\r\n\tCSR is one of the key drivers for green development of firms and for sustainability as a whole. It can be addressed according to multiple, sometimes inter-disciplinary, perspectives. Besides, other communication and governance matters, the innovation level of analysis is one of the most promising in this research field. CSR has also proved to be crucial for firm's survival, evolution and growth.
\r\n
\r\n\t \r\n\tWe search to detangle three levels of analysis: micro, team, and macro level. Each level may present different hampering or fostering factors, as well as specific dynamics.
\r\n
\r\n\t \r\n\tOriginal contributions should be strong at both theoretical and empirical levels of analysis. \r\n\tAlso, systematic literature analysis addressing the key-drivers of corporate social responsibility, including an exhaustive analysis of the different theoretical frameworks, are welcome. Strong quantitative evidence are foremost needed.
",isbn:"978-1-83880-939-3",printIsbn:"978-1-83880-938-6",pdfIsbn:"978-1-83880-940-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"f609bf3251d7cc7bae0099a4374adfc3",bookSignature:"Prof. Beatrice Orlando",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9032.jpg",keywords:"Corporate Strategy, Business Strategy, Competitive Environment, Sustainable Development, Open/closed Innovation, Cultural Factors, Business Models, Corporate Social Responsibility, Microfoundations, Governance, Obstacles, Drivers",numberOfDownloads:1908,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 12th 2020",dateEndSecondStepPublish:"June 2nd 2020",dateEndThirdStepPublish:"August 1st 2020",dateEndFourthStepPublish:"October 20th 2020",dateEndFifthStepPublish:"December 19th 2020",remainingDaysToSecondStep:"10 months",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Visiting researcher at London Business School, United Kingdom at the Department of Management and Operations in 2010, her current research focus is on entrepreneurship and innovation.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"232969",title:"Prof.",name:"Beatrice",middleName:null,surname:"Orlando",slug:"beatrice-orlando",fullName:"Beatrice Orlando",profilePictureURL:"https://mts.intechopen.com/storage/users/232969/images/system/232969.jpeg",biography:"Beatrice Orlando is an Adjunct Professor of Strategies for Business Growth at Sapienza University and of Business Management at UNINT – Rome. Professor Orlando received a Master in Finance and Ph.D in Business Management and Corporate Finance from Sapienza University of Rome, where she also graduated with a degree in Economics. She had taught several strategies and business management courses over years. In 2010, she was a visiting researcher at London Business School, United Kingdom, at the Department of Management and Operations. Professor Orlando’s current research focus is on entrepreneurship and innovation. Specifically, her research interests are innovation adoption, open innovation, behavioral strategies of the firm, diversification, organizational slack and firm’s decision making. She has published numerous articles in leading scholarly journals, such as Production, Planning and control, Technology Analysis and Strategic Management, Corporate Social Responsibility and Environmental Management.",institutionString:"University of Ferrara",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Ferrara",institutionURL:null,country:{name:"Italy"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"7",title:"Business, Management and Economics",slug:"business-management-and-economics"}],chapters:[{id:"73838",title:"How to Do CSR with Dialogic Meeting Talk: A Conceptual Framework for Managing Change in Cross-Sector Social Partnerships",slug:"how-to-do-csr-with-dialogic-meeting-talk-a-conceptual-framework-for-managing-change-in-cross-sector-",totalDownloads:106,totalCrossrefCites:0,authors:[null]},{id:"74129",title:"The Corporate Culture of the Enterprises of the Military-Industrial Complex",slug:"the-corporate-culture-of-the-enterprises-of-the-military-industrial-complex",totalDownloads:98,totalCrossrefCites:0,authors:[null]},{id:"73912",title:"CSR: A Moral Obligation or a Strategic Behavior?",slug:"csr-a-moral-obligation-or-a-strategic-behavior",totalDownloads:142,totalCrossrefCites:0,authors:[null]},{id:"74802",title:"Corporate Social Responsibility and the Public Health Imperative: Accounting and Reporting on Public Health",slug:"corporate-social-responsibility-and-the-public-health-imperative-accounting-and-reporting-on-public-",totalDownloads:65,totalCrossrefCites:0,authors:[null]},{id:"73904",title:"CSR: What Does Board Diversity Bring to the Table?",slug:"csr-what-does-board-diversity-bring-to-the-table",totalDownloads:103,totalCrossrefCites:0,authors:[null]},{id:"73206",title:"Social Responsibility and Financial Performance: The Case of STOXX Europe Index",slug:"social-responsibility-and-financial-performance-the-case-of-stoxx-europe-index",totalDownloads:128,totalCrossrefCites:0,authors:[null]},{id:"74950",title:"The Moderating Effect of Firm Visibility on the Corporate Social Responsibility-Firm Financial Performance Relationship: Evidence from France",slug:"the-moderating-effect-of-firm-visibility-on-the-corporate-social-responsibility-firm-financial-perfo",totalDownloads:91,totalCrossrefCites:0,authors:[null]},{id:"74194",title:"Corporate Social Responsibility and Sustainability in Corporate Strategy: Brazilian Cases Studies",slug:"corporate-social-responsibility-and-sustainability-in-corporate-strategy-brazilian-cases-studies",totalDownloads:94,totalCrossrefCites:0,authors:[null]},{id:"74221",title:"CSR and Innovation: Two Sides of the Same Coin",slug:"csr-and-innovation-two-sides-of-the-same-coin",totalDownloads:111,totalCrossrefCites:0,authors:[null]},{id:"73956",title:"Between Outcomes and Processes: Revisiting the Discourse on Corporate Social Responsibility Impacts",slug:"between-outcomes-and-processes-revisiting-the-discourse-on-corporate-social-responsibility-impacts",totalDownloads:34,totalCrossrefCites:0,authors:[null]},{id:"74518",title:"The Impact of the Strategic Interests and Communicative Actions between the Socially Responsible Entrepreneurial Universities and University - Industry Collaboration Ecosystem",slug:"the-impact-of-the-strategic-interests-and-communicative-actions-between-the-socially-responsible-ent",totalDownloads:130,totalCrossrefCites:0,authors:[null]},{id:"73940",title:"Corporate Social Responsibility Strategy to Raise the Value to the Community in the Mining Industry",slug:"corporate-social-responsibility-strategy-to-raise-the-value-to-the-community-in-the-mining-industry",totalDownloads:33,totalCrossrefCites:0,authors:[null]},{id:"74045",title:"Corporate Social Responsibility (CSR) Model in Improving the Quality of Green Open Space (GOS) to Create a Livable City",slug:"corporate-social-responsibility-csr-model-in-improving-the-quality-of-green-open-space-gos-to-create",totalDownloads:124,totalCrossrefCites:0,authors:[null]},{id:"73871",title:"Corporate Social Responsibility in India: The Saga Continues",slug:"corporate-social-responsibility-in-india-the-saga-continues",totalDownloads:115,totalCrossrefCites:0,authors:[null]},{id:"74186",title:"Financial Fraud and Managers, Causes and Effects",slug:"financial-fraud-and-managers-causes-and-effects",totalDownloads:87,totalCrossrefCites:0,authors:[null]},{id:"73906",title:"A State of the Art of Corporate Social Responsibility in Financial Institutions",slug:"a-state-of-the-art-of-corporate-social-responsibility-in-financial-institutions",totalDownloads:119,totalCrossrefCites:0,authors:[null]},{id:"73964",title:"Measuring Corporate Social Responsibility Performance: A Comprehensive AHP Based Index",slug:"measuring-corporate-social-responsibility-performance-a-comprehensive-ahp-based-index",totalDownloads:35,totalCrossrefCites:0,authors:[null]},{id:"73742",title:"The Ethical and Responsibility Components in Environmental Challenges: Elements of Connection between Corporate Social Responsibility and Social Impact Assessment",slug:"the-ethical-and-responsibility-components-in-environmental-challenges-elements-of-connection-between",totalDownloads:129,totalCrossrefCites:0,authors:[null]},{id:"73873",title:"What is the Business of Business? Time for Fundamental Re-Thinking",slug:"what-is-the-business-of-business-time-for-fundamental-re-thinking",totalDownloads:33,totalCrossrefCites:0,authors:[null]},{id:"73715",title:"Implementation of Corporate Social Responsibility to Increase the Value of Companies Listed on the SRI Kehati Index Indonesia",slug:"implementation-of-corporate-social-responsibility-to-increase-the-value-of-companies-listed-on-the-s",totalDownloads:131,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"194667",firstName:"Marijana",lastName:"Francetic",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/194667/images/4752_n.jpg",email:"marijana@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"8649",title:"Strategy and Behaviors in the Digital Economy",subtitle:null,isOpenForSubmission:!1,hash:"1110e49aabc5cb3d7245dc32285010c0",slug:"strategy-and-behaviors-in-the-digital-economy",bookSignature:"Beatrice Orlando",coverURL:"https://cdn.intechopen.com/books/images_new/8649.jpg",editedByType:"Edited by",editors:[{id:"232969",title:"Prof.",name:"Beatrice",surname:"Orlando",slug:"beatrice-orlando",fullName:"Beatrice Orlando"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"314",title:"Regenerative Medicine and Tissue Engineering",subtitle:"Cells and Biomaterials",isOpenForSubmission:!1,hash:"bb67e80e480c86bb8315458012d65686",slug:"regenerative-medicine-and-tissue-engineering-cells-and-biomaterials",bookSignature:"Daniel Eberli",coverURL:"https://cdn.intechopen.com/books/images_new/314.jpg",editedByType:"Edited by",editors:[{id:"6495",title:"Dr.",name:"Daniel",surname:"Eberli",slug:"daniel-eberli",fullName:"Daniel Eberli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"72982",title:"Surgical Management of Bronchiectasis",doi:"10.5772/intechopen.93103",slug:"surgical-management-of-bronchiectasis",body:'\n
\n
1. Introduction
\n
Bronchiectasis was originally described by René Laënnec in 1819. This term comes from two Greek words; “Bronkhia” and “Ektasis” meaning “Airway widening”. As a medical term, bronchiectasis refers to chronic lung disease associated with irreversible dilatation of the bronchial tree. For many years, it was considered as an orphan disease; however, the detection of bronchiectasis has been increased in the recent years as a result of increased health awareness and modern advances in the imaging techniques [1, 2].
\n
The prevalence of bronchiectasis varies in relation to geographic location. The estimated prevalence of bronchiectasis in developed countries (USA, UK, Germany, Spain) is up to 566 cases per 100,000, with 40% increase in the past decade [3, 4]. The recent findings from the British lung foundation’s project showed that around 212,000 people are currently living with bronchiectasis in the UK, with predominence of female gender and over-70 age [5]. In USA, 252,362 patients were indentified with an average annual prevalence of 701 per 100,000 persons between 2006 and 2014, with mean age of 76 years, predominace of female gender (65%), and dual diagnosis of chronic obstructive pulmonary disease (COPD) in most of the patients (51%) [6]. In China, the overall prevalence of physician-diagnosed bronchiectasis in people aged 40 years or older is estimated at 1.2% and is trending upward with aging of the population [7]. In comparison to European estimates, the recently reported patients with bronchiectasis in India were younger (median age of 56 years), more likely to be men, and showed a high frequency of severe, cystic bronchiectasis. Tuberculosis and other severe infections were the most frequently reported underlying cause [8].
\n
Most of the cases of bronchiectasis are idiopathic in etiology, however, it may be found in a variety of pulmonary diseases, genetic or acquired, such as cystic fibrosis (CF), Kartagener syndrome (triad of situs inversus, chronic sinusitis, and bronchiectasis), COPD, alpha 1-antitrypsin deficiency, bronchial asthma, or primary immunodeficiencies [9, 10]. In the absence of CF, particularly with post-infectious and allergic hypersensitivity causes, the disease is known as non-cystic fibrosis bronchiectasis (NCFB) [10].
\n
The pathogenesis of bronchiectasis is based on the “vicious cycle hypothesis” which begins by infectious or noninfectious insult to the lung, resulting in neutrophil inflammation (proteases) and impairment of the mucociliary clearance followed by microbial colonization or infection, bronchial obstruction, and exaggerated inflammatory response. The “vicious cycle” (Figure 1) refers to the occurrence of repeated infections with repeated impairment of the mucociliary apparatus subsequent to infection and inflammation [10, 11, 12].
\n
Figure 1.
Vicious cycle of bronchiectasis.
\n
The clinical diagnosis of bronchiectasis is challenging as it manifests early non-specific symptoms and signs. However, the presence of chronic cough with overproduction of sputum which may worse at the morning increases the index of suspicion for bronchiectasis especially in non-smokers [13, 14]. Other significant signs of bronchiectasis include: hemoptysis, chronic respiratory failure, pulmonary hypertension, and right-sided heart failure [13].
\n
Bronchiectasis can be classified anatomically (cylindrical, varicoid, or cystic), and radiologically (localized or diffuse) [14]. Chest radiographs show non-specific findings of bronchiectasis such as: atelectatic changes, and hyperinflation [13, 14]. High-resolution computed tomography (HRCT) of the chest is a useful imaging tool for diagnosis of bronchiectasis and detection of the underlying causes. On HRCT, bronchiectatic changes include dilated airways, thick-walled bronchi with failed tapering at the periphery of the lung,, ring opacity, tram-track sign, and finger-in-glove sign, and signet-ring sign when the dilated bronchi is larger than the companion pulmonary artery branch (Bronchial-to-arterial ratio > 1) [14].
\n
A bundle of minimum etiological tests has been recommended by European Respiratory Society (ERS) for newly diagnosed patients with bronchiectasis including: differential blood count, immunoglobulins (IgA, IgM and IgG), and allergic bronchopulmonary aspergillosis (ABPA)-specific tests (total IgE, specific IgE to Aspergillus, IgG to Aspergillus and eosinophil count), in addition to sputum culture for monitoring of bacterial and non-tuberculous infections [15].
\n
Etiology-specific investigations include: Sweat chloride assessment and cystic fibrosis transmembrane conductance regulator (CFTR) genetic analysis for cystic fibrosis, serum alpha1-antitrypsin level and phenotyping for Alpha-1-antitrypsin deficiency, measurement of nasal nitric oxide levels and ciliated epithelial biopsy for primary ciliary dyskinesia, Rheumatoid factor and anti-cyclic citrullinated peptide (CCP) for autoimmune/connective tissue diseases, and specific CT findings of congenital malformations including Williams-Campbell syndrome (bronchomalacia); Mounier-Kuhn syndrome (tracheobronchomegaly) and lung sequestration [16].
\n
Bronchoscopy is not a routine diagnostic tool for bronchiectasis in the era of HRCT, but there are several indications for diagnostic bronchoscopy in such cases including: exclusion of foreign body obstruction especially in children, exclusion of proximal obstruction in adults with localized disease, obtaining microbiological results in acute ill patients, sampling of lower respiratory tract secretions when serial sputum testing did not yield results, obtaining endobronchial biopsy of airway cilia, and localizing the site of bleeding in patients with bronchiectasis and hemoptysis [17].
\n
The age-adjusted mortality rate for both male and female patients with diagnosed bronchiectasis is more than twice the mortality in the general population [4]. The independent risk factors influencing long-term mortality (over 13 years) in patients with bronchiectasis include: age, St George’s Respiratory Questionnaire activity score, Pseudomonas aeruginosa infection, total lung capacity (TLC), residual volume/TLC, and the transfer factor coefficient [18]. Therefore, in order to reduce the suspected poor prognosis with bronchiectasis, the treatment should be directed to improve symptoms, enhance quality of life, reduce exacerbations, and limit progression of the bronchiectatic lesions [15, 19].
\n
Treatment of bronchiectasis has been considered by ERS guidelines according to the vicious cycle hypothesis [15]. Thus, the options of treatment include: long-term inhaled or oral antibiotic therapy, eradication of new pathogenic microorganisms and antibiotic treatment of exacerbations for chronic bronchial infection, long-term anti-inflammatory therapies for inflammation, long-term mucoactive treatments and airway clearance techniques for impaired mucociliary clearance, and long-term bronchodilator therapy, surgery and pulmonary rehabilitation for structural lung disease.
\n
\n
\n
2. Indications of surgery
\n
Optimization of the medical management and proper selection of patients are crucial in the decesion making for surgery. Therefore, the current guidelines by ERS and British Thoracic Society (BTS) did not consider surgery until the symptoms are controlled by optimized medical treatment [15, 20]. The indications of surgery as recently mentioned by BTS guideline (Figure 2) include: persistent symptoms despite up to a year of comprehensive medical treatment, exacerbations that are either severe or frequent and interfere with social/professional life, recurrent refractory or massive hemoptysis, post obstruction bronchiectasis distal to tumors, localized severely damaged lobe/segment that may be a source of sepsis that left in situ may lead to extension of lung damage, and treatment of complications such as empyema or lung abscess [20].
\n
Figure 2.
Current indications for surgical treatment of bronchiectasis [15, 20].
\n
Up to date, there are only 46 published studies in literature between 1960 and 2019, evaluating the surgical management of bronchiectasis [21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66]. The most common clinical manifestations in these studies were: productive cough in 17.4–100% [54, 57], fetid sputum in 15.1–80% [35, 57], and hemoptysis in 10–76.5% [44, 59], while the main and indications of surgery include: failure of medical therapy in 39.6–100% [43, 50], recurrent chest infection in 19.8–100% [23, 54], massive or recurrent hemoptysis in 3–44.3% [32, 43], lung abscess in 1.8–36.5% [32, 58], lung masses or tumors in 1.4–17.6% [42, 46], and empyema in 1.1–8.1% [30, 57]. The mean duration of symptoms before surgery ranged from 1.78–10.6 years [30, 66].
\n
Failure of prudent medical treatment is the main indication of surgery in these studies, especially with frequent exacerbations and repeated hospitalizations [41]. Some authors considered failure of treatment if sputum production persists after 2 or 3 cycles of treatment [35]. The permanently damaged areas of bronchiectasis have poor antibiotic penetration leading to failure of antibiotic therapy, and acts as a microbiological reservoir with subsequent recurrence of infection [61]. Moreover, medical treatment for long periods with persistent symptoms has additional psychological and social effects [32].
\n
Therefore, surgery after failed medical treatment should aim to improve clinical condition and health-related quality of life, in addition to resolution of terrible bronchiectasis-related complications. This aim can be achieved when the focal lesions are completely removed, however, patients with multisegmental lesions should have palliative limited resection after failure of medical treatment or in the presence of life-threatening hemoptysis [47].
\n
Recurrence of pulmonary infection is an important indication of surgery, as it can result in increased cost and side effects of antibiotic therapy for acute infection, in addition to affection of the normal lung tissue with extension of lung destruction during each episode [32]. When bronchiectasis is associated with lung abscess, surgery should be delayed until adequate control with antibiotic therapy and avoiding of preoperative drainage is recommended, however, the immediate indications of surgery in the presence of lung abscess include increased abscess size, unceasing sepsis, and contralateral contamination [30].
\n
Recurrent or massive hemoptysis of more than 600 mL of blood within 24 hours indicates surgery which is considered as emergency after failure of the conservative therapy for hemoptysis. Even after initial cessation of bleeding by balloon blockade of the bleeding bronchus or bronchial artery embolization, early surgical treatment is indicated to avoid life-threatening recurrence of hemoptysis [30].
\n
In children, the indications for surgery are the same as in adult patients. Growth retardation can be considered as an additional indication for surgery in children with satisfactory postoperative results [43]. It is crucial to exclude the underlying diseases such as Kartagener syndrome and cystic fibrosis which limit the surgical resection [36].
\n
\n
\n
3. Preoperative evaluation
\n
Preoperative evaluation should include physical examination, imaging studies, arterial blood gases, pulmonary function tests, bronchoscopy, and perfusion scans if indicated. Additional diagnostic work-up may be required for patients with cardiovascular diseases including echocardiography, stress testing, myocardial perfusion studies, and coronary angiography [48].
\n
\n
3.1 Chest radiography
\n
Chest radiography represents non-specific features of bronchiectasis with low sensitivity and difficult appreciation. The suggestive findings in moderate to severe patients include: stranding, cystic lesions, volume loss with crowding of vessels, atelectasis, tram-track appearance, ring-like opacities, and tubular densities [28, 67]. Despite inadequate role of chest radiography in evaluation of bronchiectasis, abnormalities on chest radiography is significantly correlated with severity of the disease on HRCT [68].
\n
\n
\n
3.2 High resolution computed tomography (HRCT)
\n
The images of HRCT have higher sensitivity for diagnosis and localization of bronchiectasis than radiography with very low false negative and false positive results [41, 69]. The indications of HRCT include: clinical suspicion despite normal chest radiography, clarification of abnormalities on chest radiography, and decision making for surgery [70]. The use of HRCT is not restricted by age of the patient, thus HRCT is not uncommon diagnostic tool in children with bronchiectasis [56].
\n
In addition to the great help of HRCT in diagnosis of different types of bronchiectasis (Figure 3), preoperative localization of the lesions by HRCT has specific importance in making the decision for complete anatomic resection or limited resection with preservation of the lung tissue [30].
\n
Figure 3.
Images of high resolution computed tomography show types of bronchiectasis: (A) cylindrical, (B) varicose, and (C) cystic.
\n
\n
\n
3.3 Bronchoscopy
\n
Bronchoscopy should be performed in all patients to determine the underlying causes of bronchial obstruction including: foreign body aspiration, endobronchial epithelial tumors, and enlarged hilar lymph nodes with lobar collapse [30, 36]. Preoperative removal of the secretions and clearing of the airways is an important indication of bronchoscopy in adult and children patients [63], as it is associated with lower rate of postoperative complications [41].
\n
\n
\n
3.4 Pulmonary function tests
\n
Pulmonary function tests (PFTs) are not routinely performed in cases of bronchiectasis when the lesions are localized, but PFTs should be performed in diffuse bronchiectasis and in cases of repeated operations [36]. Pulmonary function tests can be performed in adult patients or in children older than 6 years of age [59]; however, cooperation of the child may affect completeness of the pulmonary function tests [35].
\n
The patients with bronchiectasis may have obstructive ventilatory pattern related to mucus retention or immunological abnormalities. The surgical resection of pulmonary segments with little contribution to ventilatory process is expected to have no or minimal effect on postoperative pulmonary function [31]. The expected loss of pulmonary function after surgical resection of bronchiectasis can be calculated from the equation: expected loss of function = preoperative function * (number of functional segments in the lobe to be resected/total number of segments of both lungs) [53].
Ventilation/perfusion (V/Q) scintigraphy provides information about hemodynamic features (vascular perfusion), gas exchange, and quantitative lung function, which has a particular help in cases with diffuse bronchiectasis as it can determine the most affected non-perfused areas to be surgically resected [36, 37]. The affected area is considered non-perfused when the perfusion is <10% of the expected [37]. Moreover, V/Q scintigraphy is indicated in patients with poor pulmonary function to provide more quantitative information about ventilation function [38].
\n
Some authors tried to find the correlation between morphologic type of bronchiectasis and the hemodynamic perfusion features. The study by Ashour in 1996, determined a correlation of cylindric morphology with pulmonary perfusion, contrary to non-perfusion predominance in cystic type, thus the surgery for diffuse bronchiectasis can be reserved for non-perfused cystic lesions which are more damaged than cylindrical lesions [71]. Thereafter, Al-Kattan and colleagues reported a new hemodynamic classification of bronchiectasis in patients with diffuse or bilateral disease, combining the perfusion and morphologic features to provide a reasonable extent of surgery and to obtain maximum postoperative clinical improvement [37].
\n
\n
\n
\n
4. Preoperative preparation
\n
The preoperative preparation of patients with bronchiectasis should aim to provide the best possible status. Therefore, the preoperative preparation should be performed by a multidisciplinary team consists of infectious disease specialists, pulmonologists, and thoracic surgeons [72].
\n
\n
4.1 Sputum culture analysis
\n
The patients should have appropriate preoperative preparation until the sputum volume reduced to 20-50 mL per day [54, 63], or the antibiotic therapy is modified according to new culture sensitivity results of the sputum [63]. As the gram-negative bacterial infection has a significant risk for perioperative complications, surgery should be performed after negative proof of Gram-negative bacillus on sputum culture analysis [58].
\n
In patients with a history of tuberculosis, surgery should be reserved for patients with inactive disease. Some surgeons postponed elective surgery 6 months if the sputum culture was positive for acid-fast bacilli and after the completion of antituberculosis treatment [41].
\n
\n
\n
4.2 Infection control
\n
Preoperatively, patients should be hospitalized and prepared for at least 2 weeks before surgery [48]. The patients who are scheduled for surgery should have no active pulmonary infection at the time of surgery. Therefore, broadspectrum antibiotics should be given for 48 hours prior to surgery, or prophylactic antibiotics are given according to results of sputum culture and sensitivity tests [36, 54]. For prophylaxis, cephalosporin and aminoglycoside are preferred if the culture is negative and the patient has no contraindications or allergies [48].
\n
\n
\n
4.3 Chest physiotherapy and postural drainage
\n
The patients should have intensive chest physiotherapy in the preoperative period, to obtain acceptable decrease of the daily volume of the sputum [54]. Patients should have chest physiotherapy including postural drainage for at least 2 weeks bfore surgery [57], or it should be continued until the daily sputum is ≤50 mL [50]. Preoperative postural drainage is essential to clean intra-tracheal secretions, decrease the sputum volume and sputum accumulation, and hence control of the infection and optimize the respiratory status [50, 58].
\n
The recommended airway clearance techniques are active breathing techniques or oscillating positive expiratory pressure (PEP). Review of HRCT findings is helpful to determine the appropriate postural drainage in relevance to the affected pulmonary segments. The gravity assisted positioning, where not contraindicated, is recommended to enhance the effectiveness of an airway clearance technique. Modified postural drainage without head down tilt should be considered when the postural drainage is not tolerated and when the symptoms of gastroesophageal reflux increased with the technique [17, 20].
\n
\n
\n
4.4 Other considerations
\n
Nutritional support and pulmonary rehabilitation should be considered before surgical referral [20]. In patients on long-term steroid therapy, the doses may be increased by 5–10 mg/day, but surgery should be postponed in patients with uncontrolled respiratory symptoms [72].
\n
\n
\n
\n
5. Surgical procedures
\n
\n
5.1 Thoracotomy
\n
The anesthetic management during surgery for bronchiectasis should consider: (1) cleaning of the bronchus opposite to the side of surgery by aspiration before placement of endotracheal tube, and (2) avoiding contralateral contamination by: insertion of double-lumen endotracheal tube, use of Fogarty embolectomy catheter as a bronchus blocker, or advancing of the endotracheal tube to the main bronchus of the opposite side of resection [35, 37, 41, 54, 57].
\n
Posterolateral thoracotomy is the standard approach for pulmonary resection in patients with bronchiectasis. Preservation of the integrity of chest wall muscles using muscle-sparing technique is essential to reduce postoperative pain and generate an effective cough [29]. When the decision is for bilateral lung resection, the second operation can be performed with an interval of 1–4 months [49, 53].
\n
The extent of lung resection is determined by extent of the disease and cardiopulmonary reserve, thus lobectomy is performed for lesions limited to one lobe, segmentectomy is performed for fairly limited disease or when the pulmonary function is impaired, while pneumonectomy is reserved for extensive disease affecting the whole lung [33, 50, 54]. In some instances, bilobectomy and lobectomy plus segmentectomy can be performed [40, 44, 48, 50, 52, 61]. Extrapleural dissection is preferred to avoid spillage of lung content into pleural space. After identification of the hilar structures and opening of the major fissure, arterial, venous, and bronchial branches are isolated and divided, respectively [39, 63].
\n
Certain recommendations can be followed to prevent or reduce the incidences of postoperative air leak and bronchopleural fistula (BPF) after lung resection including: preservation of peribronchial tissues and avoidance of extensive lymph node dissection near to bronchi to minimize bronchial devascularization, division of the bronchus before mobilization of the resected part to avoid contamination of the healthy segments, division of the bronchial stump as short as possible which sutured by non-absorbable materials or closed with a mechanical stapler then buttressed by tissue glue or a flap from pleura, pericardium, pericardial fat pad, muscle, or omentum [41, 73].
\n
To reduce the extension of contamination during surgery, extrapleural intrapericardial pneumonectomy is recommended when there is pleural sepsis or complete fusion of the pleura. Also, the evidence of pleural infection indicates pleural space irrigation with antibiotic [73]. Following placement of the chest drains, bronchoscopic evaluation of the bronchial sutures with removal of any secretions in the airway should be performed [63]. The resected specimens should be sent for histopathological examination [41].
\n
\n
\n
5.2 Video-assisted thoracoscopic surgery (VATS)
\n
There is a little research work regarding use of VATS in the management of bronchiectasis. The reported VATS approaches for lobectomy in patients with bronchiectasis include three ports, two ports, or one port VATS [55, 62, 66]. Additionally, a two-port thoracoscopy with a utility mini-thoracotomy has been reported [45].
\n
For three ports completely VATS procedure, the ports are placed through the 7th or 8th intercostal space in the midaxillary line for a 10-mm 30° thoracoscope, the 4th or 5th intercostal space along the anterior axillary line (4–5 cm incision), and the 7th or 8th intercostal space in the auscultatory triangle (1.5 cm incision) [55]. For two ports VATS lobectomy, a 2 cm camera port through the 7th or 8th intercostal space in the anterior axillary line and a 3–5 cm utility incision through the 4th or 5th intercostal space in the anterior or mid axillary line [62]. Ocakcioglu et al. described uniportal VATS lobectomy through a utility incision of 3–5 cm from the 5th intercostal space in the anterior position without use of rib retractor. A 10 mm 30° thoracoscope is placed in the anterior part of the incision, while dissecting and holding clamps are placed through the dorsal part [66].
\n
During 3 ports VATS, the incisions change depending on the type of lung resection, whether it is an upper or lower lobectomy [62]. The presence of intrathoracic adhesions is a challenging problem during VATS which can be released by blunt or sharp dissection, or it may result in conversion of the VATS procedure to open procedure [55, 64]. As in open thoracotomy, the pulmonary artery is firstly identified and divided before the division of the veins to avoid congestion of the lobe, with separate dissection of the major pulmonary veins and the bronchus [64]. The dissection of vascular and airway structures is performed by an endoscopic linear cutter [55]. At the end of VATS procedure, the thorax is closed after retrieval of the resected specimens and meticulous control of air leak and hemorrhage [66].
\n
\n
\n
5.3 Postoperative care
\n
Bronchoscopy can be performed in the operating room for bronchial hygiene, immediately after surgery [56]. The early postoperative care should include: pain control including epidural analgesia, chest physiotherapy, antibiotic therapy according to results of culture and sensitivity [37, 56].
\n
Generally, the duration of postoperative systematic antibiotic therapy is 5 days, but it can be longer according to the inflammatory condition. Early ambulation and active cough, and 3–4 times percussive chest physiotherapy are essential for proper expectoration and lung re-expansion. The standard criteria for removal of chest tube are: stable vital signs, small amount of drainage (<100 mL/day) with clear color, lung re-expansion on chest X-ray, and absence of air leak [63].
\n
After discharge, patients should have specific or wide-spectrum antibiotic therapy for 1 week. Chest physiotherapy can be reinitiated at home and continued for 2 weeks after discharge [33].
\n
\n
\n
\n
6. Postoperative outcomes of lung resection
\n
\n
6.1 Mortality
\n
To date, few studies have evaluated postoperative outcomes after lung resection for bronchiectasis (Table 1). There is no perioperative mortality (early, operative, in-hospital, postoperative, or 30-days) after surgical resection of bronchiectasis in most of the published studies. The reported rates of perioperative mortality ranged from 0.41% [23] to 8.3% [25]. The causes of early mortality in literature include: respiratory failure [2, 27, 28, 41, 49, 57], intraoperative bleeding [24, 28, 46], postoperative pneumonia [25, 37], empyema [25, 32], pulmonary edema [27, 46], cardiac-related causes including myocardial infarction or arrhythmia [27, 35, 47, 49, 58], speptic shock [27, 56], gastrointestinal bleeding due to sepsis and stress ulcer [39], uncontrolled hemoptysis [27], pulmonary embolism [22, 32, 48, 58], cardiac arrest in patients with Kartagener syndrome [36], disseminated intravascular coagulation [44], nephropathy [22], downstream consequences of bronchial stump fistula [48, 60], multiple organ failure [48, 60], and causes unrelated to disease or technique such as cerebral edema in a child due to previously undiagnosed aquaeductus stenosis and hydrocephalus [24]. The disease-related consequences which indirectly attribute to early death include: severe disease requiring pneumonectomy or completion [28, 58], massive bleeding during the operation because of dense adhesions due to chronic and recurrent infections [44, 46], and Kartagener syndrome [36].
The rates of late or long-term mortality ranged from 0.41% [27] to 8.3% [25]. The reported causes of late mortality after surgical management of bronchiectasis included: respiratory failure [24, 52], progressive respiratory disease [25], sepsis [59], coronary artery thrombosis [22], cor pulmonale or pulmonary heart disease [22, 58], myocardial failure [22], glomerulonephritis [22], kidney failure [58], post-pneumonectomy pneumonia in the remaining lung [56], massive bleeding from the Malecot catheter used for drainage ofresidual space infection [44], suicide [22], and other causes of late deaths not attributable to bronchiectasis [21, 23, 26].
\n
\n
\n
6.2 Morbidity
\n
The reported rates of morbidity ranged from 7% [7] to 38% [39]. The most common complication is atelectasis or sputum retention requiring bronchoscopic intervention, followed by persistent air leak (Table 2). Most of the reported complications were minor, transient, and treatable.
Reported rates of complications after surgical treatment of bronchiectasis.
\n
In comparison to the published studies in the 3rd and 4th decades of 20th century, the relatively low incidences of complication in the after while studies can reflect effective antibiotic therapy, improved anesthetic techniques, adequate blood transfusion, and detailed postoperative care [21, 22]. Other factors include: surgeon’s experience, preoperative awareness of the undesirable consequences of retained secretions, preoperative teaching of breathing exercises, scheduling tracheal suction or bronchoscopy in the early postoperative period [21], good intraoperative hemostasis and careful dissection [37], low number of pneumonectomies, accurate patient selection, and careful perioperative management [45].
\n
Treatment of postoperative complications after surgery for bronchiectasis depends on its type and severity. The treatment options for complications include: physiotherapy, tube thoracotomy, bronchoscopic treatment for atelectasis, negative suction applied to the chest tubes for prolonged air leak, surgical reintervention for closure of bronchopleural fistula, medical treatment or decortication for pleural empyema, pharmacological control of supraventricular arrhythmias, reexploration for postoperative bleeding, and mechanical ventilation for respiratory insufficiency [39, 41, 60].
\n
Cobanoglu et al. did not report any significant statistical difference between tubular and saccular morphologic types of bronchiectasis regarding postoperative complication rates; however, the most severe postoperative complication, bronchopleural fistula, developed in 2 (3.22%) cases with saccular bronchiectasis [50]. Zhou et al. did not find statistically significant difference in the rates of postoperative complications between thoracotomy and VATS procedure. Minor postoperative complications were reported after thoracotomy or completely VATS lobectomy, which included pneumonia, prolonged air leak (>7 days), and atelectasis [55]. Moreover, Hao et al. did not observe major postoperative complications such as bronchopleural fistula or respiratory insufficiency was observed in VATS and thoracotomy groups. The most common complication was persistent air leak for >7 days in 8.1% of VATS group and 6% of thoracotomy group [64].
\n
\n
\n
6.3 Symptomatic improvement
\n
The clinical results after surgical resection of bronchiectasis are frequently classified into three categories. The first category (asymptomatic; excellent response) includes patients who are completely free of any symptoms suggestive of bronchiectasis, and considered themselves cured. The second category (clinical improvement; good response) includes those considered improved who have had some relief of the symptoms but still had some chronic pulmonary complaints. The third category (no improvement; poor response) includes patients with no-change, no-reduction in preoperative symptoms, or who are worse off since surgical resection. [22, 31, 32, 35, 44, 46, 47, 50]. Some authors referred to the excellent response as well outcome [36] or perfect response [41].
\n
Sanderson et al. expanded the classification of the clinical symptomatic outcome to five categories as: excellent (no symptoms at all), good (full physical capacity, occasional cough and sputum), fair-improved (tendency to cough and sputum with susceptibility to respiratory infection, hemoptysis or dyspnea), poor (residual symptoms), and worse (steady deterioration) [23]. Other authors reduced the classification of the clinical condition in two categories only by dividing the patients into an improved group (“excellent” or “good” outcomes) and an unimproved group (“no change” or “worse” outcomes) [52].
\n
In literature, through a range of follow-up between 9 months and 14 years, the proportion of asymptomatic patients or excellent improvement after surgery ranged from 22.3% [22] to 89.5% [65], while the proportion of clinical improvement with reduction of preoperative symptoms ranged from 9.6% [64] to 80.7% [56], and no improvement, worseness or relapse was reported in 1.6% [58] to 42.3% [22].
\n
\n
\n
6.4 Quality of life (QOL)
\n
Patients with bronchiectasis report worse quality of life (QOL) than do persons in the general population [74, 75]. Recurrent bronchiectasis exacerbations are related to deterioration of lung function, progression of the disease, impairment of quality of life, and increased rate of mortality [76]. Postoperative QOL and the functional consequences of lung resection (pulmonary function and exercise capacity) are poorly addressed.
\n
Vallilo et al. reported a significant improvement of the QOL in patients with symptomatic bronchiectasis which was particularly relevant in the functional and physical QOL domains. Resection of the lung area which had not contributed to ventilatory response during exercise before surgery might enable the patients to maintain the exercise performance after lung resection without impairment to the response of the ventilatory system during maximal testing [60].
\n
\n
\n
6.5 Complete versus incomplete resection
\n
The proper surgical treatment should aim to complete resection of the bronchiectatic lesions. Thus, intraoperatively detected lesions should be resected as appropriate whether determined on preoperative imaging studies or not [32]. Complete resection is defined as an anatomic resection of all affected segments preoperatively identified by high-resolution computed tomography or bronchography [48, 54, 57]. However, some authors considered pulmonary resection complete if the patient was believed to be free of bronchiectasis after thoracotomy [31, 35].
\n
Completeness of surgical resection is affected by localization of the disease and pulmonary function (Figure 4). In patients with unilateral localized bronchiectasis, the most important prognostic factor for good surgical outcomes is complete resection of all diseased segments. In bilateral localized bronchiectasis, complete surgical resection should be attempted if lung function permits, including combinations of lobectomy with segmentectomy or wedge resections on the same siting or staged [24, 39, 73]; however, limited resection of the most predominant lesion is preferred for selected patients with bilateral diffuse bronchiectasis [34, 63]. The reported completeness of resection in patients with localized bronchiectasis ranged from 55.4% [23] to 94.2% [54].
\n
Figure 4.
Simplified algorithm for complete surgical resection according to extent of bronchiectasis.
\n
Sanderson et al. found a preponderance of excellent results after complete resection in comparison with incomplete resection (36% versus 10%, P < 0.005) [23]. Agasthian et al. found that complete resection resulted in a significant increase in proportion of asymptomatic patients than incomplete resection (65.2% versus 21.4%, p < 0.05) [28]. In the study by Kutlay et al., the excellent to good results of complete resection were significantly better than those of incomplete resection (98.5 versus 76.5%, P < 0.05) [32]. Similarly, other authors reported significantly better clinical results with complete resection than incomplete resection [35, 36, 44, 46, 50, 52].
\n
\n
\n
6.6 Predictors of postoperative outcomes
\n
There is no single independent perioperative variable that can predict occurrence of adverse events after lung resection with scant available data. In the study by Fujimoto et al., the logistic analyses extracted the type of bronchiectasis (cylindrical or others), the history of sinusitis, and the type of resection (complete or incomplete) for discrimination between patients with excellent or improved clinical outcome and patients with no clinical change [30]. Hiramatsu et al. reported immuno compromised status, Pseudomonas aeruginosa infection, and extent of residual bronchiectasis, as independent and significant factors of postoperative shorter relapse-free interval [53].
\n
Eren et al. fond that the lack of preoperative bronchoscopic examination, a FEV1 of <60% of the predicted value, a history of tuberculosis, and incomplete resection were independent predictors of postoperative complications [41]. Bagheri et al. statistically evaluated several variables including: sex, age, localization of disease, and complete or incomplete resection using multivariate logistic regression. Complete resection was found to have a significantly better surgical outcome compared to incomplete resection [46]. In the study by Zhang et al., the logistic regression analysis showed that tuberculous bronchiectasis, type of bronchiectasis (saccular versus others), and type of resection (incomplete or complete) were three independent factors associated with poor surgical outcome [48]. The multivariable analyses by Jin et al., showed that age, sputum volume, gram-negative bacillus infection, and bronchial stump coverage were the four independent factors related with poor surgical outcome [58].
\n
According to the reported results by Sahin et al., the prognostic variables in pediatric patients were: FEV1 less than 60% of the predicted value, hemoptysis, and duration of symptoms [59]. Interestingly, Gorur et al. stated that multi-segmental resectable bronchiectasis should not be considered an occult risk factor for morbidity after lung resection. Moreover, the number of resected segments, hemoptysis, and absence of preoperative fiberoptic bronchoscopy were not associated with postoperative complications. Impaired pulmonary function was significantly associated with residual air space; however it did not predict the risk of persistent air leak, atelectasis or empyema [51].
\n
Completion pneumonectomy is historically recognized as a high-risk procedure especially when done for a benign disease [77]. To reduce the high-risk of completion pneumonectomy when indicated, precautions such as optimal exposure, intrapericardial isolation of blood vessels, and bronchial reinforcement are recommended [78]. In the study by Agasthian et al., all died patients after lung resection had completion pneumonectomy. The causes of death were respiratory failure and intraoperative bleeding [28]. However, Fujimoto et al. reported acceptable mortality and morbidity after completion pneumonectomy without mortality and only one patient had postoperative bronchopleural fistula that could be managed conservatively [30].
\n
\n
\n
\n
7. Specific surgical considerations
\n
\n
7.1 Non-localized bronchiectasis
\n
Patients with non-localized (multi-segmental or bilateral) bronchiectasis are generally regarded as an exclusion of surgery [39]. However, considering the limited and palliative effect of medical treatment and the risk of transplantation or radical operation, recent studies offered a limited operation to some of these patients [34, 63]. Moreover, some surgeons favored surgery in non-localized bronchiectasis to prevent extension of the disease to the unaffected lung [38].
\n
George et al. suggested that bilateral bronchiectasis need not be a contraindication to operation. In properly selected patients, lasting symptomatic improvement can be provided by resection [24]. Mazieres et al. reported favorable outcome after a limited lung resection in properly selected symptomatic patients with severe multisegmental bilateral bronchiectasis, particularly those with cystic lesions and functionless territories [34].
\n
Schneiter et al. found the same patients’ satisfaction at 6 months after surgery for patients who had resectable non-localized or localized bronchiectasis, with non-significant differences in the rates of recurrent infection and hemoptysis [38]. Aghajanzadeh et al. reported the benefits of surgery in 87 bilateral non-localized bronchiectases, and concluded that staged bilateral resection for bronchiectases can be performed at any age with acceptable morbidity and mortality [39]. Additionally, Dai et al. reported the safety of lobectomy for the predominant lesions in non-localized bronchiectasis, with significant relief of symptoms, good rates of satisfaction, no operative mortality, and minimal postoperative complications [63].
\n
\n
\n
7.2 Surgery for bronchiectasis in children
\n
The prevalence of bronchiectasis in children ranges from 0.2 to 735 cases per 100,000 [79]. Cystic fibrosis is the most common cause of bronchiectasis in developed countries while in developing countries non-CF etiologies particularly post-infectious causes are more common [80]. Surgical treatment of bronchiectasis in children is considered for cases with resectable disease after failure of the proper medical treatment. Moreover, surgery can be considered in children with diffuse disease who have expected benefit after excision of the most predominant lesions [36, 79].
\n
In literature, the studies that evaluate surgical treatment of bronchiectasis in children are scanty. However, these studies confirmed the safety of surgery for childhood bronchiectasis with low rates of mortality and morbidity. Complete resection can be considered when possible, as most of the children can benefit from surgery especially if the total excision is accomplished [26, 35, 36, 43, 56, 59].
\n
The reported surgical outcomes in children with bronchiectasis highlight: acceptable mortality and morbidity [35, 36, 43, 56, 59], significant impact of surgery on improvement of symptoms and quality of life [43, 56], good results after segmentectomy when the pulmonary segment is entirely free of disease [26], increase the chance of cure after complete resection which results in significantly better outcome than incomplete resection [35, 43], preference of pneumonectomy instead of leaving residual disease when bronchiectasis is unilateral [36], and significant impact of duration of symptoms and timely intervention on the management and prognosis [59].
\n
\n
\n
\n
8. Conclusions
\n
Bronchiectasis is a significant chronic lung disease associated with vicious cycle of inflammation, infection, mucus accumulation, and structural tissue damage. Current guidelines recommend surgical treatment of bronchiectasis in patients with localized disease when symptoms are not controlled by optimized medical treatment. Other indications in literature include recurrent refractory or massive hemoptysis, bronchiectasis distal to tumors, and treatment of subsequent complications.
\n
HRCT is the gold standard imaging tool of bronchiectasis, as has a great help in preoperative localization of the lesions which affects the decision making for surgery. Preoperative bronchoscopy is important to diagnose the underlying causes of bronchial obstruction and to clear the airways by removal of secretions. Preoperative PFTs can be performed to determine the segments with little ventilatory contribution and minimal effects on postoperative pulmonary function after surgical resection. Perfusion scans can be used to determine the most affected non-perfused areas to be resected, particularly when the pulmonary function is affected. According to hemodynamic analysis of perfusion scans in diffuse bronchiectasis, surgery can be reserved for non-perfused cystic lesions which are more damaged than cylindrical lesions.
\n
Preoperative preparation for lung resection should include sputum culture analysis to modify antibiotic therapy with culture sensitivity results. It is crucial to eradicate active pulmonary infection and provide prophylactic antibiotic therapy with cephalosporin and aminoglycoside before surgery. Preoperative airway clearance techniques including active breathing, oscillating PEP, and postural drainage, are recommended to control infection and optimize the respiratory status. Other important preoperative considerations include nutritional support and pulmonary rehabilitation.
\n
Posterolateral thoracotomy is the standard approach for the surgical resection of bronchiectasis. The extent of resection depends on extent of the disease and cardiopulmonary reserve. Preservation of peribronchial tissues, short bronchial stump, and buttressing techniques are recommended to reduce postoperative air leak and BPF. The safety and feasibility of VATS in the treatment of bronchiectasis was shown in scant studies with low morbidity and mortality. The proper care after surgery should include bronchoscopic removal of secretions, pain control, chest physiotherapy, and appropriate antibiotic therapy.
\n
In literature, the mortality rates after lung resection range from 0.41% to 8.3%. The most common causes of early mortality are respiratory failure, intraoperative bleeding, postoperative pneumonia, empyema, pulmonary edema, and cardiac-related causes; while the most common causes of late mortality are respiratory failure, progressive respiratory disease, sepsis, coronary artery thrombosis, and cor pulmonale. The morbidity rates range from 7–38%. Atelctasis or sputum retention is the most common postoperative complication, followed by persistent air leak, pneumonia, and BPF. Most of the reported complications are minor, transient, and treatable. During follow-up periods between 9 months and 14 years, the proportion of asymptomatic patients (excellent improvement) after surgery ranges from 22.3% to 89.5%. Postoperative QOL is poorly addressed, but it can be improved after resection of functionless pulmonary segments.
\n
Complete resection of the affected parenchyma results in better clinical outcome than incomplete resection; however, completeness of resection is affected by localization of the disease and pulmonary function. A large number of predictors of surgical outcomes were investigated in literature, including: type of resection, type of bronchiectasis, immuno compromised status, Pseudomonas aeruginosa infection, extent of residual bronchiectasis, lack of preoperative bronchoscopic examination, FEV1 < 60% of the predicted value, tuberculosis, hemoptysis, duration of symptoms, age, sputum volume, gram-negative bacillus infection, bronchial stump coverage, and impaired pulmonary function.
\n
Recent studies reported acceptable outcomes after a limited lung resection for the most predominant lesion in properly selected patients with non-localized bronchiectasis. Surgery can be safely performed in children with bronchiectasis, particularly when the disease is resectable disease after failure of the proper medical treatment. Acceptable postoperative rates of mortality and morbidity and a significant symptomatic improvement were reported in children.
\n',keywords:"lung, bronchiectasis, productive cough, thoracic surgery, lung resection",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/72982.pdf",chapterXML:"https://mts.intechopen.com/source/xml/72982.xml",downloadPdfUrl:"/chapter/pdf-download/72982",previewPdfUrl:"/chapter/pdf-preview/72982",totalDownloads:269,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,dateSubmitted:"January 23rd 2020",dateReviewed:"June 3rd 2020",datePrePublished:"August 14th 2020",datePublished:"December 2nd 2020",dateFinished:"August 14th 2020",readingETA:"0",abstract:"Bronchiectasis is a chronic clinicopathological disease of the lung characterized by chronic cough, sputum production, recurrent pulmonary infection, and persistent bronchial dilatation on computed tomography. For many years, bronchiectasis associated with high mortality and morbidity particularly before the advent of antibiotics. The medical treatment of bronchiectasis includes antibiotic therapy, airway clearance, bronchodilators, and anti-inflammatory agents. Surgery is mainly performed for localized disease after failure of the medical treatment, including: segmentectomy, lobectomy, and pneumonectomy. This chapter highlights the current surgical considerations for treatment of bronchiectasis, regarding indications of surgery, preoperative evaluation and preparation, available operative procedures, postoperative outcomes, and other important surgical issues.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/72982",risUrl:"/chapter/ris/72982",book:{slug:"update-in-respiratory-diseases"},signatures:"Yasser Ali Kamal",authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Indications of surgery",level:"1"},{id:"sec_3",title:"3. Preoperative evaluation",level:"1"},{id:"sec_3_2",title:"3.1 Chest radiography",level:"2"},{id:"sec_4_2",title:"3.2 High resolution computed tomography (HRCT)",level:"2"},{id:"sec_5_2",title:"3.3 Bronchoscopy",level:"2"},{id:"sec_6_2",title:"3.4 Pulmonary function tests",level:"2"},{id:"sec_7_2",title:"3.5 Perfusion scans (ventilation/perfusion scintigraphy)",level:"2"},{id:"sec_9",title:"4. Preoperative preparation",level:"1"},{id:"sec_9_2",title:"4.1 Sputum culture analysis",level:"2"},{id:"sec_10_2",title:"4.2 Infection control",level:"2"},{id:"sec_11_2",title:"4.3 Chest physiotherapy and postural drainage",level:"2"},{id:"sec_12_2",title:"4.4 Other considerations",level:"2"},{id:"sec_14",title:"5. Surgical procedures",level:"1"},{id:"sec_14_2",title:"5.1 Thoracotomy",level:"2"},{id:"sec_15_2",title:"5.2 Video-assisted thoracoscopic surgery (VATS)",level:"2"},{id:"sec_16_2",title:"5.3 Postoperative care",level:"2"},{id:"sec_18",title:"6. Postoperative outcomes of lung resection",level:"1"},{id:"sec_18_2",title:"6.1 Mortality",level:"2"},{id:"sec_19_2",title:"6.2 Morbidity",level:"2"},{id:"sec_20_2",title:"6.3 Symptomatic improvement",level:"2"},{id:"sec_21_2",title:"6.4 Quality of life (QOL)",level:"2"},{id:"sec_22_2",title:"6.5 Complete versus incomplete resection",level:"2"},{id:"sec_23_2",title:"6.6 Predictors of postoperative outcomes",level:"2"},{id:"sec_25",title:"7. Specific surgical considerations",level:"1"},{id:"sec_25_2",title:"7.1 Non-localized bronchiectasis",level:"2"},{id:"sec_26_2",title:"7.2 Surgery for bronchiectasis in children",level:"2"},{id:"sec_28",title:"8. Conclusions",level:"1"},{id:"sec_31",title:"Abbreviations",level:"1"}],chapterReferences:[{id:"B1",body:'\nGoeminne C, De Soyza A. Bronchiectasis: How to be an orphan with many parents. The European Respiratory Journal. 2016;47:10-13\n'},{id:"B2",body:'\nAliberti S, Chalmers JD. Get together to increase awareness in bronchiectasis: A report of the 2nd world bronchiectasis conference. Multidisciplinary Respiratory Medicine. 2018;13(Suppl 1):28. DOI: 10.1186/s40248-018-0138-3\n'},{id:"B3",body:'\nContarini M, Shoemark A, Rademacher J, Finch S, Gramegna A, Gaffuri M, et al. Why, when and how to investigate primary ciliary dyskinesia in adult patients with bronchiectasis. Multidisciplinary Respiratory Medicine. 2018;13(Suppl 1):26\n'},{id:"B4",body:'\nQuint JK, Millett ER, Joshi M, Navaratnam V, Thomas SL, Hurst JR, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: A population-based cohort study. The European Respiratory Journal. 2016;47(1):186-193\n'},{id:"B5",body:'\nSnell N, Gibson J, Jarrold I, Quint JK. Epidemiology of bronchiectasis in the UK: Findings from the British lung foundation’s ‘Respiratory health of the nation’ project. Respiratory Medicine. 2019;158:21-23\n'},{id:"B6",body:'\nHenkle E, Chan B, Curtis JR, Aksamit TR, Daley CL, Winthrop KL. Characteristics and health-care utilization history of patients with bronchiectasis in US Medicare enrollees with prescription drug plans, 2006 to 2014. Chest. 2018;154(6):1311-1320\n'},{id:"B7",body:'\nLin JL, Xu JF, Qu JM. Bronchiectasis in China. Annals of the American Thoracic Society. 2016;13:609-616\n'},{id:"B8",body:'\nDhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: Results from the European multicentre bronchiectasis audit and research collaboration (EMBARC) and respiratory research network of India registry. The Lancet Global Health. 2019;7(9):e1269-e1279\n'},{id:"B9",body:'\nMaselli DJ, Amalakuhan B, Keyt H, Diaz AA. Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know. International Journal of Clinical Practice. 2017;71(2):1-10. DOI: 10.1111/ijcp.12924\n'},{id:"B10",body:'\nSchäfer J, Griese M, Chandrasekaran R, Chotirmall SH, Hartl D. Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis. BMC Pulmonary Medicine. 2018;18(1):79\n'},{id:"B11",body:'\nCole PJ. Inflammation: A two-edged sword – The model of bronchiectasis. European Journal of Respiratory Diseases. Supplement. 1986;147:6-15\n'},{id:"B12",body:'\nMoulton BC, Barker AF. Pathogenesis of bronchiectasis. Clinics in Chest Medicine. 2012;33:211-217\n'},{id:"B13",body:'\nSanthosham R. Bronchiectasis. In: Parikh Rajesh PB, editor. Tips and Tricks in Thoracic Surgery. London: Springer-Verlag; 2018. pp. 87-99\n'},{id:"B14",body:'\nChana ED, Wooten WI III, Hsiehh EWY, Johnstond KL, Shafferd M, et al. Diagnostic evaluation of bronchiectasis. Respiratory Medicine. 2019;X(1):100006. DOI: 10.1016/j.yrmex.2019.100006\n'},{id:"B15",body:'\nPolverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. The European Respiratory Journal. 2017;50:1700629\n'},{id:"B16",body:'\nSmith MP. Diagnosis and management of bronchiectasis. CMAJ. 2017;189:E828-E835. DOI: 10.1503/cmaj.160830\n'},{id:"B17",body:'\nPasteur MC, Bilton D, Hill AT. British thoracic society guideline for non-CF bronchiectasis. Thorax. 2010;65(Suppl 1):i1-i58\n'},{id:"B18",body:'\nLoebinger MR, Wells AU, Hansell DM, Chinyanganya N, Devaraj A, Meister M, et al. Mortality in bronchiectasis: A long-term study assessing the factors influencing survival. The European Respiratory Journal. 2009;34(4):843-849. DOI: 10.1183/09031936.00003709\n'},{id:"B19",body:'\nKoser U, Hill A. What’s new in the management of adult bronchiectasis? F1000Research. 2017;6(F1000 Facultyb Rev):527. DOI: 10.12688/f1000research.10613.1\n'},{id:"B20",body:'\nHill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn SJ, Floto AR, et al. British thoracic society guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1):1-69. DOI: 10.1136/thoraxjnl-2018-212463\n'},{id:"B21",body:'\nHewlett TH, Ziperman HH. Bronchiectasis: Results of pulmonary resection. The Journal of Thoracic and Cardiovascular Surgery. 1960;40:71-78\n'},{id:"B22",body:'\nStreete BG, Salyer JM. Bronchiectasis: An analysis of 240 cases treated by pulmonary resection. The Journal of Thoracic and Cardiovascular Surgery. 1960;40:383-392\n'},{id:"B23",body:'\nSanderson JM, Kennedy MCS, Johnson MF, Manley DCE. Bronchiectasis: Results of surgical and conservative management - a review of 393 cases. Thorax. 1974;29:407\n'},{id:"B24",body:'\nGeorge SA, Leonardi HK, Overholt RH. Bilateral pulmonary resection for bronchiectasis: A 40-year experience. The Annals of Thoracic Surgery. 1979;28:48-53\n'},{id:"B25",body:'\nAnnest LS, Kratz JM, Crawford FA. Current results of treatment of bronchiectasis. The Journal of Thoracic and Cardiovascular Surgery. 1982;83:546-550\n'},{id:"B26",body:'\nWilson JF, Decker AM. The surgical management of childhood bronchiectasis: A review of 96 consecutive pulmonary resections in children with nontuberculous bronchiectasis. Annals of Surgery. 1982;195(3):354-363\n'},{id:"B27",body:'\nDogan R, Alp M, Kaya S, Ayrancioğlu K, Taştepe I, Unlü M, et al. Surgical treatment of bronchiectasis: A collective review of 487 cases. The Thoracic and Cardiovascular Surgeon. 1989;37(3):183-186\n'},{id:"B28",body:'\nAgasthian T, Deschamps C, Trastek VF, Allen MS, Pairolero PC. Surgical management of bronchiectasis. The Annals of Thoracic Surgery. 1996;62:976-980\n'},{id:"B29",body:'\nAshour M, Al-Kattan K, Rafay MA, Saja KF, Hajjar W, Al-Fraye AR. Current surgical therapy for bronchiectasis. World Journal of Surgery. 1999;23(11):1096-1104\n'},{id:"B30",body:'\nFujimoto T, Hillejan L, Stamatis G. Current strategy for surgical management of bronchiectasis. The Annals of Thoracic Surgery. 2001;72:1711-1715\n'},{id:"B31",body:'\nPrieto D, Bernardo J, Matos MJ, Euge Ânio L, Antunes M. Surgery for bronchiectasis. European Journal of Cardio-Thoracic Surgery. 2001;20:19-23\n'},{id:"B32",body:'\nKutlay H, Cangir AK, Enön S, Sahin E, Akal M, Güngör A, et al. Surgical treatment in bronchiectasis: Analysis of 166 patients. European Journal of Cardio-Thoracic Surgery. 2002;21:634-637\n'},{id:"B33",body:'\nBalkanli K, Genc O, Dakak M, Gürkök S, Gözübüyük A, Caylak H, et al. Surgical management of bronchiectasis: Analysis and short-term results in 238 patients. European Journal of Cardio-Thoracic Surgery. 2003;24:699-702\n'},{id:"B34",body:'\nMazieres J, Murris M, Didier A, Giron J, Dahan M, Berjaud J, et al. Limited operation for severe multisegmental bilateral bronchiectasis. The Annals of Thoracic Surgery. 2003;75:382-387\n'},{id:"B35",body:'\nHaciibrahimoglu G, Fazlioglu M, Olcmen A, Gurses A, Bedirhan MA. Surgical management of childhood bronchiectasis due to infectious disease. The Journal of Thoracic and Cardiovascular Surgery. 2004;127:1361-1365\n'},{id:"B36",body:'\nOtgun I, Karnak I, Tanyel FC, Senocak ME, Buyukpamukcu N. Surgical treatment of bronchiectasis in children. Journal of Pediatric Surgery. 2004;39:1532-1536\n'},{id:"B37",body:'\nAl-Kattan KM, Essa MA, Hajjar WM, Ashour MH, Saleh WN, Rafay MA. Surgical results for bronchiectasis based on hemodynamic (functional and morphologic) classification. The Journal of Thoracic and Cardiovascular Surgery. 2005;130:1385-1390\n'},{id:"B38",body:'\nSchneiter D, Meyer N, Lardinois D, Korom S, Kestenholz P, Weder W. Surgery for non-localized bronchiectasis. The British Journal of Surgery. 2005;92(7):836-839\n'},{id:"B39",body:'\nAghajanzadeh M, Sarshad A, Amani H, Alavy A. Surgical management of bilateral bronchiectases: Results in 29 patients. Asian Cardiovascular & Thoracic Annals. 2006;14:219-222\n'},{id:"B40",body:'\nYuncu G, Ceylan KC, Sevinc S, Ucvet A, Kaya SO, Kiter G, et al. Functional results of surgical treatment of bronchiectasis in a developing country. Archivos de Bronconeumología. 2006;42:183-188\n'},{id:"B41",body:'\nEren S, Esme H, Avci A. Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis. The Journal of Thoracic and Cardiovascular Surgery. 2007;134:392-398\n'},{id:"B42",body:'\nGuerra MS, Miranda JA, Leal F, Vouga L. Surgical treatment of bronchiectasis. Revista Portuguesa de Pneumologia. 2007;13(5):691-701\n'},{id:"B43",body:'\nSirmali M, Karasu S, Turut H, Gezer S, Kaya S, Taştepe I, et al. Surgical management of bronchiectasis in childhood. European Journal of Cardio-Thoracic Surgery. 2007;31:120-123\n'},{id:"B44",body:'\nStephen T, Thankachen R, Madhu AP, Neelakantan N, Shukla V, Korula RJ. Surgical results in bronchiectasis: Analysis of 149 patients. Asian Cardiovascular & Thoracic Annals. 2007;15:290-296\n'},{id:"B45",body:'\nGiovannetti R, Alifano M, Stefani A, Legras A, Grigoroiu M, Collet JY, et al. Surgical treatment of bronchiectasis: Early and long-term results. Interactive CardioVascular and Thoracic Surgery. 2008;7:609-612\n'},{id:"B46",body:'\nBagheri R, Haghi SZ, Fattahi Masoum SH, Bahadorzadeh L. Surgical management of bronchiectasis: Analysis of 277 patients. The Thoracic and Cardiovascular Surgeon. 2010;58:291-294\n'},{id:"B47",body:'\nGursoy S, Ozturk AA, Ucvet A, Erbaycu AE. Surgical management of bronchiectasis: The indications and outcomes. Surgery Today. 2010;40:26-30\n'},{id:"B48",body:'\nZhang P, Jiang G, Ding J, Zhou X, Gao W. Surgical treatment of bronchiectasis: A retrospective analysis of 790 patients. The Annals of Thoracic Surgery. 2010;90:246-250\n'},{id:"B49",body:'\nCaylak H, Genc O, Kavakli K, Gurkok S, Gozubuyuk A, Yucel O, et al. Surgical management of bronchiectasis: A collective review of 339 patients with long-term follow-up. The Thoracic and Cardiovascular Surgeon. 2011;59:479-483\n'},{id:"B50",body:'\nCobanoglu U, Yalcinkaya I, Er M, Isik AF, Sayir F, Mergan D. Surgery for bronchiectasis: The effect of morphological types to prognosis. Annals of Thoracic Medicine. 2011;6(1):25-32\n'},{id:"B51",body:'\nGorur R, Turut H, Yiyit N, Candas F, Yildizhan A, Sen H, et al. The influence of specific factors on postoperative morbidity in young adults with bronchiectasis. Heart, Lung & Circulation. 2011;20:468-472\n'},{id:"B52",body:'\nSehitogullari A, Bilici S, Sayir F, Cobanoglu U, Kahraman A. A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis. Journal of Cardiothoracic Surgery. 2011;6:161\n'},{id:"B53",body:'\nHiramatsu M, Shiraishi Y, Nakajima Y, Miyaoka E, Katsuragi N, Kita H, et al. Risk factors that affect the surgical outcome in the management of focal bronchiectasis in a developed country. The Annals of Thoracic Surgery. 2012;93:245-250\n'},{id:"B54",body:'\nAl-Refaie RE, Amer S, El-Shabrawy M. Surgical treatment of bronchiectasis: A retrospective observational study of 138 patients. Journal of Thoracic Disease. 2013;5:228-233\n'},{id:"B55",body:'\nZhou ZL, Zhao H, Li Y, Li JF, Jiang GC, Wang J. Completely thoracoscopic lobectomy for the surgical management of bronchiectasis. Chinese Medical Journal. 2013;126:875-878\n'},{id:"B56",body:'\nAndrade CF, Melo IA, Holand AR, Silva ÉF, Fischer GB, Felicetii JC. Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children. Pediatric Surgery International. 2014;30:63-69\n'},{id:"B57",body:'\nBalci AE, Balci TA, Ozyurtan MO. Current surgical therapy for bronchiectasis: Surgical results and predictive factors in 86 patients. The Annals of Thoracic Surgery. 2014;97:211-217\n'},{id:"B58",body:'\nJin YX, Zhang Y, Duan L, Yang Y, Jiang GN, Ding JA. Surgical treatment of bronchiectasis – A retrospective observational study of 260 patients. International Journal of Surgery. 2014;12:1050-1054\n'},{id:"B59",body:'\nSahin A, Meteroglu F, Kelekci S, Karabel M, Eren C, Eren S, et al. Surgical outcome of bronchiectasis in children: Long term results of 60 cases. Klinische Pädiatrie. 2014;226:233-237\n'},{id:"B60",body:'\nVallilo CC, Terra RM, de Albuquerque AL, Suesada MM, Mariani AW, Salge JM, et al. Lung resection improves the quality of life of patients with symptomatic bronchiectasis. The Annals of Thoracic Surgery. 2014;98:1034-1041\n'},{id:"B61",body:'\nCoutinho D, Fernandes P, Guerra M, Miranda J, Vouga L. Surgical treatment of bronchiectasis: A review of 20 years of experience. Revista Portuguesa de Pneumologia. 2016;22(2):82-85\n'},{id:"B62",body:'\nBaysungur V, Dogruyol T, Ocakcioglu I, Misirlioglu A, Evman S, Kanbur S, et al. The feasibility of thoracoscopic resection in bronchiectasis. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2017;27(3):194-196\n'},{id:"B63",body:'\nDai J, Zhu X, Bian D, Fei K, Jiang G, Zhang P. Surgery for predominant lesion in nonlocalized bronchiectasis. The Thoracic and Cardiovascular Surgeon. 2017;153:979-985\n'},{id:"B64",body:'\nHao X, Dazhong L, Lei Y, Jiaying Z, Linyou Z. Surgical treatment of bronchiectasis: 5 years of experience at a single institution. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2019;29(6):826-830\n'},{id:"B65",body:'\nNega B, Ademe Y, Tizazu A. Bronchiectasis: Experience of surgical management at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. Journal of Health Sciences. 2019;29(4):471-476. DOI: 10.4314/ejhs.v29i4.8\n'},{id:"B66",body:'\nOcakcioglu I. Uniportal thoracoscopic treatment in bronchiectasis patients: Preliminary experience. Videosurgery and Other Miniinvasive Techniques. 2019;14(2):304-310\n'},{id:"B67",body:'\nCantin L, Bankier AA, Eisenberg RL. Bronchiectasis. AJR. American Journal of Roentgenology. 2009;193(3):W158-W171\n'},{id:"B68",body:'\nvan der Bruggen-Bogaarts BA, van der Bruggen HM, van Waes PF, Lammers JW. Screening for bronchiectasis. A comparative study between chest radiography and high-resolution CT. Chest. 1996;109(3):608-611\n'},{id:"B69",body:'\nYoung K, Aspestrand F, Kolbenstvedt A. High resolution CT and bronchography in the assessment of bronchiectasis. Acta Radiologica. 1991;32:439-441\n'},{id:"B70",body:'\nFirth J. Respiratory medicine: Bronchiectasis. Clinical Medicine. 2019;19(1):64-67\n'},{id:"B71",body:'\nAshour M. Hemodynamic alterations in bronchiectasis: A basis for a new subclassification of the disease. The Journal of Thoracic and Cardiovascular Surgery. 1996;112:328-334\n'},{id:"B72",body:'\nDusica S, Nebojsa L, Miodrag M, Angelina B, Sveljko S, Radmilo J. Preoperative preparation of patients with infectious and restrictive respiratory diseases as comorbidities. Acta Chirurgica Iugoslavica. 2011;58(2):63-69\n'},{id:"B73",body:'\nAgasthian T. Surgery for bronchiectasis. Journal of Visceral Surgery. 2018;4:235\n'},{id:"B74",body:'\nO’Leary CJ, Wilson CB, Hansell DM, Cole PJ, Wilson R, Jones PW. Relationship between psychological well-being and lung health status in patients with bronchiectasis. Respiratory Medicine. 2002;96:686-692\n'},{id:"B75",body:'\nOlveira G, Olveira C, Gaspar I, Dorado A, Cruz I, Soriguer F, et al. Depression and anxiety symptoms in bronchiectasis: Associations with health-related quality of life. Quality of Life Research. 2013;22:597-665\n'},{id:"B76",body:'\nArtaraz A, Crichton ML, Finch S, Abo-Leyah H, Goeminne P, Aliberti S, et al. Development and initial validation of the bronchiectasis exacerbation and symptom tool (BEST). Respiratory Research. 2020;21(1):18\n'},{id:"B77",body:'\nMcGovern EM, Trastek VF, Pairolero PC, Payne WS. Completion pneumonectomy: Indications, complications and results. The Annals of Thoracic Surgery. 1988;46:141-146\n'},{id:"B78",body:'\nGregoire J, Deslauriers J, Guojin L, Rouleau J. Indications, risks, and results of completion pneumonectomy. The Journal of Thoracic and Cardiovascular Surgery. 1993;105:918-924\n'},{id:"B79",body:'\nMcCallum GB, Binks MJ. The epidemiology of chronic suppurative lung disease and bronchiectasis in children and adolescents. Frontiers in Pediatrics. 2017;5:27\n'},{id:"B80",body:'\nKumar A, Lodha R, Kumar P, Kabra SK. Non-cystic fibrosis bronchiectasis in children: Clinical profile, etiology and outcome. Indian Pediatrics. 2015;52(1):35-37\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Yasser Ali Kamal",address:"yaser_ali_kamal@yahoo.com",affiliation:'
Department of Cardiothoracic Surgery, Faculty of Medicine, Minia University, El-Minya, Egypt
'}],corrections:null},book:{id:"7990",title:"Update in Respiratory Diseases",subtitle:null,fullTitle:"Update in Respiratory Diseases",slug:"update-in-respiratory-diseases",publishedDate:"December 2nd 2020",bookSignature:"Jose Carlos Herrera Garcia",coverURL:"https://cdn.intechopen.com/books/images_new/7990.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"224037",title:"Dr.",name:"Jose Carlos",middleName:null,surname:"Herrera Garcia",slug:"jose-carlos-herrera-garcia",fullName:"Jose Carlos Herrera Garcia"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"73662",title:"Eosinophils as a Biomarker in Asthma and COPD",slug:"eosinophils-as-a-biomarker-in-asthma-and-copd",totalDownloads:186,totalCrossrefCites:0,signatures:"Jose Carlos Herrera Garcia",authors:[{id:"224037",title:"Dr.",name:"Jose Carlos",middleName:null,surname:"Herrera Garcia",fullName:"Jose Carlos Herrera Garcia",slug:"jose-carlos-herrera-garcia"}]},{id:"66804",title:"Smoking and COPD: Endothelium-Related and Neuro-mediated Emphysema Mechanisms",slug:"smoking-and-copd-endothelium-related-and-neuro-mediated-emphysema-mechanisms",totalDownloads:328,totalCrossrefCites:0,signatures:"Vera Nevzorova, Tatiana Brodskaya and Eugeny Gilifanov",authors:[null]},{id:"65052",title:"Emphysema",slug:"emphysema",totalDownloads:450,totalCrossrefCites:0,signatures:"Tomislav M. Jelic",authors:[null]},{id:"70075",title:"COPD Pharmacological Management Update",slug:"copd-pharmacological-management-update",totalDownloads:214,totalCrossrefCites:0,signatures:"Stefan-Marian Frent",authors:[null]},{id:"71039",title:"Thoracic Extrapulmonary Tuberculosis in the Millennial Era",slug:"thoracic-extrapulmonary-tuberculosis-in-the-millennial-era",totalDownloads:144,totalCrossrefCites:0,signatures:"Onix J. Cantres-Fonseca",authors:[null]},{id:"71960",title:"Application of Thoracic Ultrasonography for Acute Cor Pulmonale in Acute Respiratory Distress Syndrome Patients",slug:"application-of-thoracic-ultrasonography-for-acute-cor-pulmonale-in-acute-respiratory-distress-syndro",totalDownloads:202,totalCrossrefCites:0,signatures:"You Shang and Ting Zhou",authors:[null]},{id:"71803",title:"Long-Term Adherence and Maintenance of Benefits in Pulmonary Rehabilitation",slug:"long-term-adherence-and-maintenance-of-benefits-in-pulmonary-rehabilitation",totalDownloads:201,totalCrossrefCites:0,signatures:"Hulya Sahin",authors:[null]},{id:"70685",title:"The Realm of Oncological Lung Surgery: From Past to Present and Future Perspectives",slug:"the-realm-of-oncological-lung-surgery-from-past-to-present-and-future-perspectives",totalDownloads:259,totalCrossrefCites:0,signatures:"Alexander Maat, Amir Hossein Sadeghi, Ad Bogers and Edris Mahtab",authors:[null]},{id:"73670",title:"Advances in Minimally Invasive Surgery for Lung Cancer",slug:"advances-in-minimally-invasive-surgery-for-lung-cancer",totalDownloads:118,totalCrossrefCites:0,signatures:"Rachit Shah and Nils-Tomas Delagar McBride",authors:[null]},{id:"72982",title:"Surgical Management of Bronchiectasis",slug:"surgical-management-of-bronchiectasis",totalDownloads:269,totalCrossrefCites:0,signatures:"Yasser Ali Kamal",authors:[null]}]},relatedBooks:[{type:"book",id:"956",title:"Cystic Fibrosis",subtitle:"Renewed Hopes Through Research",isOpenForSubmission:!1,hash:"703f0969078948d82535b7b0c08ab613",slug:"cystic-fibrosis-renewed-hopes-through-research",bookSignature:"Dinesh Sriramulu",coverURL:"https://cdn.intechopen.com/books/images_new/956.jpg",editedByType:"Edited by",editors:[{id:"91317",title:"Dr.",name:"Dinesh",surname:"Sriramulu",slug:"dinesh-sriramulu",fullName:"Dinesh Sriramulu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"34275",title:"The Prognosis of Cystic Fibrosis - A Clinician's Perspective",slug:"the-prognosis-of-cystic-fibrosis-a-clinician-s-perspective",signatures:"Patrick Lebecque",authors:[{id:"83586",title:"Prof.",name:"Patrick",middleName:null,surname:"Lebecque",fullName:"Patrick Lebecque",slug:"patrick-lebecque"}]},{id:"34276",title:"Radiological Features of Cystic Fibrosis",slug:"radiological-features-of-cystic-fibrosis",signatures:"Iara Maria Sequeiros and Nabil A. Jarad",authors:[{id:"78568",title:"Dr.",name:"Iara Maria",middleName:null,surname:"Sequeiros",fullName:"Iara Maria Sequeiros",slug:"iara-maria-sequeiros"},{id:"126865",title:"Dr.",name:"Nabil",middleName:null,surname:"Jarad",fullName:"Nabil Jarad",slug:"nabil-jarad"}]},{id:"34277",title:"The Cystic Fibrosis 'Gender Gap': Past Observations Present Understanding and Future Directions",slug:"the-cystic-fibrosis-gender-gap-past-observations-present-understanding-future-directions",signatures:"Sanjay H. Chotirmall, Catherine M. Greene, Brian J. Harvey and Noel G. McElvaney",authors:[{id:"39463",title:"Dr.",name:"Catherine",middleName:"M.",surname:"Greene",fullName:"Catherine Greene",slug:"catherine-greene"},{id:"42784",title:"Prof.",name:"Noel G.",middleName:null,surname:"McElvaney",fullName:"Noel G. McElvaney",slug:"noel-g.-mcelvaney"},{id:"81533",title:"Dr.",name:"Sanjay",middleName:"Haresh",surname:"Chotirmall",fullName:"Sanjay Chotirmall",slug:"sanjay-chotirmall"},{id:"128629",title:"Dr.",name:"Brian",middleName:null,surname:"Harvey",fullName:"Brian Harvey",slug:"brian-harvey"}]},{id:"34278",title:"Cystic Fibrosis and Infertility",slug:"cystic-fibrosis-and-infertility",signatures:"Maria do Carmo Pimentel Batitucci, Angela Maria Spagnol Perrone and Giselle Villa Flor Brunoro",authors:[{id:"91845",title:"Dr",name:null,middleName:null,surname:"Batitucci",fullName:"Batitucci",slug:"batitucci"},{id:"124309",title:"BSc.",name:"Ângela Maria Spagnol",middleName:null,surname:"Perrone",fullName:"Ângela Maria Spagnol Perrone",slug:"angela-maria-spagnol-perrone"},{id:"124310",title:"Dr.",name:"Giselle V.",middleName:null,surname:"Brunoro",fullName:"Giselle V. Brunoro",slug:"giselle-v.-brunoro"}]},{id:"34279",title:"The Genetics of CFTR: Genotype - Phenotype Relationship, Diagnostic Challenge and Therapeutic Implications",slug:"the-genetics-of-cftr-genotype-phenotype-relationship-diagnostic-challenge-and-therapeutic-implicatio",signatures:"Marco Lucarelli, Silvia Pierandrei, Sabina Maria Bruno and Roberto Strom",authors:[{id:"81744",title:"Prof.",name:"Marco",middleName:null,surname:"Lucarelli",fullName:"Marco Lucarelli",slug:"marco-lucarelli"},{id:"88095",title:"Dr.",name:"Silvia",middleName:null,surname:"Pierandrei",fullName:"Silvia Pierandrei",slug:"silvia-pierandrei"},{id:"88097",title:"Prof.",name:"Roberto",middleName:null,surname:"Strom",fullName:"Roberto Strom",slug:"roberto-strom"},{id:"124716",title:"Dr.",name:"Sabina Maria",middleName:null,surname:"Bruno",fullName:"Sabina Maria Bruno",slug:"sabina-maria-bruno"}]},{id:"34280",title:"Biochemical and Molecular Genetic Testing Used in the Diagnosis and Assessment of Cystic Fibrosis",slug:"biochemical-and-molecular-genetic-testing-used-in-the-diagnosis-and-assessment-of-cystic-fibrosis",signatures:"Donovan McGrowder",authors:[{id:"79123",title:"Dr.",name:"Donovan",middleName:null,surname:"McGrowder",fullName:"Donovan McGrowder",slug:"donovan-mcgrowder"}]},{id:"34281",title:"Pseudomonas aeruginosa Biofilm Formation in the CF Lung and Its Implications for Therapy",slug:"pseudomonas-aeruginosa-biofilm-formation-in-the-cf-lung-and-its-implications-for-therapy",signatures:"Gregory G. Anderson",authors:[{id:"82957",title:"Dr.",name:"Gregory",middleName:null,surname:"Anderson",fullName:"Gregory Anderson",slug:"gregory-anderson"}]},{id:"34282",title:"Outcome and Prevention of Pseudomonas aeruginosa-Staphylococcus aureus Interactions During Pulmonary Infections in Cystic Fibrosis",slug:"outcome-and-prevention-of-pseudomonas-aeruginosa-staphylococcus-aureus-interactions-during-pulmonary",signatures:"Gabriel Mitchell and François Malouin",authors:[{id:"87619",title:"Dr.",name:"Francois",middleName:null,surname:"Malouin",fullName:"Francois Malouin",slug:"francois-malouin"},{id:"89089",title:"Mr.",name:"Gabriel",middleName:null,surname:"Mitchell",fullName:"Gabriel Mitchell",slug:"gabriel-mitchell"}]},{id:"34283",title:"Infection by Non Tuberculous Mycobacteria in Cystic Fibrosis",slug:"infection-by-nontuberculous-mycobacteria-in-cystic-fibrosis",signatures:"María Santos, Ana Gil-Brusola and Pilar Morales",authors:[{id:"87481",title:"Dr.",name:"Pilar",middleName:null,surname:"Morales",fullName:"Pilar Morales",slug:"pilar-morales"}]},{id:"34284",title:"Atypical Bacteria in the CF Airways: Diversity, Clinical Consequences, Emergence and Adaptation",slug:"atypical-bacteria-in-the-cf-airways-diversity-clinical-consequences-emergence-and-adaptation",signatures:"Marchandin Hélène, Michon Anne-Laure and Jumas-Bilak Estelle",authors:[{id:"81613",title:"Prof.",name:"Hélène",middleName:null,surname:"Marchandin",fullName:"Hélène Marchandin",slug:"helene-marchandin"},{id:"88985",title:"Prof.",name:"Anne-Laure",middleName:null,surname:"Michon",fullName:"Anne-Laure Michon",slug:"anne-laure-michon"},{id:"88986",title:"Prof.",name:"Estelle",middleName:null,surname:"Jumas-Bilak",fullName:"Estelle Jumas-Bilak",slug:"estelle-jumas-bilak"}]},{id:"34285",title:"Viral Respiratory Tract Infections in Cystic Fibrosis",slug:"viral-respiratory-tract-infections-in-cystic-fibrosis",signatures:"Dennis Wat",authors:[{id:"92549",title:"Dr.",name:"Dennis",middleName:null,surname:"Wat",fullName:"Dennis Wat",slug:"dennis-wat"}]},{id:"34286",title:"Immune Dysfunction in Cystic Fibrosis",slug:"immune-response-in-cystic-fibrosis",signatures:"Yaqin Xu and Stefan Worgall",authors:[{id:"81718",title:"Prof.",name:"Stefan",middleName:null,surname:"Worgall",fullName:"Stefan Worgall",slug:"stefan-worgall"}]},{id:"34287",title:"Channel Replacement Therapy for Cystic Fibrosis",slug:"channel-replacement-therapy-for-cf",signatures:"John M. Tomich, Urška Bukovnik, Jammie Layman and Bruce D. Schultz",authors:[{id:"79549",title:"Prof.",name:"John M.",middleName:null,surname:"Tomich",fullName:"John M. Tomich",slug:"john-m.-tomich"}]},{id:"34288",title:"Improving Cell Surface Functional Expression of Delta F508 CFTR: A Quest for Therapeutic Targets",slug:"improving-cell-surface-functional-expression-of-deltaf508-cftr-a-quest-for-therapeutic-targets",signatures:"Yifei Fan, Yeshavanth K. Banasavadi-Siddegowda and Xiaodong Wang",authors:[{id:"88330",title:"Dr.",name:"Xiaodong",middleName:"Robert",surname:"Wang",fullName:"Xiaodong Wang",slug:"xiaodong-wang"},{id:"124468",title:"Dr.",name:"Yifei",middleName:null,surname:"Fan",fullName:"Yifei Fan",slug:"yifei-fan"},{id:"124470",title:"Dr.",name:"Yeshavanth",middleName:null,surname:"Banasavadi-Siddegowda",fullName:"Yeshavanth Banasavadi-Siddegowda",slug:"yeshavanth-banasavadi-siddegowda"}]},{id:"34289",title:"Fine Tuning of CFTR Traffic and Function by PDZ Scaffolding Proteins",slug:"fine-tuning-of-cftr-traffic-and-function-by-pdz-scaffolding-proteins",signatures:"Florian Bossard, Emilie Silantieff and Chantal Gauthier",authors:[{id:"87647",title:"Prof.",name:"Chantal",middleName:null,surname:"Gauthier",fullName:"Chantal Gauthier",slug:"chantal-gauthier"}]},{id:"34290",title:"CFTR Gene Transfer and Tracking the CFTR Protein in the Airway Epithelium",slug:"cftr-gene-transfer-and-tracking-the-cftr-protein-in-the-airway-epithelium",signatures:"Gaëlle Gonzalez, Pierre Boulanger and Saw-See Hong",authors:[{id:"84406",title:"Dr.",name:"Saw-See",middleName:null,surname:"Hong",fullName:"Saw-See Hong",slug:"saw-see-hong"},{id:"86153",title:"Prof.",name:"Pierre",middleName:null,surname:"Boulanger",fullName:"Pierre Boulanger",slug:"pierre-boulanger"},{id:"86155",title:"Dr.",name:"Gaëlle",middleName:null,surname:"Gonzalez",fullName:"Gaëlle Gonzalez",slug:"gaelle-gonzalez"}]},{id:"34291",title:"VIP as a Corrector of CFTR Trafficking and Membrane Stability",slug:"vasoative-intestinal-peptide-vip-as-a-corrector-of-cftr-trafficking-and-membrane-stability",signatures:"Valerie Chappe and Sami I. Said",authors:[{id:"84459",title:"Prof.",name:"Valerie",middleName:null,surname:"Chappe",fullName:"Valerie Chappe",slug:"valerie-chappe"},{id:"91057",title:"Prof.",name:"Sami",middleName:null,surname:"Said",fullName:"Sami Said",slug:"sami-said"}]},{id:"34292",title:"Pharmacological Potential of PDE5 Inhibitors for the Treatment of Cystic Fibrosis",slug:"pharmacological-potential-of-pde5-inhibitors-for-the-treatment-of-cystic-fibrosis",signatures:"Bob Lubamba, Barbara Dhooghe, Sabrina Noël and Teresinha Leal",authors:[{id:"88540",title:"Prof.",name:"Teresinha",middleName:null,surname:"Leal",fullName:"Teresinha Leal",slug:"teresinha-leal"},{id:"129673",title:"Dr.",name:"Bob",middleName:"Arthur",surname:"Lubamba",fullName:"Bob Lubamba",slug:"bob-lubamba"}]},{id:"34293",title:"Pharmacological Modulators of Sphingolipid Metabolism for the Treatment of Cystic Fibrosis Lung Inflammation",slug:"pharmacological-modulators-of-sphingolipid-metabolism-for-the-treatment-of-cystic-fibrosis-lung-infl",signatures:"M.C. Dechecchi, E. Nicolis, P. Mazzi, M. Paroni, F. Cioffi, A. Tamanini,V. Bezzerri, M. Tebon, I. Lampronti, S. Huang, L. Wiszniewski, M.T. Scupoli, A. Bragonzi, R. Gambari, G. Berton and G. Cabrini",authors:[{id:"53357",title:"Prof.",name:"Roberto",middleName:null,surname:"Gambari",fullName:"Roberto Gambari",slug:"roberto-gambari"},{id:"82889",title:"Dr.",name:"Song",middleName:null,surname:"Huang",fullName:"Song Huang",slug:"song-huang"},{id:"85366",title:"Dr.",name:"Maria Cristina",middleName:null,surname:"Dechecchi",fullName:"Maria Cristina Dechecchi",slug:"maria-cristina-dechecchi"},{id:"86524",title:"Dr.",name:"Elena",middleName:null,surname:"Nicolis",fullName:"Elena Nicolis",slug:"elena-nicolis"},{id:"86525",title:"Dr.",name:"Paola",middleName:null,surname:"Mazzi",fullName:"Paola Mazzi",slug:"paola-mazzi"},{id:"86527",title:"Dr.",name:"Moira",middleName:null,surname:"Paroni",fullName:"Moira Paroni",slug:"moira-paroni"},{id:"86528",title:"Dr.",name:"Federica",middleName:null,surname:"Cioffi",fullName:"Federica Cioffi",slug:"federica-cioffi"},{id:"86529",title:"Dr.",name:"Valentino",middleName:null,surname:"Bezzerri",fullName:"Valentino Bezzerri",slug:"valentino-bezzerri"},{id:"86531",title:"Dr.",name:"Maela",middleName:null,surname:"Tebon",fullName:"Maela Tebon",slug:"maela-tebon"},{id:"86536",title:"Dr.",name:"Ilaria",middleName:null,surname:"Lampronti",fullName:"Ilaria Lampronti",slug:"ilaria-lampronti"},{id:"86540",title:"Dr.",name:"Ludovic",middleName:null,surname:"Wiszniewski",fullName:"Ludovic Wiszniewski",slug:"ludovic-wiszniewski"},{id:"86541",title:"Dr.",name:"Maria Teresa",middleName:null,surname:"Scupoli",fullName:"Maria Teresa Scupoli",slug:"maria-teresa-scupoli"},{id:"86543",title:"Prof.",name:"Alessandra",middleName:null,surname:"Bragonzi",fullName:"Alessandra Bragonzi",slug:"alessandra-bragonzi"},{id:"86544",title:"Prof.",name:"Giorgio",middleName:null,surname:"Berton",fullName:"Giorgio Berton",slug:"giorgio-berton"},{id:"86546",title:"Dr.",name:"Giulio",middleName:null,surname:"Cabrini",fullName:"Giulio Cabrini",slug:"giulio-cabrini"}]},{id:"34294",title:"The Importance of Adherence and Compliance with Treatment in Cystic Fibrosis",slug:"the-importance-of-adherence-and-compliance-with-treatment-in-cystic-fibrosis",signatures:"Rosa Patricia Arias-Llorente, Carlos Bousoño García and Juan J. Díaz Martín",authors:[{id:"81752",title:"Dr.",name:"Rosa Patricia",middleName:null,surname:"Arias Llorente",fullName:"Rosa Patricia Arias Llorente",slug:"rosa-patricia-arias-llorente"},{id:"88980",title:"Prof.",name:"Carlos",middleName:"GarcÃa",surname:"Bousoño",fullName:"Carlos Bousoño",slug:"carlos-bousono"}]},{id:"34295",title:"Improving the Likelihood of Success in Trials and the Efficiency of Delivery of Mucolytics and Antibiotics",slug:"improving-the-likelihood-of-success-in-trials-and-efficiency-of-delivery-of-mucolytics-and-antibioti",signatures:"Carlos F. Lange",authors:[{id:"87618",title:"Prof.",name:"Carlos",middleName:"Frederico",surname:"Lange",fullName:"Carlos Lange",slug:"carlos-lange"}]},{id:"34296",title:"Airways Clearance Techniques in Cystic Fibrosis: Physiology, Devices and the Future",slug:"airway-clearance-techniques-in-cystic-fibrosis-physiology-devices-and-the-future",signatures:"Adrian H. Kendrick",authors:[{id:"81571",title:"Dr.",name:"Adrian",middleName:"H.",surname:"Kendrick",fullName:"Adrian Kendrick",slug:"adrian-kendrick"}]},{id:"34297",title:"The Physiotherapist's Use of Exercise in the Management of Young People with Cystic Fibrosis",slug:"the-physiotherapist-s-use-of-exercise-in-the-management-of-young-people-with-cystic-fibrosis",signatures:"Allison Mandrusiak and Pauline Watter",authors:[{id:"84089",title:"Dr.",name:"Allison",middleName:null,surname:"Mandrusiak",fullName:"Allison Mandrusiak",slug:"allison-mandrusiak"},{id:"87978",title:"Dr.",name:"Pauline",middleName:null,surname:"Watter",fullName:"Pauline Watter",slug:"pauline-watter"}]},{id:"34298",title:"Exercise Performance and Breathing Patterns in Cystic Fibrosis",slug:"exercise-performance-and-breathing-patterns-in-cystic-fibrosis",signatures:"Georgia Perpati",authors:[{id:"79721",title:"Dr.",name:"Georgia",middleName:null,surname:"Perpati",fullName:"Georgia Perpati",slug:"georgia-perpati"}]}]}]},onlineFirst:{chapter:{type:"chapter",id:"71630",title:"Outdoor Recreation within the School Setting: A Physiological and Psychological Exploration",doi:"10.5772/intechopen.91900",slug:"outdoor-recreation-within-the-school-setting-a-physiological-and-psychological-exploration",body:'\n
\n
1. Introduction
\n
Schools are widely acknowledged as a vital setting to develop a child’s physical activity participation [1], with a comprehensive review from over 25 years discovering the positive links between a child attending school and participating in greater levels of physical activity [2]. Not only is the school context where children spend the majority of their time each week (+ 30 hours in many cases), but the school is also a resource full of outdoor recreational options for children to develop physical activity, cognitive and social habits. Such outdoor recreational pursuits could include non-curricular (e.g., after school, active transportation), co-curricular recreational opportunities (via recess, school sporting carnivals) and curricular programs (via outdoor learning/recreational programs). The importance of these outdoor recreational settings in school become underscored by the continual reductions in the ability of children to experience opportunities to play around the home and neighbourhoods (e.g., concerns of neighbourhood safety, pollution, restrictions and non-play values at home) [3, 4]. Moreover, it is vital that a child experiences a multitude of opportunities to be physically active during school recreation to meet national activity guidelines. International guidelines recommend children participate in 1 hour of moderate to vigorous physical activity (e.g., activity which makes you sweat and puff) to develop positive physical activity habits to protect against chronic diseases such as Type 2 diabetes, cardiovascular disease and osteoporosis [5].
\n
In addition to the physical benefits that can be derived from outdoor recreational strategies within schools, research over the past two decades continues to unveil the interconnections between both the body and the mind [6]. For example, Santrock [7] makes the statement “biological processes can influence cognitive processes and vice versa … we are talking about the development of an integrated individual with a mind and body that are interdependent” (p. 16). The brain is one of the busiest organs in the human body by processing around one fifth of the body’s metabolism during cognitive processes. Therefore, it should be no surprise that cognitive processes require a steady stream of oxygen and energy from physical activities to meet such mental demands [8] and why sedentary pursuits of sitting/standing should be avoided to ensure that mental demands are optimally catered for [9]. So if a child is undertaking vigorous outdoor recreational pursuits at school, it is expected that a child’s capacity to be able to remember, perceive, concentrate and attend to academic tasks should be improved [6].
\n
This chapter will begin by discussing how children can be physiologically effected from outdoor recreation in schools. The discussion will commence with an exploration of both structured (e.g., a set purpose, location) and unstructured (e.g., less pre-determined purpose) playground strategies during school recess. The discussion continues with exploration into before- and after-school outdoor recreational strategies that have been introduced to influence school children’s physical activity participation and development. The next section considers the psychological context of recess, before detailing the specific and intersecting dimensions of children’s cognitive and social development during outdoor recreation in schools. Finally, an overview is provided with key insights that have emerged from the literature in relation to the physiological and psychological effects that have been measured within outdoor recreational school contexts.
\n
\n
\n
2. Physiological effects from outdoor recreation in schools
\n
The provision of a catalogue of outdoor recreational opportunities in schools is vital to ensure that children develop healthy habits and strong minds to take with them into both adolescence and adulthood [1, 10]. The impact and level of quality of earlier life experiences in physical and recreational pursuits often tracks into adulthood [11, 12]. Despite physical activity options being required to be delivered in various capacities of the school system, research continues to recognise that children will engage or prefer to engage in more sedentary-type behaviours of sitting and standing [13]. Large proportions of children exceed national screen time recommendations [14] and not meeting child physical activity guidelines has become the norm across most countries worldwide [15, 16]. For instance, a major international report on adolescent physical activity participation from decades of population data revealed that in most countries, just one (lowest) or two (highest) out of 5 children will meet national physical activity guidelines [17]. These guidelines are designed to ensure children are optimally healthy to prevent disease. Despite such dire health results, there has been continual research to try and promote positive outdoor recreational strategies in schools to have an impact on school children’s physical activities. With the positive links of physical activity participation on biological improvements well established [18, 19], most research focusing on the physiological effects from outdoor recreation in schools has been concerned with improving physical activity levels [20].
\n
\n
2.1 School playground recreational strategies to develop school children’s physical skills and habits
\n
The school playground during recess is a powerful outdoor recreational school context to enhance children’s physical abilities. The school playground has a combination of supervision, access and safety which allows wide ranging physical activities for children [10]. In many jurisdictions, the school playground during recess time has become the main option for children’s physical activity participation, as PE time allocations have been reduced and eradicated [21]. Earlier work researching the impact of children engaging in school playgrounds during recess has suggested that almost half of a child’s daily physical activity is sourced from the school playground [22]. The importance of discovering customisable strategies within the school playground recreational context is therefore vital.
\n
There have been a number of strategies trialled within school playgrounds during recess to improve outdoor recreational activity levels such as themed activity weeks, providing games equipment, loose parts, surface markings, fitness ideas and providing more natural features [20]. Most of these strategies have been successful on participation levels from short-term measurements, which is likely due to the novelty of introducing new strategies compared to constant playground agendas and the desire from the children to expand their play options with variety [10]. Themed activity weeks of having alternating weeks with an obstacle course, frisbee activities, fitness circuits and a week with normal activities is one of the playground intervention packages mentioned [23]. This alternating recreational strategy unveiled that physical activity participation levels were greatest during the two weeks in which the children participated in a fitness themed week or their normal playground activities. Fitness-focused playgrounds during recess have also had a positive impact on children’s physical activity levels compared to recess periods with no set playground agenda being implemented [24]. The implementation of games equipment with providing activity details and instructions for a range of games and activities for the children to perform in the school playground has also been introduced. Scholars discovered that providing the game cards increased the physical activity levels in the school children [25]. The implementation of other recreational games have also had success on children’s physical activity levels such as via interactive bowling and running games [26], alongside games offered by trained staff in recreational sports [27] such as in softball, tag, basketball and relay games. The painting of school surfaces with markings [28, 29, 30, 31] to encourage the outdoor recreational pursuits with jumping lines, board games, agility snakes and hopscotch have seen the physical benefits of energy expenditure increases (can help with obesity), duration engaged in physical activity, improved compliance with national physical activity guidelines and overall increases in the intensity of a child’s physical activity participation over a 2 year period. Moreover, combining a range of strategies such as training staff to facilitate children’s activities within the school playground, breaking up the playground into activity zones (e.g., soccer, tag games) and the introduction of loose sporting equipment (e.g., balls, markers) have had a positive impact on the intensities children’s engaged in their outdoor recreational activities at school [32]. Additionally, even the simple redesign of playgrounds for outdoor recreation with equipment such as climbing structures, slides, and a spinning apparatus have had a positive impact on children’s physical activity levels [33] or reducing sedentary behaviour [34].
\n
Less structured recreational strategies without a set location, time or purpose have been found to have quite holistic benefits on children’s physical health. For instance, these strategies have simply involved getting rid of school playground rules/regulation, providing more natural features (such as rocks, trees, gardens) and implementing sparable, movable household items known as loose parts. Although not directly measuring physical activity participation, a New Zealand primary school principal reported on the amount of new physical activities taking place for children’s physical development when he removed excess school playground rules and regulations [35, 36]. The Principal described how the allowance of play which was perceived as more risky unlocked a variety of physical activities such as climbing structures like hand rails and trees, skating across hard surfaced areas and sliding in the mud. Moreover, the Principal noticed a dramatic reduction in physical injury from providing more play freedom. The recreational pursuit of climbing can have a multitude of benefits on a developing child, including muscular strength, endurance and flexibility [37]. Although tree climbing is perceived by many as being risky [38], the introduction of features such as trees, rocks, gardens and grass areas has seen school children vary their outdoor recreational physical activities, enhance the amount of space and opportunities for physical activity, play freedom and have had an impact on moderate levels of children’s physical activity [39, 40, 41]. By greening outdoor recreational areas in schools, the ability to improve children’s self-reported wellness is also enhanced [42, 43].
\n
Overcoming adult perceptions of risky play [44] also reignited a multitude of larger studies on the provision of loose parts on children’s physical development. Most of this more modern research stemmed from Bundy and colleagues’ pilot study [44] research which recognised that adults perceived loose parts materials (e.g., sticks, crates, hay bales) as too risky, yet the findings demonstrated the entire opposite in very young children. The loose parts were able to transform the school playgrounds into rich childhood developmental hubs via outdoor recreation and reigniting the momentum of loose parts from the 1970’s [45]. The resulting physical activity outcomes from introducing loose parts have seen increases in primary school children’s (of a range of year levels) physical activity enjoyment, intensities, steps/distance, activity types, playability, durations, complexity and many of these physical activity developments were sustained for long-term follow-up studies (e.g., 1–2½ years) [20]. The earlier findings were also supported by studies across other locations such as the United Kingdom [46] and New Zealand [47] with positive teacher reports of similar developments. Moreover, “relocatable” sports equipment are also reported to have positive effects on children’s physical activity [48].
\n
\n
\n
2.2 Before and after-school recreational strategies to develop school children’s physical skills and habits
\n
By investigating the school playground strategies above, it becomes clear that continuing to consider strategies which will not burden teachers’ curricular commitments can be powerful on a child’s physical development. It is also vital to consider a holistic approach to outdoor recreation during school days for children’s physical development with additional strategies, particularly with curricular physical activity opportunities being constrained [49]. Beyond the school playground, the most prevalent outdoor recreation school avenues are through after school programs, school camps/excursions, and active transport (to and from school via movement).
\n
After school programs typically involve collaboration between the community and the school. Internationally, there have been a number of extracurricular recreational programs, commonly focused on increasing physical activity through sports. For instance, in Hungary, physical education teachers coordinate and organise physical activities outside of school as a formal requirement [50]. In Taiwan, there are opportunities for children to connect, learn from and interact with adults from training institutions in how to undertake and participate in sports [51]. The Australian Sporting Schools program has been a significant recreational strategy introduced to schools which has been intended to increase children’s participation in local sport with the delivery of programs by a national sporting organisation [52]. Whilst many of the after-school and extracurricular programs which are implemented worldwide have little research data showcasing program effectiveness, the reach of the Sporting Schools program from 4000 [53] to almost 7500 schools [54] nationwide shows some impact of the program.
\n
Although much of the research of this chapter showcases programs to develop school children’s health via outdoor recreational strategies within the school setting, it should be acknowledged that there has been some research with school children outside of schools. Summer camps for instance are highly popular in places such as Canada and the USA with large summer breaks [55]. Such camps can offer chances for outdoor recreational activities in areas of sport and adventure and have been identified as having a positive impact on school children’s physical health [56], physical activity levels and meeting daily physical activity recommendations [57, 58]. Another outdoor recreational pursuit for school children is to walk or ride to school via active transportation [59]. Scholars describe active transportation as creating important physical activity habits in school children, environmentally friendly travel habits and a valuable opportunity to invigorate children’s physical activity participation rates and levels [60, 61]. Although scholars caution school communities about potential safety risks such as road traffic and strangers, it is acknowledged internationally that school communities can consider programs such as a walking school bus concept in which adults lead a group of children [62, 63]. This can be achieved by considering stakeholder partnerships and the level of infrastructure and resources around a school’s transportation networks to actively transport to and from school. Although this extra-curricular strategy to encourage physical activity has widespread support, there still remains a gap in the data relating to long-term insights and standardised outcome measures of physical activity [64, 65]. As detailed earlier in the chapter, if physical activity levels can be increased, this can also have a positive impact on the flow of nutrients to the brain to enhance cognitive performance. In the next section of this chapter, we unpack a range of the outdoor recreational strategies in schools which have had an impact on psychological functioning.
\n
\n
\n
\n
3. Psychological effects from outdoor recreation in schools
\n
We begin this next section by considering the psychological context of recess before moving to specific areas of cognitive and social development. The psychological context of outdoor recreation in schools is rarely acknowledged, yet can be a major contributor to cognitive and social outcomes. One way to consider the psychological context is in terms of structure versus autonomy (e.g., ensuring more choice in how things are done). Structure can be imposed in a variety of ways including clearly articulated rules negotiated with children through to non-negotiable top-down rules or quick decisions by teachers on duty during recess regarding the rule boundaries and positive or negative play [66]. An increase in banning of activities that children consider to be fun has been found in a large UK study [67] and is likely to extend to other countries given the heightened concern expressed by teachers about risky play during recess [44, 68]. Teachers often face the dilemma of allowing children more autonomy or acting in accordance with their perceived duty of care which can involve imposing excessive rules and safety requirements.
\n
Structure has sometimes been introduced as a means of increasing physical activity. There is speculation that an emphasis on sports and other structured physical activity can change the social hierarchy of the playground, elevating the status of children with better physical skills [69]. It is possible that high levels of structure to achieve physical activity outcomes may have a negative impact on children’s autonomous decision making and social interaction processes. With less choices and opportunities for decision making during play, children suggest such restriction can cause boredom, misbehaviours (and injury) and a desire to lash out during school recess periods [70].
\n
Many researchers and teachers argue that children need more elements of choice from the psychological component of autonomy to learn life skills. It is known that recess times are some the best times to offer such opportunities with minimum structure or intervention. As noted previously, loose parts have been offered to children during recess as a means of promoting physical activity through imaginative play. One of the adult-perceived difficulties with loose parts play is the potential for accidents and injuries. Interestingly, both parents [71] and teachers [72] seem to have a lower tolerance for risky play when a child has a disability. Interventions involving loose parts have helped to overcome many of the concerns related to risky play. Some interventions have included risk-reframing workshops to support shifts in thinking of teachers and parents about risks in play [73]. Interventions without these workshops have also succeeded in shifting adult behaviour from enforcing playground rules to granting children greater autonomy to make decisions about their play [47]. Hyndman and colleagues discovered that the introduction of loose parts can help facilitate outdoor school recreation activities which aligned with both national curriculum objectives [74] and key criterions of creativity [75]. This was achieved by encouraging children to learn and undertake more complexity with their recess activities with loose parts equipment. Loose parts have also been reported by teachers to have a positive impact on children’s cognitive engagement during outdoor recreation activities [76] with impacts on short-term enjoyment levels [77], a key psychosocial influence for sustained participation.
\n
Other interventions have provided more explicit play goals, but these have been negotiated with school personnel and children. The Health Active Peaceful Playgrounds for Youth (HAPPY) intervention [78] is an example of this type of approach. Some children were offered specific training relating to physical activity and social inclusion with peers. Children in this study were found to value clear rules for games that were known to all children. It is perhaps the arbitrariness of rules in some contexts that causes difficulties for children. For example, a staff member in one of the loose parts studies [46] mentioned that prior to the introduction of loose parts, children were held back by having to remember the recess rules. Emerging evidence also suggests that psychological benefits may be amplified if recess occurs in natural environments. This is mainly due to the stress-reductions experienced by children when in nature [79].
\n
Some of the research questions regarding cognition and academic skills are relatively standard and relate to the possibility that recess provides a context for promotion and development of these skills. Surprisingly, some researchers are also interested in a null result, showing no effect. The reason for the latter interest is that time spent in recess is often perceived as time that could be better spent on direct instruction on academic tasks. Current evidence indicates that school recess does not have a negative impact and may have a positive impact in some areas of cognition and academic achievement.
\n
There are sound reasons to believe that short-term or habitual physical activity will promote cognitive skills with a flow-on effect to academic skills. Children’s enjoyment of more vigorous recreation activities during school recess has also been linked to improved quality of life [80]. Nonetheless, results have not been as clear as expected. Recent systematic reviews [81, 82] have shown mixed results and have called for high quality studies to address this question.
\n
Physical activity in adults has been found to promote higher order cognition known as executive functions (EF). The core EFs are working memory, inhibitory control and cognitive flexibility [83]. Performance on EF tasks is predictive of academic performance [84]. Working memory involves holding and manipulating information in memory, such as when solving mental arithmetic problems. Inhibitory control is the ability to suppress a prepotent response. In academic work, the first response that comes to mind may not be the correct one and inability to suppress competing responses may interfere with task completion. Cognitive flexibility involves the ability to shift strategies when the one used becomes unproductive. A strategy may be effective in solving simple problems, for example, but no longer works when problems become more complex. Inability to change strategy makes it difficult to progress to higher level school work.
\n
The EFs are known to be quite malleable during childhood. Researchers have therefore attempted to understand the mechanisms that support improvements in EFs. Physical activity has been identified as a potential contributor to brain plasticity, neurogenesis and resilience to damage. This is achieved through processes such as promoting blood vessel growth that support the brain’s increased energy needs [85]. Research studies have not had a clear focus on recess, physical activity and EFs. Studies that might help understand the outdoor recreation in schools, physical activity and EF relationship have not always taken place during outdoor recreation in schools. For example, the FITKids randomised controlled trial [86] took place after school, but included games, teaching of skills and other challenges that could be available during outdoor recreation in schools. The FITKids trial was conducted with 7–9 year olds, with the intervention group showing improvements in two core EFS, inhibition and flexibility. This continues to be a promising area of investigation and more studies are needed. Current systematic reviews indicate that the results of studies are mixed, but importantly no studies show a decline in EFs following increased in physical activity [87, 88, 89].
\n
Mathematics and literacy are the most common academic areas investigated by researchers. Time spent in physical activity during recess has not been found to adversely impact academic performance [15]. This has been demonstrated in a range of studies including a large cross-sectional Spanish study with 1780 participants aged 6–18 years [90]. There are also studies that have found a positive impact of physical activity on academic skills. A recent meta-analysis of 26 studies with participants aged 4–13 years found physical activity to lead to improvements in mathematics, reading and classroom behaviour. Mathematics was also found to improve in a recess study with Grades 3–5 involving exergaming [91]. Children in this study participated in “Dance-Dance-Revolution” (DDR), which involved aerobic activity and choreographed footwork and was appealing to the participants in the study.
\n
One hypothesis regarding the mixed findings for EFs and academic performance is that physical activity alone is not enough to promote cognitive or academic development. What is needed is the addition of cognitive or social demands [88]. For example, DDR placed pressure on memory for the choreographed steps. It is also important to note that these interventions were offered during some recess sessions (e.g., DDR was 90 minutes per week), but children also had access to free play time.
\n
To our knowledge there are no high-quality studies of unstructured recess interventions and EFs or academic outcomes. There is potential for future research as some researchers argue that structured activity during recess may interfere with academic performance, particularly for younger children who may need a break to during recess to reduce interference with preceding and following class instruction [89].
\n
\n
\n
4. The social-psychological intersections of outdoor recreation in schools
\n
For many children, school recess is the only opportunity to engage in peer activities with minimal adult supervision. Ideally, school recess offers opportunities for children to practice social interaction skills, negotiate with others to achieve goals, form enduring friendships, support peers experiencing difficulties and learn to manage their own risk-taking behaviours. Although social time on the playground may appear to be nothing more than a break from class, the quality and quantity of social time may have important implications for psychosocial development and academic achievement. For young children, level of social interaction with peers has been found to be positively associated with academic achievement whereas level of social interaction with teachers was negatively associated [92].
\n
Social interactions are often different for girls and boys during outdoor recess. Girls have been reported to have higher levels of enjoyment for social and imaginative play [93], alongside more time in pretend play which requires planning with peers. Boys are more likely to engage in rough and tumble play, particularly in the early school years. Rough and tumble generally involves play fighting, wrestling and other behaviours that are sometimes mistaken for aggression [66]. Rough and tumble is therefore often banned or restricted on school playgrounds. Rough and tumble is developmentally important for the development of self-control, conflict resolution and affiliation. It is a positive behavior for most children with the exception of boys with a “rejected” sociometric status for whom it can predict antisocial behaviours. It is important to note that the gender differences observed during outdoor recess in western schools may not be universal. For example, there is evidence that rough and tumble play occurs equally for both genders in forager societies [94].
\n
The majority of school children look forward to recess time and see it as an opportunity to engage in fun activities with friends. For a significant minority of children however, recess is a time when they are isolated, rejected or bullied. Elementary school children have nominated outside recess as particularly problematic for bullying [95]. Recess should offer an opportunity to promote psychosocial development, but this is currently not true for all children. Many of the issues that contribute to negative social outcomes are the same as those that contribute to social outcomes, including poor supervision, lack of materials and lack of space [96].
\n
Some of the difficulties children have on outdoor school playgrounds relate to the spaces available. Children typically have the choice of large open spaces that are easy for adult surveillance or seeking privacy behind buildings where they may feel vulnerable. A recent study has shown that many children prefer “in-between” spaces for at least some of their outdoor play [97]. These spaces include under staircases, under trees and edges of buildings. Importantly, these spaces maintained a visual line to the main play areas and therefore did not incur the vulnerabilities of being out-of-sight. Some children said they worried about the boisterous play on the main playground. The in-between spaces meant they were less likely to be hit by a ball or knocked over by another child. Children also used these spaces for imaginative play or to define boundaries such as goal posts. In-between spaces provided greater opportunities for children to self-select their play and define their peer groups. Unfortunately, these spaces were often considered to be out-of-bounds.
\n
Difficulties for children can stem from underlying psychological problems. Children with internalising or externalising disorders may have difficulties with social interactions on the playground. In recent years, social skills interventions have targeted peer interactions on the playground to support children’s access to a complex social environment and with the goal of achieving the flow-on effect of improved academic outcomes [98].
\n
Unfortunately, recess is often perceived as a privilege rather than an essential part of the school day. Consequently, there is a widespread practice of restricting or removing recess privileges from students for misbehaviour or to catch up on schoolwork [67]. Recess restriction continues to be a recommended behaviour management technique [99]. When asked, children indicate a preference for longer recess periods [67, 100]. Clearly, recess is valued by children which makes it an easy target for disciplinary practices. Children from third and fifth grade in two US schools indicated that they understood the reasons for teachers restricting outdoor recess, but largely considered it unfair and argued that it exacerbates antisocial behaviour for some children [100]. The children in this study valued the autonomy experienced during recess which included being able to run around and talk to peers about their chosen topics.
\n
Loose parts play during outdoor recess has been hypothesised to have a positive impact on social interaction and social skills [101]. There are many reports from teachers to indicate that children’s play is more cooperative and more inclusive when loose parts are introduced [76, 102]. A recent systematic review of loose parts play interventions found that high quality studies have not demonstrated significant changes in children’s social competence and social skills [103]. One of the issues is that children in these studies may already be functioning well in terms of social competence and social skills [104]. This assumption is reinforced by social play often generating extremely high levels of enjoyment for children compared to other play categories [93, 105]. More research is needed to determine if children with poor social skills make improvements when negotiating with others in loose parts play and if fewer children are rejected or neglected during loose parts play.
\n
Understanding of social development outcomes related to outdoor recess remains under-researched. There is criticism that the strong claims from authoritative organisations about the benefits of recess for social development have not been matched by strong evidence [106]. At a minimum, the current evidence suggests that outdoor recess has little impact on the social development for the majority of children. Recess is valued by children as autonomous time to spend with peers and provides teachers with opportunities to observe children’s abilities to manage risks and negotiate with peers to achieve complex goals.
\n
\n
\n
5. Conclusion
\n
With the increasing burdens facing teachers (curriculum demands, professional development, student engagement/inclusion and workload intensification), it is more important than ever to ensure that there are quality outdoor recreational opportunities provided for school children. The chapter has detailed how the outdoor recreation setting during school recess is having an impact on children’s physiological and psychological outcomes. Interestingly, it is clear that due to well-known biological benefits of physical activity on the human body, most physiological research investigating outdoor recreation in schools has simply focused on how to increase physical activity participation. Although a focus on participation levels is important to help children meet physical activity guidelines in order to prevent lifestyle diseases such as Type 2 diabetes, cardiovascular disease and osteoporosis. Yet what this chapter also uncovers is the strong interlinking nature between the physical, psychological and social outcomes of health. There were clear overlaps and insights gained between investigations across health dimensions. It becomes clear that the substantial amount of time children will be exposed to during “critical windows” of recess time in schools is vital to develop positive and holistic behavioural habits. Further investigations into school recreational contexts have the potential to continue to shed light on the developmental potential and possibilities that could be achieved for outdoor school recreational settings to be prioritised and protected into the future. There are numerous key messages from this chapter. First, it is the important to maintain or extend children’s opportunities for outdoor recreation during recess due to the physiological and psychological benefits of extended outdoor interactions with peers. Second, allowing time for high quality outdoor recreation during recess does not interfere with academic outcomes. Third, many changes to school playgrounds, such as introduction of loose parts, are effective in bringing about change without adding to teacher workload. Finally, children look forward to outdoor recreation during recess, it improves their overall school experience.
\n
\n\n',keywords:"school playgrounds, recess, physical activity, psychological wellbeing, health",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/71630.pdf",chapterXML:"https://mts.intechopen.com/source/xml/71630.xml",downloadPdfUrl:"/chapter/pdf-download/71630",previewPdfUrl:"/chapter/pdf-preview/71630",totalDownloads:286,totalViews:0,totalCrossrefCites:0,dateSubmitted:"December 4th 2019",dateReviewed:"February 26th 2020",datePrePublished:"April 2nd 2020",datePublished:"January 20th 2021",dateFinished:"April 2nd 2020",readingETA:"0",abstract:"School recess is a crucial outdoor recreation period to develop health behaviours such as physical activity, social and thinking skills that can track into adulthood. As students in some schools can be immersed in playground recreation opportunities via up to 4200 school breaks during their schooling (three times per day, 5 days per week, 39 weeks per year, 7 years of primary school), the school playground has become an emerging focus for researchers to facilitate important health outcomes. Outdoor recreation activities during school recess can contribute up to half of a child’s recommended physical activity participation. Ensuring there is an enhanced understanding and awareness of what can enhance or hinder outdoor recreation activities within school contexts is therefore important to develop both physical and psychological strategies to help promote sustainable health outcomes. Despite outdoor recreation during school recess periods being a vital setting to develop physical, social and cognitive habits, the possibilities during this period have only started to gain momentum in the first two decades of the twenty-first century. This chapter will outline the important link between school playgrounds for outdoor recreation during school recess and the various physiological and psychological effects that have been revealed from various strategies that have been implemented for children with typical and atypical development.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/71630",risUrl:"/chapter/ris/71630",signatures:"Brendon Patrick Hyndman and Shirley Wyver",book:{id:"9839",title:"Outdoor Recreation",subtitle:"Physiological and Psychological Effects on Health",fullTitle:"Outdoor Recreation - Physiological and Psychological Effects on Health",slug:"outdoor-recreation-physiological-and-psychological-effects-on-health",publishedDate:"January 20th 2021",bookSignature:"Hilde G. Nielsen",coverURL:"https://cdn.intechopen.com/books/images_new/9839.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"158692",title:"Ph.D.",name:"Hilde G.",middleName:null,surname:"Nielsen",slug:"hilde-g.-nielsen",fullName:"Hilde G. Nielsen"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"316357",title:"Dr.",name:"Brendon",middleName:null,surname:"Hyndman",fullName:"Brendon Hyndman",slug:"brendon-hyndman",email:"bhyndman@csu.edu.au",position:null,institution:null},{id:"316615",title:"Dr.",name:"Shirley",middleName:null,surname:"Wyver",fullName:"Shirley Wyver",slug:"shirley-wyver",email:"shirley.wyver@mq.edu.au",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Physiological effects from outdoor recreation in schools",level:"1"},{id:"sec_2_2",title:"2.1 School playground recreational strategies to develop school children’s physical skills and habits",level:"2"},{id:"sec_3_2",title:"2.2 Before and after-school recreational strategies to develop school children’s physical skills and habits",level:"2"},{id:"sec_5",title:"3. Psychological effects from outdoor recreation in schools",level:"1"},{id:"sec_6",title:"4. The social-psychological intersections of outdoor recreation in schools",level:"1"},{id:"sec_7",title:"5. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'\nHills AP, Dengel DR, Lubans DR. Supporting public health priorities: Recommendations for physical education and physical activity promotion in schools. Progress in Cardiovascular Diseases. 2015;57(4):368-374\n'},{id:"B2",body:'\nFerreira I, Van Der Horst K, Wendel-Vos W, Kremers S, Van Lenthe FJ, Brug J. Environmental correlates of physical activity in youth–a review and update. Obesity Reviews. 2007;8(2):129-154\n'},{id:"B3",body:'\nHand KL, Freeman C, Seddon PJ, Recio MR, Stein A, van Heezik Y. Restricted home ranges reduce children’s opportunities to connect to nature: Demographic, environmental and parental influences. Landscape and Urban Planning. 2018;172:69-77\n'},{id:"B4",body:'\nHolt NL, Lee H, Millar CA, Spence JC. ‘Eyes on where children play’: A retrospective study of active free play. Children’s Geographies. 2015;13(1):73-88\n'},{id:"B5",body:'\nHyndman B. The importance of school playgrounds for active, healthy students. In: Contemporary School Playground Strategies for Healthy Students. Singapore: Springer; 2017. pp. 1-12\n'},{id:"B6",body:'\nDodd GD. The unrealised value of human motion–‘moving back to movement!’. Asia-Pacific Journal of Health, Sport and Physical Education. 2015;6(2):191-213\n'},{id:"B7",body:'\nSantrock JW. Life-Span Development 13th ed. New York: McGraw-Hill; 2002\n'},{id:"B8",body:'\nOgoh S, Ainslie PN. Cerebral blood flow during exercise: Mechanisms of regulation. Journal of Applied Physiology. 2009;107(5):1370-1380\n'},{id:"B9",body:'\nFalck RS, Davis JC, Liu-Ambrose T. What is the association between sedentary behaviour and cognitive function? A systematic review. British Journal of Sports Medicine. 2017;51(10):800-811\n'},{id:"B10",body:'\nHyndman B. Contemporary School Playground Strategies for Healthy Students. Singapore: Springer; 2017\n'},{id:"B11",body:'\nTelama R, Yang X, Leskinen E, Kankaanpään A, Hirvensalo M, Tammelin T, et al. Tracking of physical activity from early childhood through youth into adulthood. Medicine and Science in Sports and Exercise. 2014;46(5):955-962\n'},{id:"B12",body:'\nLadwig MA, Vazou S, Ekkekakis P. “My best memory is when I was done with it”: PE memories are associated with adult sedentary behavior. Translational Journal of the American College of Sports Medicine. 2018;3(16):119-129\n'},{id:"B13",body:'\nHesketh K, Lakshman R, Van Sluijs E. Barriers and facilitators to young children’s physical activity and sedentary behaviour: A systematic review and synthesis of qualitative literature. Obesity Reviews. 2017;18(9):987-1017\n'},{id:"B14",body:'\nHoughton S, Hunter SC, Rosenberg M, Wood L, Zadow C, Martin K, et al. Virtually impossible: Limiting Australian children and adolescents daily screen based media use. BMC Public Health. 2015;15(1):5\n'},{id:"B15",body:'\nSchranz N, Olds T, Cliff D, Davern M, Engelen L, Giles-Corti B, et al. Results from Australia’s 2014 report card on physical activity for children and youth. Journal of Physical Activity & Health. 2014;11(s1):S21-SS5\n'},{id:"B16",body:'\nDentro KN, Beals K, Crouter SE, Eisenmann JC, McKenzie TL, Pate RR, et al. Results from the United States’ 2014 report card on physical activity for children and youth. Journal of Physical Activity & Health. 2014;11(s1):S105-SS12\n'},{id:"B17",body:'\nGuthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1.6 million participants. The Lancet Child & Adolescent Health. 2020;4(1):23-35\n'},{id:"B18",body:'\nCesa CC, Sbruzzi G, Ribeiro RA, Barbiero SM, de Oliveira PR, Eibel B, et al. Physical activity and cardiovascular risk factors in children: Meta-analysis of randomized clinical trials. Preventive Medicine. 2014;69:54-62\n'},{id:"B19",body:'\nDonnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, Sullivan DK, et al. Physical activity across the curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventive Medicine. 2009;49(4):336-341\n'},{id:"B20",body:'\nHyndman B. Where to next for school playground interventions to encourage active play? An exploration of structured and unstructured school playground strategies. Journal of Occupational Therapy, Schools, & Early Intervention. 2015;8(1):56-67\n'},{id:"B21",body:'\nHolmes RM, Kohm KE. Outdoor play in recess time. In: The SAGE Handbook of Outdoor Play and Learning. Thousand Oaks, California, USA: Sage; 2017. p. 69\n'},{id:"B22",body:'\nErwin H, Abel M, Beighle A, Noland MP, Worley B, Riggs R. The contribution of recess to children’s school-day physical activity. Journal of Physical Activity & Health. 2012;9(3):442-448\n'},{id:"B23",body:'\nStellino MB, Sinclair CD, Partridge JA, King KM. Differences in children’s recess physical activity: Recess activity of the week intervention. The Journal of School Health. 2010;80(9):436-444\n'},{id:"B24",body:'\nScruggs PW, Beveridge SK, Watson DL. Increasing children’s school time physical activity using structured fitness breaks. Pediatric Exercise Science. 2003;15(2):156-169\n'},{id:"B25",body:'\nVerstraete SJ, Cardon GM, De Clercq DL, De Bourdeaudhuij IM. Increasing children’s physical activity levels during recess periods in elementary schools: The effects of providing game equipment. European Journal of Public Health. 2006;16(4):415-419\n'},{id:"B26",body:'\nConnolly P, McKenzie T. Effects of a games intervention on the physical activity levels of children at recess. Research Quarterly for Exercise and Sport. 1995;66(1):A60\n'},{id:"B27",body:'\nHowe C, Freedson P, Alhassan S, Feldman H, Osganian S. A recess intervention to promote moderate-to-vigorous physical activity. Pediatric Obesity. 2012;7(1):82-88\n'},{id:"B28",body:'\nStratton G, Leonard J. The effects of playground markings on the energy expenditure of 5-7-year-old school children. Pediatric Exercise Science. 2002;14(2):170-180\n'},{id:"B29",body:'\nStratton G. Promoting children’s physical activity in primary school: An intervention study using playground markings. Ergonomics. 2000;43(10):1538-1546\n'},{id:"B30",body:'\nStratton G, Mullan E. The effect of multicolor playground markings on children’s physical activity level during recess. Preventive Medicine. 2005;41(5-6):828-833\n'},{id:"B31",body:'\nRidgers ND, Stratton G, Fairclough SJ, Twisk JW. Long-term effects of a playground markings and physical structures on children’s recess physical activity levels. Preventive Medicine. 2007;44(5):393-397\n'},{id:"B32",body:'\nHuberty JL, Siahpush M, Beighle A, Fuhrmeister E, Silva P, Welk G. Ready for recess: A pilot study to increase physical activity in elementary school children. The Journal of School Health. 2011;81(5):251-257\n'},{id:"B33",body:'\nFrost MC, Kuo ES, Harner LT, Landau KR, Baldassar K. Increase in physical activity sustained 1 year after playground intervention. American Journal of Preventive Medicine. 2018;54(5):S124-S129\n'},{id:"B34",body:'\nHamer M, Aggio D, Knock G, Kipps C, Shankar A, Smith L. Effect of major school playground reconstruction on physical activity and sedentary behaviour: Camden active spaces. BMC Public Health. 2017;17(1):552\n'},{id:"B35",body:'\nMcLachlan B. Project play at Swanson school. Play and Folklore. 2014;61(1):4-8\n'},{id:"B36",body:'\nCouper L, McLachlan B. The role of adults in school playgrounds. In: Learning and Connecting in School Playgrounds: Using the Playground as a Curriculum Resource. London, UK: Routledge; 2019. p. 46\n'},{id:"B37",body:'\nSiegel SR, Fryer SM. Rock climbing for promoting physical activity in youth. American Journal of Lifestyle Medicine. 2017;11(3):243-251\n'},{id:"B38",body:'\nGull C, Goldenstein SL, Rosengarten T. Benefits and risks of tree climbing on child development and resiliency. International Journal of Early Childhood Environmental Education. 2018;5(2):10-29\n'},{id:"B39",body:'\nDyment JE, Bell AC. Grounds for movement: Green school grounds as sites for promoting physical activity. Health Education Research. 2008;23(6):952-962\n'},{id:"B40",body:'\nDyment JE, Bell AC, Lucas AJ. The relationship between school ground design and intensity of physical activity. Children’s Geographies. 2009;7(3):261-276\n'},{id:"B41",body:'\nDyment JE, Bell AC. Active by design: Promoting physical activity through school ground greening. Children’s Geographies. 2007;5(4):463-477\n'},{id:"B42",body:'\nPaddle E, Gilliland J. Orange is the new green: Exploring the restorative capacity of seasonal foliage in schoolyard trees. International Journal of Environmental Research and Public Health. 2016;13(5):497\n'},{id:"B43",body:'\nGroves L, McNish H. Natural play: Making a difference to children’s learning and wellbeing. Forestry Commission Scotland. 2011\n'},{id:"B44",body:'\nBundy AC, Luckett T, Tranter PJ, Naughton GA, Wyver SR, Ragen J, et al. The risk is that there is ‘no risk’: A simple, innovative intervention to increase children’s activity levels. International Journal of Early Years Education. 2009;17(1):33-45\n'},{id:"B45",body:'\nNicholson S. How not to cheat children, the theory of loose parts. Landscape Architecture. 1971;62(1):30-34\n'},{id:"B46",body:'\nJames D. Survey of the Impact of Scrapstore PlayPod in Primary Schools. Children’s Scrapstore: Bristol; 2012\n'},{id:"B47",body:'\nFarmer V, Williams S, Mann J, Schofield G, McPhee J, Taylor R. The effect of increasing risk and challenge in the school playground on physical activity and weight in children: A cluster randomised controlled trial (PLAY). International Journal of Obesity. 2017;41(5):793-800\n'},{id:"B48",body:'\nParrish A-M, Okely AD, Batterham M, Cliff D, Magee C. PACE: A group randomised controlled trial to increase children’s break-time playground physical activity. Journal of Science and Medicine in Sport. 2016;19(5):413-418\n'},{id:"B49",body:'\nUsher W, Edwards A, Cudmore L. Positioning Australia’s contemporary health and physical education curriculum to address poor physical activity participation rates by adolescent girls. Health Education Journal. 2016;75(8):925-938\n'},{id:"B50",body:'\nDörgő S, Bognár J. Historical and current trends in the K-12 education, physical education, and after-school sports programs: The Hungarian per-spective. In: Global Perspectives on Physical Education and After-School Sport Programs. Lanham, Maryland, USA: University Press of America; 2013. p. 151\n'},{id:"B51",body:'\nChepyator-Thomson JR, Hsu S-H. Global Perspectives on Physical Education and after-School Sport Programs. 2013\n'},{id:"B52",body:'\nStylianou M, Hogan A, Enright E. Youth sport policy: The enactment and possibilities of ‘soft policy’ in schools. Sport, Education and Society. 2019;24(2):182-194\n'},{id:"B53",body:'\nHogan A, Stylianou M. School-based sports development and the role of NSOs as ‘boundary spanners’: Benefits, disbenefits and unintended consequences of the sporting schools policy initiative. Sport, Education and Society. 2018;23(4):367-380\n'},{id:"B54",body:'\nSport Australia. About Sporting Schools. Canberra, Australia: Australian Sports Commission. 2020\n'},{id:"B55",body:'\nBaker BL, McGregor A, Johnson LG, Taylor M. Summer day camp attendance facilitates some children meeting physical activity recommendations: Differences by gender and weight status. Journal of Applied Biobehavioral Research. 2017;22(4):e12097\n'},{id:"B56",body:'\nSeal N, Seal J. Developing healthy childhood behaviour: Outcomes of a summer camp experience. International Journal of Nursing Practice. 2011;17(4):428-434\n'},{id:"B57",body:'\nHinton V, Buchanan AM. Positive behavior interventions and support in a physical activity summer camp. The Physical Educator. 2015;72(4):660\n'},{id:"B58",body:'\nBrazendale K, Beets MW, Weaver RG, Chandler JL, Randel AB, Turner-McGrievy GM, et al. Children’s moderate to vigorous physical activity attending summer day camps. American Journal of Preventive Medicine. 2017;53(1):78-84\n'},{id:"B59",body:'\nSliwa SA, Calvert HG, Williams HP, Turner L. Prevalence and types of school-based out-of-school time programs at elementary schools and implications for student nutrition and physical activity. The Journal of School Health. 2019;89(1):48-58\n'},{id:"B60",body:'\nPucher J, Buehler R, Bassett DR, Dannenberg AL. Walking and cycling to health: A comparative analysis of city, state, and international data. American Journal of Public Health. 2010;100(10):1986-1992\n'},{id:"B61",body:'\nBegum N, Abernethy P, Clemens S, Harper C. Physical activity and school active transport behaviours of Queensland school children. Journal of Science and Medicine in Sport. 2012;15:S212\n'},{id:"B62",body:'\nBeaton W. Going where No walking school bus has gone before: The Ottawa experience (breakout presentation). Journal of Transport and Health. 2017;7:S57\n'},{id:"B63",body:'\nKang B, Diao C. Walking school bus program feasibility in a suburban setting. Journal of Planning Education and Research. 2018:0739456X18817353\n'},{id:"B64",body:'\nVilla-González E, Barranco-Ruiz Y, Evenson KR, Chillón P. Systematic review of interventions for promoting active school transport. Preventive Medicine. 2018;111:115-134\n'},{id:"B65",body:'\nLarouche R, Mitra R, EOD W. Transport and physical wellbeing. In: Transportation and Children’s Well-Being. Amsterdam, The Netherlands: Elsevier; 2020. pp. 21-39\n'},{id:"B66",body:'\nChancellor B, Hyndman B. The rush to judgement: Mapping moral geographies of the primary school playground. Global Studies of Childhood. 2017;7(1):38-50\n'},{id:"B67",body:'\nBaines E, Blatchford P. School break and lunch times and young people’s social lives: A follow-up national study. Final Report to the Nuffield Foundation (Ref EDU/42402); 2019\n'},{id:"B68",body:'\nBrussoni M, Gibbons R, Gray C, Ishikawa T, Sandseter EBH, Bienenstock A, et al. What is the relationship between risky outdoor play and health in children? A systematic review. International Journal of Environmental Research and Public Health. 2015;12(6):6423-6454\n'},{id:"B69",body:'\nBundy AC, Wyver S, Beetham KS, Ragen J, Naughton G, Tranter P, et al. The Sydney playground project-levelling the playing field: A cluster trial of a primary school-based intervention aiming to promote manageable risk-taking in children with disability. BMC Public Health. 2015;15(1):1125\n'},{id:"B70",body:'\nHyndman B. What students want and need within school playgrounds for safety and play freedom. In: Contemporary School Playground Strategies for Healthy Students. Singapore: Springer; 2017. pp. 117-124\n'},{id:"B71",body:'\nBeetham K, Sterman J, Bundy A, Wyver S, Ragen J, Engelen L, et al. Lower parent tolerance of risk in play for children with disability than typically developing children. International Journal of Play. 2019;8(2):174-185\n'},{id:"B72",body:'\nSpencer G, Bundy A, Wyver S, Villeneuve M, Tranter P, Beetham K, et al. Uncertainty in the school playground: Shifting rationalities and teachers’ sense-making in the management of risks for children with disabilities. Health, Risk & Society. 2016;18(5-6):301-317\n'},{id:"B73",body:'\nNiehues AN, Bundy A, Broom A, Tranter P. Reframing healthy risk taking: Parents’ dilemmas and strategies to promote children’s well-being. Journal of Occupational Science. 2016;23(4):449-463\n'},{id:"B74",body:'\nHyndman B, Mahony L, Te Ava A, Smith S, Nutton G. Complementing the Australian primary school health and physical education (HPE) curriculum: Exploring children’s HPE learning experiences within varying school ground equipment contexts. Education. 2017;45(5):613-628\n'},{id:"B75",body:'\nHyndman B, Mahony L. Developing creativity through outdoor physical activities: A qualitative exploration of contrasting school equipment provisions. Journal of Adventure Education and Outdoor Learning. 2018;18(3):242-256\n'},{id:"B76",body:'\nHyndman B, Benson AC, Telford A. A guide for educators to move beyond conventional school playgrounds: The RE-AIM evaluation of the lunchtime enjoyment activity and play (LEAP) intervention. Australian Journal of Teacher Education. 2014;39(1-Article 6):1-30\n'},{id:"B77",body:'\nHyndman BP, Benson AC, Ullah S, Telford A. Evaluating the effects of the lunchtime enjoyment activity and play (LEAP) school playground intervention on children’s quality of life, enjoyment and participation in physical activity. BMC Public Health. 2014;14(1):164\n'},{id:"B78",body:'\nDudley D, Cotton W, Peralta L, Winslade M. A stepped-wedge implementation and evaluation of the healthy active peaceful playgrounds for youth (HAPPY) intervention. BMC Public Health. 2018;18(1):532\n'},{id:"B79",body:'\nMygind L, Stevenson MP, Liebst LS, Konvalinka I, Bentsen P. Stress response and cognitive performance modulation in classroom versus natural environments: A quasi-experimental pilot study with children. International Journal of Environmental Research and Public Health. 2018;15(6):1098\n'},{id:"B80",body:'\nHyndman B, Benson AC, Lester L, Telford A. Is there a relationship between primary school children’s enjoyment of recess physical activities and health-related quality of life? A cross-sectional exploratory study. Health Promotion Journal of Australia. 2017;28(1):37-43\n'},{id:"B81",body:'\nGunnell KE, Poitras VJ, LeBlanc A, Schibli K, Barbeau K, Hedayati N, et al. Physical activity and brain structure, brain function, and cognition in children and youth: A systematic review of randomized controlled trials. Mental Health and Physical Activity. 2019;16:105-127\n'},{id:"B82",body:'\nSingh AS, Saliasi E, Van Den Berg V, Uijtdewilligen L, De Groot RH, Jolles J, et al. Effects of physical activity interventions on cognitive and academic performance in children and adolescents: A novel combination of a systematic review and recommendations from an expert panel. British Journal of Sports Medicine. 2019;53(10):640-647\n'},{id:"B83",body:'\nWilloughby M, Holochwost SJ, Blanton ZE, Blair CB. Executive functions: Formative versus reflective measurement. Measurement: Interdisciplinary Research & Perspectives. 2014;12(3):69-95\n'},{id:"B84",body:'\nWilloughby M, Kupersmidt J, Voegler-Lee M, Bryant D. Contributions of hot and cool self-regulation to preschool disruptive behavior and academic achievement. Developmental Neuropsychology. 2011;36(2):162-180\n'},{id:"B85",body:'\nCotman CW, Berchtold NC, Christie L-A. Exercise builds brain health: Key roles of growth factor cascades and inflammation. Trends in Neurosciences. 2007;30(9):464-472\n'},{id:"B86",body:'\nHillman CH, Pontifex MB, Castelli DM, Khan NA, Raine LB, Scudder MR, et al. Effects of the FITKids randomized controlled trial on executive control and brain function. Pediatrics. 2014;134(4):e1063-e1e71\n'},{id:"B87",body:'\nDiamond A, Ling DS. Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not. Developmental Cognitive Neuroscience. 2016;18:34-48\n'},{id:"B88",body:'\nAlvarez-Bueno C, Pesce C, Cavero-Redondo I, Sanchez-Lopez M, Martínez-Hortelano JA, Martinez-Vizcaino V. The effect of physical activity interventions on children’s cognition and metacognition: A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry. 2017;56(9):729-738\n'},{id:"B89",body:'\nPellegrini AD, Bohn CM. The role of recess in children’s cognitive performance and school adjustment. Educational Research. 2005;34(1):13-19\n'},{id:"B90",body:'\nEsteban-Cornejo I, Martinez-Gomez D, Garcia-Cervantes L, Ortega FB, Delgado-Alfonso A, Castro-Piñero J, et al. Objectively measured physical activity during physical education and school recess and their associations with academic performance in youth: The UP&DOWN study. Journal of Physical Activity & Health. 2017;14(4):275-282\n'},{id:"B91",body:'\nGao Z, Hannan P, Xiang P, Stodden DF, Valdez VE. Video game–based exercise, Latino Children’s physical health, and academic achievement. American Journal of Preventive Medicine. 2013;44(3):S240-S2S6\n'},{id:"B92",body:'\nPellegrini AD. Kindergarten children’s social-cognitive status as a predictor of first-grade success. Early Child Research Quarterly. 1992;7(4):565-577\n'},{id:"B93",body:'\nHyndman B, Chancellor B. Engaging children in activities beyond the classroom walls: A social–ecological exploration of Australian primary school children’s enjoyment of school play activities. Journal of Playwork Practice. 2015;2(2):117-141\n'},{id:"B94",body:'\nBoyette AH. Children’s play and culture learning in an egalitarian foraging society. Child Development. 2016;87(3):759-769\n'},{id:"B95",body:'\nVaillancourt T, Brittain H, Bennett L, Arnocky S, McDougall P, Hymel S, et al. Places to avoid: Population-based study of student reports of unsafe and high bullying areas at school. Canadian Journal of School Psychology. 2010;25(1):40-54\n'},{id:"B96",body:'\nMcNamara L, Colley P, Franklin N. School recess, social connectedness and health: A Canadian perspective. Health Promotion International. 2017;32(2):392-402\n'},{id:"B97",body:'\nAminpour F, Bishop K, Corkery L. The hidden value of in-between spaces for children’s self-directed play within outdoor school environments. Landscape and Urban Planning. 2020;194:103683\n'},{id:"B98",body:'\nAnderson DH, Trinh SM, Caldarella P, Hansen BD, Richardson MJ. Increasing positive playground interaction for kindergarten students at risk for emotional and behavioral disorders. Early Childhood Education Journal. 2018;46(5):487-496\n'},{id:"B99",body:'\nLandrum TJ, Kauffman JM. Behavioral approaches to classroom management. In: Handbook of classroom management. London, UK: Routledge; 2013. pp. 57-82\n'},{id:"B100",body:'\nFink DB, Ramstetter CL. “Even if They’re being bad, maybe they need a chance to run around”: What children think about recess. The Journal of School Health. 2018;88(12):928-935\n'},{id:"B101",body:'\nBundy AC, Naughton G, Tranter P, Wyver S, Baur L, Schiller W, et al. The Sydney playground project: Popping the bubblewrap-unleashing the power of play - A cluster randomized controlled trial of a primary school playground-based intervention aiming to increase children’s physical activity and social skills. BMC Public Health. 2011;11(1):680\n'},{id:"B102",body:'\nRyan K, Woytovech C, Bruya L, Woytovech A, Shumate B, Malkusak A, et al. Loose parts: The collaboration process for a school playground. Journal of Kinesiology & Wellness. 2012;1(1):4-13\n'},{id:"B103",body:'\nGibson JL, Cornell M, Gill T. A systematic review of research into the impact of loose parts play on children’s cognitive, social and emotional development. School Mental Health. 2017;9(4):295-309\n'},{id:"B104",body:'\nBundy A, Engelen L, Wyver S, Tranter P, Ragen J, Bauman A, et al. Sydney playground project: A cluster-randomized trial to increase physical activity, play, and social skills. The Journal of School Health. 2017;87(10):751-759\n'},{id:"B105",body:'\nHyndman B, Telford A, Finch C, Ullah S, Benson AC. The development of the lunchtime enjoyment of activity and play questionnaire. The Journal of School Health. 2013;83(4):256-264\n'},{id:"B106",body:'\nMassey W, Neilson L, Salas J. A critical examination of school-based recess: What do the children think? Qualitative Research in Sport, Exercise and Health. 2019:1-15\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Brendon Patrick Hyndman",address:"bhyndman@csu.edu.au",affiliation:'
School of Education, Faculty of Arts and Education, Charles Sturt University, Australia
Faculty of Human Sciences, Macquarie University, Australia
'}],corrections:null},book:{id:"9839",title:"Outdoor Recreation",subtitle:"Physiological and Psychological Effects on Health",fullTitle:"Outdoor Recreation - Physiological and Psychological Effects on Health",slug:"outdoor-recreation-physiological-and-psychological-effects-on-health",publishedDate:"January 20th 2021",bookSignature:"Hilde G. Nielsen",coverURL:"https://cdn.intechopen.com/books/images_new/9839.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"158692",title:"Ph.D.",name:"Hilde G.",middleName:null,surname:"Nielsen",slug:"hilde-g.-nielsen",fullName:"Hilde G. Nielsen"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"218979",title:"Dr.",name:"Filippo",middleName:null,surname:"Gambinossi",email:"gambinossi@gmail.com",fullName:"Filippo Gambinossi",slug:"filippo-gambinossi",position:null,biography:null,institutionString:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"1",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:null},booksEdited:[],chaptersAuthored:[{title:"E-ALD: Tailoring the Optoeletronic Properties of Metal Chalcogenides on Ag Single Crystals",slug:"e-ald-tailoring-the-optoeletronic-properties-of-metal-chalcogenides-on-ag-single-crystals",abstract:"Technological development in nanoelectronics and solar energy devices demands nanostructured surfaces with controlled geometries and composition. Electrochemical atomic layer deposition (E-ALD) is recognized as a valid alternative to vacuum and chemical bath depositions in terms of growth control, quality and performance of semiconducting systems, such as single 2D semiconductors and multilayered materials. This chapter is specific to the E-ALD of metal chalcogenides on Ag single crystals and highlights the electrochemistry for the layer-by-layer deposition of thin films through surface limited reactions (SLRs). Also discussed herein is the theoretical framework of the under potential deposition (UPD), whose thermodynamic treatment open questions to the correct interpretation of the experimental data. Careful design of the E-ALD process allows fine control over both thickness and composition of the deposited layers, thus tailoring the optoelectronic properties of semiconductor compounds. Specifically, the possibility to tune the band gap by varying either the number of deposition cycles or the growth sequence of ternary compounds paves the way toward the formation of advanced photovoltaic materials.",signatures:"Emanuele Salvietti, Andrea Giaccherini, Filippo Gambinossi, Maria\nLuisa Foresti, Maurizio Passaponti, Francesco Di Benedetto and\nMassimo Innocenti",authors:[{id:"189009",title:"Prof.",name:"Massimo",surname:"Innocenti",fullName:"Massimo Innocenti",slug:"massimo-innocenti",email:"m.innocenti@unifi.it"},{id:"189015",title:"Dr.",name:"Francesco",surname:"Di Benedetto",fullName:"Francesco Di Benedetto",slug:"francesco-di-benedetto",email:"francesco.dibenedetto@unifi.it"},{id:"189017",title:"MSc.",name:"Andrea",surname:"Giaccherini",fullName:"Andrea Giaccherini",slug:"andrea-giaccherini",email:"andrea.giaccherini@unifi.it"},{id:"218978",title:"Dr.",name:"Emanuele",surname:"Salvietti",fullName:"Emanuele Salvietti",slug:"emanuele-salvietti",email:"emanuele.salvietti@unifi.it"},{id:"218979",title:"Dr.",name:"Filippo",surname:"Gambinossi",fullName:"Filippo Gambinossi",slug:"filippo-gambinossi",email:"gambinossi@gmail.com"},{id:"218980",title:"MSc.",name:"Maurizio",surname:"Passaponti",fullName:"Maurizio Passaponti",slug:"maurizio-passaponti",email:"maurizio.passaponti@unifi.it"},{id:"218981",title:"Prof.",name:"Maria Luisa",surname:"Foresti",fullName:"Maria Luisa Foresti",slug:"maria-luisa-foresti",email:"marialuisa.foresti@unifi.it"}],book:{title:"Semiconductors",slug:"semiconductors-growth-and-characterization",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"24712",title:"Dr.",name:"Usha",surname:"Philipose",slug:"usha-philipose",fullName:"Usha Philipose",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of North Texas",institutionURL:null,country:{name:"United States of America"}}},{id:"189009",title:"Prof.",name:"Massimo",surname:"Innocenti",slug:"massimo-innocenti",fullName:"Massimo Innocenti",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Florence",institutionURL:null,country:{name:"Italy"}}},{id:"189015",title:"Dr.",name:"Francesco",surname:"Di Benedetto",slug:"francesco-di-benedetto",fullName:"Francesco Di Benedetto",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"189017",title:"MSc.",name:"Andrea",surname:"Giaccherini",slug:"andrea-giaccherini",fullName:"Andrea Giaccherini",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Florence",institutionURL:null,country:{name:"Italy"}}},{id:"197956",title:"Associate Prof.",name:"S.R.",surname:"Majid",slug:"s.r.-majid",fullName:"S.R. Majid",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},{id:"208020",title:"Dr.",name:"Abhay",surname:"Singh",slug:"abhay-singh",fullName:"Abhay Singh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"216449",title:"Ms.",name:"Pei Yi",surname:"Chan",slug:"pei-yi-chan",fullName:"Pei Yi Chan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/216449/images/5826_n.jpg",biography:"A physics graduate from University of Malaya, Malaysia. Experienced in working on materials science especially on energy storage device. Main study focuses on electrode material for the electrochemical capacitor.",institutionString:null,institution:{name:"Kuala Lumpur Metropolitan University College",institutionURL:null,country:{name:"Malaysia"}}},{id:"218978",title:"Dr.",name:"Emanuele",surname:"Salvietti",slug:"emanuele-salvietti",fullName:"Emanuele Salvietti",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"218980",title:"MSc.",name:"Maurizio",surname:"Passaponti",slug:"maurizio-passaponti",fullName:"Maurizio Passaponti",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"218981",title:"Prof.",name:"Maria Luisa",surname:"Foresti",slug:"maria-luisa-foresti",fullName:"Maria Luisa Foresti",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"open-access-funding-institutions-list",title:"List of Institutions by Country",intro:"
If you are associated with any of the institutions in our list below, you can apply to receive OA publication funds by following the instructions provided in the links.
",metaTitle:"List of Institutions by Country",metaDescription:"If you are associated with any of the institutions in our list below, you can apply to receive OA publication funds by following the instructions provided in the links. However, if your research is financed through any of the below-mentioned funders, please consult their Open Access policies or grant ‘terms and conditions’ to explore ways to cover your publication costs (also accessible by clicking on the link in their title).",metaKeywords:null,canonicalURL:"open-access-funding-institutions-list",contentRaw:'[{"type":"htmlEditorComponent","content":"
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\\n\\n
CSIC affiliated authors can also take advantage of a central Open Access fund (amounting to 10,000 EUR) to cover up to 50% of the rest of the OAPF until it expires. Effective for chapters accepted from January 1, 2020.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
The Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\n
Corresponding authors will receive a 15% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\\n\\n
\\n\\t
Virginia Polytechnic Institute and State University
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\n
CSIC affiliated authors can also take advantage of a central Open Access fund (amounting to 10,000 EUR) to cover up to 50% of the rest of the OAPF until it expires. Effective for chapters accepted from January 1, 2020.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
The Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\n
Corresponding authors will receive a 15% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\n
\n\t
Virginia Polytechnic Institute and State University
Important: You must be a member or grantee of the above listed institutions in order to apply for their Open Access publication funds.
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. Hashim",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/6700/images/1864_n.jpg",biography:"Currently I am carrying out research in several areas of interest, mainly covering work on chemical and bio-sensors, semiconductor thin film device fabrication and characterisation.\nAt the moment I have very strong interest in radiation environmental pollution and bacteriology treatment. The teams of researchers are working very hard to bring novel results in this field. 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). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/55578/images/4574_n.png",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. His current research interests include the areas of mobile communication systems and channel modeling in addition to atmospheric optical communications, adaptive optics and statistics",institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:5816},{group:"region",caption:"Middle and South America",value:2,count:5281},{group:"region",caption:"Africa",value:3,count:1754},{group:"region",caption:"Asia",value:4,count:10511},{group:"region",caption:"Australia and Oceania",value:5,count:906},{group:"region",caption:"Europe",value:6,count:15913}],offset:12,limit:12,total:119060},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{hasNoEditors:"0",sort:"dateEndThirdStepPublish"},books:[{type:"book",id:"10567",title:"Uncertainty Management in Engineering - Topics in Pollution Prevention and Controls",subtitle:null,isOpenForSubmission:!0,hash:"4990db602d31f1848c590dbfe97b6409",slug:null,bookSignature:"Prof. Rehab O. Abdel Rahman and Dr. Yung-Tse Hung",coverURL:"https://cdn.intechopen.com/books/images_new/10567.jpg",editedByType:null,editors:[{id:"92718",title:"Prof.",name:"Rehab",surname:"Abdel Rahman",slug:"rehab-abdel-rahman",fullName:"Rehab Abdel Rahman"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8977",title:"Protein Kinase - New Opportunities, Challenges and Future Perspectives",subtitle:null,isOpenForSubmission:!0,hash:"6d200cc031706a565b554fdb1c478901",slug:null,bookSignature:"Dr. Rajesh Kumar Singh",coverURL:"https://cdn.intechopen.com/books/images_new/8977.jpg",editedByType:null,editors:[{id:"329385",title:"Dr.",name:"Rajesh",surname:"Singh",slug:"rajesh-singh",fullName:"Rajesh Singh"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10582",title:"Chemical Vapor Deposition",subtitle:null,isOpenForSubmission:!0,hash:"f9177ff0e61198735fb86a81303259d0",slug:null,bookSignature:"Dr. Sadia Ameen, Dr. M. Shaheer Akhtar and Prof. Hyung-Shik Shin",coverURL:"https://cdn.intechopen.com/books/images_new/10582.jpg",editedByType:null,editors:[{id:"52613",title:"Dr.",name:"Sadia",surname:"Ameen",slug:"sadia-ameen",fullName:"Sadia Ameen"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10814",title:"Anxiety, Uncertainty, and Resilience During the Pandemic Period - Anthropological and Psychological Perspectives",subtitle:null,isOpenForSubmission:!0,hash:"2db4d2a6638d2c66f7a5741d0f8fe4ae",slug:null,bookSignature:"Prof. Fabio Gabrielli and Dr. Floriana Irtelli",coverURL:"https://cdn.intechopen.com/books/images_new/10814.jpg",editedByType:null,editors:[{id:"259407",title:"Prof.",name:"Fabio",surname:"Gabrielli",slug:"fabio-gabrielli",fullName:"Fabio Gabrielli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10519",title:"Middleware Architecture",subtitle:null,isOpenForSubmission:!0,hash:"c326d436ae0f4c508849d2336dbdfb48",slug:null,bookSignature:"Dr. Mehdia Ajana El Khaddar",coverURL:"https://cdn.intechopen.com/books/images_new/10519.jpg",editedByType:null,editors:[{id:"26677",title:"Dr.",name:"Mehdia",surname:"Ajana El Khaddar",slug:"mehdia-ajana-el-khaddar",fullName:"Mehdia Ajana El Khaddar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10504",title:"Crystallization",subtitle:null,isOpenForSubmission:!0,hash:"3478d05926950f475f4ad2825d340963",slug:null,bookSignature:"Dr. Youssef Ben Smida and Dr. Riadh Marzouki",coverURL:"https://cdn.intechopen.com/books/images_new/10504.jpg",editedByType:null,editors:[{id:"311698",title:"Dr.",name:"Youssef",surname:"Ben Smida",slug:"youssef-ben-smida",fullName:"Youssef Ben Smida"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9816",title:"Idiopathic Pulmonary Fibrosis",subtitle:null,isOpenForSubmission:!0,hash:"365bb9762ba33db2d07e677690af1772",slug:null,bookSignature:"Dr. Salim Surani and Dr. Venkat Rajasurya",coverURL:"https://cdn.intechopen.com/books/images_new/9816.jpg",editedByType:null,editors:[{id:"15654",title:"Dr.",name:"Salim",surname:"Surani",slug:"salim-surani",fullName:"Salim Surani"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10789",title:"Cervical Cancer - A Global Public Health Treatise",subtitle:null,isOpenForSubmission:!0,hash:"3f7a79875d0d0ae71479de8c60276913",slug:null,bookSignature:"Dr. Rajamanickam Rajkumar",coverURL:"https://cdn.intechopen.com/books/images_new/10789.jpg",editedByType:null,editors:[{id:"120109",title:"Dr.",name:"Rajamanickam",surname:"Rajkumar",slug:"rajamanickam-rajkumar",fullName:"Rajamanickam Rajkumar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10568",title:"Hysteresis in Engineering",subtitle:null,isOpenForSubmission:!0,hash:"6482387993b3cebffafe856a916c44ce",slug:null,bookSignature:"Dr. Giuseppe Viola",coverURL:"https://cdn.intechopen.com/books/images_new/10568.jpg",editedByType:null,editors:[{id:"173586",title:"Dr.",name:"Giuseppe",surname:"Viola",slug:"giuseppe-viola",fullName:"Giuseppe Viola"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10668",title:"Sustainable Concrete",subtitle:null,isOpenForSubmission:!0,hash:"55856c6a8bc3a5b21dae5a1af09a56b6",slug:null,bookSignature:"Prof. Hosam M. Saleh",coverURL:"https://cdn.intechopen.com/books/images_new/10668.jpg",editedByType:null,editors:[{id:"144691",title:"Prof.",name:"Hosam",surname:"Saleh",slug:"hosam-saleh",fullName:"Hosam Saleh"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10557",title:"Elaeis guineensis",subtitle:null,isOpenForSubmission:!0,hash:"79500ab1930271876b4e0575e2ed3966",slug:null,bookSignature:"Dr. Hesam Kamyab",coverURL:"https://cdn.intechopen.com/books/images_new/10557.jpg",editedByType:null,editors:[{id:"225957",title:"Dr.",name:"Hesam",surname:"Kamyab",slug:"hesam-kamyab",fullName:"Hesam Kamyab"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10648",title:"Vibrios",subtitle:null,isOpenForSubmission:!0,hash:"863c86c37b8a066ed95397fd9a114a71",slug:null,bookSignature:"Dr. Lixing Huang and Dr. Jie Li",coverURL:"https://cdn.intechopen.com/books/images_new/10648.jpg",editedByType:null,editors:[{id:"333148",title:"Dr.",name:"Lixing",surname:"Huang",slug:"lixing-huang",fullName:"Lixing Huang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:25},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:7},{group:"topic",caption:"Business, Management and Economics",value:7,count:3},{group:"topic",caption:"Chemistry",value:8,count:11},{group:"topic",caption:"Computer and Information Science",value:9,count:9},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:9},{group:"topic",caption:"Engineering",value:11,count:25},{group:"topic",caption:"Environmental Sciences",value:12,count:2},{group:"topic",caption:"Immunology and Microbiology",value:13,count:4},{group:"topic",caption:"Materials Science",value:14,count:7},{group:"topic",caption:"Mathematics",value:15,count:2},{group:"topic",caption:"Medicine",value:16,count:44},{group:"topic",caption:"Neuroscience",value:18,count:3},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:3},{group:"topic",caption:"Physics",value:20,count:4},{group:"topic",caption:"Psychology",value:21,count:4},{group:"topic",caption:"Robotics",value:22,count:1},{group:"topic",caption:"Social Sciences",value:23,count:3},{group:"topic",caption:"Technology",value:24,count:1},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:2}],offset:12,limit:12,total:169},popularBooks:{featuredBooks:[{type:"book",id:"8472",title:"Bioactive Compounds in Nutraceutical and Functional Food for Good Human Health",subtitle:null,isOpenForSubmission:!1,hash:"8855452919b8495810ef8e88641feb20",slug:"bioactive-compounds-in-nutraceutical-and-functional-food-for-good-human-health",bookSignature:"Kavita Sharma, Kanchan Mishra, Kula Kamal Senapati and Corina Danciu",coverURL:"https://cdn.intechopen.com/books/images_new/8472.jpg",editors:[{id:"197731",title:"Dr.",name:"Kavita",middleName:null,surname:"Sharma",slug:"kavita-sharma",fullName:"Kavita Sharma"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9685",title:"Agroecosystems",subtitle:"Very Complex Environmental Systems",isOpenForSubmission:!1,hash:"c44f7b43a9f9610c243dc32300d37df6",slug:"agroecosystems-very-complex-environmental-systems",bookSignature:"Marcelo L. Larramendy and Sonia Soloneski",coverURL:"https://cdn.intechopen.com/books/images_new/9685.jpg",editors:[{id:"14764",title:"Dr.",name:"Marcelo L.",middleName:null,surname:"Larramendy",slug:"marcelo-l.-larramendy",fullName:"Marcelo L. Larramendy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8564",title:"Cell Interaction",subtitle:"Molecular and Immunological Basis for Disease Management",isOpenForSubmission:!1,hash:"98d7f080d80524285f091e72a8e92a6d",slug:"cell-interaction-molecular-and-immunological-basis-for-disease-management",bookSignature:"Bhawana Singh",coverURL:"https://cdn.intechopen.com/books/images_new/8564.jpg",editors:[{id:"315192",title:"Dr.",name:"Bhawana",middleName:null,surname:"Singh",slug:"bhawana-singh",fullName:"Bhawana Singh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9629",title:"Electroencephalography",subtitle:"From Basic Research to Clinical Applications",isOpenForSubmission:!1,hash:"8147834b6c6deeeec40f407c71ad60b4",slug:"electroencephalography-from-basic-research-to-clinical-applications",bookSignature:"Hideki Nakano",coverURL:"https://cdn.intechopen.com/books/images_new/9629.jpg",editors:[{id:"196461",title:"Prof.",name:"Hideki",middleName:null,surname:"Nakano",slug:"hideki-nakano",fullName:"Hideki Nakano"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8760",title:"Structure Topology and Symplectic Geometry",subtitle:null,isOpenForSubmission:!1,hash:"8974840985ec3652492c83e20233bf02",slug:"structure-topology-and-symplectic-geometry",bookSignature:"Kamal Shah and Min Lei",coverURL:"https://cdn.intechopen.com/books/images_new/8760.jpg",editors:[{id:"231748",title:"Dr.",name:"Kamal",middleName:null,surname:"Shah",slug:"kamal-shah",fullName:"Kamal Shah"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9161",title:"Frailty in the Elderly",subtitle:"Understanding and Managing Complexity",isOpenForSubmission:!1,hash:"a4f0f2fade8fb8ba35c405f5ad31a823",slug:"frailty-in-the-elderly-understanding-and-managing-complexity",bookSignature:"Sara Palermo",coverURL:"https://cdn.intechopen.com/books/images_new/9161.jpg",editors:[{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8445",title:"Dam Engineering",subtitle:"Recent Advances in Design and Analysis",isOpenForSubmission:!1,hash:"a7e4d2ecbc65d78fa7582e0d2e143906",slug:"dam-engineering-recent-advances-in-design-and-analysis",bookSignature:"Zhongzhi Fu and Erich Bauer",coverURL:"https://cdn.intechopen.com/books/images_new/8445.jpg",editors:[{id:"249577",title:"Dr.",name:"Zhongzhi",middleName:null,surname:"Fu",slug:"zhongzhi-fu",fullName:"Zhongzhi Fu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9385",title:"Renewable Energy",subtitle:"Technologies and Applications",isOpenForSubmission:!1,hash:"a6b446d19166f17f313008e6c056f3d8",slug:"renewable-energy-technologies-and-applications",bookSignature:"Tolga Taner, Archana Tiwari and Taha Selim Ustun",coverURL:"https://cdn.intechopen.com/books/images_new/9385.jpg",editors:[{id:"197240",title:"Associate Prof.",name:"Tolga",middleName:null,surname:"Taner",slug:"tolga-taner",fullName:"Tolga Taner"}],equalEditorOne:{id:"186791",title:"Dr.",name:"Archana",middleName:null,surname:"Tiwari",slug:"archana-tiwari",fullName:"Archana Tiwari",profilePictureURL:"https://mts.intechopen.com/storage/users/186791/images/system/186791.jpg",biography:"Dr. Archana Tiwari is Associate Professor at Amity University, India. Her research interests include renewable sources of energy from microalgae and further utilizing the residual biomass for the generation of value-added products, bioremediation through microalgae and microbial consortium, antioxidative enzymes and stress, and nutraceuticals from microalgae. She has been working on algal biotechnology for the last two decades. She has published her research in many international journals and has authored many books and chapters with renowned publishing houses. She has also delivered talks as an invited speaker at many national and international conferences. Dr. Tiwari is the recipient of several awards including Researcher of the Year and Distinguished Scientist.",institutionString:"Amity University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Amity University",institutionURL:null,country:{name:"India"}}},equalEditorTwo:{id:"197609",title:"Prof.",name:"Taha Selim",middleName:null,surname:"Ustun",slug:"taha-selim-ustun",fullName:"Taha Selim Ustun",profilePictureURL:"https://mts.intechopen.com/storage/users/197609/images/system/197609.jpeg",biography:"Dr. Taha Selim Ustun received a Ph.D. in Electrical Engineering from Victoria University, Melbourne, Australia. He is a researcher with the Fukushima Renewable Energy Institute, AIST (FREA), where he leads the Smart Grid Cybersecurity Laboratory. Prior to that, he was a faculty member with the School of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA. His current research interests include power systems protection, communication in power networks, distributed generation, microgrids, electric vehicle integration, and cybersecurity in smart grids. He serves on the editorial boards of IEEE Access, IEEE Transactions on Industrial Informatics, Energies, Electronics, Electricity, World Electric Vehicle and Information journals. Dr. Ustun is a member of the IEEE 2004 and 2800, IEC Renewable Energy Management WG 8, and IEC TC 57 WG17. He has been invited to run specialist courses in Africa, India, and China. He has delivered talks for the Qatar Foundation, the World Energy Council, the Waterloo Global Science Initiative, and the European Union Energy Initiative (EUEI). His research has attracted funding from prestigious programs in Japan, Australia, the European Union, and North America.",institutionString:"Fukushima Renewable Energy Institute, AIST (FREA)",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"National Institute of Advanced Industrial Science and Technology",institutionURL:null,country:{name:"Japan"}}},equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8937",title:"Soil Moisture Importance",subtitle:null,isOpenForSubmission:!1,hash:"3951728ace7f135451d66b72e9908b47",slug:"soil-moisture-importance",bookSignature:"Ram Swaroop Meena and Rahul Datta",coverURL:"https://cdn.intechopen.com/books/images_new/8937.jpg",editors:[{id:"313528",title:"Associate Prof.",name:"Ram Swaroop",middleName:null,surname:"Meena",slug:"ram-swaroop-meena",fullName:"Ram Swaroop Meena"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7031",title:"Liver Pathology",subtitle:null,isOpenForSubmission:!1,hash:"631321b0565459ed0175917f1c8c727f",slug:"liver-pathology",bookSignature:"Vijay Gayam and Omer Engin",coverURL:"https://cdn.intechopen.com/books/images_new/7031.jpg",editors:[{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8158",title:"Veganism",subtitle:"a Fashion Trend or Food as a Medicine",isOpenForSubmission:!1,hash:"d8e51fc25a379e5b92a270addbb4351d",slug:"veganism-a-fashion-trend-or-food-as-a-medicine",bookSignature:"Miljana Z. Jovandaric",coverURL:"https://cdn.intechopen.com/books/images_new/8158.jpg",editors:[{id:"268043",title:"Dr.",name:"Miljana Z.",middleName:"Z",surname:"Jovandaric",slug:"miljana-z.-jovandaric",fullName:"Miljana Z. Jovandaric"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"2160",title:"MATLAB",subtitle:"A Fundamental Tool for Scientific Computing and Engineering Applications - Volume 1",isOpenForSubmission:!1,hash:"dd9c658341fbd264ed4f8d9e6aa8ca29",slug:"matlab-a-fundamental-tool-for-scientific-computing-and-engineering-applications-volume-1",bookSignature:"Vasilios N. Katsikis",coverURL:"https://cdn.intechopen.com/books/images_new/2160.jpg",editors:[{id:"12289",title:"Prof.",name:"Vasilios",middleName:"N.",surname:"Katsikis",slug:"vasilios-katsikis",fullName:"Vasilios Katsikis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:5315},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"8472",title:"Bioactive Compounds in Nutraceutical and Functional Food for Good Human Health",subtitle:null,isOpenForSubmission:!1,hash:"8855452919b8495810ef8e88641feb20",slug:"bioactive-compounds-in-nutraceutical-and-functional-food-for-good-human-health",bookSignature:"Kavita Sharma, Kanchan Mishra, Kula Kamal Senapati and Corina Danciu",coverURL:"https://cdn.intechopen.com/books/images_new/8472.jpg",editors:[{id:"197731",title:"Dr.",name:"Kavita",middleName:null,surname:"Sharma",slug:"kavita-sharma",fullName:"Kavita Sharma"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9685",title:"Agroecosystems",subtitle:"Very Complex Environmental Systems",isOpenForSubmission:!1,hash:"c44f7b43a9f9610c243dc32300d37df6",slug:"agroecosystems-very-complex-environmental-systems",bookSignature:"Marcelo L. Larramendy and Sonia Soloneski",coverURL:"https://cdn.intechopen.com/books/images_new/9685.jpg",editors:[{id:"14764",title:"Dr.",name:"Marcelo L.",middleName:null,surname:"Larramendy",slug:"marcelo-l.-larramendy",fullName:"Marcelo L. Larramendy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8564",title:"Cell Interaction",subtitle:"Molecular and Immunological Basis for Disease Management",isOpenForSubmission:!1,hash:"98d7f080d80524285f091e72a8e92a6d",slug:"cell-interaction-molecular-and-immunological-basis-for-disease-management",bookSignature:"Bhawana Singh",coverURL:"https://cdn.intechopen.com/books/images_new/8564.jpg",editors:[{id:"315192",title:"Dr.",name:"Bhawana",middleName:null,surname:"Singh",slug:"bhawana-singh",fullName:"Bhawana Singh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9629",title:"Electroencephalography",subtitle:"From Basic Research to Clinical Applications",isOpenForSubmission:!1,hash:"8147834b6c6deeeec40f407c71ad60b4",slug:"electroencephalography-from-basic-research-to-clinical-applications",bookSignature:"Hideki Nakano",coverURL:"https://cdn.intechopen.com/books/images_new/9629.jpg",editors:[{id:"196461",title:"Prof.",name:"Hideki",middleName:null,surname:"Nakano",slug:"hideki-nakano",fullName:"Hideki Nakano"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8760",title:"Structure Topology and Symplectic Geometry",subtitle:null,isOpenForSubmission:!1,hash:"8974840985ec3652492c83e20233bf02",slug:"structure-topology-and-symplectic-geometry",bookSignature:"Kamal Shah and Min Lei",coverURL:"https://cdn.intechopen.com/books/images_new/8760.jpg",editors:[{id:"231748",title:"Dr.",name:"Kamal",middleName:null,surname:"Shah",slug:"kamal-shah",fullName:"Kamal Shah"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9161",title:"Frailty in the Elderly",subtitle:"Understanding and Managing Complexity",isOpenForSubmission:!1,hash:"a4f0f2fade8fb8ba35c405f5ad31a823",slug:"frailty-in-the-elderly-understanding-and-managing-complexity",bookSignature:"Sara Palermo",coverURL:"https://cdn.intechopen.com/books/images_new/9161.jpg",editors:[{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8445",title:"Dam Engineering",subtitle:"Recent Advances in Design and Analysis",isOpenForSubmission:!1,hash:"a7e4d2ecbc65d78fa7582e0d2e143906",slug:"dam-engineering-recent-advances-in-design-and-analysis",bookSignature:"Zhongzhi Fu and Erich Bauer",coverURL:"https://cdn.intechopen.com/books/images_new/8445.jpg",editors:[{id:"249577",title:"Dr.",name:"Zhongzhi",middleName:null,surname:"Fu",slug:"zhongzhi-fu",fullName:"Zhongzhi Fu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9385",title:"Renewable Energy",subtitle:"Technologies and Applications",isOpenForSubmission:!1,hash:"a6b446d19166f17f313008e6c056f3d8",slug:"renewable-energy-technologies-and-applications",bookSignature:"Tolga Taner, Archana Tiwari and Taha Selim Ustun",coverURL:"https://cdn.intechopen.com/books/images_new/9385.jpg",editors:[{id:"197240",title:"Associate Prof.",name:"Tolga",middleName:null,surname:"Taner",slug:"tolga-taner",fullName:"Tolga Taner"}],equalEditorOne:{id:"186791",title:"Dr.",name:"Archana",middleName:null,surname:"Tiwari",slug:"archana-tiwari",fullName:"Archana Tiwari",profilePictureURL:"https://mts.intechopen.com/storage/users/186791/images/system/186791.jpg",biography:"Dr. Archana Tiwari is Associate Professor at Amity University, India. Her research interests include renewable sources of energy from microalgae and further utilizing the residual biomass for the generation of value-added products, bioremediation through microalgae and microbial consortium, antioxidative enzymes and stress, and nutraceuticals from microalgae. She has been working on algal biotechnology for the last two decades. She has published her research in many international journals and has authored many books and chapters with renowned publishing houses. She has also delivered talks as an invited speaker at many national and international conferences. Dr. Tiwari is the recipient of several awards including Researcher of the Year and Distinguished Scientist.",institutionString:"Amity University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Amity University",institutionURL:null,country:{name:"India"}}},equalEditorTwo:{id:"197609",title:"Prof.",name:"Taha Selim",middleName:null,surname:"Ustun",slug:"taha-selim-ustun",fullName:"Taha Selim Ustun",profilePictureURL:"https://mts.intechopen.com/storage/users/197609/images/system/197609.jpeg",biography:"Dr. Taha Selim Ustun received a Ph.D. in Electrical Engineering from Victoria University, Melbourne, Australia. He is a researcher with the Fukushima Renewable Energy Institute, AIST (FREA), where he leads the Smart Grid Cybersecurity Laboratory. Prior to that, he was a faculty member with the School of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA. His current research interests include power systems protection, communication in power networks, distributed generation, microgrids, electric vehicle integration, and cybersecurity in smart grids. He serves on the editorial boards of IEEE Access, IEEE Transactions on Industrial Informatics, Energies, Electronics, Electricity, World Electric Vehicle and Information journals. Dr. Ustun is a member of the IEEE 2004 and 2800, IEC Renewable Energy Management WG 8, and IEC TC 57 WG17. He has been invited to run specialist courses in Africa, India, and China. He has delivered talks for the Qatar Foundation, the World Energy Council, the Waterloo Global Science Initiative, and the European Union Energy Initiative (EUEI). His research has attracted funding from prestigious programs in Japan, Australia, the European Union, and North America.",institutionString:"Fukushima Renewable Energy Institute, AIST (FREA)",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"National Institute of Advanced Industrial Science and Technology",institutionURL:null,country:{name:"Japan"}}},equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8937",title:"Soil Moisture Importance",subtitle:null,isOpenForSubmission:!1,hash:"3951728ace7f135451d66b72e9908b47",slug:"soil-moisture-importance",bookSignature:"Ram Swaroop Meena and Rahul Datta",coverURL:"https://cdn.intechopen.com/books/images_new/8937.jpg",editors:[{id:"313528",title:"Associate Prof.",name:"Ram Swaroop",middleName:null,surname:"Meena",slug:"ram-swaroop-meena",fullName:"Ram Swaroop Meena"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7031",title:"Liver Pathology",subtitle:null,isOpenForSubmission:!1,hash:"631321b0565459ed0175917f1c8c727f",slug:"liver-pathology",bookSignature:"Vijay Gayam and Omer Engin",coverURL:"https://cdn.intechopen.com/books/images_new/7031.jpg",editors:[{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"8472",title:"Bioactive Compounds in Nutraceutical and Functional Food for Good Human Health",subtitle:null,isOpenForSubmission:!1,hash:"8855452919b8495810ef8e88641feb20",slug:"bioactive-compounds-in-nutraceutical-and-functional-food-for-good-human-health",bookSignature:"Kavita Sharma, Kanchan Mishra, Kula Kamal Senapati and Corina Danciu",coverURL:"https://cdn.intechopen.com/books/images_new/8472.jpg",editedByType:"Edited by",editors:[{id:"197731",title:"Dr.",name:"Kavita",middleName:null,surname:"Sharma",slug:"kavita-sharma",fullName:"Kavita Sharma"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8760",title:"Structure Topology and Symplectic Geometry",subtitle:null,isOpenForSubmission:!1,hash:"8974840985ec3652492c83e20233bf02",slug:"structure-topology-and-symplectic-geometry",bookSignature:"Kamal Shah and Min Lei",coverURL:"https://cdn.intechopen.com/books/images_new/8760.jpg",editedByType:"Edited by",editors:[{id:"231748",title:"Dr.",name:"Kamal",middleName:null,surname:"Shah",slug:"kamal-shah",fullName:"Kamal Shah"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9536",title:"Education at the Intersection of Globalization and Technology",subtitle:null,isOpenForSubmission:!1,hash:"0cf6891060eb438d975d250e8b127ed6",slug:"education-at-the-intersection-of-globalization-and-technology",bookSignature:"Sharon Waller, Lee Waller, Vongai Mpofu and Mercy Kurebwa",coverURL:"https://cdn.intechopen.com/books/images_new/9536.jpg",editedByType:"Edited by",editors:[{id:"263302",title:"Dr.",name:"Sharon",middleName:null,surname:"Waller",slug:"sharon-waller",fullName:"Sharon Waller"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8564",title:"Cell Interaction",subtitle:"Molecular and Immunological Basis for Disease Management",isOpenForSubmission:!1,hash:"98d7f080d80524285f091e72a8e92a6d",slug:"cell-interaction-molecular-and-immunological-basis-for-disease-management",bookSignature:"Bhawana Singh",coverURL:"https://cdn.intechopen.com/books/images_new/8564.jpg",editedByType:"Edited by",editors:[{id:"315192",title:"Dr.",name:"Bhawana",middleName:null,surname:"Singh",slug:"bhawana-singh",fullName:"Bhawana Singh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9629",title:"Electroencephalography",subtitle:"From Basic Research to Clinical Applications",isOpenForSubmission:!1,hash:"8147834b6c6deeeec40f407c71ad60b4",slug:"electroencephalography-from-basic-research-to-clinical-applications",bookSignature:"Hideki Nakano",coverURL:"https://cdn.intechopen.com/books/images_new/9629.jpg",editedByType:"Edited by",editors:[{id:"196461",title:"Prof.",name:"Hideki",middleName:null,surname:"Nakano",slug:"hideki-nakano",fullName:"Hideki Nakano"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9685",title:"Agroecosystems",subtitle:"Very Complex Environmental Systems",isOpenForSubmission:!1,hash:"c44f7b43a9f9610c243dc32300d37df6",slug:"agroecosystems-very-complex-environmental-systems",bookSignature:"Marcelo L. Larramendy and Sonia Soloneski",coverURL:"https://cdn.intechopen.com/books/images_new/9685.jpg",editedByType:"Edited by",editors:[{id:"14764",title:"Dr.",name:"Marcelo L.",middleName:null,surname:"Larramendy",slug:"marcelo-l.-larramendy",fullName:"Marcelo L. Larramendy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9524",title:"Organ Donation and Transplantation",subtitle:null,isOpenForSubmission:!1,hash:"6ef47e03cd4e6476946fc28ca51de825",slug:"organ-donation-and-transplantation",bookSignature:"Vassil Mihaylov",coverURL:"https://cdn.intechopen.com/books/images_new/9524.jpg",editedByType:"Edited by",editors:[{id:"313113",title:"Associate Prof.",name:"Vassil",middleName:null,surname:"Mihaylov",slug:"vassil-mihaylov",fullName:"Vassil Mihaylov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9280",title:"Underwater Work",subtitle:null,isOpenForSubmission:!1,hash:"647b4270d937deae4a82f5702d1959ec",slug:"underwater-work",bookSignature:"Sérgio António Neves Lousada",coverURL:"https://cdn.intechopen.com/books/images_new/9280.jpg",editedByType:"Edited by",editors:[{id:"248645",title:"Dr.",name:"Sérgio António",middleName:null,surname:"Neves Lousada",slug:"sergio-antonio-neves-lousada",fullName:"Sérgio António Neves Lousada"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9161",title:"Frailty in the Elderly",subtitle:"Understanding and Managing Complexity",isOpenForSubmission:!1,hash:"a4f0f2fade8fb8ba35c405f5ad31a823",slug:"frailty-in-the-elderly-understanding-and-managing-complexity",bookSignature:"Sara Palermo",coverURL:"https://cdn.intechopen.com/books/images_new/9161.jpg",editedByType:"Edited by",editors:[{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8158",title:"Veganism",subtitle:"a Fashion Trend or Food as a Medicine",isOpenForSubmission:!1,hash:"d8e51fc25a379e5b92a270addbb4351d",slug:"veganism-a-fashion-trend-or-food-as-a-medicine",bookSignature:"Miljana Z. Jovandaric",coverURL:"https://cdn.intechopen.com/books/images_new/8158.jpg",editedByType:"Edited by",editors:[{id:"268043",title:"Dr.",name:"Miljana Z.",middleName:"Z",surname:"Jovandaric",slug:"miljana-z.-jovandaric",fullName:"Miljana Z. Jovandaric"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"1148",title:"Neurosurgery",slug:"neurosurgery",parent:{title:"Surgery",slug:"surgery"},numberOfBooks:6,numberOfAuthorsAndEditors:160,numberOfWosCitations:55,numberOfCrossrefCitations:32,numberOfDimensionsCitations:82,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicSlug:"neurosurgery",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"8339",title:"Neurosurgical Procedures",subtitle:"Innovative Approaches",isOpenForSubmission:!1,hash:"32ead2c9d075e8762721f52b7ea22b51",slug:"neurosurgical-procedures-innovative-approaches",bookSignature:"Alba Scerrati and Pasquale De Bonis",coverURL:"https://cdn.intechopen.com/books/images_new/8339.jpg",editedByType:"Edited by",editors:[{id:"182614",title:"Dr.",name:"Alba",middleName:null,surname:"Scerrati",slug:"alba-scerrati",fullName:"Alba Scerrati"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6374",title:"Hydrocephalus",subtitle:"Water on the Brain",isOpenForSubmission:!1,hash:"b431d113b9d7fca7e67c463f0970ed04",slug:"hydrocephalus-water-on-the-brain",bookSignature:"Bora Gürer",coverURL:"https://cdn.intechopen.com/books/images_new/6374.jpg",editedByType:"Edited by",editors:[{id:"95341",title:"Dr.",name:"Bora",middleName:null,surname:"Gürer",slug:"bora-gurer",fullName:"Bora Gürer"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5234",title:"Trauma, Tumors, Spine, Functional Neurosurgery",subtitle:null,isOpenForSubmission:!1,hash:"58640694ad7cbb2e82d217935b12f243",slug:"from-bench-to-bedside-trauma-tumors-spine-functional-neurosurgery",bookSignature:"Francesco Signorelli",coverURL:"https://cdn.intechopen.com/books/images_new/5234.jpg",editedByType:"Edited by",editors:[{id:"74494",title:"Dr.",name:"Francesco",middleName:null,surname:"Signorelli",slug:"francesco-signorelli",fullName:"Francesco Signorelli"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"749",title:"Explicative Cases of Controversial Issues in Neurosurgery",subtitle:null,isOpenForSubmission:!1,hash:"ba447398ca3b67eb3d9978174712132a",slug:"explicative-cases-of-controversial-issues-in-neurosurgery",bookSignature:"Francesco Signorelli",coverURL:"https://cdn.intechopen.com/books/images_new/749.jpg",editedByType:"Edited by",editors:[{id:"74494",title:"Dr.",name:"Francesco",middleName:null,surname:"Signorelli",slug:"francesco-signorelli",fullName:"Francesco Signorelli"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1244",title:"Spine Surgery",subtitle:null,isOpenForSubmission:!1,hash:"9ea5cece2b7ea45907a75de2cc8955f9",slug:"spine-surgery",bookSignature:"Kook Jin Chung",coverURL:"https://cdn.intechopen.com/books/images_new/1244.jpg",editedByType:"Edited by",editors:[{id:"113935",title:"Dr.",name:"Kook Jin",middleName:null,surname:"Chung",slug:"kook-jin-chung",fullName:"Kook Jin Chung"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"690",title:"Gamma Knife Radiosurgery",subtitle:null,isOpenForSubmission:!1,hash:"adb45f5be8b65b622ee009c0e5ebe34c",slug:"gamma-knife-radiosurgery",bookSignature:"David Mathieu",coverURL:"https://cdn.intechopen.com/books/images_new/690.jpg",editedByType:"Edited by",editors:[{id:"76960",title:"Dr.",name:"David",middleName:null,surname:"Mathieu",slug:"david-mathieu",fullName:"David Mathieu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:6,mostCitedChapters:[{id:"37120",doi:"10.5772/29607",title:"Trigeminocardiac Reflex in Neurosurgery - Current Knowledge and Prospects",slug:"the-trigeminocardiac-reflex-in-neurosurgery-current-knowledge-and-prospects",totalDownloads:3009,totalCrossrefCites:8,totalDimensionsCites:24,book:{slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"Amr Abdulazim, Martin N. Stienen, Pooyan Sadr-Eshkevari, Nora Prochnow, Nora Sandu, Benham Bohluli and Bernhard Schaller",authors:[{id:"78171",title:"Prof.",name:"Bernhard",middleName:null,surname:"Schaller",slug:"bernhard-schaller",fullName:"Bernhard Schaller"},{id:"78525",title:"Mr.",name:"Amr",middleName:null,surname:"Abdulazim",slug:"amr-abdulazim",fullName:"Amr Abdulazim"},{id:"78530",title:"Dr",name:"Pooyan",middleName:null,surname:"Sadr-Eshkevari",slug:"pooyan-sadr-eshkevari",fullName:"Pooyan Sadr-Eshkevari"},{id:"126039",title:"Dr.",name:"Martin",middleName:"Nikolaus",surname:"Stienen",slug:"martin-stienen",fullName:"Martin Stienen"},{id:"126040",title:"Dr.",name:"Nora",middleName:null,surname:"Prochnow",slug:"nora-prochnow",fullName:"Nora Prochnow"},{id:"126041",title:"Dr.",name:"Benham",middleName:null,surname:"Bohluli",slug:"benham-bohluli",fullName:"Benham Bohluli"}]},{id:"25103",doi:"10.5772/31283",title:"Applications of Gamma Knife Radiosurgery for Experimental Investigations in Small Animal Models",slug:"applications-of-gamma-knife-radiosurgery-for-experimental-investigations-in-small-animal-models",totalDownloads:1988,totalCrossrefCites:5,totalDimensionsCites:9,book:{slug:"gamma-knife-radiosurgery",title:"Gamma Knife Radiosurgery",fullTitle:"Gamma Knife Radiosurgery"},signatures:"Gabriel Charest, Benoit Paquette and David Mathieu",authors:[{id:"76960",title:"Dr.",name:"David",middleName:null,surname:"Mathieu",slug:"david-mathieu",fullName:"David Mathieu"},{id:"86376",title:"MSc.",name:"Gabriel",middleName:null,surname:"Charest",slug:"gabriel-charest",fullName:"Gabriel Charest"},{id:"127758",title:"Prof.",name:"Benoit",middleName:null,surname:"Paquette",slug:"benoit-paquette",fullName:"Benoit Paquette"}]},{id:"34185",doi:"10.5772/38321",title:"The Minimally Invasive Retroperitoneal Transpsoas Approach",slug:"the-minimally-invasive-lateral-retroperitoneal-transpsoas-approach",totalDownloads:5190,totalCrossrefCites:0,totalDimensionsCites:7,book:{slug:"spine-surgery",title:"Spine Surgery",fullTitle:"Spine Surgery"},signatures:"Tien V. Le and Juan S. Uribe",authors:[{id:"116635",title:"Dr.",name:"Juan",middleName:null,surname:"Uribe",slug:"juan-uribe",fullName:"Juan Uribe"},{id:"117884",title:"Dr.",name:"Tien",middleName:null,surname:"Le",slug:"tien-le",fullName:"Tien Le"}]}],mostDownloadedChaptersLast30Days:[{id:"58783",title:"Craniocervical Junction Syndrome: Anatomy of the Craniocervical and Atlantoaxial Junctions and the Effect of Misalignment on Cerebrospinal Fluid Flow",slug:"craniocervical-junction-syndrome-anatomy-of-the-craniocervical-and-atlantoaxial-junctions-and-the-ef",totalDownloads:9114,totalCrossrefCites:1,totalDimensionsCites:1,book:{slug:"hydrocephalus-water-on-the-brain",title:"Hydrocephalus",fullTitle:"Hydrocephalus - Water on the Brain"},signatures:"Scott Rosa, John W. Baird, David Harshfield and Mahan\nChehrenama",authors:[{id:"232739",title:"Dr.",name:"Scott",middleName:null,surname:"Rosa",slug:"scott-rosa",fullName:"Scott Rosa"},{id:"232757",title:"Dr.",name:"John",middleName:null,surname:"Baird",slug:"john-baird",fullName:"John Baird"},{id:"232759",title:"Dr.",name:"David",middleName:null,surname:"Harshfield",slug:"david-harshfield",fullName:"David Harshfield"},{id:"232760",title:"Dr.",name:"Mahan",middleName:null,surname:"Chehrenama",slug:"mahan-chehrenama",fullName:"Mahan Chehrenama"}]},{id:"50887",title:"Lumbar Spinal Stenosis, Clinical Presentation, Diagnosis, and Treatment",slug:"lumbar-spinal-stenosis-clinical-presentation-diagnosis-and-treatment",totalDownloads:1332,totalCrossrefCites:0,totalDimensionsCites:1,book:{slug:"from-bench-to-bedside-trauma-tumors-spine-functional-neurosurgery",title:"Trauma, Tumors, Spine, Functional Neurosurgery",fullTitle:"From Bench to Bedside - Trauma, Tumors, Spine, Functional Neurosurgery"},signatures:"Luiz Cláudio Lacerda Rodrigues",authors:[{id:"181285",title:"Dr.",name:"Luiz Claudio",middleName:null,surname:"Rodrigues",slug:"luiz-claudio-rodrigues",fullName:"Luiz Claudio Rodrigues"}]},{id:"37140",title:"The Role of Neural Stem Cells in Neurorestoration",slug:"neural-stem-cells-in-the-adult-human-brain",totalDownloads:1497,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"E.O. Vik-Mo, A. Fayzullin, M.C. Moe, H. Olstorn and I.A. Langmoen",authors:[{id:"79180",title:"Dr.",name:"Morten",middleName:"C.",surname:"Moe",slug:"morten-moe",fullName:"Morten Moe"},{id:"85741",title:"Ms.",name:"Rebecca",middleName:null,surname:"Frøen",slug:"rebecca-froen",fullName:"Rebecca Frøen"},{id:"86937",title:"Prof.",name:"Iver A.",middleName:null,surname:"Langmoen",slug:"iver-a.-langmoen",fullName:"Iver A. Langmoen"},{id:"87159",title:"MSc.",name:"Erik O.",middleName:null,surname:"Johnsen",slug:"erik-o.-johnsen",fullName:"Erik O. Johnsen"},{id:"87161",title:"Dr.",name:"Einar",middleName:"Osland",surname:"Vik-Mo",slug:"einar-vik-mo",fullName:"Einar Vik-Mo"}]},{id:"37137",title:"Targeting the Subthalamic Nucleus for Deep Brain Stimulation in Parkinson Disease: The Impact of High Field Strength MRI",slug:"advent-of-3-tesla-mri-for-planning-functional-neurosurgery-first-comparative-study",totalDownloads:2125,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"Dirk Winkler, Marc Tittgemeyer, Karl Strecker, Axel Goldammer, Jochen Helm, Johannes Schwarz and Jürgen Meixensberger",authors:[{id:"88690",title:"Dr",name:null,middleName:null,surname:"Winkler",slug:"winkler",fullName:"Winkler"}]},{id:"51687",title:"Surgical Treatment of Spinal Meningiomas",slug:"surgical-treatment-of-spinal-meningiomas",totalDownloads:1113,totalCrossrefCites:1,totalDimensionsCites:2,book:{slug:"from-bench-to-bedside-trauma-tumors-spine-functional-neurosurgery",title:"Trauma, Tumors, Spine, Functional Neurosurgery",fullTitle:"From Bench to Bedside - Trauma, Tumors, Spine, Functional Neurosurgery"},signatures:"Antonino Raco, Alessandro Pesce and Massimo Miscusi",authors:[{id:"181308",title:"Prof.",name:"Massimo",middleName:null,surname:"Miscusi",slug:"massimo-miscusi",fullName:"Massimo Miscusi"},{id:"183073",title:"Dr.",name:"Alessandro",middleName:null,surname:"Pesce",slug:"alessandro-pesce",fullName:"Alessandro Pesce"},{id:"183074",title:"Prof.",name:"Antonino",middleName:null,surname:"Raco",slug:"antonino-raco",fullName:"Antonino Raco"}]},{id:"37135",title:"Balloon-Kyphoplasty for Vertebral Compression Fractures",slug:"balloon-kyphoplasty-for-vertebral-compression-fractures",totalDownloads:3245,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"Luca Arpino and Pierpaolo Nina",authors:[{id:"75917",title:"Dr.",name:"Luca",middleName:null,surname:"Arpino",slug:"luca-arpino",fullName:"Luca Arpino"},{id:"99739",title:"Dr.",name:"Pierpaolo",middleName:null,surname:"Nina",slug:"pierpaolo-nina",fullName:"Pierpaolo Nina"}]},{id:"37138",title:"An Assistive Surgical MRI Compatible Robot - First Prototype with Field Tests",slug:"an-assistive-surgical-mri-compatible-robot-first-prototype-with-field-tests",totalDownloads:1954,totalCrossrefCites:1,totalDimensionsCites:1,book:{slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"Tapio Heikkilä, Sanna Yrjänä, Pekka Kilpeläinen, John Koivukangas and Mikko Sallinen",authors:[{id:"5451",title:"Dr.",name:"Mikko",middleName:null,surname:"Sallinen",slug:"mikko-sallinen",fullName:"Mikko Sallinen"},{id:"78356",title:"Dr.",name:"Tapio",middleName:null,surname:"Heikkila",slug:"tapio-heikkila",fullName:"Tapio Heikkila"},{id:"123508",title:"Dr.",name:"Sanna",middleName:null,surname:"Yrjänä",slug:"sanna-yrjana",fullName:"Sanna Yrjänä"},{id:"123509",title:"Mr.",name:"Pekka",middleName:null,surname:"Kilpelainen",slug:"pekka-kilpelainen",fullName:"Pekka Kilpelainen"},{id:"123510",title:"Prof.",name:"John",middleName:null,surname:"Koivukangas",slug:"john-koivukangas",fullName:"John Koivukangas"}]},{id:"51582",title:"Biomarkers of Acute Brain Injury in the Emergency Department",slug:"biomarkers-of-acute-brain-injury-in-the-emergency-department",totalDownloads:1124,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"from-bench-to-bedside-trauma-tumors-spine-functional-neurosurgery",title:"Trauma, Tumors, Spine, Functional Neurosurgery",fullTitle:"From Bench to Bedside - Trauma, Tumors, Spine, Functional Neurosurgery"},signatures:"Linda Papa and Kimberly Rosenthal",authors:[{id:"88648",title:"Dr.",name:"Linda",middleName:null,surname:"Papa",slug:"linda-papa",fullName:"Linda Papa"},{id:"181850",title:"BSc.",name:"Kimberly",middleName:null,surname:"Rosenthal",slug:"kimberly-rosenthal",fullName:"Kimberly Rosenthal"}]},{id:"37127",title:"Pineal Region Tumors",slug:"pineal-region-tumors",totalDownloads:4953,totalCrossrefCites:0,totalDimensionsCites:3,book:{slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"Paolo Cipriano Cecchi, Giuliano Giliberto, Angelo Musumeci and Andreas Schwarz",authors:[{id:"84401",title:"Dr.",name:"Paolo Cipriano",middleName:null,surname:"Cecchi",slug:"paolo-cipriano-cecchi",fullName:"Paolo Cipriano Cecchi"},{id:"86369",title:"Dr.",name:"Giuliano",middleName:null,surname:"Giliberto",slug:"giuliano-giliberto",fullName:"Giuliano Giliberto"},{id:"86370",title:"Dr.",name:"Angelo",middleName:null,surname:"Musumeci",slug:"angelo-musumeci",fullName:"Angelo Musumeci"},{id:"86784",title:"Dr.",name:"Andreas",middleName:null,surname:"Schwarz",slug:"andreas-schwarz",fullName:"Andreas Schwarz"}]},{id:"37130",title:"Surgical Management of Posterior Circulation Aneurysms: Defining the Role of Microsurgery in Contemporary Endovascular Era",slug:"surgical-management-of-posterior-circulation-aneurysms-defining-the-role-of-microsurgery-in-contempo",totalDownloads:2948,totalCrossrefCites:1,totalDimensionsCites:1,book:{slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"Leon Lai and Michael Kerin Morgan",authors:[{id:"74913",title:"Dr.",name:"Leon",middleName:null,surname:"Lai",slug:"leon-lai",fullName:"Leon Lai"},{id:"85814",title:"Prof.",name:"Michael Kerin",middleName:null,surname:"Morgan",slug:"michael-kerin-morgan",fullName:"Michael Kerin Morgan"}]}],onlineFirstChaptersFilter:{topicSlug:"neurosurgery",limit:3,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[{type:"book",id:"10176",title:"Microgrids and Local Energy Systems",subtitle:null,isOpenForSubmission:!0,hash:"c32b4a5351a88f263074b0d0ca813a9c",slug:null,bookSignature:"Prof. Nick Jenkins",coverURL:"https://cdn.intechopen.com/books/images_new/10176.jpg",editedByType:null,editors:[{id:"55219",title:"Prof.",name:"Nick",middleName:null,surname:"Jenkins",slug:"nick-jenkins",fullName:"Nick Jenkins"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:8,limit:8,total:1},route:{name:"profile.detail",path:"/profiles/218979/filippo-gambinossi",hash:"",query:{},params:{id:"218979",slug:"filippo-gambinossi"},fullPath:"/profiles/218979/filippo-gambinossi",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()