\r\n\tThis book intends to explore the domain of Concurrent Computing in computer science with special emphasis on insight and deeper understanding, not just on formalisms. An attempt has been made to present the material in a clear and simple style which encompasses many challenges and opportunities in the area of Concurrent Computing.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"5fab5068913d637f8d6761e3c1c61256",bookSignature:"Dr. Dr. Dinesh G. Harkut",publishedDate:null,coverURL:"//cdnintech.com/web/frontend/www/assets/cover.jpg",keywords:"Concurrent Programming, Concurrent Algorithms, Concurrent Data Structures, Multi-Processor System, Networked Computer Systems, Deterministic Parallelism, Message Passing, Concurrent Server Architectures, Real Time System, Cluster Computing, High-Speed Networks",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 2nd 2019",dateEndSecondStepPublish:"October 23rd 2019",dateEndThirdStepPublish:"December 22nd 2019",dateEndFourthStepPublish:"March 11th 2020",dateEndFifthStepPublish:"May 10th 2020",remainingDaysToSecondStep:"a year",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"216122",title:"Dr.",name:"Dinesh G.",middleName:null,surname:"Harkut",slug:"dinesh-g.-harkut",fullName:"Dinesh G. Harkut",profilePictureURL:"https://mts.intechopen.com/storage/users/216122/images/system/216122.png",biography:"Dr. Dinesh G. Harkut is Associate Professor at Prof Ram Meghe College of Engineering & Management (PRMCEAM), Badnera, India, in the Computer Science and Engineering Department. He obtained a bachelor’s degree, a master’s of engineering (CSE), and a PhD (CSE) from SGBAU Amravati University, Maharashtra, India. He also holds a master’s degree and PhD in Business Administration.\nHis primary research interests are in artificial intelligence, big data, analytics, embedded systems, and e-commerce. He has supervised eighteen master’s degree and twenty-four bachelor’s degree students. He has published forty-seven papers in refereed journals and published six books with international publishers. He has also organized various workshops, sessions, conferences, and trainings. He has two patents filed and published in his name in India. \nHe is a member of the Board of Studies (Computer Science and Engineering) and a recognized PhD supervisor at SGBAU Amravati University, Maharashtra, India. He holds membership in various professional bodies including the Institution of Electronics and Telecommunication Engineers (IETE), New Delhi; International Society for Technology in Education (ISTE), New Delhi; Universal Association of Computer and Electronics Engineers (UACEE), USA; International Economics Development and Research Center (IEDRC), Hong Kong; International Association of Engineers (IAENG), Hong Kong; and the European Alliance for Innovation, Belgium.",institutionString:"Prof Ram Mehge College of Engineering and Management",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"Sant Gadge Baba Amravati University",institutionURL:null,country:{name:"India"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"9",title:"Computer and Information Science",slug:"computer-and-information-science"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"301331",firstName:"Mia",lastName:"Vulovic",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/301331/images/8498_n.jpg",email:"mia.v@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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According to the CDC’s SEARCH for Diabetes among Youth Study, over 200, 000 people younger than 20 years have DM, with type 1 diabetes (T1DM) being more prevalent (1.93 for every 1, 000 young people), except among American Indian youth where it is less prevalent than type 2 diabetes (T2DM) [1, 2]. The prevalence rate of T2DM in the general population of youth is much less (0.24 per 1, 000 young people [1, 2]. With regard to incidence, an estimated 28.1 cases of DM occur per 100, 000 youth per year—18, 436 youth (about 19.7 per 100, 000) are diagnosed with T1DM, and 5, 089 (about 8.5 per 100, 000) are diagnosed with T2DM [1]. Within the past 20 years, the incidence of T2DM has increased, which may be attributable to the concurrent epidemic of overweight and obesity [3]. T1DM is most common among white youth followed by Hispanic and African American youth. T2DM more commonly occurs among American Indian and African American youth and is least common among Asian/Pacific Islander and non-Hispanic white youth. Asian/Pacific Islander youth have, on average, the least incidence and prevalence of both types of diabetes [1, 2].
The health issues faced by adolescent diabetics are similar to those experienced by adults, especially as they mature into adulthood (National Diabetes Education Program, NDEP) [4]. These issues include maintaining optimal blood glucose (glycemic) control, weight management, healthy nutrition, proper physical exercise, and prevention of long-term complications such as diabetic eye disease, diabetic renal disease, diabetic vascular disease, and diabetic nerve disease. Poor glycemic control manifests acutely as hypoglycemia and diabetic ketoacidosis, and chronically as health complications such as retinopathy and nerve damage [3, 4]. Both acute manifestations of poor glycemic control are potentially fatal and more so in youth who may not be fully cognizant of the symptoms, especially while at play. It is therefore important for diabetic youth and those who care for them to be properly educated about the symptoms, signs, and management of these conditions, and to be trained on maintaining optimal blood glucose control, which also helps to delay the onset of complications [3, 4].
Overweight and obesity have become increasingly important health issues in young diabetics. This is due to the rapid rise in cases of T2DM among this population within the last 20 years. T2DM in youth has been found to be associated with overweight and obesity, and therefore weight control has become an important component in the management of the disease [3, 5]. Nutrition is also a major issue in diabetic youth because healthful nutrition helps with blood glucose control, weight management, and maintenance of an optimum nutritional status necessary to maintain good health, boost immunity, and help prevent complications [4, 6]. Physical exercise is another important health issue. Diabetics tend to avoid physical exercise due to fear of hypoglycemia and other short-term effects of physical stress [4]. However, while blood glucose control is a concern during exercise, physical exercise has been shown to improve the health and quality of life of diabetics especially since it helps with weight and blood glucose control, improves blood circulation, and increases insulin sensitivity, thus reducing the complications associated with the disease [3, 4, 7]. It is important to encourage exercise in diabetic youth, create exercise regimens that meet their needs, and ensure proper supervision by experienced fitness instructors trained in diabetic exercise management and blood glucose control [4].
In the remainder of this chapter, we address adherence for children and adolescents with diabetes. The majority of our information will address issues for youth with T1DM, although more research on adherence for youth with T2DM is needed.
Adherence is a focal point of this chapter, and in subsequent sections of this chapter, we discuss other factors related to adherence, successful interventions, and ideas for improving child adherence. The World Health Organization (WHO) has developed an inclusive definition of adherence, which we believe encompasses health care needs of youth with diabetes as well as other types of chronic illnesses [8]. The WHO, in a report on long-term therapies for those with chronic illnesses edited by Sabate, described adherence (and we paraphrase their ideas) as behaviors indicating an individual was following medical and lifestyle recommendations related to a chronic illness [8]. Adherence is thus important to maintaining health and a good quality of life when a child or individual is facing a chronic condition. In the following section of this chapter, we discuss key items for adherence for children with diabetes, focusing chiefly on the importance of diet and exercise as long-term contributors to a healthy lifestyle.
In a recent study examining adherence to clinical practice guidelines, Amed et al. [9] reported that only about 7–8% of youth with T1DM were meeting national and international adherence practice guidelines. Moreover, they also indicated that children and adolescents who had been struggling with their diabetes for a longer period of time (i.e., had a longer time since diagnosis [4+ years]) were apt to have poor adherence and caretaking of their diabetes. Adherence is also a problem for youth with T2DM, and more youth are coping with T2DM and facing the same types of negative health outcomes as faced by children and adolescents with T1DM and as adults with T2DM [10]. Obese youth may be at a very high risk for T2DM, and increasing intake of fruits and vegetables and decreasing intake of foods high in fat and sugar may reduce health risks for these youth.
Youth with either T1DM or T2DM (usually older children) may face significant health risks. Microvascular risks, which can be lessened when glycemic control remains good, include nephropathy, retinopathy, and neuropathy. Similar to adults, children may face macrovascular risks (e.g., cardiovascular problems) as a long-term complication related to their diabetes [11]. Macrovascular risks also may be attenuated with good glycemic control, making adherence a key health topic for children and adolescents as the patterns and behaviors they establish as youth will impact their health quality in later years. Youth with T2DM may also face significant health challenges related to obesity, making cardiovascular health particularly important. One study assessing outcomes for youth with T2DM may provide a wealth of information for those interested in learning about health outcomes for youth with T2DM. This study is entitled the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, and this is a well-designed multisite study funded by the National Institute of Diabetes and Digestive Kidney Diseases [10].
Social isolation can be a negative experience for individuals with diabetes. Marrero et al. [12] proposed that peer support can reduce isolation and provide support for the diabetes patient in reaching his or her goals. Support from health professionals and clinicians also can be critical to reducing isolation. Support can also be provided “online.” For example, Nicholas et al. [13] reported that adolescents with diabetes who received online support were less likely to feel isolated because they had diabetes. Adolescents in the online program showed enhanced knowledge about their diabetes. Results from qualitative interviews indicated that adolescents reported reduced feelings of isolation, and they felt less “different” after participating in online support and education groups. Some adolescents in an 8-week online educational and support group reported improved quality of support from others outside their family; however, these results were not robust, and further research on the “support” gained from online groups is needed.
Older children and adolescents experiencing stress may have poorer immune system functioning and have poorer glycemic control [14]. Thus, the experience of stress may exacerbate problems with diabetes management, making adherence an important tool in combating the stress-poor glycemic control link. In addition, females and youth in ethnic minority groups may report higher levels of stress, indicating a greater need for support in helping them maintain optimal glucose levels. Delamater et al. reported that youth (participants in their study were aged 9–20 years) were clearly stressed over their diet. Health professionals need to assess adolescent stress levels and converse with adolescents to determine when referral for counseling to problem-solve coping with stressors and develop plans for improving adherence is needed. Working with children and adolescents to develop a strong relationship to be able to assess child functioning and have rapport so that the youngster remains positive about referral for supportive counseling is important as well to ensure that referrals themselves are considered positive by the youth. Stress also may be related to poor glycemic control for youth with T2DM. For example, Walders-Abramson and colleagues [15] from the Treatment Options for Type 2 Diabetes in Adolescents and Youth Study Group found that for youth with T2DM the odds of having difficulty with adherence to their medication regimen increased if they were experiencing difficulty with significant life stressors. They also found increased depression among youth coping with significant stressors, and this variable may also impact adherence for youth with T2DM [15].
Similarly, suffering from symptoms related to depression, a common problem for youth with T1DM, may be related to poor adherence to diabetic regimens [16]. In a meta-analysis and systematic review of the literature, Kongkaew et al. [17] found a relationship between feelings of depression and problems with adherence in youth with diabetes. They recommended working with adolescents to improve adherence behaviors in addition to working with adolescents to improve their mood [17]. Working on improving mood may indirectly improve adherence because if one feels happier, it may be easier to manage diabetes self-care. Researchers have reported that other variables, in addition to depressed mood, may interact to influence adherence problems, including appetite disturbance, poor self-care skills, or experiencing significant life stressors [15, 16]. Thus, additional studies assessing self-care, stressful life events, and emotional stressors are needed to begin to understand the pathways to poor adherence in adolescents experiencing emotional distress.
Herzer and Hood reported that adolescents with diabetes may experience relatively high levels of anxiety [18]. These researchers found that higher state anxiety (e.g., anxiety related to daily stressors) was related to less frequent monitoring of blood glucose levels and poorer glycemic control. Although anxiety may be less prominent than depression and less common in younger children, they too may experience anxiety related to their diabetes management [19]. Hence, it remains essential for clinicians and health professionals to monitor children’s feelings of worry and concern over their diabetes management and health risks related to this chronic illness. Health professionals can assist children and adolescents in identifying the aforementioned feelings and educating children about how tension and worry can negatively impact their motivation to follow their diabetes regimen. It is important to point out that being anxious and not following the regimen can actually lead to more feelings of anxiety as blood glucose levels remain too high as a consequence of poor adherence to dietary guidelines, insulin administration, etc. Buckloh et al. [11] conducted focus groups with parents and caregivers for youth with T1DM and found that parents also were experiencing anxiety related to adherence issues with their child as well as evolving anxiety related to possible long-term complications related to their child’s diabetes. Hence, focusing on anxiety in parents and children and how to reduce anxiety related to adhering to diet, exercise, testing blood glucose levels, and insulin administration will assist the entire family’s coping, which may have a positive impact on glucose monitoring and glycemic control. Improving exercise and teaching parents and children relaxation skills (e.g., breathing and positive imagery) may be helpful anxiety management strategies.
In this section on emotional functioning, we have focused primarily on internalizing symptoms, namely, depression and anxiety, in youth with T1DM. It is noteworthy that youth with T1DM can experience a myriad of psychological problems, related to both internalizing (e.g., anxiety and depression) and externalizing (i.e., acting out) symptoms related to conduct problems [19]. It will remain important to continue to examine the relations among conduct problems and other mental health issues such as attention problems and oppositional behaviors to improve our understanding of how emotional problems impact adherence. Furthermore, there is relatively less literature on emotional problems and adherence for adolescents with T2DM, and this will be another area for future study.
Youth with T1DM work to adhere to insulin administration, typically using the diabetes pump. They also must count their carbohydrates in order to regulate intake of carbohydrates. They must juggle monitoring blood glucose levels and administering insulin as well as managing their stress, diet, and exercise, which all can have a significant impact on their diabetes management.
Youth with T2DM struggle with adherence to taking medications regularly. In a recent study, the Today Study Group or Today Group reported that administration of two medications—metformin and rosiglitazone—improved diabetes management, especially for girls [10]. Youth do struggle with taking medications regularly, and like their counterparts with T1DM, those with T2DM also must work to monitor their diet, exercise, and stress levels. Interestingly, the lifestyle intervention employed in the study by the Today Group did not provide “value added” to glycemic control over and above the medications. The Today Group concluded that more fine-grained analysis of the lifestyle intervention and further study of interventions to improve adherence among youth this T2DM will be needed [10]. In the next paragraphs of this section on key areas for adherence, we will review research conducted with youth with T1DM as the majority of research is with children with T1DM. However, more research on dietary and exercise adherence for youth with T2DM will advance knowledge about optimal care for youth with T2DM.
After conducting a multisite study in Brazil, Davison and colleagues [20] in the Brazilian Type 1 Diabetes Study Group indicated that approximately 54% of the youth with T1DM in their sample were adherent to their diet, which these researchers defined as following the diet about 80% of the time. There were over 3, 000 patients in the sample for this study and these youth had participated in medical follow-up for at least 1 year. Surprisingly, only about 12% were following a diet prescribed by the Brazilian Diabetes Society, and 48% of the patients followed a diet of avoiding sweets and sugar. Moreover, it was unclear about whether they were knowledgeable about the importance of counting carbohydrates to maintain good glycemic control. Problems with glycemic control were evident in this sample. Adherence to dietary guidelines was associated with lower rates of hyperglycemia and ketoacidosis, but adherence to the diet was not associated with episodes of hypoglycemia [20].
Adherence to dietary guidelines for children and adolescents with type 1diabetes involves a balance of carbohydrate and insulin levels to maintain recommended blood glucose levels. In a review of studies examining nutrition of children with T1DM, Patton [21] discovered that youth with diabetes may consume more fruits and vegetables than their peers. We believe that after investigating the eating habits of clients with diabetes, health professionals should praise the eating habits of youth with diabetes if they are making efforts to consume more fruits and vegetables. On the other hand, Patton also mentioned that these youth may need to watch and also reduce their fat consumption [21]. In addition to teaching youth to count carbohydrates, paying attention to the general health level of the youth’s diet may contribute to helping them engage in healthy habits. We recommend that children become involved in learning about healthy eating and that health professionals and parents use rewards and encouragement to assist children in setting and achieving dietary goals. For very young children, using games and immediate rewards for trying new healthy foods may be a good way to involve them in plans for healthy eating.
Patton et al. [22] found that adherence to insulin administration is one cornerstone of good management, and in addition, eating a healthy diet and managing carbohydrate intake further helps manage diabetes. Self-monitoring charts, to track insulin administration, may help youth and their parents follow recommendations for regular testing of blood glucose levels. Incentives can be used to encourage youth to improve the regularity with which they test blood glucose levels. Some youngsters may be more likely to remember to test with reminders from an adult, and then the boy or girl can work toward more independent blood glucose monitoring and more control over self-monitoring schedules.
Our team wanted to highlight the importance of increasing knowledge about the impact of physical activity for children. Engaging in regular physical activity may be a key ingredient for glycemic control for youth with diabetes. Quirk et al. [23] reviewed studies from 1964 to 2012 on the effectiveness of physical activity for children and adolescents with diabetes (youth were between 8 and 17 years of age). They discovered 26 studies, and in 23 of these studies, there was at least one positive outcome for children and adolescents who engaged in exercise. However, in the studies reviewed, the length of the physical activity interventions varied between 2 and 39 weeks. The type of exercise also varied; some studies assessed engagement in one exercise (e.g., walking, swimming), and in other studies, several types of activities were used (e.g., cycling, games with balls, lifting weights, circuit training). Thus, there was great variety in the studies under review. Quirk et al. did find that engaging in physical activity had a moderate impact on glycosated hemoglobin levels, which is positive. Studies were often atheoretical and did not address change in motivation or psychological variables [23]. Future research on the impact of physical activity and the psychological variables associated with engagement in regular physical activity will advance knowledge about how activity affects children and adolescents with diabetes.
The support that the child receives from his or her family can positively impact diabetes management, and this includes adherence to medical regimens. Positive support occurs when the family allows for individuality and has open communication about medical management. Open communication allows the child to provide input and involves respecting his or her personality. We recommend regular family meetings to discuss how the family is coping and to discuss diabetes management so that a pattern of open communication can develop. Rules in the family should be consistently applied and remain flexible [24]. Within the family, the parent–child relationship can be the key factor determining positive steps toward adhering to the medical regimen. This relationship and the communication during mealtimes and snack times also can influence adherence [22].
Family support for diabetes management (especially for tasks needed to manage the illness on a daily basis) is related to improved adherence and ultimately improved metabolic control [25]. It is important for parents to remain flexible at mealtimes and in their communications with their child and to not appear too critical in order to engage the child and promote positive conversations about measuring carbohydrate intake and ensuring a healthy diet. Having open communication can help the child and parent by opening opportunities to discuss the child’s goals and areas for improving monitoring of diabetes management. Adolescent disclosure is essential to high parental knowledge and positive adolescent adjustments to diabetes adherence. On the other hand, nondisclosure and secrecy on the part of the adolescent has been shown to be related to greater symptoms of depression among adolescents trying to manage their diabetes [26]. Some adolescents may be likely to keep secrets about those times they “slip” in terms of adhering to their diabetes care; therefore, parents may want to ask adolescents about slips and promote an atmosphere of correcting, but not admonishing slips, so that adolescents can talk to them about snacking and appropriate corrections to insulin dosages can be made. Disclosure on the part of adolescents may be more important for mothers compared to fathers [26]; however, this is an area for further study.
Developing specific daily and weekly goals for diabetes management may be another protective factor to ensure that children and adolescents remain “on track” in terms of following their diabetes regimen. Youth should be involved in setting goals and providing input on plans to improve their adherence. In fact, joint decision making between parents and youth with diabetes may be one way to improve youth involvement in their diabetes care [27]. Involving them in decisions may improve their adherence to their diet and other aspects of their medical regimen. Miller and Jawad encouraged caregivers and other health care professionals to inspire youth with diabetes to express their views [27]. We believe that this is important, and we also recommend that longitudinal, qualitative research be conducted to examine what type of shared management and decision making should occur for youth of different ages residing in various family situations.
A literature search for this chapter revealed that there is relatively less information available discussing children’s ideas about what children and adolescents need to facilitate their diabetes management at school. This is unfortunate, given that children and adolescents typically view management at school as a significant issue. Nabors et al. [28] assessed children’s perceptions of supports needed for their diabetes management at school. Children mentioned that support for individual care plans is needed. Some reported that they needed more snacks available or support from a peer in walking to see the nurse. Some children also wanted to check their blood glucose outside of the classroom in order to have some privacy [28]. The American Diabetes Association has developed guidelines for care of children with diabetes at school [29]. We recommend that health professionals or the medical team working with school-based management review these guidelines and then plan to meet with children, their parents or caregivers, and the school nurse to individualize care plans for the children, which are then shared with teachers. Very little information is available about the support that children need for participation in after-school and extracurricular activities, and this is an area for additional research.
In a review of qualitative studies (from 2005 to 2011) of youth with diabetes, Ritholz et al. [30] discussed difficulties with interpersonal relationships as being a burden to some patients with diabetes. When reviewing studies focusing on children, they found that parents and family were sometimes perceived as supportive but could hinder an adolescent’s or child’s ability to socialize when not supporting their independence in attending social events. Parents also reported concerns about their child’s growing independence in the adolescent years when he or she would have to manage his or her diabetes more independently in social situations [30]. Parents can become anxious about their child’s ability to manage his or her diabetes regimen in social situations involving food or those where a child would be noticed as doing something different if he or she had to test his or her blood glucose level or administer insulin. Dr. Nabors, an author for this chapter, has worked with children at diabetes camps for several years. In groups at camp, children have reported that attending camp is very beneficial for reducing feelings of isolation and feelings of being “the only one who is different.” Involving children and adolescents with diabetes in peer support networks, with other same-aged youth with diabetes, may be an important way to reduce feelings of isolation for children and adolescents with diabetes. Marrero et al. supported the notion of peer support to reduce isolation and provide support for the diabetes patient in reaching his or her goals [12]. Support from health professionals and clinicians also can be critical to reducing isolation and sharing ideas that will both encourage and educate children with diabetes.
Supporting adherence in children with diabetes.
Figure 1 presents ideas for supporting a child as he or she copes with diabetes and the challenges of adhering to his or her medical regimen. It is important to consider that these factors interact and reciprocally influence each other. We believe that this graphic may assist health professionals in designing support plans for youth that focus on child, family, and environmental factors that will enhance support for following the medical regimen.
In a recent meta-analysis of 21 studies, Hood and colleagues [31] found a strong relationship between adherence and metabolic control in children and adolescents with T1DM. One key component of successful interventions is psychoeducation, aimed at educating parents of children with diabetes [32]. When parents learn more about diabetes management, they can better care for and teach their child about diabetes management tasks. When parents realize the importance of following the medical regimen, they are more likely to closely monitor and follow guidelines for diet, exercise, and glucose monitoring provided by their child’s medical team. We believe that parent education and ongoing support from the medical team, to maintain education with booster sessions to adapt parent training to the child’s age, self-efficacy for diabetes management, and family routines, are important. The child’s medical team can provide booster sessions to enhance parent knowledge and provide needed support to parents on an as-needed basis. Online interventions to educate parents may also be effective in educating them and linking them to support from the medical team and other parents, as in the Dutch Sugarsquare intervention [33]. Internet education may be especially important in rural areas or when parents lack transportation to access care in hospital settings to participate in support groups.
Health professionals can improve adherence. Patient-centered care will be important in developing plans that work for individual children and their family members. Kienle et al. [34, p. 13] stated, “The cornerstone of diabetic care is comprehensive case management including intense education to enable self-management adjusted for the child’s age and developmental stage and with assistance from caring and knowledgeable adults.” In their manuscript, Kienle et al. reported on a case study to improve child involvement in diabetes management for a girl with diabetes and other special needs. A patient-centered approach with repeated educational sessions was used to improve the girls’ involvement in her care. The aforementioned authors wrote that reeducation was critical to helping the girl as she learned and strove to improve her diabetes management. In the long run, the authors reported higher self-esteem and greater involvement in social activities [34]. Although children who do not have special needs may not need extensive reeducation, we believe that they can benefit from booster sessions or support groups, which allow review of the importance of adherence to dietary and exercise recommendations as well as reinforcing the importance of glucose monitoring.
We also believe that goal setting will be important for children and their parents. While setting goals, the child and parents should be involved in goal setting. As the child ages, parents can become less involved in leading goal-setting efforts. However, we believe that they should remain interested, caring, and involved on some level to support their adolescent. Evaluating alternatives to reach a level of good diabetes management, setting a plan, and breaking steps of the plan down into obtainable goals are part of an effective decision making process. After executing goals, it becomes important for the child/adolescent and family to evaluate the effectiveness of their plan, in terms of diabetes management and quality of life for the youth. Enhanced levels of positive communication from parents and lower negative communications from both parents and adolescents can improve communication, leading to better adherence [35]. Similarly, problem-solving skills may be another tool to teach children with diabetes to review situations in their lives and brainstorm about adherence issues and develop goals that will best assist them, within the context where they are, in managing their diabetes. Teaching children to advocate for themselves and what they need to manage their diabetes is another tool in helping them to be able to implement goals they have for themselves [36].
Marrero et al. [12] recommend that when assisting with goal setting, it is important that the individual feels that he or she can achieve them. They recommend key components of motivational interviewing as being consistent with a patient-centered model to promote self-management as the provider is developing attainable goals from the patient’s own frame of reference and using encouragement and praise to help motivate the patient to achieve his or her goals. We believe that this patient-centered stance, to the extent possible with a child and parent or caregiver in a “shared” management approach, will foster self-efficacy for diabetes management and enhanced involvement in diabetes care for children as well as adolescents. We recommend setting goals related to carbohydrate counting and teaching children and adolescents about counting carbohydrates. A relatively recent study has shown this is an effective dietary technique with adults [37]. If carbohydrate counting begins in childhood, perhaps this method can become a more routine behavior in adolescence, making it relatively easier to allow the adolescent to have primary control in counting carbohydrates and dietary management.
After receiving education about diabetes management, text messaging and reminders may be a way to boost adherence. This may be because children, adolescents, and parents or caregivers may respond well to reminders to help them with monitoring adherence to diabetes regimens. It may be feasible for children to send information on their monitoring efforts via mobile phone to research staff. This method may result in successful support, and messaging may be a good method for providing booster sessions, in terms of reminders and short educational messages to improve adherence.
The next paragraphs of this chapter present information related to adherence through case studies with fictional characters to review key issues related to adherence. This will illustrate key points in the research on adherence at an individual level.
Jacklyn is an 11-year-old white girl with T1DM. She has had diabetes since she turned 4 years old. She is the youngest of four children. She gets along well with her siblings and parents most of the time. She has one good friend at school and two close friends in her neighborhood. She enjoys dancing and belongs to a local dance group. Her grades at school remain strong, with a long-standing academic record of A’s and B’s.
Jacklyn has recently experienced stress because her older sister, whom she used to be very close to, is now spending the majority of her time with a new boyfriend. Also, her mother just began working full time. Previously, she had a part-time job at a local school. This meant her mother’s schedule matched Jacklyn’s schedule and therefore her mother was readily available to help her manage her diabetes regimen. She packed Jacklyn’s lunch and cooked all of her meals and was home to help Jacklyn with snacking. Since her part-time job was at Jacklyn’s school, her mother was always available to help Jacklyn if she had a hypoglycemic or hyperglycemic episode at school. She had snacks on hand to bring to Jacklyn’s classroom. Jacklyn wears a diabetic pump, which she likes better than shots.
Currently Jacklyn’s mother has begun a full-time job in a local bank. Thus, for the first time, Jacklyn is having opportunities to manage her diabetes more independently. However, this has been proving a difficult task for Jacklyn. She keeps forgetting her snack to bring to school. She is having difficulty preparing her snacks at home and remembering to test her blood sugar and call her mother with the results. Jacklyn’s mother is concerned for her daughter’s diabetes management and mentioned this to the diabetes educator at one of Jacklyn’s regular clinic visits. The diabetes educator had several recommendations to assist Jacklyn with her diabetes management.
First, the diabetes educator provided Jacklyn with a self-monitoring book, where she could record her blood sugar levels. She taught Jacklyn to set the alarm on her iPad so that she would have a “reminder” to remember to check her blood sugar regularly when she was home alone after school before her mother came home from work. She talked with Jacklyn about snacks she could have and then worked with Jacklyn and her mother to help them get snacks ready, in correct proportions, so that Jacklyn could easily get a snack, with knowledge of the carbohydrates in the snack, after testing her blood sugar when this was called for, based on results of blood glucose monitoring.
The diabetes educator recommended that Jacklyn and her mother have nightly checks to determine how her diabetes management had gone each day. At these “check-in” meetings, they could brainstorm about ways to improve diabetes management or it was an opportunity for Jacklyn’s mother to praise her new-found independence if self-monitoring was leading to regular “testing” and better dietary monitoring/management.
Jacklyn responded well to the prospect of participating in meetings and was very excited to have positive support as she began to tackle having greater levels of responsibility in management of her diabetes regimen. However, she did ask that some meetings occur during brief telephone contacts as she had a very busy social life and was involved in after-school activities. The diabetes educator did request that there be one in-person mother–daughter session to address communication about diabetes management between mother and daughter.
In this session, Jacklyn worked with her mother and the diabetes educator, in a private session, to rehearse ways to let other girls in her peer group know that she needed to count her carbohydrates and snack “thoughtfully” in order to best manage her diabetes. In their group session, the diabetes educator, Jacklyn, and her mother worked on improving their communication so that Jacklyn could tell her mother when she ate extra portions of high-carbohydrate foods and had “extra” snacks, so that when they talked on the telephone, her mother could offer the best guidance about insulin administration on her pump. Jacklyn’s mother acknowledged that she could be very overprotective of her daughter and would try to use text messages rather than phone checks to briefly “check in” with her daughter. Her mother admitted she needed to place more trust in Jacklyn to manage her snacking and communicate with her mother about her own ideas about how best to manage her diet. At the end of this session, both mother and daughter agreed to a few more sessions to discuss communication and teamwork around diabetes management.
For the next few sessions, Jacklyn showed some resistance to sharing information with her mother because she was worried that her mother would become angry with her related to her “extra” snacking. Although her mother was not as receptive as she could have been, with further counseling sessions, she became more open to listening to her daughter and working with her daughter to develop a shared decision-making approach to setting goals and managing diet to help Jacklyn take a greater role in managing her diabetes. After a few more in-person sessions, the diabetes educator moved to telephone contacts and text messages with Jacklyn to keep in contact and help her keep tracking her carbohydrates and remembering to test her blood sugar levels. In time, the need for telephone checks also was reduced, and Jacklyn contacted her diabetes educator for support when needed. Jacklyn and her mother maintained their weekly meetings so that they had a dedicated time to plan regarding meals, snacks, and weekly diabetes management goals.
Over time, Jacklyn made progress in becoming more involved in her diabetes management. She was more involved in counting her carbohydrates. She was more involved in decision making about what she ate and in managing her diabetes. Jacklyn and her mother worked with the diabetes educator to develop a plan for Jacklyn to improve her self-monitoring and record her blood sugar levels by developing a logging method by storing her numbers on her telephone in a “notes application.” Jacklyn continued to exercise regularly, and her involvement in decisions about her diabetes management improved, which improved her belief in her ability to make good decisions about managing her diabetes and to have more of a role in managing her diabetes.
Jacklyn did not present with serious emotional issues related to her diabetes management. Should this have been the case, then referral to a child psychologist or mental health counselor may have been warranted. Addressing emotional issues, such as depression, can improve diabetes management [16, 17]. Jacklyn was experiencing some feelings of sadness related to spending less time with her sister. A possible other area to improve quality of life may have been to ensure that Jacklyn was involved in meaningful activities with friends. Ensuring that she had opportunities to socialize with peers may have further contributed to positive emotional functioning.
Jacklyn might have benefitted from participating in a diabetes support group or attending a summer camp with other youth with T1DM. She would then be able to access peer support. If she was feeling isolated and perhaps feeling that she was the “only child” who had diabetes, being with others could have alleviated loneliness. If she experienced feelings of isolation due to believing that her friends did not understand her medical condition, support from peers facing similar issues could have provided a boost to her spirits, thereby improving her self-efficacy for managing her illness.
Self-monitoring of eating behaviors and carbohydrate counts was very helpful in assisting this youngster in understanding what she needed to do in terms of next steps in her diabetes management. This is consistent with research indicating that self-monitoring of blood glucose levels is critical to diabetes management in youth with T1DM [38]. Developing monitoring plans, which can “fit in” with children’s and adolescents’ busy lifestyles, and which can help them communicate with their parents, can be a way to track progress and gather concrete data about ways to improve diabetes management. Calendars, tracking sheets, food diaries, and other tools can be customized to meet the individual needs of child–caregiver units so that they can work together to manage the child’s diabetes and implement his or her medical regimen. It can be beneficial to monitor stress and exercise levels, in addition to diet and blood glucose testing, so that the child and caregiver gain an understanding of the need to juggle four balls when managing diabetes: food, blood glucose monitoring, exercise, and stress.
Support from her mother was critical to Jacklyn’s diabetes management. This is consistent with literature indicating that family cohesion and teamwork, particularly around the child’s diabetes management goals, can facilitate adherence [22]. Family meetings or finding opportunities to discuss a shared vision for diabetes management may help families find the time to plan for success and plan for monitoring the four areas for self-management (food, blood glucose monitoring, exercise, and stress). It is noteworthy that the role of the diabetes educator could be played by other health professionals such as the school nurse, the nurse on the medical team, a doctor, or a child health psychologist. Moreover, support need not always be in person or in the same setting or room. For instance, Nicholas and colleagues [13] found that participation in an online support and education program facilitated diabetes management. We believe that more research into the utility of online support is needed, as this type of support may be critical to those children and adolescents residing in rural areas where they are not close to a children’s medical center. Whether it is online or in person, some of the key ingredients to adherence success are support, monitoring, and teamwork to help the child learn greater self-management.
Raphael is a 16-year-old male diagnosed as obese and as having T2DM related to his obesity. He is struggling with issues related to adhering to recommendations to facilitate weight loss and improve his involvement in regular physical activity, which at the current time is walking. Raphael finds walking boring and does not want any people in his neighborhood to see him walking. He reported that there was no healthy food at home and that if he ate healthy food at lunch at school, he would face teasing from his friends with whom he eats lunch. Raphael was referred for counseling by the medical team at the obesity management clinic at a local hospital. The medical team in this clinic is assisting in managing Raphael’s weight management and diabetes, with consultation from a pediatric endocrinologist. In his first counseling session, Raphael stated that he felt change in his eating and exercise habits was not possible. He also admitted to having difficulty remembering to take his diabetes medication. He reported he takes his medicine about 50% of the time. His grades at school are in the “B” range, and he said he got along well with his mother, a single parent. He never sees his father and is an only child. After coming home from school, he snacks and plays video games. He has a great love of electronics, and some day he would like to have a job developing video games.
Raphael was slow to warm up to interacting with his counselor. He stated, “I’m fine and don’t need to be here.” The counselor attempted to establish common ground with Raphael and confirm his need to attend some counseling to learn about ways to better manage his health issues. His counselor was a male and tried to engage Raphael in conversations about video games. This was an activity Raphael liked, so he told his counselor about some games he enjoyed. Raphael particularly enjoyed games where he played against other teenagers online. After this discussion, Raphael’s counselor asked if he could provide Raphael with education about diabetes management, and Raphael reluctantly agreed to discuss this.
The counselor, who was well versed in pediatric health issues, provided Raphael with information about the long-term and short-term health risks associated with his weight and diabetes. He provided Raphael with pamphlets that had information about diabetes management. He and Raphael reviewed information about diabetes from the American Diabetes Association on the counselor’s laptop computer. Raphael showed surprise when learning the severity of some of the medical complications associated with T2DM. He reported, “I didn’t think it was that important to take my pills or to count my carbs.”
After several sessions, Raphael and his counselor agreed to a plan to improve his adherence to taking his medications and improving his diet. They involved his mother in a session, and with her assistance, they talked about having more vegetables and fruits in the refrigerator and about buying less of the high-fat, high-carbohydrate snacks that Raphael was used to consuming while he played video games in the kitchen after school. They agreed to have fruits and vegetables with light dressing available for snacks, and Raphael agreed to play video games in his room after he had his afterschool snack and tested his blood sugar. This would make it more difficult to access snacks without thinking about getting up and leaving the games in which he was involved.
Raphael also agreed to keep a calendar to monitor taking his medication every day. He agreed to take his medication in the morning, with his mother observing his actions. After taking the medication, his mother would record successful administration of the medication on the calendar. This was to occur for 1 month, and if Raphael established a regular routine for taking his medication, then he and his mother would talk about gradually turning over responsibility for taking his medication to Raphael.
A similar plan was developed for helping Raphael to begin to count his carbohydrate intake and record his snacks using a food diary. Both Raphael and his mother recorded what he ate during the day and in the evenings. His mother took notes and recorded what Raphael ate daily, and they talked about his calorie intake, how many carbohydrates he had eaten, and how often he had tested his blood sugar. Raphael was to record his blood sugar levels after school, but he was having difficulty doing this, so his mother assisted with recording this, in the hopes that after some time with this added support, Raphael would be able to record results of his daily blood glucose testing and his diet more independently. Raphael seemed to enjoy the help from his mother and her support. He did not wish to be responsible for monitoring on his own, so this shared management approach was successful. His counselor invited his mother to every third counseling session, and they had weekly phone sessions so that the counselor could support Raphael’s mother’s involvement in this shared management approach. Raphael’s counselor contacted the nurse on his medical team and his mother also reported on their progress to the medical team. After communicating, it was agreed that referral to a nutrition expert at the hospital was necessary to gain further information and to educate Raphael and his mother further regarding weight loss and diet.
Progress was very slow in terms of improving physical activity. Raphael did not want to participate in gym class—he usually sat on the sidelines. The reason for this is he did not want to be made fun of by peers for being overweight and unable to play games well. For similar reasons, fear of teasing and stigma due to his weight, Raphael did not want to exercise in the neighborhood at home. In order to improve his access to a place where he could exercise, Raphael’s counselor called a local training center. The counselor networked with the medical team to write an application to the training center so that Raphael could get a complimentary membership, as Raphael’s mother could not afford to pay for a gym membership for her son. Raphael’s mother worked with the counselor to develop an incentive for Raphael to work out. She agreed to reward Raphael for weekly physical activity by providing him with an allowance that he could spend on computer games. A month after joining the gym, Raphael went for a first training session. He agreed to walk on the indoor track, but not to lift weights. He was able to go to the gym once per week and was earning some extra money for video games, but progress in this area was slow and an area for continued planning and discussion in counseling sessions.
Raphael and his mother were referred to online support groups for parents and youth with diabetes after a period of time. Raphael’s mother reported that she benefitted from her participation in the parent group. However, Raphael did not connect with others in his adolescent group. Therefore, the counselor contacted his medical team to see if there were other peers with which Raphael could be connected. The nurse for the team could not identify any peer support that would be a “match” for Raphael from among their current records, but the team (counselor, mother, and medical professionals) supporting Raphael all became aware of his need for peer support in coping with being overweight and having T2DM. They kept in touch through monthly telephone meetings coordinated by Raphael’s counselor. Raphael continued in counseling, and his sessions were now biweekly. He enjoyed his referral to the nutrition expert and agreed to meet with her once per month.
In summary, Raphael showed some improvement in his diabetes management and in thinking about weight loss. Planning was in place to ensure long-term medical monitoring and support for Raphael from his mother and the medical team. This additional level of accountability was in place to improve his chances at monitoring his diabetes and weight issues. After 6 months, he was taking his medication regularly, and his snacking was healthier in nature because he was consuming more fruits and vegetables rather than potato chips and candy. He was monitoring his blood glucose levels as well. His exercise level had not greatly improved, and this was an area for continued goal setting. Eventually, it was hoped that his mother would provide less support and that Raphael would become more involved in managing his diabetes and caring for his health. This fictional case provides examples of how a counselor (and this role could also be played by other health professionals) can be an integral part of the diabetes team to help an adolescent with diabetes management. This case outlined the need for close collaboration between the parent, child, and medical team and the need for a long-term commitment to improving adherence and supporting the adolescent in order for him to learn more about his condition and become more involved in self-care. Also, this case review highlighted the importance of parent support and shared parent–child management of the diabetes regimen.
Jonas, a 15-year-old male with T1DM, came to his medical team because he was experiencing teasing related to needing privacy to test his blood glucose levels at school. He had requested to leave the classroom to “give myself my needle stick” to test my blood sugar. His teacher was not understanding of his need for privacy. His teacher mentioned this in front of the class, and after this incident, another boy in his class started calling him a “sissy” for his requests to “test” outside the classroom. Jonas wished to test his blood sugar levels outside the classroom so he did not feel like “everyone is ‘staring at me’ when I need to stick my finger with a needle to test my blood sugar.”
Jonas mentioned this problem to a nurse on his diabetes management team when he came in for a regular visit with his team at a local children’s hospital. The nurse recommended that Jonas have a talk with his teacher about his diabetes. Jonas replied, “Again? I have talked with him before. He doesn’t listen.” The nurse also had an opportunity to talk with Jonas’s mother about his diabetes management at school. His mother mentioned that it was difficult for Jonas to have snacks in the classroom if his blood sugar level was low. Also, it was difficult for him to get permission to go and see the school nurse if he felt he needed her assistance if he thought his blood sugar levels were either too high or too low. After a brief conversation with the team, his nurse asked Jonas and his mother if they could talk by telephone later on the same day, after clinic had ended. The nurse for the medical team called Jonas and his mother and placed them on speaker phone so that she and Jonas’s doctor could converse with Jonas and his mother about diabetes management at school.
During this conversation, both Jonas and his mother indicated that support at school for testing, snacking, and diabetes management was “below average” this year. Although support had been good in some of the previous years, it tended to change based on the classroom teacher and the changes in personnel, in terms of school nursing. The doctor brought up the need for written, special education planning as part of Jonas’s school record in order to ensure that he could check his blood sugar and snack to follow his diabetes regimen. Jonas was hesitant about having a special plan, but his mother thought it would be important. The adults promised Jonas that having a special plan at school, in terms of a section 504 plan or other health impaired plan, would help Jonas, in that he would no longer need to worry about asking his teacher to test and have snacks when he needed them. After another round of discussion in the telephone conference, Jonas reluctantly agreed for his mother to approach the school staff (school principal and school nurse) about having a written health care plan for Jonas at school. His mother promised the medical team she would contact them about her progress.
Jonas’s mother met with the school principal and nurse. At first, they did not wish to develop a written plan, but his mother requested a written health care plan be developed for her son’s school record. She had been advised by the medical team to make sure a written health care plan, with information for handling emergency situations, was developed for the school setting. The principal and nurse agreed to this plan and a second meeting was set. This meeting included the principal, the school nurse, Jonas’s mother, the nurse from Jonas’s hospital-based medical care team, and his teacher. Jonas was present as well, for part of the meeting. During this meeting, a school health care plan was drafted. It included an agreement to allow Jonas to go outside the classroom to test his blood sugar level, and it required snacks to be kept in the classroom. If Jonas was experiencing a hyperglycemic or hypoglycemic episode, then a friend or classmate would walk to the nurse with him. The school nurse and his teachers, as well as the front office staff, had a special health care card with what to do if Jonas needed immediate medical attention related to his diabetes. The nurse on Jonas’s medical team visited his classroom to explain his diabetes and needs for monitoring and medical management, in an effort to increase understanding and acceptance among his classmates.
In the long run, after the plan was implemented, Jonas said it was beneficial because he did not have to keep re-explaining about his diabetes to his teacher. The teacher reported increased confidence for assisting Jonas with managing his diabetes. His mother reported hearing fewer complaints from Jonas about his diabetes management at school. Written care plans can benefit children in school settings. In addition, our team believes that written care plans can help coaches and other leaders of extracurricular activities assist children with managing their diabetes and will provide important instruction about emergency planning. Written care plans should include information about eating, snacking, insulin administration, testing, and emergency planning and contacts. These plans can be a protective factor for youth with diabetes.
This chapter has presented information on areas that influence children’s adherence and variables that influence children’s abilities to adhere to their medical regimens. The research we have reviewed emphasizes the importance of teamwork between the child and the family for establishing goals. We think that teamwork is critical, and we would like to add that the medical team is a key player on the team. When these professionals emphasize patient-centered care (with parent involvement) and goal setting, they will gain advantages in meeting children and parents “where they are” and developing specific, individualized plans to help children manage their diabetes regimen over time, thereby reducing health risks and improving quality of life and health outcomes for these children.
We have several ideas for future research to advance the field. For example, conducting more research about ways to optimize diabetes management in schools and during extracurricular after-school activities will provide information about what works best in real-world settings. Further information about “best practices” for improving adherence in children with special needs will extend the literature. Similarly, more information is needed about programs for improving diabetes management in children and adolescents with T2DM. Since many children with T2DM may be overweight, it will be important to incorporate diabetes education and awareness into weight management programs, so that youth with weight problems who develop T2DM have support for their diabetes management within the context of their weight management treatment. Perhaps researchers can utilize studies with adults with T2DM as a starting point for developing interventions to improve adherence for adolescents with T2DM since the majority of youth with T2DM will probably be in this development period.
Venditti et al. [36] discussed lifestyle coaching as an intervention to improve diabetes management. We believe that peer support from other youth with diabetes and lifestyle coaching are underexplored interventions for improving youth adherence. Peer support can occur in online or “in person” though support groups and may be an inexpensive way to provide education and support for children and adolescents with diabetes, especially during the first few years after receiving a diagnosis. Parent or caregiver support groups could work in a similar fashion to provide education and support for parents of young children who have recently been diagnosed with diabetes. Peer and parent support can also be critical when adherence becomes difficult, such as during the teenage years or after a difficult life period for youth that has been filled with significant life stressors. Understanding ways to involve peers in positive ways, to make sure that peer support has a positive and uplifting impact on emotional functioning and diabetes management, also remains important to ensuring that peer support results in positive health and emotional outcomes for youth with diabetes.
Since the turn of the twentieth century, the air temperature has risen, expected to proceed to rise as a result of climatic variability. These rises in temperatures may trigger high-temperature stress (HTS): serious damage to plants [1, 2]. As a result, food and feed security have become a crucial challenge under current prevailing agro-climatic conditions [3, 4, 5]. Climate modeling has indicated that high temperature during the day and night is threatening global agriculture production system [6]. The result is that maize crop yield is reduced globally [7, 8]. Maize is one of the important crops being cultivated globally with a wide range of uses, and it is an important food crop in the world [9, 10, 11], it has been primarily aimed for increasing yield, quality, and stability under different environments [12, 13, 14, 15]. Maize is an important component of human food, animal feed, and biofuel industries [5]. It ranks top among cereal crops globally and becomes raw material of numerous food and feed industries. Among growth limiting factors, heat stress has a major effect on maize growth and nutrient composition at different developmental stages. Since several abiotic stresses occur simultaneously, such as drought stress and heat stress, the development of improved breeding procedures is essential for increasing the maize productivity and quality [16]. There is a crucial need for further research to develop maize genotypes tolerant to high temperature and drought stress.
Various physiological and biochemical processes govern plant growth and yield. Stomatal conductance, for example, regulates water loss as transpiration as well as an influx of CO2 for its fixation in the Calvin cycle. Several researchers had suggested that the stomatal conductance is an important indirect heat-tolerant selection criterion in crops [17]. Similarly, osmoprotectants and chaperone proteins got an important part in the adaptive reaction of maize to heat stress and combined stresses. Moreover, leaf senescence-related proteins enhance maize tolerance to combined heat and drought stress [18]. Introgression of these traits in locally acclimated maize hybrids through potential donor hybrids helps in developing maize hybrids tolerant to heat and drought stress. Moreover, identification of donor genotypes possessing favorable traits is important in heat stress breeding programs [19]. Therefore, the present review aimed to evaluate the updates on the effect of heat stress on different plant developmental stages, some physiological and biochemical traits, yield and yield traits of maize. Moreover, this review included updates on various strategies used to improve crop tolerance against heat stress including, conventional breeding strategies, management practices, shotgun approaches, and molecular biology-based strategies. Given the critical analysis of success and limitations for improving maize crop productivity under heat stress, future directions for research are also suggested.
Temperature above 350C for a prolonged period is considered unfavorable for crop growth and development and, particularly 400C during flowering and grain filling have severe negative impacts on grain yield [5]. Plants under heat stress exhibited significantly reduced stomatal conductance resulting in a reduced rate of photosynthesis. Excessive heat also causes a reduction in net photosynthesis, leaf area, reduced biomass accumulation and seed weight [20]. However, heat-tolerant maize varieties that produced the highest metabolites are not usually high yielding varieties. The heat-tolerant maize varieties are usually characterized by the reduced plant height, leaves plant−1, and leaf area index ultimately reduced the yield. Therefore, several factors should be put into consideration when selecting for heat tolerance in maize. At the cellular level, HTS triggers the appearance of certain genes and increases the accumulation of certain metabolites that may enhance the heat enduring ability of plants [21]. Generally, remarkable genotypic variations in the stomatal conductance were observed [22, 23]. Stomatal conductance, which is a key trait of the photosynthetic leaf, was significantly influenced by abiotic stresses [24]. Delay canopy senescence due to various light interceptions by green leaf area has been reported to be necessary for high productivity of hybrid maize under normal watering and drought stress [16]. The impinging of high-intensity light to plants can lead to permanent damage to membrane structure [20]. The cell membrane is considered the first physiologically sensitive structure to the high temperature and becomes functionally inactive at heat stress [25]. Membrane function and cell wall stretch have inverse relation [26, 27]. Continuous damage in the biological membrane may downregulate the mobility of water, ions, and soluble organic solid molecules within plant cell membranes; hence carbon of production, transport, and accumulation may be affected by these factors. Membrane stability could be used as an assessment of high-temperature tolerance of plants. It is the most appropriate and convenient test; leakages of electrolytes at a high temperature can be measured by this test [28].
Soil plant analyses development (SPAD) value and grain yield have a significant relationship after anthesis, but no positive association has been noticed during the middle and later grain-filling stages [29, 30]. During HTS, the chlorophyll biosynthesis gene gets downregulated [31]. Experimental observation has suggested that the differences among net photosynthetic ratio after exposure to high temperatures were related to the conversion of the chlorophyll “a” into chlorophyll b ratio; due to low chlorophyll “a” and rapid leaf senescence, the photosynthetic rate is negatively affected [32]. HTS induces several metabolic events at the cellular and subcellular levels. The heat stress influences the production of ROS and oxidative stress as well [33, 34, 35]. The antioxidative defense system includes both enzymatic and nonenzymatic antioxidants that are shown to participate in response to the development of oxidative stress influenced by heat stress [21].
Scientists showed that rather extreme heat intensity could cause serious tissue damage as well as mortality may arise in a matter of minutes and could ultimately be due to a massive collapse of cell organization [36]. Damages can occur just after deep-term exposures at moderate to maximum heat stress. Informal and gradual damages caused by high temperatures include chlorophyll and mitochondrial destruction of enzymatic activity, protein catabolism impairment, protein deterioration, and cell turgidity looseness [37]. As can be seen in studies, with either the introduction of heat-shocked proteins, plants and animals react to high-temperature pressure [38, 39]. These are intended to avoid species from the harmful impacts of heat stress as well as other sources of pressure [40]. A simple reaction to high-temperature stress is a reduction in regular cellular metabolism. This drop is especially marked at 45°C. The fall in the natural production of protein also goes hand in hand with increased expression and transcription of a fresh set of molecules identified as heat-shock proteins (HSPs) [41]. Previous studies demonstrated that in Zea mays, high-temperature stress reduced the protein production and changes the chemical structure of these proteins [42]. Heat stress at the reproduction phase negatively affects the physiology of plants like flower initiation, source-sink relationship, and falling of pods, which ultimately decreases the number of seeds [43]. High-temperature stress is most crucial for the physiological traits of crop plants. High temperature reduced the number of ears, number of kernels, chlorophyll efficiency, firing of leaf, and blasting of the tassel [44]. Climatic stress like high-temperature stress severely reduces the growth and yield of several crops belongs to Leguminosae (Fabaceae). Heat stress severely reduced the physiological growth development and production of Vigna radiata. Heat stress reduced dry matter production and other yield attributes [45].
HTS hampers the plant growth; particularly germination and seedling emergence are more sensitive [46]. Stressful environment severely reduces the germination and early seedling growth in several crop plants [47, 48]. However, seeds of sensitive crops exposed to 24 and 48 h moderate heat stress exhibited a higher germination rate. Such an increase in seed germination rate due to short-term exposure to moderate heat stress was attributed to the altered expression of gibberellin and abscisic acid biosynthesis genes [49]. The seedling stage is generally considered as the most sensitive stage to stress in maize development [50]. However, the detrimental impact of water deficit stress on the initial phase of growth and seedling establishment of maize plants cannot be underestimated [51, 52, 53].
The appropriate sowing date is important for seed germination and seedling establishment to physiological maturity. The heat-tolerant maize varieties germinated earlier than the non-drought tolerant maize varieties under the critical level of watering. During germination, HTS is associated with an impaired emergency, and a reduced plant stand and plant density [54]. Biochemical components such as soluble sugar and proline increased with increased stress, while starch content and relative water content reduced with increased water deficit [55]. Fluctuations in mean daily temperature (either it is maximum or minimum) disturb seed germination ability [56]. High-temperature stress is the main cause of the reduction in plant yield due to poor germination. [57, 58] studied the impact of high temperature on various developmental phases, especially at seedling emergence in various crop genotypes. Critical periods of stress in maize include seedling establishment stages, rapid growth period, pollination and grain-filling stage. It is proven that in the maize plant with the implementation of stress, not only the leaf area is reduced, but also its growth rate is affected and the appearance of each leaf is delayed [59].
HTS at the grain-filling stage in spring maize is the main obstacle [60]. Temperature beyond 40°C, mainly during flowering and grain filling has a severe impact on plant grain productivity [5]. Grain filling is highly sensitive to drought and heat, due to the involvement of the array of diverse enzymes and transporters, located in the leaves and seeds [45]. During HTS, the stability of the thylakoid membrane structure is reduced, resulting in degrading chlorophyll, which reduces light energy absorption, transfer, and photosynthetic carbon assimilation, and ultimately photosynthesis is reduced. Inhibited photosynthesis decreases the supply of photosynthates to the grain, leading to a serious reduction of kernel weight and grain yield [60, 61, 62]. Delay in the development of reproductive organs might be the result of the reduced cell division and cell elongation processes due to reduced supply of photosynthates and carbohydrate metabolism during the active vegetative growth stages [63].
A projection based on the increased daily maximum temperatures concluded that to increase the maize yields by 12% for the period 2016–2035, improved technologies would be needed [64]. Maize plant can face moderate to high temperature, but temperature above 35°C for a long duration is considered unfavorable for crop growth and development, and temperature beyond 40°C, mainly during flowering and grain filling will have a severe impact on plant grain productivity [5]. Meanwhile, early season temperature increases have induced the maize reproductive period to start earlier, developing the risk of water and heat stress. Declines in time to maturation of maize shown of independence of effects to availability of water, the potential of yield which becoming increasingly limited by warming itself [65]. Irrigation regimes were the major determinant of grain yield during the grain-filling stage in maize while significant differences in the number of kernels per row were obtained among irrigation regimes [66]. A large difference in grain yield is caused due to HTS, which is shown in Figure 1. Tissue injuries inversely influence the photosynthetic rate during heat stress, which can cause leaf damaging and increase the rate of leaf senescence that largely results in decreasing photosynthetic efficiency [44]. Reduced chlorophyll content, including grain yields and oxidative damages, possibly had a direct correlation under heat stress [5, 67]. Previous research studies indicate that high temperature has a severe effect on the cob growth rate as well as biomass partitioning [68]. Many factors including duration of pollen viability, increased kernel abortion rate, lower the rate of cell division in storage tissue (endosperm), decrease in starch synthesis, downregulate the sink capacity of developing kernel, increased rate of sugar accumulation, kernel development, and less/higher enzyme activities could be responsible for the reduction in kernel per row under heat stress [44, 67]. Stress environment leads to a severe reduction in yield of crop plants probably by disrupting leaf gas exchange properties, which not only limit the size of the source and sink tissues, but the phloem loading, assimilate translocation, and dry matter partitioning are also impaired [46]. Unsuccessful fertilization reduces the seed size and increases flower abortion rate owing to high temperature and it has negative effects on plant reproductive phase [69, 70]. Temperature range 0–35oC, is considered suitable for leaf growth, the temperature range 35–40oC has an inverse relation with leaf growth. Temperature beyond 35-40oC is responsible for lower net photosynthetic rate, which further leads to protein aggregation, enzyme inactivation, inhibition of protein synthesis leading to the degradation of protein synthesis [69, 71]. Eventually, an increase in temperature beyond its critical value leads to generating a heat stress that harms the morphological growth, grain yield, and yield-related attributes of two maize cultivars “Xida 319” and “Xida 889” [72].
Differences in total leaf collars, cumulative leaf area, and grain yield of three corn hybrids grown under normal Ames, Iowa temperatures and normal +4°C temperatures.
Temperatures higher than 35°C negatively affect maize grain quality. Grain quality, which is governed by factors including the duration and rate of grain filling and the availability of assimilates, is negatively influenced under water deficit conditions. Similar negative effects of stress were reported on the grain weight of wheat [15, 73, 74, 75]. Variations in flour quality in a hard-grained crop could be related to changes in protein composition due to heat stress during the grain-filling stage [76]. As per the findings of Mousavi et al. [77], heat stress at the flowering stage greatly reduced the starch content due to the reduction in the photosynthetic activities leading to an increase in the grain protein ratio. Usually, maize quality properties are affected by genotypes, environmental factors, and their interactions (Figure 2). Therefore, growth and development of maize are dramatically affected by heat stress leading to reduced grain weight with low starch, crude oil, and protein contents [30]. Grain filling is the most environmentally sensitive phase in maize, which strongly affects grain development quantitatively and qualitatively [7, 15]. Oury and Godin [78] reported a negative correlation between protein contents and grain weight in maize under stress conditions. Association analysis revealed that cob length, thousand-grain weight, and protein contents had a significant relationship with grain yield of maize [79].
Quality of maize is influenced by genotype, environment, and their interaction.
In the previous study, the starch content in waxy maize grain was decreased, whereas protein content was increased, resulting in the change of grain quality [80]. However, the activities of enzymes involved in the synthesis of starch and protein are still lacking [81]. The qualitative and quantitative characteristics of grain productivity are mainly influenced by the environmental fluctuation and these changes inversely influence the development and maturing of seed that affect the seed-filling process and deposition of reserves [80]. Generally, high impinging of light affects negatively in plant productivity by causing premature senescence, decreased seed-filling duration, and enhancing remobilization of photosynthates from source to sink [82]. These factors combined, mainly lowers plant biomass and productivity, and finally lowers the assimilate production and mobilization of the reserve to different developing crops [83]. Generally, it is predicted that gene controlling cell division gets downregulated due to water stress, which could be responsible for the decreased cell number in cotyledons along with endosperm. However, further research is required to find out the actual mechanisms controlling these events. Probably due to low enzyme efficiency or high km carbohydrate gene gets downregulated in developing seedling, resulting in limited availability of sucrose, finally producing reduced seed size [45]. The time of seed filling reduced in pea, soybean, and white lupin, resulting in smaller grains [84]. Heat stress during grain filling markedly decreased starch accumulation in wheat [85] and rice [86].
High-temperature stress decreases the protein concentration in the wheat seeds during seed formation stage [76]. Carbon and nitrogen transmission in the seed is improved with the maximum temperature but C transfer is reduced by the daily temperature fluctuations [87]. Temperature variability effects are more visible on the size of seed than seed N contents [87]. Size of seed and protein concentration in the seed are inversely proportional to each other [88]. High-temperature stress reduces seed production, which ultimately declines the seed protein contents [89]. Protein accumulation in the seeds depends upon high-temperature stress [89]. When high-temperature stress occurs at the seed-filling stage it declines the seed protein contents [89]. When wheat crops are exposed to the high-temperature, glutenin protein production is decreased while gliadins protein production remains stable [90]. Seed protein contents of various crops are decreased after imposing the high-temperature stress, but various amino acid concentrations become low [91]. Heat stress damaged the protective layer of seed and food storage tissues of seed, which is why the quality of seed was deteriorated (Figure 3).
Quality of maize is deteriorated due to heat stress.
Enhancement of the antioxidant defense system is an important strategy to scavenge ROS by antioxidant enzymes [92]. Similar to antioxidant defense, phytohormones such as auxin (indole acetic acid, IAA), cytokinins (CKs), abscisic acid (ABA), ethylene (ET), gibberellins (GAs), salicylic acid (SA), brassinosteroids (BRs), and jasmonates (JAs) have key roles in coordinating various signal transduction pathways during the abiotic-stress response [93]. Many studies have shown that altering cultural practices, such as planting rate [94], planting date [95, 96], the phenological variation of crop cultivars [60, 95] soil management [97], nutrient management [60], and irrigation [60] can positively or negatively modify maize yield response to climate change.
Advancing or delaying the sowing date may be a potent, farmer-friendly and biologically viable strategy to avoid HTS. Earlier findings reported that earlier sowing dates and longer season varieties have overcome the negative effects of climate warming on spring maize yield [95]. Similarly, other findings reported by [98] showed that by changing sowing date from late April to late May, the mean daily temperature decreased 1.7 and 4.3°C whereas the diurnal temperature increased 4.3 and 3.1°C during grain-filling middle stage (16-45 days after silking) and grain-filling late stage (45 days after silking to maturity), respectively.
High air temperatures during the crop growing season can reduce harvestable yields. However, crop varieties with improved heat tolerance traits as well as crop management strategies at the farm scale are thus needed for climate change mitigation. Therefore, to mitigate the negative impact of increased growing season temperatures on crop growth and yield, especially in low latitude regions, heat-tolerant crop varieties, as well as modified farm management practices are needed, especially in the areas when irrigation is needed for crop production and irrigation water depends on the underground aquifers [99]. They also observed that applied irrigation at nighttime through subsurface drip reduced the root-zone soil temperature, which helped plant for improving plant growth and yield of corn. Optimizing irrigation has the potential to improve the water use efficiency of maize leading to enhanced heat tolerance [60]. Soil drought stress and atmospheric high temperature in the vegetative growth period could delay the process of growth of spring maize and shorten the reproductive stage, but those get improved when the soil moisture content in the maize field is maintained 65% field capacity by drip irrigation [100].
Plant growth hormones and exogenous chemicals (e.g., ABA and CaCl2) play important roles in strengthening heat tolerance in maize under HTS [60]. Exogenous ABA induces maize to produce HSPs, strengthening PSII heat tolerance [101]. An exogenous CaCl2 increases the maize cell membrane antioxidant capacity to improve heat tolerance [102]. Phytohormones such as auxin (IAA), cytokinins (CKs), abscisic acid (ABA), ethylene (ET), gibberellins (GAs), salicylic acid (SA), brassinosteroids (BRs), and jasmonates (JAs) have key roles in coordinating various signal transduction pathways during the abiotic-stress response [93].
Auxin or indole-3-acetic acid (Aux/IAA) acts as a chemical messenger to communicate cell activities when crops face different environmental stresses, including salinity, drought, waterlogging, extreme temperatures (heat, chilling, and freezing), heavy metals, light (intense and weak), and radiation (UV-A/B) [92, 103, 104]. Cytokinin (CK) is one of them, which functions solely and or with other hormones to mediate different mechanisms within plants in response to environmental fluctuations. During heat stress, protein denaturation and metabolic imbalance are occurred due to the excessive production of ROS. While to survive against heat stress, plants stimulate heat-shock proteins as a protective measure to prevent protein denaturation [105]. For example, the upregulation of heat-shock proteins in tobacco and bentgrass was recorded due to the enhancement of the antioxidant activity as a result of higher CK in plant cells [106]. Besides this, external application of CK inhibits the damage in photosynthesis under heat stress in maize, rice, and passion fruit [107, 108]. Salicylic acid (SA) is a naturally occurring phenolic compound [109] which plays a crucial part in the regulation of growth and development of the plants, and also a defensive mechanism to survive against abiotic stresses [110]. Similar to SA, abscisic acid (ABA) plays a vital role in plants’ physiological adjustments such as against abiotic stresses [111, 112] along with increasing seedling growth, endogenous levels of ABA, and reduced oxidative damage to plants due to heat stress. Similarly, Hasanuzzaman et al. [21] observed that ABA is a signaling molecule and also enhance the number of other signaling molecules such as nitric oxide for thermos-tolerance. Similar to other phytohormones, gibberellic acid (GAs) also interacts with other phytohormones in numerous developmental and stimulus-response processes in plants. GAs have been reported to alleviate the adverse effects of abiotic stress in plants, including rice as reported by Yamaguchi [113]. Brassinosteroids (BRs) is a new group of phytohormones, present in almost every part of the plants [114]. Similar to other phytohormones, BRs have shown tremendous potential against the abiotic stress-induced oxidative stress [103] including high temperature [115].
Inadequate and imbalanced nutrients and impaired soil fertility are associated with mineral-nutrient deficiencies and toxicities [116, 117, 118]. Adequate nutrition is essential for the integrity of plant structure and key physiological processes. For example, nitrogen (N) and magnesium are a structural part of chlorophyll and these are needed for photosynthesis. Nitrogen plays a very crucial role in temperature stress tolerance. At higher temperatures, the intensity of light is also very high. So, high light intensity, as a function of high temperature, which affects the uptake of mineral nutrients, ultimately influences the plant growth negatively. Since N plays a major role in the utilization of absorbed light energy and photosynthetic carbon metabolism [119, 120]. Whereas phosphorus is needed for energy production and storage; it is a structural part of nucleic acids and potassium is needed for osmotic regulation and activation of enzymes [117, 118]. Maize physiological function decreases under abiotic stress but can be compensated by nutritional management, for example, adequate potassium fertilizer improves cell membrane stability, turgor pressure, water potential in maize under water-deficit conditions [60]. Thus, a strategy to improve heat tolerance in maize at the grain-filling stage is to regulate nutrition.
Selection criteria have been proposed in traditional breeding to facilitate the detection of heat-tolerant maize variety. As different varieties respond differently to HTS, breeding heat-tolerant varieties is an effective strategy to improve heat tolerance at the spring maize grain-filling stage [60]. Screening of various cultivars was done to screen the warmness of the plant canopy, stomata behavior of upper most leaf (flag leaf), and photosynthesizing efficiency that are closely related to each other for the production maximum grain production under high-temperature stress conditions [121, 122, 123].
Under HT conditions, plants exhibit various mechanisms for surviving, which include long-term evolutionary phenological and morphological adaptations and short-term avoidance or acclimation mechanisms such as changing the leaf orientation, transpirational cooling, or alteration of membrane lipid compositions [92]. Also, high-temperature stress can be avoided by crop management practices such as selecting proper sowing methods, choice of sowing date, cultivars, irrigation methods, etc. It was discussed that combined hotter and drier climate change scenarios cause a greater maize yield reduction than hotter only scenarios. The incorporating drought and heat tolerance into maize germplasm has the potential to offset predicted yield losses and sustain maize productivity under climate change [19].
Tao and Zhao [60] reported that superoxide dismutase (SOD) increased and malonic dialdehyde (MDA) decreased in maize ear leaf for enhancing the stability of cell membrane, which helps to improve photosynthesis for good grain-filling characteristics (long quickly increase period and high mean rate of grain filling). It also produced high kernel weight under HTS [124, 125] leading to reporting of new origins of genetic engineering which exhibited leakage of electrolytes and MSI are the two basic parameters to screen the temperature stress-tolerant cultivars of various crops [126]. Electrical ions were gathered from the affected plants and were washed out with pure water to measure the membrane stability index MSI [127]. Seed production ability and stability index of the membrane were closely related to each other [3]. Mitochondrial tetrazolium is a very useful indicator of HTS sensitivity. Leaves’ tissues were dipped in triphenyl tetrazolium chloride chemical mixture during HTS. The spectrographic technique was used to quantify the related rates of triphenyl tetrazolium chloride reduction to formazan and tissues viability [128]. Heat tolerance (HT) of the crop is generally defined as the ability of the plant to grow and produce an economic yield under HS. This is a highly specific trait, and closely related to the species, even different organs and tissues of the same plant, may vary significantly in this respect. Plants have evolved various mechanisms for thriving under higher prevailing temperatures. They include short-term avoidance/acclimation mechanism or long-term evolutionary adaptations [92]. Many alternative traits related to heat resistance in Zea mays have been identified, including leaf kinetics, net photosynthesis rate (Pn), leaf anatomy at seedling stage [129] anther emergence [130], pollen grain viability [131], etc. However, the utility of those traits in stress breeding is not well established to date. Furthermore, most of the research focused on the heat stress on temperate maize, whereas only limited information is available on tropical maize [42].
One of the ways to deal with the adverse effects of heat stress may involve exploring some molecules that have the potential to protect the plants from the harmful effects of HT. In recent decades, exogenous application of protectants such as osmoprotectants, phytohormones, signaling molecules, trace elements, etc., have shown a beneficial effect on plants grown under HTS and these protectants have growth-promoting and antioxidant capacity [21, 92]. Exogenous applications of several phytohormones were found to be effective in mitigating heat stress in plants. Accumulation of osmolytes such as proline (Pro), glycine betaine (GB), and trehalose (Tre) is a well-known adaptive mechanism in plants against abiotic stress conditions including HT [92]. Supplementation with Pro and GB considerably reduced the H2O2 production, improved the accumulation of soluble sugars, and protected the developing tissues from heat stress effects. At the field level, managing or manipulating cultural practices, such as the timing and methods for sowing, irrigation management, and selection of cultivars and species, can also considerably decrease the adverse effects of HT stress. In recent decades, exogenous applications of protectants such as osmoprotectants, phytohormones, signaling molecules, trace elements, etc., have shown beneficial effects on plants growing under HT, due to the growth-promoting and antioxidant activities of these compounds [21, 92].
The genetic analytical study depends upon the genetic markers. Information about genetic reproduction aids to identify potential gene markers [132]. To mitigate the harmful effects of high-temperature several gene markers like a random polymorphic amplifier, AFLP (amplifier fragmentation length polymorphism), as well as sequenced simple repeats SSR, were used to increase the crop production under heat-stress [133, 134]. During genetic breeding, the SNP marker was used because of its genetic sequence in legumes to identify resistant genotypes against heat stress [135]. QTL chromosome numbers and their origin were very useful to mitigate the effects of heat stress [132]. Different molecular markers are studied in population genomics across the environment in many individuals to find out novel variation patterns and help to find if the genes have functions in significant ecological traits. Genome-wide association study (GWAS) is a powerful tool for understanding the complete set of genetic variants in different crop cultivars to recognize allelic variant linked with any specific [136]. GWASs generally highlight linkage among SNPs single nucleotide polymorphism marker and traits and based on GWAS design, genotyping tools, statistical models for examination, and results in interpretation [137].
Heat stress disturbed the crop metabolic activities by changing tissue balance. Heat stress directly produced toxic substances in plant tissues call ROS due to which plant suffers from oxidative stress. Moreover, to reduce oxidative damage resulting from heat-induced oxidative stress, plants have developed different adaptive mechanisms, via the biosynthesis of enzymatic and non-enzymatic antioxidants and the sequestering of other materials in crop tissues. Enhancement of antioxidant defense system is an important strategy to scavenge ROS by antioxidant enzymes such as ascorbate peroxidase (APX), ascorbate reductase (AR), catalase (CAT), glutathione reductase (GR), glutathione peroxidase (GPX), and superoxide dismutase (SOD) and with non-enzymatic antioxidants such as ascorbate (AsA), glutathione (GSH), carotenoids, flavanones, and anthocyanins [92]. Furthermore, adaptation to temperature changes, at the molecular level, was accompanied by the degradation of the normal proteins and the synthesis of HSPs involved in the mechanism of defense in plants. Seed germination is the most critical growth stage of the whole plant life cycle because it is the first step to carry out whole-plant growth and development, but heat stress is the main reducing factor of seedling emergence in semiarid areas [138, 139].
Heat stress and unprecedented climate changes have become a major challenge for sustainable crop production globally. Plant growth, development, and productivity get compromised due to heat stress. Elucidating maize hybrid for temperature tolerance could be an indispensable step toward a balanced yield. Tolerance and avoidance of stress could be an easy way to boost crop production under a changing climate; for example photosynthetic rate can be improved by targeting candidate traits and candidate genes involved in photosynthesis at a molecular level. It could lead to high assimilates production, more transportation of sugar to grain; finally, it decreases grain-filling rate, improves kernel size, and could be very useful to improve plant productivity. Heat-insensitive maize hybrids can be developed by gene editing CRISPER-CAS9 system through targeting a gene that is responsible for heat sensitivity. The base of further research should be focused on spring maize crops. Field experiments regarding the sowing date are essential by analyzing the impact of meteorological factors on maize growth and grain yield. Application of osmoprotectants, nanotechnology, and the use of sustainable agriculture agents have become necessary for further research. Further, interdisciplinary studies that include agronomy, animal sciences, and climate modeling are warranted to assess the impact of the feeding of both the HTS-tolerant maize varieties and those grown under heat stress on animal health and production. This review could encourage such interdisciplinary approaches to develop maize hybrids with high nutritional values and are not prone to drastic yield reductions owing to fluctuations in agro-climatic factors (especially temperature) and the outcome may lead to sustainable maize production in the tropics under changing climate.
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\\n\\n4.1 The Corresponding Author represents and warrants that the Chapter does not and will not breach any applicable law or the rights of any third party and, specifically, that the Chapter contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy. The Corresponding Author warrants and represents that: (i) the Chapter is the original work of themselves and any Co-Author and is not copied wholly or substantially from any other work or material or any other source; (ii) the Chapter has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) they themselves and any Co-Author are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) they themselves and any Co-Author have not assigned and will not during the term of this Publication Agreement purport to assign any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
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\\n\\nThe Corresponding Author agrees to indemnify and hold IntechOpen harmless against all liabilities, costs, expenses, damages and losses and all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of or in connection with any breach of the aforementioned representations and warranties. This indemnity shall not cover IntechOpen to the extent that a claim under it results from IntechOpen's negligence or willful misconduct.
\\n\\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\\n\\n5. TERMINATION
\\n\\n5.1 IntechOpen has a right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Corresponding Author or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Corresponding Author or any Co-Author (being an individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Corresponding Author or any Co-Author (being a company) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for or enters into any compromise or arrangement with any of its creditors.
\\n\\nIn case of termination, IntechOpen will notify the Corresponding Author, in writing, of the decision.
\\n\\n6. INTECHOPEN’S DUTIES AND RIGHTS
\\n\\n6.1 Unless prevented from doing so by events outside its reasonable control, IntechOpen, in its discretion, agrees to publish the Chapter attributing it to the Corresponding Author and any Co-Author.
\\n\\n6.2 IntechOpen has the right to use the Corresponding Author’s and any Co-Author’s names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Chapter and has the right to contact the Corresponding Author and any Co-Author until the Chapter is publicly available on any platform owned and/or operated by IntechOpen.
\\n\\n6.3 IntechOpen is granted the authority to enforce the rights from this Publication Agreement, on behalf of the Corresponding Author and any Co-Author, against third parties (for example in cases of plagiarism or copyright infringements). In respect of any such infringement or suspected infringement of the copyright in the Chapter, IntechOpen shall have absolute discretion in addressing any such infringement which is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\\n\\n7. MISCELLANEOUS
\\n\\n7.1 Further Assurance: The Corresponding Author shall and will ensure that any relevant third party (including any Co-Author) shall, execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\\n\\n7.2 Third Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\\n\\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\\n\\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\\n\\n7.5 Variation: No variation of this Publication Agreement shall be effective unless it is in writing and signed by the parties (or their duly authorized representatives).
\\n\\n7.6 Severance: If any provision or part-provision of this Publication Agreement is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted.
\\n\\nAny modification to or deletion of a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\\n\\n7.7 No partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Corresponding Author or any Co-Author, nor authorize any party to make or enter into any commitments for or on behalf of any other party.
\\n\\n7.8 Governing law: This Publication Agreement and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with it or its subject matter or formation shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of or in connection with this Publication Agreement (including any non-contractual disputes or claims).
\\n\\nLast updated: 2020-11-27
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The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
\n\n1. DEFINITIONS
\n\nCorresponding Author: The Author of the Chapter who serves as a Signatory to this Agreement. The Corresponding Author acts on behalf of any other Co-Author.
\n\nCo-Author: All other Authors of the Chapter besides the Corresponding Author.
\n\nIntechOpen: IntechOpen Ltd., the Publisher of the Book.
\n\nBook: The publication as a collection of chapters compiled by IntechOpen including the Chapter. Chapter: The original literary work created by Corresponding Author and any Co-Author that is the subject of this Agreement.
\n\n2. CORRESPONDING AUTHOR'S GRANT OF RIGHTS
\n\n2.1 Subject to the following Article, the Corresponding Author grants and shall ensure that each Co-Author grants, to IntechOpen, during the full term of copyright and any extensions or renewals of that term the following:
\n\nThe aforementioned licenses shall survive the expiry or termination of this Agreement for any reason.
\n\n2.2 The Corresponding Author (on their own behalf and on behalf of any Co-Author) reserves the following rights to the Chapter but agrees not to exercise them in such a way as to adversely affect IntechOpen's ability to utilize the full benefit of this Publication Agreement: (i) reprographic rights worldwide, other than those which subsist in the typographical arrangement of the Chapter as published by IntechOpen; and (ii) public lending rights arising under the Public Lending Right Act 1979, as amended from time to time, and any similar rights arising in any part of the world.
\n\nThe Corresponding Author confirms that they (and any Co-Author) are and will remain a member of any applicable licensing and collecting society and any successor to that body responsible for administering royalties for the reprographic reproduction of copyright works.
\n\nSubject to the license granted above, copyright in the Chapter and all versions of it created during IntechOpen's editing process (including the published version) is retained by the Corresponding Author and any Co-Author.
\n\nSubject to the license granted above, the Corresponding Author and any Co-Author retains patent, trademark and other intellectual property rights to the Chapter.
\n\n2.3 All rights granted to IntechOpen in this Article are assignable, sublicensable or otherwise transferrable to third parties without the Corresponding Author's or any Co-Author’s specific approval.
\n\n2.4 The Corresponding Author (on their own behalf and on behalf of each Co-Author) will not assert any rights under the Copyright, Designs and Patents Act 1988 to object to derogatory treatment of the Chapter as a consequence of IntechOpen's changes to the Chapter arising from translation of it, corrections and edits for house style, removal of problematic material and other reasonable edits.
\n\n3. CORRESPONDING AUTHOR'S DUTIES
\n\n3.1 When distributing or re-publishing the Chapter, the Corresponding Author agrees to credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen. The Corresponding Author warrants that each Co-Author will also credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen, when they are distributing or re-publishing the Chapter.
\n\n3.2 When submitting the Chapter, the Corresponding Author agrees to:
\n\nThe Corresponding Author will be held responsible for the payment of the Open Access Publishing Fees.
\n\nAll payments shall be due 30 days from the date of the issued invoice. The Corresponding Author or the payer on the Corresponding Author's and Co-Authors' behalf will bear all banking and similar charges incurred.
\n\n3.3 The Corresponding Author shall obtain in writing all consents necessary for the reproduction of any material in which a third-party right exists, including quotations, photographs and illustrations, in all editions of the Chapter worldwide for the full term of the above licenses, and shall provide to IntechOpen upon request the original copies of such consents for inspection (at IntechOpen's option) or photocopies of such consents.
\n\nThe Corresponding Author shall obtain written informed consent for publication from people who might recognize themselves or be identified by others (e.g. from case reports or photographs).
\n\n3.4 The Corresponding Author and any Co-Author shall respect confidentiality rights during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Corresponding Author and any Co-Author are confidential and are intended only for the recipient. The contents may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
\n\n4. CORRESPONDING AUTHOR'S WARRANTY
\n\n4.1 The Corresponding Author represents and warrants that the Chapter does not and will not breach any applicable law or the rights of any third party and, specifically, that the Chapter contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy. The Corresponding Author warrants and represents that: (i) the Chapter is the original work of themselves and any Co-Author and is not copied wholly or substantially from any other work or material or any other source; (ii) the Chapter has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) they themselves and any Co-Author are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) they themselves and any Co-Author have not assigned and will not during the term of this Publication Agreement purport to assign any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\n\nThe Corresponding Author also warrants and represents that: (i) they have the full power to enter into this Publication Agreement on their own behalf and on behalf of each Co-Author; and (ii) they have the necessary rights and/or title in and to the Chapter to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licenses expressed to be granted in this Publication Agreement. If the Chapter was prepared jointly by the Corresponding Author and any Co-Author, the Corresponding Author warrants and represents that: (i) each Co-Author agrees to the submission, license and publication of the Chapter on the terms of this Publication Agreement; and (ii) they have the authority to enter into this Publication Agreement on behalf of and bind each Co-Author. The Corresponding Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each such Co-Author.
\n\nThe Corresponding Author agrees to indemnify and hold IntechOpen harmless against all liabilities, costs, expenses, damages and losses and all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of or in connection with any breach of the aforementioned representations and warranties. This indemnity shall not cover IntechOpen to the extent that a claim under it results from IntechOpen's negligence or willful misconduct.
\n\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\n\n5. TERMINATION
\n\n5.1 IntechOpen has a right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Corresponding Author or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Corresponding Author or any Co-Author (being an individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Corresponding Author or any Co-Author (being a company) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for or enters into any compromise or arrangement with any of its creditors.
\n\nIn case of termination, IntechOpen will notify the Corresponding Author, in writing, of the decision.
\n\n6. INTECHOPEN’S DUTIES AND RIGHTS
\n\n6.1 Unless prevented from doing so by events outside its reasonable control, IntechOpen, in its discretion, agrees to publish the Chapter attributing it to the Corresponding Author and any Co-Author.
\n\n6.2 IntechOpen has the right to use the Corresponding Author’s and any Co-Author’s names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Chapter and has the right to contact the Corresponding Author and any Co-Author until the Chapter is publicly available on any platform owned and/or operated by IntechOpen.
\n\n6.3 IntechOpen is granted the authority to enforce the rights from this Publication Agreement, on behalf of the Corresponding Author and any Co-Author, against third parties (for example in cases of plagiarism or copyright infringements). In respect of any such infringement or suspected infringement of the copyright in the Chapter, IntechOpen shall have absolute discretion in addressing any such infringement which is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\n\n7. MISCELLANEOUS
\n\n7.1 Further Assurance: The Corresponding Author shall and will ensure that any relevant third party (including any Co-Author) shall, execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\n\n7.2 Third Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\n\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\n\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\n\n7.5 Variation: No variation of this Publication Agreement shall be effective unless it is in writing and signed by the parties (or their duly authorized representatives).
\n\n7.6 Severance: If any provision or part-provision of this Publication Agreement is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted.
\n\nAny modification to or deletion of a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\n\n7.7 No partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Corresponding Author or any Co-Author, nor authorize any party to make or enter into any commitments for or on behalf of any other party.
\n\n7.8 Governing law: This Publication Agreement and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with it or its subject matter or formation shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of or in connection with this Publication Agreement (including any non-contractual disputes or claims).
\n\nLast updated: 2020-11-27
\n\n\n\n
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I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). 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