},{group:"topic",caption:"Psychology",value:21,count:10},{group:"topic",caption:"Robotics",value:22,count:2},{group:"topic",caption:"Social Sciences",value:23,count:9},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:4}],offset:12,limit:12,total:174},popularBooks:{featuredBooks:[{type:"book",id:"10858",title:"MOOC (Massive Open Online Courses)",subtitle:null,isOpenForSubmission:!1,hash:"d32f86793bc72dde32532f509b1ec5b0",slug:"mooc-massive-open-online-courses-",bookSignature:"Dragan Cvetković",coverURL:"https://cdn.intechopen.com/books/images_new/10858.jpg",editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10195",title:"Serotonin and the CNS",subtitle:"New Developments in Pharmacology and Therapeutics",isOpenForSubmission:!1,hash:"7ed9d96da98233a885bd2869a8056c36",slug:"serotonin-and-the-cns-new-developments-in-pharmacology-and-therapeutics",bookSignature:"Berend Olivier",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg",editors:[{id:"71579",title:"Prof.",name:"Berend",middleName:null,surname:"Olivier",slug:"berend-olivier",fullName:"Berend Olivier"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10755",title:"Corporate Governance",subtitle:"Recent Advances and Perspectives",isOpenForSubmission:!1,hash:"ffe06d1d5c4bf0fc2e63511825fe1257",slug:"corporate-governance-recent-advances-and-perspectives",bookSignature:"Okechukwu Lawrence Emeagwali and Feyza Bhatti",coverURL:"https://cdn.intechopen.com/books/images_new/10755.jpg",editors:[{id:"196317",title:"Associate Prof.",name:"Okechukwu Lawrence",middleName:null,surname:"Emeagwali",slug:"okechukwu-lawrence-emeagwali",fullName:"Okechukwu Lawrence Emeagwali"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11120",title:"Environmental Impact and Remediation of Heavy Metals",subtitle:null,isOpenForSubmission:!1,hash:"9e77514288e7394f1e6cd13481af3509",slug:"environmental-impact-and-remediation-of-heavy-metals",bookSignature:"Hosam M. Saleh and Amal I. Hassan",coverURL:"https://cdn.intechopen.com/books/images_new/11120.jpg",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",middleName:null,surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10901",title:"Grapes and Wine",subtitle:null,isOpenForSubmission:!1,hash:"5d7f2aa74874444bc6986e613ccebd7c",slug:"grapes-and-wine",bookSignature:"Antonio Morata, Iris Loira and Carmen González",coverURL:"https://cdn.intechopen.com/books/images_new/10901.jpg",editors:[{id:"180952",title:"Prof.",name:"Antonio",middleName:null,surname:"Morata",slug:"antonio-morata",fullName:"Antonio Morata"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11080",title:"Engineering Principles",subtitle:"Welding and Residual Stresses",isOpenForSubmission:!1,hash:"6c07a13a113bce94174b40096f30fb5e",slug:"engineering-principles-welding-and-residual-stresses",bookSignature:"Kavian Omar Cooke and Ronaldo Câmara Cozza",coverURL:"https://cdn.intechopen.com/books/images_new/11080.jpg",editors:[{id:"138778",title:"Dr.",name:"Kavian",middleName:"Omar",surname:"Cooke",slug:"kavian-cooke",fullName:"Kavian Cooke"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11332",title:"Essential Oils",subtitle:"Advances in Extractions and Biological Applications",isOpenForSubmission:!1,hash:"742e6cae3a35686f975edc8d7f9afa94",slug:"essential-oils-advances-in-extractions-and-biological-applications",bookSignature:"Mozaniel Santana de Oliveira and Eloisa Helena de Aguiar Andrade",coverURL:"https://cdn.intechopen.com/books/images_new/11332.jpg",editors:[{id:"195290",title:"Ph.D.",name:"Mozaniel",middleName:null,surname:"Santana De Oliveira",slug:"mozaniel-santana-de-oliveira",fullName:"Mozaniel Santana De Oliveira"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11029",title:"Hepatitis B",subtitle:null,isOpenForSubmission:!1,hash:"609701f502efc3538c112ff47a2c2119",slug:"hepatitis-b",bookSignature:"Luis Rodrigo",coverURL:"https://cdn.intechopen.com/books/images_new/11029.jpg",editors:[{id:"73208",title:"Prof.",name:"Luis",middleName:null,surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9537",title:"Human Rights in the Contemporary World",subtitle:null,isOpenForSubmission:!1,hash:"54f05b93812fd434f3962956d6413a6b",slug:"human-rights-in-the-contemporary-world",bookSignature:"Trudy Corrigan",coverURL:"https://cdn.intechopen.com/books/images_new/9537.jpg",editors:[{id:"197557",title:"Dr.",name:"Trudy",middleName:null,surname:"Corrigan",slug:"trudy-corrigan",fullName:"Trudy Corrigan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11371",title:"Cerebral Circulation",subtitle:"Updates on Models, Diagnostics and Treatments of Related Diseases",isOpenForSubmission:!1,hash:"e2d3335445d2852d0b906bb9750e939f",slug:"cerebral-circulation-updates-on-models-diagnostics-and-treatments-of-related-diseases",bookSignature:"Alba Scerrati, Luca Ricciardi and Flavia Dones",coverURL:"https://cdn.intechopen.com/books/images_new/11371.jpg",editors:[{id:"182614",title:"Dr.",name:"Alba",middleName:null,surname:"Scerrati",slug:"alba-scerrati",fullName:"Alba Scerrati"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11012",title:"Radiopharmaceuticals",subtitle:"Current Research for Better Diagnosis and Therapy",isOpenForSubmission:!1,hash:"f9046d6f96148b285e776f384991120d",slug:"radiopharmaceuticals-current-research-for-better-diagnosis-and-therapy",bookSignature:"Farid A. Badria",coverURL:"https://cdn.intechopen.com/books/images_new/11012.jpg",editors:[{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9974",title:"E-Learning and Digital Education in the Twenty-First Century",subtitle:null,isOpenForSubmission:!1,hash:"88b58d66e975df20425fc1dfd22d53aa",slug:"e-learning-and-digital-education-in-the-twenty-first-century",bookSignature:"M. Mahruf C. Shohel",coverURL:"https://cdn.intechopen.com/books/images_new/9974.jpg",editors:[{id:"94099",title:"Dr.",name:"M. Mahruf C.",middleName:null,surname:"Shohel",slug:"m.-mahruf-c.-shohel",fullName:"M. Mahruf C. Shohel"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:4428},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"10858",title:"MOOC (Massive Open Online Courses)",subtitle:null,isOpenForSubmission:!1,hash:"d32f86793bc72dde32532f509b1ec5b0",slug:"mooc-massive-open-online-courses-",bookSignature:"Dragan Cvetković",coverURL:"https://cdn.intechopen.com/books/images_new/10858.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:1677,editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10195",title:"Serotonin and the CNS",subtitle:"New Developments in Pharmacology and Therapeutics",isOpenForSubmission:!1,hash:"7ed9d96da98233a885bd2869a8056c36",slug:"serotonin-and-the-cns-new-developments-in-pharmacology-and-therapeutics",bookSignature:"Berend Olivier",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:1337,editors:[{id:"71579",title:"Prof.",name:"Berend",middleName:null,surname:"Olivier",slug:"berend-olivier",fullName:"Berend Olivier"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10755",title:"Corporate Governance",subtitle:"Recent Advances and Perspectives",isOpenForSubmission:!1,hash:"ffe06d1d5c4bf0fc2e63511825fe1257",slug:"corporate-governance-recent-advances-and-perspectives",bookSignature:"Okechukwu Lawrence Emeagwali and Feyza Bhatti",coverURL:"https://cdn.intechopen.com/books/images_new/10755.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:1309,editors:[{id:"196317",title:"Associate Prof.",name:"Okechukwu Lawrence",middleName:null,surname:"Emeagwali",slug:"okechukwu-lawrence-emeagwali",fullName:"Okechukwu Lawrence Emeagwali"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11120",title:"Environmental Impact and Remediation of Heavy Metals",subtitle:null,isOpenForSubmission:!1,hash:"9e77514288e7394f1e6cd13481af3509",slug:"environmental-impact-and-remediation-of-heavy-metals",bookSignature:"Hosam M. Saleh and Amal I. Hassan",coverURL:"https://cdn.intechopen.com/books/images_new/11120.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:847,editors:[{id:"144691",title:"Prof.",name:"Hosam M.",middleName:null,surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10901",title:"Grapes and Wine",subtitle:null,isOpenForSubmission:!1,hash:"5d7f2aa74874444bc6986e613ccebd7c",slug:"grapes-and-wine",bookSignature:"Antonio Morata, Iris Loira and Carmen González",coverURL:"https://cdn.intechopen.com/books/images_new/10901.jpg",publishedDate:"June 15th 2022",numberOfDownloads:2273,editors:[{id:"180952",title:"Prof.",name:"Antonio",middleName:null,surname:"Morata",slug:"antonio-morata",fullName:"Antonio Morata"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11080",title:"Engineering Principles",subtitle:"Welding and Residual Stresses",isOpenForSubmission:!1,hash:"6c07a13a113bce94174b40096f30fb5e",slug:"engineering-principles-welding-and-residual-stresses",bookSignature:"Kavian Omar Cooke and Ronaldo Câmara Cozza",coverURL:"https://cdn.intechopen.com/books/images_new/11080.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:591,editors:[{id:"138778",title:"Dr.",name:"Kavian",middleName:"Omar",surname:"Cooke",slug:"kavian-cooke",fullName:"Kavian Cooke"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11332",title:"Essential Oils",subtitle:"Advances in Extractions and Biological Applications",isOpenForSubmission:!1,hash:"742e6cae3a35686f975edc8d7f9afa94",slug:"essential-oils-advances-in-extractions-and-biological-applications",bookSignature:"Mozaniel Santana de Oliveira and Eloisa Helena de Aguiar Andrade",coverURL:"https://cdn.intechopen.com/books/images_new/11332.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:515,editors:[{id:"195290",title:"Ph.D.",name:"Mozaniel",middleName:null,surname:"Santana De Oliveira",slug:"mozaniel-santana-de-oliveira",fullName:"Mozaniel Santana De Oliveira"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11029",title:"Hepatitis B",subtitle:null,isOpenForSubmission:!1,hash:"609701f502efc3538c112ff47a2c2119",slug:"hepatitis-b",bookSignature:"Luis Rodrigo",coverURL:"https://cdn.intechopen.com/books/images_new/11029.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:413,editors:[{id:"73208",title:"Prof.",name:"Luis",middleName:null,surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9537",title:"Human Rights in the Contemporary World",subtitle:null,isOpenForSubmission:!1,hash:"54f05b93812fd434f3962956d6413a6b",slug:"human-rights-in-the-contemporary-world",bookSignature:"Trudy Corrigan",coverURL:"https://cdn.intechopen.com/books/images_new/9537.jpg",publishedDate:"June 8th 2022",numberOfDownloads:2194,editors:[{id:"197557",title:"Dr.",name:"Trudy",middleName:null,surname:"Corrigan",slug:"trudy-corrigan",fullName:"Trudy Corrigan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11371",title:"Cerebral Circulation",subtitle:"Updates on Models, Diagnostics and Treatments of Related Diseases",isOpenForSubmission:!1,hash:"e2d3335445d2852d0b906bb9750e939f",slug:"cerebral-circulation-updates-on-models-diagnostics-and-treatments-of-related-diseases",bookSignature:"Alba Scerrati, Luca Ricciardi and Flavia Dones",coverURL:"https://cdn.intechopen.com/books/images_new/11371.jpg",publishedDate:"June 23rd 2022",numberOfDownloads:341,editors:[{id:"182614",title:"Dr.",name:"Alba",middleName:null,surname:"Scerrati",slug:"alba-scerrati",fullName:"Alba Scerrati"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"11043",title:"Endometriosis",subtitle:"Recent Advances, New Perspectives and Treatments",isOpenForSubmission:!1,hash:"7baf1c70b11d41400bb9302ae9411ca4",slug:"endometriosis-recent-advances-new-perspectives-and-treatments",bookSignature:"Giovana Ap. Gonçalves",coverURL:"https://cdn.intechopen.com/books/images_new/11043.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"185930",title:"Associate Prof.",name:"Giovana",middleName:null,surname:"Gonçalves",slug:"giovana-goncalves",fullName:"Giovana Gonçalves"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10536",title:"Campylobacter",subtitle:null,isOpenForSubmission:!1,hash:"c4b132b741dd0a2ed539b824ab63965f",slug:"campylobacter",bookSignature:"Guillermo Tellez-Isaias and Saeed El-Ashram",coverURL:"https://cdn.intechopen.com/books/images_new/10536.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"73465",title:"Dr.",name:"Guillermo",middleName:null,surname:"Téllez",slug:"guillermo-tellez",fullName:"Guillermo Téllez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10798",title:"Starch",subtitle:"Evolution and Recent Advances",isOpenForSubmission:!1,hash:"f197f6062c1574a9a90e50a369271bcf",slug:"starch-evolution-and-recent-advances",bookSignature:"Martins Ochubiojo Emeje",coverURL:"https://cdn.intechopen.com/books/images_new/10798.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11083",title:"Hazardous Waste Management",subtitle:null,isOpenForSubmission:!1,hash:"d553bd4f6f1c4b115ca69bd19faac7dc",slug:"hazardous-waste-management",bookSignature:"Rajesh Banu Jeyakumar, Kavitha Sankarapandian and Yukesh Kannah Ravi",coverURL:"https://cdn.intechopen.com/books/images_new/11083.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"218539",title:"Dr.",name:"Rajesh Banu",middleName:null,surname:"Jeyakumar",slug:"rajesh-banu-jeyakumar",fullName:"Rajesh Banu Jeyakumar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10848",title:"Tribology of Machine Elements",subtitle:"Fundamentals and Applications",isOpenForSubmission:!1,hash:"3c4ca4c4692ca8d4fa749b4ae81ec1fa",slug:"tribology-of-machine-elements-fundamentals-and-applications",bookSignature:"Giuseppe Pintaude, Tiago Cousseau and Anna Rudawska",coverURL:"https://cdn.intechopen.com/books/images_new/10848.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"18347",title:"Prof.",name:"Giuseppe",middleName:null,surname:"Pintaude",slug:"giuseppe-pintaude",fullName:"Giuseppe Pintaude"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10856",title:"Crude Oil",subtitle:"New Technologies and Recent Approaches",isOpenForSubmission:!1,hash:"8d0a7ca35b3de95b295dc4eab39a087e",slug:"crude-oil-new-technologies-and-recent-approaches",bookSignature:"Manar Elsayed Abdel-Raouf and Mohamed Hasan El-Keshawy",coverURL:"https://cdn.intechopen.com/books/images_new/10856.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"102626",title:"Prof.",name:"Manar",middleName:null,surname:"Elsayed Abdel-Raouf",slug:"manar-elsayed-abdel-raouf",fullName:"Manar Elsayed Abdel-Raouf"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9625",title:"Spinocerebellar Ataxia",subtitle:"Concepts, Particularities and Generalities",isOpenForSubmission:!1,hash:"365a7025fd46eb45de2549bdd9d50b98",slug:"spinocerebellar-ataxia-concepts-particularities-and-generalities",bookSignature:"Patricia Bozzetto Ambrosi",coverURL:"https://cdn.intechopen.com/books/images_new/9625.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"221787",title:"Dr.",name:"Patricia",middleName:null,surname:"Bozzetto Ambrosi",slug:"patricia-bozzetto-ambrosi",fullName:"Patricia Bozzetto Ambrosi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10905",title:"Plant Defense Mechanisms",subtitle:null,isOpenForSubmission:!1,hash:"84ad5b27dde5f01dc76087d0fd6fa834",slug:"plant-defense-mechanisms",bookSignature:"Josphert Ngui Kimatu",coverURL:"https://cdn.intechopen.com/books/images_new/10905.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"224171",title:"Prof.",name:"Josphert N.",middleName:null,surname:"Kimatu",slug:"josphert-n.-kimatu",fullName:"Josphert N. Kimatu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10686",title:"Natural Gas",subtitle:"New Perspectives and Future Developments",isOpenForSubmission:!1,hash:"581763788a6a59e653a9d1d9b5a42d79",slug:"natural-gas-new-perspectives-and-future-developments",bookSignature:"Maryam Takht Ravanchi",coverURL:"https://cdn.intechopen.com/books/images_new/10686.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"2416",title:"Dr.",name:"Maryam",middleName:null,surname:"Takht Ravanchi",slug:"maryam-takht-ravanchi",fullName:"Maryam Takht Ravanchi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10988",title:"Railway Transport Planning and Manageme",subtitle:null,isOpenForSubmission:!1,hash:"5cb54cc53caedad9ec78372563c82e2c",slug:"railway-transport-planning-and-management",bookSignature:"Stefano de Luca, Roberta Di Pace and Chiara Fiori",coverURL:"https://cdn.intechopen.com/books/images_new/10988.jpg",editedByType:"Edited by",publishedDate:"June 28th 2022",editors:[{id:"271061",title:"Prof.",name:"Stefano",middleName:null,surname:"de Luca",slug:"stefano-de-luca",fullName:"Stefano de Luca"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"1316",title:"Higher Education",slug:"higher-education",parent:{id:"265",title:"Education",slug:"social-sciences-education"},numberOfBooks:9,numberOfSeries:0,numberOfAuthorsAndEditors:166,numberOfWosCitations:50,numberOfCrossrefCitations:71,numberOfDimensionsCitations:130,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"1316",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"11004",title:"Medical Education for the 21st Century",subtitle:null,isOpenForSubmission:!1,hash:"f8863875cdefa578f26a438ea21bdc1e",slug:"medical-education-for-the-21st-century",bookSignature:"Michael S. Firstenberg and Stanislaw P. Stawicki",coverURL:"https://cdn.intechopen.com/books/images_new/11004.jpg",editedByType:"Edited by",editors:[{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10495",title:"Insights Into Global Engineering Education After the Birth of Industry 5.0",subtitle:null,isOpenForSubmission:!1,hash:"e83ddb1aa8017926d0635bbe8a90feca",slug:"insights-into-global-engineering-education-after-the-birth-of-industry-5-0",bookSignature:"Montaha Bouezzeddine",coverURL:"https://cdn.intechopen.com/books/images_new/10495.jpg",editedByType:"Edited by",editors:[{id:"313464",title:"Dr.Ing.",name:"Montaha",middleName:null,surname:"Bouezzeddine",slug:"montaha-bouezzeddine",fullName:"Montaha Bouezzeddine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8283",title:"Innovations in Higher Education",subtitle:"Cases on Transforming and Advancing Practice",isOpenForSubmission:!1,hash:"9c8b8a6fe8578fbf2398932ce8c1b717",slug:"innovations-in-higher-education-cases-on-transforming-and-advancing-practice",bookSignature:"Dominique Parrish and Joanne Joyce-McCoach",coverURL:"https://cdn.intechopen.com/books/images_new/8283.jpg",editedByType:"Edited by",editors:[{id:"197795",title:"Associate Prof.",name:"Dominique",middleName:null,surname:"Parrish",slug:"dominique-parrish",fullName:"Dominique Parrish"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8039",title:"Theorizing STEM Education in the 21st Century",subtitle:null,isOpenForSubmission:!1,hash:"0c99d528dbcc6ed5e8a26f96b36c812d",slug:"theorizing-stem-education-in-the-21st-century",bookSignature:"Kehdinga George Fomunyam",coverURL:"https://cdn.intechopen.com/books/images_new/8039.jpg",editedByType:"Edited by",editors:[{id:"267912",title:"Dr.",name:"Kehdinga George",middleName:null,surname:"Fomunyam",slug:"kehdinga-george-fomunyam",fullName:"Kehdinga George Fomunyam"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9040",title:"Pedagogy in Basic and Higher Education",subtitle:"Current Developments and Challenges",isOpenForSubmission:!1,hash:"3ef45143bf2a8d798f0e423e098afe6c",slug:"pedagogy-in-basic-and-higher-education-current-developments-and-challenges",bookSignature:"Kirsi Tirri and Auli Toom",coverURL:"https://cdn.intechopen.com/books/images_new/9040.jpg",editedByType:"Edited by",editors:[{id:"234399",title:"Prof.",name:"Kirsi",middleName:null,surname:"Tirri",slug:"kirsi-tirri",fullName:"Kirsi Tirri"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7804",title:"Teacher Education in the 21st Century",subtitle:null,isOpenForSubmission:!1,hash:"1722e45e6ebd731426bc0e4ac5c6eee2",slug:"teacher-education-in-the-21st-century",bookSignature:"Reginald Botshabeng Monyai",coverURL:"https://cdn.intechopen.com/books/images_new/7804.jpg",editedByType:"Edited by",editors:[{id:"210249",title:"Prof.",name:"Reginald",middleName:"Botshabeng",surname:"Monyai",slug:"reginald-monyai",fullName:"Reginald Monyai"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7576",title:"Reimagining New Approaches in Teacher Professional Development",subtitle:null,isOpenForSubmission:!1,hash:"7ebab0695715a9b2a759da32380ded9a",slug:"reimagining-new-approaches-in-teacher-professional-development",bookSignature:"Vimbi Petrus Mahlangu",coverURL:"https://cdn.intechopen.com/books/images_new/7576.jpg",editedByType:"Edited by",editors:[{id:"196797",title:"Prof.",name:"Vimbi",middleName:"Petrus",surname:"Mahlangu",slug:"vimbi-mahlangu",fullName:"Vimbi Mahlangu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5773",title:"Global Voices in Higher Education",subtitle:null,isOpenForSubmission:!1,hash:"98977ad0f9bc0a5224a23d6f67b343ca",slug:"global-voices-in-higher-education",bookSignature:"Susan L. Renes",coverURL:"https://cdn.intechopen.com/books/images_new/5773.jpg",editedByType:"Edited by",editors:[{id:"158868",title:"Dr.",name:"Susan",middleName:null,surname:"Renes",slug:"susan-renes",fullName:"Susan Renes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1990",title:"International Perspectives of Distance Learning in Higher Education",subtitle:null,isOpenForSubmission:!1,hash:"e9f445b89a42e6221004f529ac247127",slug:"international-perspectives-of-distance-learning-in-higher-education",bookSignature:"Joi L. Moore and Angela D. Benson",coverURL:"https://cdn.intechopen.com/books/images_new/1990.jpg",editedByType:"Edited by",editors:[{id:"102403",title:"Dr.",name:"Joi L.",middleName:null,surname:"Moore",slug:"joi-l.-moore",fullName:"Joi L. Moore"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:9,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"32519",doi:"10.5772/33745",title:"Self-Regulated Learning Activities: Supporting Success in Online Courses",slug:"self-regulated-learning-activities-supporting-success-in-online-courses-",totalDownloads:2691,totalCrossrefCites:1,totalDimensionsCites:10,abstract:null,book:{id:"1990",slug:"international-perspectives-of-distance-learning-in-higher-education",title:"International Perspectives of Distance Learning in Higher Education",fullTitle:"International Perspectives of Distance Learning in Higher Education"},signatures:"Maureen Snow Andrade",authors:[{id:"96902",title:"Dr.",name:"Maureen",middleName:null,surname:"Snow Andrade",slug:"maureen-snow-andrade",fullName:"Maureen Snow Andrade"}]},{id:"32516",doi:"10.5772/32879",title:"Open and Distance Learning in Dual Mode Universities: A Treasure Unexploited",slug:"open-and-distance-learning-in-dual-mode-universities-a-treasure-unexploited",totalDownloads:5389,totalCrossrefCites:4,totalDimensionsCites:9,abstract:null,book:{id:"1990",slug:"international-perspectives-of-distance-learning-in-higher-education",title:"International Perspectives of Distance Learning in Higher Education",fullTitle:"International Perspectives of Distance Learning in Higher Education"},signatures:"Paul Birevu Muyinda",authors:[{id:"93065",title:"Dr.",name:"Paul",middleName:null,surname:"Birevu Muyinda",slug:"paul-birevu-muyinda",fullName:"Paul Birevu Muyinda"}]},{id:"69651",doi:"10.5772/intechopen.89841",title:"Parental Engagement in Children’s Learning: A Holistic Approach to Teacher-Parents’ Partnerships",slug:"parental-engagement-in-children-s-learning-a-holistic-approach-to-teacher-parents-partnerships",totalDownloads:1389,totalCrossrefCites:5,totalDimensionsCites:7,abstract:"This study presents the standpoint of parental engagement, conceptualized by Janet Goodall and collaborators, as a framework that is coherent to the principles of the holistic approach of pedagogy to teacher-parents’ partnerships. We bring forward the evolution of the concept of parental engagement and its main standpoints, in relation to more traditional theories on parental involvement. We also discuss previous findings about teachers’ and parents’ roles in education and teacher-parents’ partnerships, as well as how do changes in educational paradigms challenge home-school collaboration. Finally, the article highlights the need to implement research-based parental engagement practices in educational systems around the world.",book:{id:"9040",slug:"pedagogy-in-basic-and-higher-education-current-developments-and-challenges",title:"Pedagogy in Basic and Higher Education",fullTitle:"Pedagogy in Basic and Higher Education - Current Developments and Challenges"},signatures:"Cristiana Levinthal de Oliveira Lima and Elina Kuusisto",authors:null},{id:"65030",doi:"10.5772/intechopen.83417",title:"Lack of Qualified Teachers: A Global Challenge for Future Knowledge Development",slug:"lack-of-qualified-teachers-a-global-challenge-for-future-knowledge-development",totalDownloads:2054,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"A major challenge for teacher education in the twenty-first century is to provide society with qualified teachers to teach and prepare the next generation of citizens. The situation in, for example, Sweden and South Africa faces huge issues concerning an increased lack of teachers in the future, as well as difficulties with teacher attrition. Examples from the USA show that up to 50% of new teachers quit working as teachers within 5 years. The difficulties with knowledge transfer to new generations, are a global threat. In this chapter, the deficiency of examined teachers is addressed in Section 1. This is followed by an overview of two key aspects of teachers’ professional development, namely bridging the gap between practice and theory to enhance teaching quality as well as the importance of practice-based professional development to maintain teachers to work as teacher in a long-term perspective. The results of a case study of students’ views on theories are presented, showing a strong experienced dichotomy between theory and practice, and difficulties to see how theories could be used to better understand classroom situations. Finally, a proposal of how to bridge the gap between theory and practice with designed modules is presented.",book:{id:"7804",slug:"teacher-education-in-the-21st-century",title:"Teacher Education in the 21st Century",fullTitle:"Teacher Education in the 21st Century"},signatures:"Mona Holmqvist",authors:[{id:"275455",title:"Dr.",name:"Mona",middleName:null,surname:"Holmqvist",slug:"mona-holmqvist",fullName:"Mona Holmqvist"}]},{id:"70433",doi:"10.5772/intechopen.90502",title:"The Moral Role of Pedagogy as the Science and Art of Teaching",slug:"the-moral-role-of-pedagogy-as-the-science-and-art-of-teaching",totalDownloads:1127,totalCrossrefCites:6,totalDimensionsCites:6,abstract:"The purpose of this chapter is to present the key concepts and actors in pedagogy and didactics in the context of institutional teaching. We present a holistic approach to education and view human beings as lifelong learners who need to be educated comprehensively to actualize their full potential. In this chapter we discuss how pedagogy, the science and art of teaching, can promote the educational goals identified in the curriculum. In this chapter we adhere to the Didaktik curriculum tradition in which values and morals are emphasized in guiding the teaching-studying-learning process. This means that pedagogy is moral in nature, and the teacher’s main task is to reflect the values underlying her teaching and the purposes she wants to advance in her teaching. We also discuss the current pedagogical challenges in both basic and higher education in educating students for the twenty-first century.",book:{id:"9040",slug:"pedagogy-in-basic-and-higher-education-current-developments-and-challenges",title:"Pedagogy in Basic and Higher Education",fullTitle:"Pedagogy in Basic and Higher Education - Current Developments and Challenges"},signatures:"Kirsi Tirri and Auli Toom",authors:[{id:"234399",title:"Prof.",name:"Kirsi",middleName:null,surname:"Tirri",slug:"kirsi-tirri",fullName:"Kirsi Tirri"},{id:"298433",title:"Dr.",name:"Auli",middleName:null,surname:"Toom",slug:"auli-toom",fullName:"Auli Toom"}]}],mostDownloadedChaptersLast30Days:[{id:"69139",title:"Formative Assessment in Mathematics Education in the Twenty-First Century",slug:"formative-assessment-in-mathematics-education-in-the-twenty-first-century",totalDownloads:1277,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Assessment does not always have to involve paper and pencil but can instead be a project, an observation, or a task that shows a student has acquired the concept and can make sound connections and linkages with other related concepts. Learning is meaningful when the student comprehends the relationship of what is being learned to other knowledge. Furthermore, concept map measures aspects of learning, which conventional tests cannot measure such as students’ misconceptions. As such, the chapter shall focus on formative assessment in mathematics classroom mediated by a method of teaching (concept mapping) that promotes critical thinking, which assists teachers to teach and assess students’ understanding and make connections between concepts explicitly.",book:{id:"8039",slug:"theorizing-stem-education-in-the-21st-century",title:"Theorizing STEM Education in the 21st Century",fullTitle:"Theorizing STEM Education in the 21st Century"},signatures:"Benard Chigonga",authors:[{id:"298587",title:"Dr.",name:"Benard",middleName:null,surname:"Chigonga",slug:"benard-chigonga",fullName:"Benard Chigonga"}]},{id:"68547",title:"The Role of Mathematical Modeling in STEM Integration and Education",slug:"the-role-of-mathematical-modeling-in-stem-integration-and-education",totalDownloads:1246,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"With the rapidly developing technology, the labor force of the society has changed direction, and in the age of informatics, creative engineering applications have come to the forefront. Accordingly, the education levels of the labor force were also changed. The science, technology, engineering, and mathematics (STEM) education model in most countries aims to teach science, mathematics, technology, and engineering in relation to primary, secondary, high school, and higher education. STEM education, which has an impact in our country in recent years, has an important role in acquiring new skills, supporting creativity, innovation, and entrepreneurship, gaining the ability to transition between professions and adapting to new occupations. Nowadays, technology is expected to have different skills from individuals who will work in different fields with rapid development. Also, different teaching strategies play a major role in STEM integration and training. One of them, mathematical modeling, is the process of analyzing real-life or realistic situation using mathematical methods in the most general sense. The idea that mathematical modeling cycles should be used in STEM education at all levels from primary to tertiary education has gained importance in recent years, since it increases the students’ motivation towards the lesson and they learn better by concentrating their attention.",book:{id:"8039",slug:"theorizing-stem-education-in-the-21st-century",title:"Theorizing STEM Education in the 21st Century",fullTitle:"Theorizing STEM Education in the 21st Century"},signatures:"Murat Tezer",authors:[{id:"299964",title:"Associate Prof.",name:"Murat",middleName:null,surname:"Tezer",slug:"murat-tezer",fullName:"Murat Tezer"}]},{id:"66203",title:"Including Students with Disabilities in a Physical Education Teacher Preparation Program: An Institutional Perspective",slug:"including-students-with-disabilities-in-a-physical-education-teacher-preparation-program-an-institut",totalDownloads:1943,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"The increasing number of students with disabilities who have the goal of becoming a teacher in either elementary or high school is one of the challenges we are currently facing at the academic colleges of education in Israel. In this chapter, we address the inclusion challenge, namely how we have taken up the challenge to modify one existing teacher preparation program (TPP) in physical education (PE) to enable students with disabilities to study at the same level as the other students who are enrolled in the program. The chapter is composed of four sections. In the first section, we introduce the term inclusive education, elaborate upon its concepts, and highlight a number of developmental phases associated with this term. In the second section, we present the theoretical background and the practical frameworks of an inclusive pedagogy. In the third section, we describe a number of actions taken in one college that enabled students with disabilities to enroll in a PE TPP. In the fourth section, we conclude our discussion and provide a number of ideas for future research, in order to strengthen the understanding of how to integrate students with disabilities in PE TPP.",book:{id:"7804",slug:"teacher-education-in-the-21st-century",title:"Teacher Education in the 21st Century",fullTitle:"Teacher Education in the 21st Century"},signatures:"Ronnie Lidor and Yeshayahu Hutzler",authors:[{id:"293567",title:"Dr.",name:"Ronnie",middleName:null,surname:"Lidor",slug:"ronnie-lidor",fullName:"Ronnie Lidor"},{id:"293600",title:"Prof.",name:"Yeshayahu",middleName:null,surname:"Hutzler",slug:"yeshayahu-hutzler",fullName:"Yeshayahu Hutzler"}]},{id:"69651",title:"Parental Engagement in Children’s Learning: A Holistic Approach to Teacher-Parents’ Partnerships",slug:"parental-engagement-in-children-s-learning-a-holistic-approach-to-teacher-parents-partnerships",totalDownloads:1389,totalCrossrefCites:5,totalDimensionsCites:7,abstract:"This study presents the standpoint of parental engagement, conceptualized by Janet Goodall and collaborators, as a framework that is coherent to the principles of the holistic approach of pedagogy to teacher-parents’ partnerships. We bring forward the evolution of the concept of parental engagement and its main standpoints, in relation to more traditional theories on parental involvement. We also discuss previous findings about teachers’ and parents’ roles in education and teacher-parents’ partnerships, as well as how do changes in educational paradigms challenge home-school collaboration. Finally, the article highlights the need to implement research-based parental engagement practices in educational systems around the world.",book:{id:"9040",slug:"pedagogy-in-basic-and-higher-education-current-developments-and-challenges",title:"Pedagogy in Basic and Higher Education",fullTitle:"Pedagogy in Basic and Higher Education - Current Developments and Challenges"},signatures:"Cristiana Levinthal de Oliveira Lima and Elina Kuusisto",authors:null},{id:"55240",title:"Challenging Performativity in Higher Education: Promoting a Healthier Learning Culture",slug:"challenging-performativity-in-higher-education-promoting-a-healthier-learning-culture",totalDownloads:1789,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The nature and context of education have changed dramatically in recent decades. The increased prioritisation of standardisation, performance indicators and metrics often means that holistic, affective and wellbeing education are seen as less important in the educational endeavour. The value of education for education's sake is under siege. Previous emphasis on the education of the whole person (i.e., moral and creative aesthetic development) is often replaced by a more functionalist perspective of education as servicing economic need and global capitalist interests. Marketization of education has increased at an exponential rate and has had an adverse impact on the health and well‐being of both educators and students. This chapter elucidates how the triad of assessment, student well‐being and academic well‐being intersects in the ever increasing performative and neo‐liberalist cultures of higher education. It demonstrates the reciprocal dynamic of stress that is becoming more and more evident among educators and students. The chapter makes the case for more empowering and human‐centred educative contexts in order to facilitate better educational outcomes for students and healthier outcomes for all involved in the educational endeavour.",book:{id:"5773",slug:"global-voices-in-higher-education",title:"Global Voices in Higher Education",fullTitle:"Global Voices in Higher Education"},signatures:"Christine Deasy and Patricia Mannix‐McNamara",authors:[{id:"198284",title:"Dr.",name:"Christine",middleName:null,surname:"Deasy",slug:"christine-deasy",fullName:"Christine Deasy"},{id:"198290",title:"Dr.",name:"Patricia",middleName:null,surname:"Mannix McNamara",slug:"patricia-mannix-mcnamara",fullName:"Patricia Mannix McNamara"}]}],onlineFirstChaptersFilter:{topicId:"1316",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81937",title:"Socialization Experiences among Undergraduate Students in Higher Learning Institutions (HLI)",slug:"socialization-experiences-among-undergraduate-students-in-higher-learning-institutions-hli-",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.99007",abstract:"This work portrays the problems of socialization among undergraduate students in higher learning institutions. The socialization processes in higher learning institution are significant for the successful navigation of students in the academic programs and university environment in preparing the next generation of professional practitioners and scholars. But the undergraduate student socialization experiences of students at university environment are overlooked. To navigate in the higher learning institutions, students should be socialized effectively to the normative contexts of the higher learning institutions. The normative contexts of the higher learning institutions are generally categorized into social and academic contexts, because these context academic and social context integration have been linked to student retention and success. Social integration involves interpersonal relationships, support, interactions with others, and a sense of belonging at a university, which stems from extracurricular activities, informal dealings with peer groups, and interactions with faculty and staff, whereas academic integration is described through grade performance and intellectual development that reflects an ability to meet the standards of the academic system; intellectual development involves a student valuing their education as a process of development in which they gain knowledge and ideas. Students’ background is also the contributing factor for students’ socialization in the University.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Mulusew Birhanu Ayalew"},{id:"80280",title:"Adoption of Online Learning during the Covid19 Pandemic Lockdown by Universities in Garowe",slug:"adoption-of-online-learning-during-the-covid19-pandemic-lockdown-by-universities-in-garowe",totalDownloads:87,totalDimensionsCites:0,doi:"10.5772/intechopen.99941",abstract:"In response to the Covid-19 outbreak the world closed and therefore countries like Somalia have not been exceptional. The government of Somalia and all higher education institutions adopted crisis intervention measures on implementation of blended learning approaches like online teaching and learning. In this chapter we explore the process and challenges of adopting online learning in response to the world wide lockdown due to the pandemic. Given that this was an abrupt requirement, the survey was interested in finding out whether universities adopted and adapted easily. Researchers compared findings from previous studies and theoretical inclinations on online learning. Results indicate that the adoption of online learning among universities in Garowe was as a matter of crisis management whereby administration, lecturers and students were all not ready and had no prior grounding in this pedagogical learning platform. Just like previous studies online learning implementers have continued to encounter several challenges like intermittent internet network, cost of gadgets and facilities, inadequate skills of both the instructors and students, aspects of communication and satisfaction from stakeholders. With the research survey in Garowe, results show that this is still pervading and therefore need for more rigorous contextualised research on this subject.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Tumwebaze Alicon Auf and Omer Abdi Hamdi"},{id:"78597",title:"Public-Private Participation in Funding University Education in Sub-Saharan Africa: A Nigerian Case-Study for Sustainable Development",slug:"public-private-participation-in-funding-university-education-in-sub-saharan-africa-a-nigerian-case-s",totalDownloads:134,totalDimensionsCites:0,doi:"10.5772/intechopen.99940",abstract:"The developing countries in Africa still cannot withstand the pressure of the highly competitive global education market. Together with the large numbers of people who make a living in various innovative companies, these countries have solved key contemporary issues affecting global education. For this reason, it is necessary to actively respond to current technological innovation and educational challenges and to eliminate new technology graduates who can effectively interact with students through the responsive expansion of education and training. Expansion of education can produce effective expansion that promotes educational development, but due to budget constraints, most African governments cannot successfully and sustainably implement such educational programs. This is difficult. However, public-private partnership efforts provide a way out of this financial dilemma. The Sub-Saharan Africa initiative has achieved important educational objectives, such as: ensuring relevance for quality; secure funding for sustainability and establish resource mobilization partnerships and connections; and promote international cooperation. This discussion is relevant to the basic conditions for a successful public-private partnership with educational institutions and extended education and sheds light on the impact, lessons, and challenges. The public is increasingly concerned about the importance of higher education in the 21st century. This chapter explores some of the key functions of an innovative education system that supports the development of education in Nigeria and enhances people’s ability to use information. Nigeria’s education system re-emphasizes the importance of public and private universities, but the country does not have a sustainable education system and well-equipped educational institutions to support people’s ability to use information, learning, education, and research activities.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Lawrence Jones-Esan"},{id:"79197",title:"University Teachers’ Conceptions of What University Is: Implications for the Future of Higher Education",slug:"university-teachers-conceptions-of-what-university-is-implications-for-the-future-of-higher-educatio",totalDownloads:107,totalDimensionsCites:0,doi:"10.5772/intechopen.100813",abstract:"This chapter presents the perception of university teachers about the university, the most recent changes and how they have influenced their activity. The phenomenographic study was conducted with 10 university teachers, nine females and one male with more than 15 years of professional activity. The perception of the university emerges, in the teachers’ voice, focused on the description of its mission, namely as a context for the production and diffusion of knowledge to society, as a space for creative and critical thinking about the world, as an interdisciplinary space and as a system focused on teaching and research. It also includes characteristics related to its structure and functioning, such as the level of hierarchization, bureaucratization, competitiveness, dehumanization and bibliometrics overvaluation. Regarding the perceived changes, they are related to the structural reforms resulting from the Bologna Process, diverse student populations, research and internationalization, new technologies, institutional cooperation, bureaucratization and relationship with the community. Teachers also revealed some dissatisfaction in the way they are experiencing university life due to the overwork resulting from the multiple tasks required in the four activity strands (teaching, research, management and extension) with an impact on quality and innovation, but in line with what the institution demands.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Elisa Chaleta"},{id:"78595",title:"Globalization and Education: Trends towards Sustainability",slug:"globalization-and-education-trends-towards-sustainability",totalDownloads:57,totalDimensionsCites:0,doi:"10.5772/intechopen.99974",abstract:"Higher Education Institutions (IES) have a very relevant role in the path towards sustainability. The problem of the implementation of curricular sustainability is the disparity of solutions that can be adopted depending on the political and economic situation of each country. The study of a practical case in the south of Honduras allows the student to approach key decisions in a real scenario to bring improvements to a very disadvantaged population, lacking basic services, such as water and electricity, under the premise of sustainability, facing aspects as relevant such as sustainable mobility, water resources management, energy and construction models, in a context where globalization and technological innovation play a very important role. It is essential to know in depth the real context where structural changes will be applied to understand that there is no single reality, that actions are built adapting to specific situations and that the effectiveness of the measures that can be adopted to establish models that prioritize that part of sustainability that best weighs the balance between the environment, society and the economy for each case.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Maria Olga Bernaldo and Gonzalo Fernandez-Sanchez"},{id:"79255",title:"Higher Education Institutions (HEIs) in Africa Embracing the “New Normal” for Knowledge Production and Innovation: Barriers, Realities, and Possibilities",slug:"higher-education-institutions-heis-in-africa-embracing-the-new-normal-for-knowledge-production-and-i",totalDownloads:128,totalDimensionsCites:1,doi:"10.5772/intechopen.101063",abstract:"If Africa is to remain relevant and competitive in today’s knowledge-based economy, it has to rely on higher education institutions (HEIs) as centers of excellence for knowledge production. HEIs nurture and sustain the production of highly-skilled individuals to support Africa’s growing economies. Among all possible ways, this could be achievable through strategic curricula innovation driven by emerging mobile technologies. Consequently, Africa’s HEIs need to embrace the ‘New Normal’ by optimizing online teaching and learning in their pursuit to expand information and communications technology (ICT) literacy as a means to increase students’ opportunities in higher education (HE). However, Africa’s ability to embrace the ‘New Normal’ has been marred by inadequate ICT infrastructures, low connectivity, unreliable power supply, and national budget constraints that may undermine Africa’s HEIs’ potential to augment knowledge production and innovation.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Christopher B. Mugimu"}],onlineFirstChaptersTotal:17},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{},subseries:{},overviewPageOFChapters:[],overviewPagePublishedBooks:[],openForSubmissionBooks:{},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{}},subseries:{item:{id:"95",type:"subseries",title:"Urban Planning and Environmental Management",keywords:"Circular economy, Contingency planning and response to disasters, Ecosystem services, Integrated urban water management, Nature-based solutions, Sustainable urban development, Urban green spaces",scope:"