MRC score [11].
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IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"2290",leadTitle:null,fullTitle:"Protein-Protein Interactions - Computational and Experimental Tools",title:"Protein-Protein Interactions",subtitle:"Computational and Experimental Tools",reviewType:"peer-reviewed",abstract:"Proteins are indispensable players in virtually all biological events. The functions of proteins are coordinated through intricate regulatory networks of transient protein-protein interactions (PPIs). To predict and/or study PPIs, a wide variety of techniques have been developed over the last several decades. Many in vitro and in vivo assays have been implemented to explore the mechanism of these ubiquitous interactions. However, despite significant advances in these experimental approaches, many limitations exist such as false-positives/false-negatives, difficulty in obtaining crystal structures of proteins, challenges in the detection of transient PPI, among others. To overcome these limitations, many computational approaches have been developed which are becoming increasingly widely used to facilitate the investigation of PPIs. This book has gathered an ensemble of experts in the field, in 22 chapters, which have been broadly categorized into Computational Approaches, Experimental Approaches, and Others.",isbn:null,printIsbn:"978-953-51-0397-4",pdfIsbn:"978-953-51-4312-3",doi:"10.5772/2679",price:139,priceEur:155,priceUsd:179,slug:"protein-protein-interactions-computational-and-experimental-tools",numberOfPages:486,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:"5ad647ca09bc52a34fb2d02f38aa2455",bookSignature:"Weibo Cai and Hao Hong",publishedDate:"March 30th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/2290.jpg",numberOfDownloads:62886,numberOfWosCitations:110,numberOfCrossrefCitations:43,numberOfCrossrefCitationsByBook:4,numberOfDimensionsCitations:109,numberOfDimensionsCitationsByBook:5,hasAltmetrics:0,numberOfTotalCitations:262,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 24th 2011",dateEndSecondStepPublish:"June 21st 2011",dateEndThirdStepPublish:"October 26th 2011",dateEndFourthStepPublish:"November 25th 2011",dateEndFifthStepPublish:"March 24th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,8,9",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"119750",title:"Dr.",name:"Weibo",middleName:null,surname:"Cai",slug:"weibo-cai",fullName:"Weibo Cai",profilePictureURL:"https://mts.intechopen.com/storage/users/119750/images/3147_n.jpg",biography:"Dr Weibo Cai received his BS degree from Nanjing University in \n1995 and a PhD degree in Chemistry from UCSD in 2004. After \nthree years of post-doctoral training at the Molecular Imaging \nProgram at Stanford University, he joined the University of Wisconsin - Madison as a Biomedical Engineering Cluster Hire in February 2008 and is currently an Assistant Professor with joint appointment in the Departments of Radiology and Medical Physics. Prof Cai has authored > 90 peer-reviewed articles which have been cited > 3,100 times (H-index: 29). Prof Cai has won many prestigious awards and served on the Editorial Board of 18 scientific journals. He is currently the Executive Editor of the American Journal of Nuclear Medicine and Molecular Imaging.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"252246",title:"Dr.",name:"Hao",middleName:null,surname:"Hong",slug:"hao-hong",fullName:"Hao Hong",profilePictureURL:"https://mts.intechopen.com/storage/users/252246/images/system/252246.jpg",biography:"Hao Hong started his postion as a Research Assistant Professor of Radiology at the University of Michigan in 2014. He received his PhD degree in Biochemistry and Molecular Biology from Nanjing University (P.R. China) in 2008. He acquired his postdoctoral training from 2008 to 2013 in the Department of Radiology, University of Wisconsin, Madison. His research interest is in the design and optimization of new imaging tracers for cancer as well as modification/application of nanomaterials for image-guided therapeutic delivery. 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As soon as the diagnosis is suspected, patients are referred to neurology, as well as physical and occupational therapy. Rehabilitation focuses on contracture prevention, including passive range of motion exercises at relevant joints, supportive splints for elbows and hand, and muscle strengthening exercises to promote normal function [1, 2]. Primary or secondary surgical intervention is indicated in cases of severe nerve injury and absent or suboptimal functional recovery. Interventions include nerve microsurgery, joint and bony procedures, tendon lengthening and transfers [3]. Post-operative management after nerve surgery can also include electrical muscle stimulation to facilitate muscle function [4]. Botulinum toxin injections can be used to treat muscle imbalance and contractures. A systematic review identified 4 groups of indicators for botulinum injection: contracture of shoulder adduction, limited active elbow flexion and extension, and pronation contracture of the lower arm [5]. However, specific indications for nerve repair or secondary surgery are largely institution-specific due to a lack of randomized trials and multicenter prospective studies.
Outcomes are often difficult to compare due to the variability of anatomical lesions, variety in surgical technique, and difference in outcome reporting [6]. While the majority of OBPP outcome measurements focus on the functional limitation of the upper extremity, affected children often have associated psychosocial problems, most commonly in the area of activity and participation, such as sports [7]. In comparison to healthy children, children with OBPP have been found to be at high risk for anxiety, depression, and aggression. Mothers with children with OBPP have been found to have increased maternal distress compared to mothers with healthy children [8].
The International Classification of Functioning, Disability and Health (ICF) is a validated and valuable tool developed by the World Health Organization for identifying and comparing areas of function and disability of persons in several domains. The ICF framework consists of five domains: body structure, body function, activity, participation, and environmental factors [9]. These domains are detailed in the integrated biopsychosocial model in Figure 1. The activity domain evaluates task execution in the context of disablement or physical ability. The participation domain addresses patient involvement in activities of daily living (ADL) or patient self-perception of engagement and psychometric well-being [10]. Children, adolescents, and young adults with OBPP are important stakeholders, and the application of holistic OBPP evaluation that measures various ICF domains can help improve understanding of their situation. In this chapter, we describe all currently used outcome measures for OBPP, map them against domains in International Classification of Functioning, Disability and Health, and contrast OBPP with another perinatal condition affecting the upper limb, cerebral palsy (CP).
Integrated ICF Model [
With the onset of World War I and II alongside the spread of poliomyelitis, surgeons and neurologists saw a rapid increase in peripheral nerve injuries in the hospitals. A majority of these cases affected the upper limb, including brachial plexus lesions. In response, the British Medical Research Council (MRC) created the MRC score to examine the limbs for peripheral nerve lesions as seen in Table 1. It tested limb segment positioning without and against gravity, and manual resistance was tested to grade muscle strength on a six point scale measuring no activity, flicker, movement with gravity eliminated, movement against gravity, and normal power. Grade 4 is subdivided into 3 categories: slight, moderate, and strong resistance. However, these subdivisions are subjective and thus, levels of resistance are highly dependent on the evaluator [11]. The MRC scale has become the most recognized scale for evaluating strength in patients with peripheral nerve injuries, and it is commonly used for assessing elbow flexion in infants with OBPP [12, 13, 14, 15, 16]. Individual surgeons often develop and use their own modifications for documenting results, especially for how grade 4 can be defined for different movements or muscles.
MRC score | |
---|---|
Grade | Clinical Finding |
0 | No contraction |
1 | Flicker, trace of contraction |
2 | Active movement with gravity eliminated |
3 | Active movement against gravity |
4 | Active movement against gravity and resistance |
5 | Normal power |
MRC score [11].
Over time, the Gilbert Muscle Grading System emerged in 1987 to address MRC’s limitations with manual resistance as seen in Table 2. It evaluates shoulder function on a 0–5 point scale, representing: flaccid, no active external rotation (ER) at abduction to 45°, no active ER at abduction to <90°, weak active ER at abduction to 90°, weak active ER at abduction to <120°, and complete active ER at abduction to >120° [17]. The Gilbert shoulder abduction sub score can be converted into the Mallet shoulder abduction sub score by utilizing the corresponding range of motion [18]. In both cases, the MRC scale is not suitable for infants due to the cognitive requirement for the exam [19].
Gilbert Shoulder Classification | |
---|---|
Grade (Function) | Clinical Finding |
0 (none) | Flaccid shoulder |
1 (poor) | No active external rotation at abduction to 45° |
2 (fair) | No external rotation at abduction to 90° |
3 (satisfactory) | Weak active external rotation at abduction to 90° |
4 (good) | Weak active external rotation at abduction to <120° |
5 (excellent) | Complete active external rotation at abduction to >120° |
Gilbert Shoulder Classification [17].
The Miami scale was developed to address the limitation in choosing a grade within the Gilbert system. It totals the score for shoulder abduction and external rotation to calculate a grade of 0–5, where 0 represents no function and 5 is excellent. This score has been found to have a weak correlation with Gilbert and Mallet, but it has not been validated for OBPP [20].
A decade earlier, the Mallet score was created in 1972 to evaluate OBPP injuries on a scale of 1–5 by testing functionality of the affected limb as seen in Table 3 [21]. Commonly used to assess shoulder abduction before and after surgery, the Mallet score translates grade of shoulder external rotation into degrees of deficiency. A score of 1 corresponds to a flail shoulder and a score of 5 indicating a normal shoulder [22]. The Mallet classification system includes 5 sub scores for shoulder movements: abduction, external rotation, hand to neck, hand on spine, and hand to mouth, to give a maximum score of 25. Active range of motion measurements can be translated into the Mallet scale [21].
Mallet Score | |
---|---|
Grade | Clinical Finding |
I | Flail shoulder |
II | 0° of external rotation Active abduction <30° Hand to mouth with marked trumpet sign Hand to back of neck impossible Hand to back impossible |
III | External rotation < 20° Active abduction 30°– 90° Hand to mouth possible with partial trumpet sign (> 40° shoulder abduction) Hand to back of neck with difficulty Hand to back with difficulty |
IV | External rotation > 20° Active abduction > 90° Hand to mouth easy with <40° shoulder abduction Hand to back of neck easy Hand to back easy |
V | Normal shoulder |
Mallet score [21].
Modified versions of the Mallet scale have also been created. In addition to the classical shoulder assessments of the Mallet system, Birch’s modified Mallet system evaluates resting position and fixed forearm supination on a scale of 1–5, with 1 being most affected and 5 being normal [23]. Nath et al’s modified Mallet system integrates Birch’s modification to further define deformity [24]. Terzis and Papakonstantinou created a modified Mallet scale that measures the same shoulder movements as the original Mallet scale, but it uses a scale of 1–4 [25]. Abzug et al’s modification measures a 6th sub score to the original Mallet system: hand to belly; this additional internal rotation position improves assessment of postoperative midline function [26, 27].
After noting the deficiencies in the Mallet and MRC scoring systems, the active movement scale (AMS) was created in 1995 as a novel evaluative tool to be used on infants and children at any time point (Table 4). While a child is playing, upper limb movement is observed in the gravity-eliminated and anti-gravity planes. At the shoulder, abduction, and adduction, flexion, external rotation, internal rotation are tested; at the elbow, flexion and extension; at the forearm, pronation and supination; at the wrist, finger, and thumb, flexion and extension. AMS is quantified on an 8 point scale (0 for no visible contraction to 7 for full motion) based on the percent of active motion noted within individual joint passive range of motion [28]. It is recommended that the estimated passive range of motion (PROM) be verified with goniometry for accurate scoring [29]. It has showed moderate to excellent reliability in children with OBPP between 1 month and 15 years of age [30]. Active range of motion measurements can be reliably converted to the AMS scale. The extended numerical scale improves distinguishing ability and allows for extended statistical analysis.
AMS Score | |
---|---|
Grade | Clinical Finding |
0 | Gravity eliminated: no contraction |
1 | Gravity eliminated: contraction, no motion |
2 | Gravity eliminated: motion < ½ range |
3 | Gravity eliminated: Motion > ½ range |
4 | Gravity eliminated: full motion |
5 | Against gravity: motion < ½ range |
6 | Against gravity: motion > ½ range |
7 | Against gravity: full motion |
AMS Score [28].
However, upper-extremity movements of forearm pronation and supination are less reliably evaluated with AMS [19]. AMS has been shown to be more popular in North America while Europe has shown preference towards MRC. Although it has been shown to work on an extended age range, AMS is typically used in younger children [31]. Though this is the case, AMS is often time consuming in younger children as it requires patience and creativity from the provider and cooperation from the child to elicit all the desired motions [32].
The Toronto Test Score was created in 1994 to predict a child’s prognosis prior to microsurgical intervention (Table 5). Shoulder flexion, extension, abduction, and external rotation is measured; elbow flexion, radioulnar supination, and wrist extension is also recorded. On a scale of 0 (no motion or contraction) to 7 (full motion), if a 3 month child scores < 3.5, this result recommends nerve surgery [33]. It has been validated for use in children with OBPP. Composite Toronto and AMS scores have demonstrated a strong correlation [34].
Toronto Score | ||
---|---|---|
Grade | Clinical Finding | Score |
0 | Gravity eliminated: no contraction | 0 |
1 | Gravity eliminated: contraction, no motion | .3 |
2 | Gravity eliminated: motion < ½ range | .3 |
3 | Gravity eliminated: Motion > ½ range | .6 |
4 | Gravity eliminated: full motion | .6 |
5 | Against gravity: motion < ½ range | .6 |
6 | Against gravity: motion > ½ range | 1.3 |
7 | Against gravity: full motion | 2 |
Toronto Test Score [33].
In 1993, the Raimondi hand and wrist score was developed specifically for OBPP with a scale ranging from 1, for total palsy, to 5, for nearly normal hand function (Table 6). By incorporating sensation and motor function in its evaluation, the Raimondi scale is able to determine extent of hand function [35]. The Gilbert-Raimondi score classifies elbow function in OBPP by analyzing flexion, extension, and lack of extension to assign a value of I (poor recovery), II (satisfactory recovery) or III (good recovery) [36]. Gilbert-Raimondi can also be used to classify hand function on a scale of 0 to 5 [37].
Raimondi Hand Score | |
---|---|
Grade | Clinical Finding |
0 | Complete paralysis or functionally useless finger flexion Non-usable thumbs without grasping function Little or no sensation |
1 | Limited finger flexion No finger or wrist extension Key grip possible |
2 | Active wrist extension Passive flexion of fingers (tenodesis) Passive key grip in pronation |
3 | Complete active finger and wrist flexion Active thumb movement, including abduction and opposition Intrinsic equilibrium No active supination |
4 | Complete active finger and wrist flexion Active wrist extension but weak finger extension Good opposition of thumb with active ulnar intrinsic muscles Partial pronation and supination |
5 | Grade 4, but with active finger extension Complete pronation and supination |
Raimondi Hand Score [35].
Active range of motion (AROM) has shown to have the largest support from the international brachial plexus surgeon community according to the iPLUTO study [31]. It has a continuous scale and normative values are readily available. However, the methodology in assessment varies. Some use goniometers for a precise measurement; however, it is cumbersome to use, especially with a fussy child. Passive range of motion (PROM) is also commonly assessed and reported as these children commonly develop internal rotation shoulder and elbow flexion contractures [31].
Traditional surgeon- or therapist-reported physical exam outcome measures, like Mallet, Toronto, and AMS, have been validated for OBPP and can discriminate the deficit in active range of motion in the upper extremity [30]. However, these scales focus primarily on individual muscle power. Systematic review has shown that measures of shoulder or elbow range of motion are most frequently used for outcome assessment for OBPP [38]. Notably, a study surveyed attendees of the International Symposium of Brachial Plexus Surgery over the course of nine months. Fifty-nine participants responded and all but two were surgeons. Most responders were based in Europe or North America and identified as a member of a brachial plexus team. There was a consensus (76%) to include passive range of motion for shoulder adduction and abduction and elbow extension. 95% of respondents believed active range motion should also be measured by evaluating shoulder abduction and adduction, elbow flexion and extension, wrist extension, and finger flexion and extension. 83% expressed that the Mallet score was a suitable outcome measure, and 76% said it should be expressed using its sub scores for each movement, rather than using an aggregate score. There was also insufficient evidence for the use of Azbug et al’s modified Mallet scale, which includes hand-to-belly to assess active internal rotation [31].
At each age group, there is a different motivation for assessment. During infancy, the degree of impairment is identified and recovery is monitored to determine qualification for surgery; thus, range of motion, strength, and limb integration must be evaluated. As the child develops, the assessment must evolve with them. For a school-aged patient, participation in age-related school and leisure activities as well as qualify of life is important to their development. Adolescents with OBPP may face functional limitations stemming from factors that these surgeon-centered outcome measures do not assess, such as psychosocial factors, poor self-perception, or social environmental influences [39]. While functional impairment must also be measured, psychometric assessment must now be included to holistically measure OBPP outcomes [10].
Several tools have been developed for global clinical assessment that evaluate domains aside from “body function and structure”, which has been well documented by the MRC, Mallet, and AMS scales. The Brachial Plexus Outcome Measure (BPOM) activity scale, specific for school-aged children with OBPP, measures function relative to activity limitations stemming from brachial plexus nerve injury. It consists of eleven tasks, which contain components of the fifteen movements used in the AMS scale, and performance is graded using the Functional Movement Scale ranging from 1 to 5. Patients fill out the self-evaluation scale with 3 visual analog scales to score perceived hand and arm function as well as aesthetic appearance of the affected limb [40]. BPOM measures a component of the ICF definition of participation by considering the child’s upper limb performance within the context of their life [38]. Its authors recommend clinicians to supplement the BPOM activity scale with a global standardized participation questionnaire when needed to measure the ICF “activity and participation” domain [40].
Sensory discriminatory function in patients with OBPP can be evaluated using Semmes-Weinstein monofilaments and two-point discrimination. The Semmes-Weinstein monofilament test uses five monofilaments of different diameters, where thicker filaments exert higher pressure when applied to skin [41]. Behavior cues, such as retractive movements with active motion and facial grimacing, in response to pinprick across dermatomes can be classified using the Sensory Grading Scale by Narakas when testing infants [10]. It is classified under the “body function” ICF domain [38].
Noting the lack of sensitivity of the Gilbert-Raimondi hand classification, the nine hole peg test has been validated to evaluate fine upper motor function in patients with OBPP [42]. It requires participants to repeatedly place and subsequently remove nine pegs into nine holes one at a time, as fast as they can. This test has shown to have high interrater and test–retest reliability for both the adult and pediatric population [43]. It is classified under the “activity” ICF domain [44]. However, the iPLUTO survey showed a consensus to not use this tool [31]. Recognizing the dynamics of a dominant and assisting hand in bimanual hand activity, the Assisting Hand Assessment (AHA) was developed in 2003 as a hand function evaluation tool for children with unilateral upper limb dysfunction, including those with OBPP and cerebral palsy (CP). It has been shown to be reliable in children between ages of 18 months and 12 years. Classified under the “activity” ICF domain, the AHA reflects the person’s usual performance in daily activities [45].
The Children’s Hand-use Experience Questionnaire (CHEQ), a tool for evaluating hand function in unilateral upper limb injury, covers the level of activity in the ICF framework. It is administered in two steps. First, a play session requiring bimanual handling of 22 specific toys is observed; then, the session is reviewed by trained assessors to rate each object-related action on a 4-point scale. It is unique as the questionnaire includes the child’s emotional experience of impaired hand function in bimanual activities. Validity has been demonstrated in adolescents aged 6–18 years with OBPP and CP. It should be noted that ratings for children under 13 years of age are completed by parents, who tend to overestimate their child’s problems [46].
Disability is commonly assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure in brachial plexus injuries. It is a 30 item, self-reported questionnaire measuring physical function where every question is answered on a scale from 1 to 5, and the total minimum score ranges between 30 and 150 [47]. It has shown responsiveness and validity across the whole upper extremity in adults and covers the “activity and participation” ICF domain [48, 49]. A shorter version, QuickDASH, is comprised of 11 items assessed on a 5-point scale; it has shown higher discriminatory power in detecting disability and has been proven as a valid instrument for children ages 8–18 [50].
To determine arm and hand spontaneous function in the home environment, the parent-reported Hand Use at Home (HUH) questionnaire was developed, which is categorized under the activity and participation of ICF. It includes a host of bimanual activities and has been validated in children aged 3–10 years with unilateral cerebral palsy and OBPP [51].
The Pediatric Outcomes Data Collection Instrument (PODCI) was developed to provide a standardized outcome measurement for pediatric musculoskeletal conditions, and it has been validated for OBPP [52]. The tool has seven dimensions: upper extremity function, transfers and mobility, physical function and sports, comfort or lack of pain, happiness, satisfaction, and expectations [53]. It falls under the “activity, participation, and environmental” domains of the ICF framework [38].
The 36 item Pediatric Quality of Life Inventory, PedsQL, assesses the impact of a child’s chronic condition on the family, where a higher score represents low impact [54]. It is developed for pediatric patients with chronic health conditions. It is a promising health-related quality of life instrument designed for a broad age range, including categories for both parents and patients. It measures the core health dimensions outlined by the WHO, including functionality at school [55]. This measurement is a validated outcome measure that is categorized under the “activity and participation” ICF domain [44].
Patient-Reported Outcomes Measurement Information System (PROMIS) developed by the NIH includes several measures to holistically evaluate physical, mental, and social health [56]. The health quality of children with obstetric brachial plexus palsy as measured by PROMIS is not well understood. For other brachial plexus related injuries, such as brachial plexus birth injury, PROMIS domains have shown promise as useful tools for evaluation [56].
A summary of OBPP outcome measure classification by ICF domain can be found in Figure 2. In a systematic review of classifying OBPP outcome measures by ICF domain, only 8% (18/217) of papers represented the ICF component of “activity and participation” and only 4% (9/217) of studies incorporated the concept of environmental factors during OBPP measurement; the remaining 88% (190/217) studied the ICF domain of “body structure and function”. In total, only 2% (4/217) of papers evaluated all three ICF domains [38]. It should be noted that the ICF framework does not include the impact of the child’s disability on the family. Family members have been found to experience “third-party functioning and disability” as a result of their loved one’s health condition [57].
Classification of OBPP outcome measures by ICF domain.
Similar to OBPP, children with the most common type of hemiplegic cerebral palsy (HCP) have a weak upper limb from their pre- or perinatal period. In CP, damage or abnormalities of the cerebral motor cortex affects muscle coordination and movement. Other central nervous system deficits in HCP include sensory impairments, failure of sensorimotor integration, and potential learning disabilities [58]. There has been extensive study of upper extremity dysfunction in children with CP, including the age at which children plateau in function and the use of multimodal therapeutics such as synergistic Botox, occupational therapy, and augmented feedback therapeutics such as virtual reality [58].
Children with HCP often take longer to complete bimanual activities. They may ask for assistance if they are comfortable or they may avoid certain activities due to negative effects on their self-esteem and self-concept. This interplay between body structure and function with environmental and personal factors again proves the importance of the ICF framework.
Since cerebral palsy and obstetric brachial plexus palsy both exhibit unilateral upper limb palsy, they share several outcome measurements. AROM and PROM are also often measured by goniometry for CP patients, similar to OBPP patients. For both diagnoses, it is important to note that this outcome can be affected by age, gender, baseline level of physical activity, and any co-existing illness. MRC has been utilized for measuring muscle power in CP patients although this was developed initially for brachial plexus lesions [59]. Mean time to complete nine-hole pegboard, which measures finger dexterity, has been used in CP patients as well [60, 61].
Other scales more specific to CP that fall under the “body function and structure” domain of the ICF framework include the Ashworth and Modified Ashworth scales for spasticity and Kendall scale for muscle strength [62]. The Quality of Upper Extremity Skills Test (QUEST) is used to assess the body structure and function domain by taking into consideration disassociated movement, grasp, protective extension, and weight bearing. The test–retest reliability ranges from 0.75 to 0.95 depending on the factor considered [63]. The Melbourne Assessment of Unilateral Upper Limb Function (MUUL) is a video-based measurement with 16 items, each containing subskills that cover various characteristics of movement including target accuracy, fluency, and movement. A score out of 122 is calculated and then converted into a percentage that describes the quality of upper limb movement in CP patients [64]. The Box and Blocks timed test measures unilateral dexterity by having children move blocks from one side a box to another using the dominant hand and the non-dominant hand [65]. The Barry-Albright Dystonia (BAD) scale rates the severity of dystonia in eight different body regions—eyes, mouth, neck, trunk, both arms, and both legs [66].
There are also a variety of scales utilized to assess OBPP that are also used for CP that address the activity and participation domain of the ICF framework. One such outcome measure, as previously mentioned, is the Assisting Hand Assessment (AHA). Children with unilateral CP are videorecorded as they play with toys and/or boardgames that provoke use of both hands and are then assigned a raw score between 22 and 88 which are then converted to logit based AHA units [45]. AHA is often used in research and has good reliability and validity in children but requires extensive training to administer the assessment. The Pediatric Outcomes Data Collection Instrument (PODCI) helps families communicate information about their environment and share how it affects the gait and quality of life of children with musculoskeletal health issues. In comparison to its use for OBPP, PODCI only demonstrates moderate sensitivity to detect changes of walking function due to its expansive scoring system [67]. This outcome measure also has high ceiling effects [68]. Children’s Hand-use Experience Questionnaire (CHEQ) was developed to be a useful tool to assess patients who have limitations in one hand making it difficult to perform bimanual activities.
There are other outcome measures that fall under the activity and participation domain used for CP but not OBPP. Pediatric Quality of Life Inventory (PedsQL), a part of the participation ICF domain, is used by families to score their children with CP taking into consideration a variety of other factors that affect life [69, 70, 71]. One that falls under the ICF framework is Pediatric Evaluation of Disability Inventory (PEDI). PEDI is administered to children less than seven years of age and is formatted as a semi-structured interview administered by proxy [72]. It assesses for ability to provide self-care and maintain social function. The Canadian Occupational Performance Measure (COPM) is a 5-step process used by occupational therapists to evaluate the effect of therapy on various individualized outcomes of importance such as self-care, productivity, and leisure and rate performance and satisfaction on a scale of 1–10 [73]. Jebsen Taylor Hand Function Test (JTHFT) is a timed test of hand dexterity in everyday activities used in children greater than 5 years of age [74]. Although COPM and JTHFT are not diagnosis specific to CP, they have been utilized to evaluate CP patients over time [74, 75]. PROMIS has also been utilized for CP patient evaluation [76]. The Hand Assessment for Infants (HAI) is used to describe unilateral hand function in CP patients by quantifying the contribution of each hand separately and together during a 10–15-minute play session with specific toys eliciting a wide range of motor actions [77]. Both Hands Assessment (BoHA) is a video-taped tool that was developed for children under 12 years of age with bilateral CP and measures the effectiveness of each individual hand during multiple bimanual tasks. Although the scale is highly precise and captures the mobility subdomain of the activity domain of the ICF framework, it requires administrators to undergo formal training and scoring can be time-intensive [78]. ABILHAND-Kids, from the self-care subdomain of the activity domain, is a questionnaire administered to the parents of CP children, thus leading to possible over- or under-estimation of their child’s bimanual everyday activities [78]. The Gross Motor Function Scale (GMFS) evaluates a child’s ability to complete basic motor functions such as crawling, jumping, or climbing up stairs on a four point scale for each task [79]. Peabody Developmental Motor Scales second edition (PDMS-2) assesses fine motor skills in children with results expressed as raw scores, standard scores and total motor quotient [80]. Children’s Assessment of Participation and Assessment (CAPE) is a 55-item questionnaire administered to the child and parent and is designed to examine how children with physical disabilities like CP participate in everyday activities outside of the school setting and document the diversity, intensity, and enjoyment of activities [81].
A summary of CP outcome measure classification by ICF domain can be found in Figure 3. There is a discordance between outcome measures that focus on ICF levels of activity and participation and functional measures that attempt to quantify motion. Both OBPP and CP have effects on patients beyond movement and strength. Quality of life, stress to caregivers, involvement in school and family activities, self-image and self-esteem can all be affected, indicating the need for more biopsychosocial approaches. Although capturing outcomes incorporating multiple domains of the ICF framework is beneficial, the amount of time and training required for measures of activity and participation often leads to these outcomes not being utilized to its full extent in the clinical setting. The existing body of literature shows that compared to OBPP surgeons, CP surgeons report on more domains of the ICF framework. Mallet, MRC, AMS, AROM, PROM, and Gilbert are mostly used in reporting outcomes on OBPP patients, putting emphasis on quantifying motion. In CP, more emphasis may be placed on activity and participation due to the added complexity of the diagnosis with neurological involvement.
Classification of CP outcome measures by ICF domain.
Currently, most tools used to assess OBPP progression measure range of motion and strength, which are classified under the body function and structure domain of the ICF model. Numerous instruments have been developed, such as the DASH and PODCI score, to include other factors of disability, like self-perception and functional impairment. However, these scales are not typically included during standard OBPP assessments, in contrast to CP outcome reporting, which generally focuses more on the activity and participation domain of the ICF model. Further standardization and incorporation of outcomes that fall under the activity and participation domain would be beneficial to assess OBPP more holistically.
The authors declare no conflict of interest.
None.
Takeuchi and Shimizu Takeuchi first described Moyamoya disease, in 1957 [1]. The term “Moyamoya” was coined to this illness due to its angiographic appearance of “something hazy, like a puff of cigarette smoke” (Moyamoya in Japanese) [1] “Moyamoya disease” (MMD) and “Moyamoya syndrome” (MMS) are both chronic cerebrovascular diseases affecting distal internal carotid and proximal portions of the anterior and middle cerebral arteries [2]. Though Moyamoya disease and Moyamoya syndrome are used synonymously, a subtle distinction separates these two entities. Moyamoya vasculopathy in those with underlying risk factors are described under the umbrella term “Moyamoya syndrome”, thus a wide variety of conditions can incite a Moyamoya vasculopathy, however, if a similar angiographic appearance is evident in those with no risk factors, except for an underlying genetic predisposition, it is entitled as “Moyamoya disease” [2]. One more distinction is the” bilateral “angiographic appearance pathognomonic for Moyamoya disease, whilst” unilateral “vasculopathy always qualifies to a Moyamoya syndrome, even without an underlying associated risk factor [2].
We searched PubMed from 1968 to January 2021 with the words “Moyamoya disease”, “Moyamoya syndrome”, “population-based”, “epidemiology”, “risk factors”, “genetics”, “clinical aspects”,clinical features of Moyamoya, seizure and Moyamoya, headache and Moyamoya, paediatric Moyamoya, Adult Moyamoya, stroke and Moyamoya, neuropsychological profile of Moyamoya, Research studies on Moyamoya, Case reports of Moyamoya. Relevant articles were also searched in the national and International journals where the full article could be retrieved. Clinical manifestation and underlying pathophysiology was reviewed in the searched article to provide an extensive review ofclinical aspects of Moyamoya disease.
This disease entity was believed to affect Asian heritage, given their genetic predisposition. However, it is now a well-known fact that this disease entity can affect American and European ethnicities [3]. This disease has a bimodal distribution of age-specific incidence rates with two peaks in the age groups of 5 years in children andmid-40s in the adults [3, 4]. It is twice more common in females as in males [3]. The incidence estimates of 0.35–0.54/100,000 are found in the Japanese and Korean populations [5]. An incidence of 0.086 cases per 100,000 persons inAmericans, incidence-rate ratios are 4.6 for Asian Americans, 2.2 for blacks, and 0.5 for Hispanics [6].
Moyamoya disease has a genetic aetiology, as mentioned above. Many studies where total genome search linkage was performed found an association between the disease and markers located at 3p24.2–26 chromosome [7], a possible connection of the marker D6S441 located on chromosome 6 which also has HLA gene [8], linkage to chromosome 17 have also been reported.
Moyamoya syndrome is associated with many conditions, as described below: [8].
Chromosomal/Genetic disorder | Neurofibromatosis, “Down’s syndrome, Turner syndrome |
---|---|
Haematological disorders | Sickle cell anaemia, Thalassemia, Aplastic anaemia |
Infectious disease | Leptospirosis, Tuberculous meningitis |
Neoplasms | Craniopharyngioma, Wilms tumour |
Drug abuse | Phenobarbital |
Autoimmune diseases | “Behcet’s disease, “Sjögren’s syndrome, systemic lupus erythematosus (SLE), Henoch Scholein Purpura (HSP) and ‘Graves’ disease |
Others | Cardiomyopathy, Polycystic kidney, Pulmonary sarcoidosis, Irradiation, Trauma, Renal artery stenosis |
A role of fibroblast growth factor, prostaglandin, and activation of cox2 in the vascular smooth muscle, EBV DNA and propionibacteria have all been proposed as a possible mediator of the neovascular response [9].
Disease progression can be slow, with overlapping intermittent events, or it can be a fulminant course, with rapid neurologic decline [10]. It has been reported that symptomatic progression is observed for five years, and delay in the rap initiation may have catastrophic consequences [10].
Various guidelines have been published over time and again. In 1996 and 1997 Japan published diagnostic criteria for the pathology and treatment of MMD [11]. In 2012, Japan published the latest guidelines based on 1997 guidelines [11].
Though cerebral angiography remains the gold standard for the diagnosis (Table 1), novel guidelines added a staging based on scores of magnetic resonance (MR) angiography (MRA) [12].
Stage | Cerebral angiographic findings |
---|---|
I | Narrowing of the carotid fork |
II | Initiation of the moyamoya (dilated major cerebral artery and a slight moyamoya vessel network) |
III | Intensification of the moyamoya (disappearance of the middle and anterior cerebral arteries, and thick and distinct moyamoya vessels) |
IV | Minimization of the moyamoya (disappearance of the posterior cerebral artery, and narrowing of individual moyamoya vessels) |
V | Reduction of the moyamoya (disappearance of all the main cerebral arteries arising from the internal carotid artery system, further minimization of the moyamoya vessels, and an increase in the collateral pathways from the external carotid artery system) |
VI | Disappearance of the moyamoya (disappearance of the moyamoya vessels, with cerebral blood flow derived only from the external carotid artery and the vertebrobasilar artery systems) |
Stages and cerebral angiographic findings.
Stenosis or occlusion at the end of ICA and/or the initial segment of the ACA and/or MCA.
At least two obvious shadows of the blood flow are displayed on the same scan level at the basal ganglia region, suggesting the existence of an abnormal vascular network.
The above manifestations are bilateral, but bilateral lesions may be staged differently.
The total score was the sum total of MRA results and each side (right and left were scored individually) as shown in the Tables 2 and 3.
Scoring for each artery | |
---|---|
Score | MRA Findings |
Internal carotid artery | |
0 | Normal |
1 | Stenosis of C1 |
2 | Discontinuity of the C1 signal |
3 | Invisible |
Middle cerebral artery | |
0 | Normal |
1 | Stenosis of M1 |
2 | Discontinuity of the M1 signal |
3 | Invisible |
Anterior cerebral artery | |
0 | Normal A2 and blood vessels distal to A2 |
1 | Signal decrease A2 and its distal blood vessels |
2 | Invisible |
Posterior cerebral artery | |
0 | Normal P2 and blood vessels distal to P2 |
1 | Signal decrease P2 and its distal blood vessels |
2 | Invisible |
Classification and scoring based on the MRA findings.
MRA total score | MRA stage |
---|---|
0–1 | 1 |
2–4 | 2 |
5–7 | 3 |
8–10 | 4 |
Total score calculated individually for the right and left side.
As per the new guidelines, other diseases viz. atherosclerosis, autoimmune diseases, meningitis, brain tumours, Down syndrome, Recklinghausen’s disease, head injury and cerebrovascular damage after head irradiation, should be excluded [12].
Pathological findings suggestive of MMD are fibrocellular thickening of arterial intima, waviness of internal elastic lamina, thinning of the media, variable stenosis and occlusion of the implicated vessels, presence of anastomotic and perforating branches around the circle of Willis and pial reticular conglomerate of small blood vessels [12].
Definitive MMD: Either angiographic or MRA appearance of vessels bilaterally with the exclusion of alternative diagnosis [13].
Probable MMD: Either angiographic or MRA appearance of vessels unilaterally with the exclusion of alternative diagnosis [13]. Unilateral MMD may progress to bilateral MMD in 10 to 39% of the cases.
If the autopsy is performed with no previous angiography, pathological findings similar to those mentioned above may serve in the diagnosis of MMD [13].
Quasi MMD or Rui MMD:Evidence of stenosis or occlusion of distal ICA or proximal MCA or ACA with abnormal vascular network either unilateral or bilateral, in association with an underlying disease [13]. Concurrent occurrence of congenital disease is common in children, and acquired disorderis common in adults.
Unstable MMD: Defined as “rapid progression or repeated stroke”. It is a clinically challenging condition. It is more prevalent in patients younger than threeyears and those with an associated underlying disease. It is a possible risk factor associated with perioperative ischemic complication [14].
Moyamoya disease/syndrome symptoms can be broadly categorised into two, by the underlying mechanism (Figure 1). The first category of symptoms is oligemia like transient ischemic attack (TIA), stroke, and oligemia like transient ischemic attack (TIA), stroke, and seizures. Amongst the ischemic symptoms, completed strokes are more common in children, a possible explanation being their inability to identify and complain about TIAs [11]. The second category of symptoms are due to the compensatory mechanisms’ harmful consequences to ischemia like a haemorrhage from fragile collateral vessels and headaches from dilated transdural collaterals [10].
Flow chart showing the clinical manifestation of Moyamoya disease based on underlying pathogenic mechanism.
The research committee has identified nine types of initial episodes of MMD.
Hemorrhagic type.
Epileptic type.
Infarction type (can be same side or alternating hemiplegia).
TIA type.
Frequent TIA type (two or more attacks per month).
Headache type.
Asymptomatic type.
Other types.
Details unknown type.
Moyamoya disease presents with ischemic symptoms in children, an incidence of 68% and adults usually present with a hemorrhagic stroke, about 42% [10].
Amongst the ischemic symptoms, completed strokes are more common in children, a possible explanation being their inability to identify and complain about TIAs [15]. They can be transient or fixed. Most commonly occur in the territory of the internal carotid artery and proximal middle and anterior cerebral arteries [10].
Underlying mechanism:
Progressive stenosis of the internal carotid and middle cerebral arteries are responsible for most of the symptoms [10].
Maximally dilated cortical vessels in patients with chronic ischemia, constrict in response to the decreased carbon dioxide due to hyperventilation, resulting in reduced cerebral perfusion and thus exacerbating the symptoms [16].
Precipitating factors: [16].
Crying (In the paediatric population).
Hyperventilation (In paediatric population).
Exercise.
Anaesthesia.
Dehydration.
Altitude.
Eating a hot meal.
Focal Symptoms: [10].
Hemiparesis.
Dysarthria.
Aphasia.
Visual deficits.
Chorea.
Non-focal symptoms: [10].
Headache: Approximately 20% of the paediatric patients under the age of 14 years suffer from headache. Likely explanantion for the headache was the reduction of cerebral blood flow or cerebral blood flow reserve and diffusive cortical inhibition [17]. Dilatation of meningeal and leptomeningeal collateral vessels may stimulate dural nociceptors. Every refractory headache, especially in the paediatric population should be thoroughly worked up for moyamoya disease [17] Headaches can be migraine-like episodes which may respond to revascularization surgery or remain refractory to surgery [17].
Cognitive impairment, learning disability, and attention deficits.
Seizures.
Syncope.
Personality change, mistaken for a psychiatric illness like schizophrenia, acute transient psychosis, and mania [18].
Symptoms and signs which serve as biomarkers in MMD/MMS:
Orthostatic intolerance (also termed “orthostatic dysregulation”): [19] Orthostatic intolerance is defined as” a disturbance in the physiological adjustment mechanism compensating for physical stresses, such as standing, and causes a variety of symptoms associated with hemodynamic or autonomic nervous system compromise”. These symptoms can have a potential impact on the quality of life of paediatric MMD patients. In a study done by H. Uchino et al., 59% of children 10–15 years old suffered from orthostatic intolerance. These symptoms usually go unnoticed, and thus a thorough history from the patients and their caretakers become mandatory.
Symptoms which are suggestive of orthostatic intolerance:
Frequent headache.
Susceptibility to vertigo & dizziness on standing.
Fatigue.
Difficulty while getting out of bed.
Motion sickness.
Palpitation &/or dyspnea after mild exercise.
Tendency for fainting in the standing position.
Anorexia.
Occasional umbilical colic (severe abdominal pain).
Nausea on taking a hot bath or encountering unpleasant experiences.
Absent from school due to the above symptoms.
Pallor.
Fundus: Retinovascular anomalies and “morning glory disk” an enlargement of the optic disk should compel the clinician to look for moyamoya vasculopathy [20]. Morning glory syndrome or Morning glory disc anomaly is an unusual congenital optic disc anomaly characterised by a funnel-shaped excavation of the posterior globe that incorporates the optic disc [21]. Kindler described it in 1970 because it resembled the morning glory flower. The disc itself is enlarged, and orange or pink in colour within a surrounding area of peripapillary chorioretinal pigmentary changes. Alteration of lamina cribrosa and posterior sclera due to embryonic developmental defect leads to this fundus’s flowery appearanace. Presence of this sign indicates an association with systemic or intracranial vasculopathies such as MMD. Morning glory disc occurs in 50% of patients with the MMD (Figure 2).
Showing morning glory disc [courtesy:Indian J Radiol imaging. 2018 Apr-Jun] [
Showing funnel-shaped excavation of posterior globe [courtesy: Indian J Radiol imaging. 2018 Apr-Jun] [
Sequelae of MMD: [16].
Refractory headaches.
Recurrent TIAs.
Posterior cerebral artery (PCA) involvement.
Recurrent intracranial aneurysms.
Unstable MMD.
In children with MMD, recurrent ischemias can result in cerebral atrophy and thus emanate the onset of learning difficulties, cognitive impairment and mental retardation.
Hemorrhagic manifestations are more common in adults than in children. These haemorrhages are seen in 42% of the adults. The location of the bleeding can be intraventricular, intraparenchymal or subarachnoid.
Underlying mechanism:
Rupture of fragile collateral vessels as a result of chronic oligemia [23].
Development of cerebral aneurysms at the apex of the basilar artery and posterior communicating artery, areas of increased shear stress due to shifting circulatory pattern at the base of the brain is another source of haemorrhage [24].
Quasi MMD is common in adults, and the manifestations may range from asymptomatic to catastrophic haemorrhage and rebleeding with a moribund prognosis [13].
Ischemic symptoms are more common in the paediatric population, as described above. Amongst the ischemic symptoms transient ischemic attacks(TIA) are more common in the paediatric population with an incidence of 81% and infarctions are experienced by adults in approximately 51% [25].
Reason for the above observation could be due to better development of leptomeningeal collaterals (LMCs) in children than adults [25]. Various factors have been implicated in this observation: [25].
Ageing: Significant decrease in LMCs and increased tortuosity and vascular resistance in leptomeningeal vessels.
Concomitant diseases in adult MMD patients like hypertension may have an effect on the development of collaterals.
Focal cerebral ischemia may stimulate cytokines’ secretion, such as angiogenic peptides and vascular endothelial growth factor (VEGF). These cytokines levels are lower in adults.
Associated underlying conditions are commonly observed in adults with MMD.
Clinical clues for associated disorders: [10].
History of radiotherapy | Head and neck malignancies like optic gliomas, craniopharyngiomas, and pituitary tumours |
Endocrine insufficiency | Neurofibromas or tumours compressing hypothalamic–optic pathway and pituitary stalk |
Visual field defects | Tumours compressing hypothalamic–optic pathway, Strokes involving the visual pathway |
Anaemia | Sickle cell anaemia, Thalassemia, Aplastic anaemia |
Acute abdomen, bone crises | Sickle cell anaemia |
Neurocutaneous markers | Neurofibromatosis, Down’s syndrome,Turner syndrome |
Refractory hypertension | Renal Artery Stenosis |
Fever | Leptospirosis, CNS tuberculosis |
Recurrent falls (Especially in the Paediatric population) | TIAs |
Systemic symptoms like cutaneous rash, joint pains | SLE, Sjogren syndrome and HSP |
Special Precautions to be exercised:
EEG: Hyperventilation may precipitate an acute oligemic episode, thus caution has been exercised in patients with suspected moyamoya disease. Specific alterations in MMD/MMS have characteristic changes in EEG, consisting of the gradual decrease in frequency and amplitude activation after hyperventilation. These EEG changes are referred to as re-build-up phenomenon [2].
Anaesthesia and postop care.
Travelling to high altitudes.
Exercise.
A vast constellation of symptoms constitutes a repertoire in MMD. They may facilitate the diagnosis or add more confusion to the diagnosis. Fundus examination and characteristic angiogram findings clinch the diagnosis of MMD. A high index of clinical suspicion and an eye to recognise the disease’s common and unusual manifestations and inciting events may prevent delay in the diagnosis. Early recognition of illness with prompt treatment may halt the progression and allay catastrophic neurological deficits.
"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges".
\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.
",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\\n\\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\\n\\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nOAI-PMH
\\n\\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\\n\\nLicense
\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\\n\\nPeer Review Policies
\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\\n\\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
\\n\\n\\n"}]'},components:[{type:"htmlEditorComponent",content:'
The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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Through comparative analysis, the chapter investigates sustainability potential of vernacular architecture in the region to derive core concepts as guidelines of reproducing the characteristics of society and reveal identity of contemporary architecture in the Arab World.",book:{id:"8260",slug:"urban-and-architectural-heritage-conservation-within-sustainability",title:"Urban and Architectural Heritage Conservation within Sustainability",fullTitle:"Urban and Architectural Heritage Conservation within Sustainability"},signatures:"Maha Salman",authors:[{id:"258226",title:"Dr.",name:"Maha",middleName:null,surname:"Salman",slug:"maha-salman",fullName:"Maha Salman"}]},{id:"51000",doi:"10.5772/63726",title:"Towards Sustainable Sanitation in an Urbanising World",slug:"towards-sustainable-sanitation-in-an-urbanising-world",totalDownloads:3202,totalCrossrefCites:11,totalDimensionsCites:17,abstract:"Urban sanitation in low‐ and middle‐income countries is at an inflection point. It is increasingly acknowledged that conventional sewer‐based sanitation cannot be the only solution for expanding urban areas. There are other objective reasons apart from the lack of capital. The lack of stable energy supplies, of spare parts and of human resources for reliable operation, and the increasing water scarcity are factors that seriously limit the expansion of centralised systems. This chapter argues that a new paradigm for urban sanitation is possible, if the heterogeneity within developing cities is reflected in the implementation of different sanitation systems, adapted to each urban context and integrated under one institutional roof. This new paradigm entails: (1) innovative management arrangements; (2) increased participation and the integration of individual, community and private sector initiatives; (3) thinking at scale to open new opportunities; (4) improved analysis of the situation and awareness raising. Moving beyond conventional approaches towards sustainable urbanisation needs to follow both a top‐down and a bottom‐up approach, with proper incentives and a variety of sanitation systems which, in a future perspective, will become part of the ‘urban ecosystem’.",book:{id:"5235",slug:"sustainable-urbanization",title:"Sustainable Urbanization",fullTitle:"Sustainable Urbanization"},signatures:"Philippe Reymond, Samuel Renggli and Christoph Lüthi",authors:[{id:"181079",title:"Dr.",name:"Christoph",middleName:null,surname:"Lüthi",slug:"christoph-luthi",fullName:"Christoph Lüthi"},{id:"182136",title:"Mr.",name:"Philippe",middleName:null,surname:"Reymond",slug:"philippe-reymond",fullName:"Philippe Reymond"},{id:"182137",title:"Mr.",name:"Samuel",middleName:null,surname:"Renggli",slug:"samuel-renggli",fullName:"Samuel Renggli"}]},{id:"42926",doi:"10.5772/55736",title:"Disaster Risk Management and Social Impact Assessment: Understanding Preparedness, Response and Recovery in Community Projects",slug:"disaster-risk-management-and-social-impact-assessment-understanding-preparedness-response-and-recove",totalDownloads:10044,totalCrossrefCites:3,totalDimensionsCites:11,abstract:null,book:{id:"3364",slug:"environmental-change-and-sustainability",title:"Environmental Change and Sustainability",fullTitle:"Environmental Change and Sustainability"},signatures:"Raheem A. Usman, F.B. Olorunfemi, G.P. Awotayo, A.M. Tunde and\nB.A. Usman",authors:[{id:"156875",title:"Dr.",name:"Usman A",middleName:null,surname:"Raheem",slug:"usman-a-raheem",fullName:"Usman A Raheem"},{id:"166449",title:"Dr.",name:"A.M",middleName:null,surname:"Tunde",slug:"a.m-tunde",fullName:"A.M Tunde"},{id:"167886",title:"Dr.",name:"F.B.",middleName:null,surname:"Olorunfemi",slug:"f.b.-olorunfemi",fullName:"F.B. Olorunfemi"},{id:"167887",title:"Dr.",name:"G.P.",middleName:null,surname:"Awotayo",slug:"g.p.-awotayo",fullName:"G.P. Awotayo"}]},{id:"44263",doi:"10.5772/54339",title:"Conservation and Sustainability of Mexican Caribbean Coral Reefs and the Threats of a Human-Induced Phase-Shift",slug:"conservation-and-sustainability-of-mexican-caribbean-coral-reefs-and-the-threats-of-a-human-induced-",totalDownloads:2352,totalCrossrefCites:4,totalDimensionsCites:11,abstract:null,book:{id:"3364",slug:"environmental-change-and-sustainability",title:"Environmental Change and Sustainability",fullTitle:"Environmental Change and Sustainability"},signatures:"José D. Carriquiry, Linda M. Barranco-Servin, Julio A. Villaescusa,\nVictor F. Camacho-Ibar, Hector Reyes-Bonilla and Amílcar L. Cupul-\nMagaña",authors:[{id:"158136",title:"Prof.",name:"Jose D.",middleName:"D.",surname:"Carriquiry",slug:"jose-d.-carriquiry",fullName:"Jose D. Carriquiry"},{id:"160078",title:"Dr.",name:"Julio A.",middleName:null,surname:"Villaescusa",slug:"julio-a.-villaescusa",fullName:"Julio A. Villaescusa"},{id:"160079",title:"MSc.",name:"Linda M.",middleName:null,surname:"Barranco-Servin",slug:"linda-m.-barranco-servin",fullName:"Linda M. Barranco-Servin"},{id:"160082",title:"Prof.",name:"Victor F.",middleName:null,surname:"Camacho-Ibar",slug:"victor-f.-camacho-ibar",fullName:"Victor F. Camacho-Ibar"},{id:"167394",title:"Dr.",name:"Hector",middleName:null,surname:"Reyes-Bonilla",slug:"hector-reyes-bonilla",fullName:"Hector Reyes-Bonilla"},{id:"167395",title:"Dr.",name:"Amilcar L.",middleName:null,surname:"Cupul-Magaña",slug:"amilcar-l.-cupul-magana",fullName:"Amilcar L. Cupul-Magaña"}]}],mostDownloadedChaptersLast30Days:[{id:"64381",title:"Sustainability and Vernacular Architecture: Rethinking What Identity Is",slug:"sustainability-and-vernacular-architecture-rethinking-what-identity-is",totalDownloads:4441,totalCrossrefCites:8,totalDimensionsCites:22,abstract:"Sustainability has often been a fundamental part of the composition of both tangible and intangible cultural resources; sustainability and preservation of cultural identity are complementary. Elements of sustainable design are integral to vernacular architecture that have evolved over time using local materials and technology emerging from ambient natural and cultural environment creating optimum relationships between people and their place. This chapter aims to redefine what identity is as a concept and the impact of globalization on contemporary architecture especially on regions with rich heritage and unique culture as the Arab World. To accomplish this, the chapter examines the emergence of “local identity” as a reaction to the globalization of cultural values, uniform architectural styles, and stereotype patterns through discussing sustainability as a motivation for identity in culture and architecture. The research methodology is based on conducting a qualitative analysis of literature review to the main concepts discussed in this chapter such as: identity, culture, vernacular architecture, and sustainability. Through comparative analysis, the chapter investigates sustainability potential of vernacular architecture in the region to derive core concepts as guidelines of reproducing the characteristics of society and reveal identity of contemporary architecture in the Arab World.",book:{id:"8260",slug:"urban-and-architectural-heritage-conservation-within-sustainability",title:"Urban and Architectural Heritage Conservation within Sustainability",fullTitle:"Urban and Architectural Heritage Conservation within Sustainability"},signatures:"Maha Salman",authors:[{id:"258226",title:"Dr.",name:"Maha",middleName:null,surname:"Salman",slug:"maha-salman",fullName:"Maha Salman"}]},{id:"67342",title:"Introductory Chapter: Heritage Conservation - Rehabilitation of Architectural and Urban Heritage",slug:"introductory-chapter-heritage-conservation-rehabilitation-of-architectural-and-urban-heritage",totalDownloads:2616,totalCrossrefCites:3,totalDimensionsCites:6,abstract:null,book:{id:"8260",slug:"urban-and-architectural-heritage-conservation-within-sustainability",title:"Urban and Architectural Heritage Conservation within Sustainability",fullTitle:"Urban and Architectural Heritage Conservation within Sustainability"},signatures:"Kabila Faris Hmood",authors:[{id:"214741",title:"Prof.",name:"Dr. Kabila",middleName:"Faris",surname:"Hmood",slug:"dr.-kabila-hmood",fullName:"Dr. Kabila Hmood"}]},{id:"76898",title:"The Relationship between Land Use and Climate Change: A Case Study of Nepal",slug:"the-relationship-between-land-use-and-climate-change-a-case-study-of-nepal",totalDownloads:700,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Land Use and Climate change are interrelated to each other. This change influences one another at various temporal and spatial scales; however, improper land uses are the primary causal factor on climate change. It studies relevant literature and Nepal’s case to assess the relationship between land use and climate change. Similarly focuses on how land-use impacts climate change and vice versa. In recent centuries land-use change significant effects on ecological variables and climate change. Likewise, understanding the research on both topics will help decision-makers and conservation planners manage land and climate.",book:{id:"10754",slug:"the-nature-causes-effects-and-mitigation-of-climate-change-on-the-environment",title:"The Nature, Causes, Effects and Mitigation of Climate Change on the Environment",fullTitle:"The Nature, Causes, Effects and Mitigation of Climate Change on the Environment"},signatures:"Pawan Thapa",authors:[{id:"349566",title:"M.Sc.",name:"Pawan",middleName:null,surname:"Thapa",slug:"pawan-thapa",fullName:"Pawan Thapa"}]},{id:"50282",title:"Relation Between Land Use and Transportation Planning in the Scope of Smart Growth Strategies: Case Study of Denizli, Turkey",slug:"relation-between-land-use-and-transportation-planning-in-the-scope-of-smart-growth-strategies-case-s",totalDownloads:4667,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"In the decision-making process of planning residential areas in developing countries, importance of the commercial areas and need for a sustainable urban transportation infrastructure have generally been ignored based on several sociopolitical reasons. Meanwhile, decision-making periods of location choice and determining areal densities are conducted without quantitative spatial/technical analyses. Those urban matters bring along new planning paradigms like smart growth (SG) and new urbanism. SG is a land use planning paradigm which indicates that traffic problems should be minimized by transit alternatives, effective demand management and providing a balance between land use and transportation planning. This study aims to apply SG strategies to the land use planning process and evaluate the accuracy of land use planning decisions in the perspective of sustainable transportation. In order to reveal the effects of land use planning decisions on the available transportation infrastructure, two scenarios are investigated for 2030. In the first scenario “do nothing” option is considered, while the residential area densities and trip generation rates are regulated based on SG strategies in the second scenario. The results showed that the land use and traffic impact analyses should simultaneously be conducted before land use configuration process.",book:{id:"5235",slug:"sustainable-urbanization",title:"Sustainable Urbanization",fullTitle:"Sustainable Urbanization"},signatures:"Gorkem Gulhan and Huseyin Ceylan",authors:[{id:"182126",title:"Dr.",name:"Gorkem",middleName:null,surname:"Gulhan",slug:"gorkem-gulhan",fullName:"Gorkem Gulhan"},{id:"185555",title:"Dr.",name:"Huseyin",middleName:null,surname:"Ceylan",slug:"huseyin-ceylan",fullName:"Huseyin Ceylan"}]},{id:"42926",title:"Disaster Risk Management and Social Impact Assessment: Understanding Preparedness, Response and Recovery in Community Projects",slug:"disaster-risk-management-and-social-impact-assessment-understanding-preparedness-response-and-recove",totalDownloads:10045,totalCrossrefCites:3,totalDimensionsCites:11,abstract:null,book:{id:"3364",slug:"environmental-change-and-sustainability",title:"Environmental Change and Sustainability",fullTitle:"Environmental Change and Sustainability"},signatures:"Raheem A. Usman, F.B. Olorunfemi, G.P. Awotayo, A.M. Tunde and\nB.A. Usman",authors:[{id:"156875",title:"Dr.",name:"Usman A",middleName:null,surname:"Raheem",slug:"usman-a-raheem",fullName:"Usman A Raheem"},{id:"166449",title:"Dr.",name:"A.M",middleName:null,surname:"Tunde",slug:"a.m-tunde",fullName:"A.M Tunde"},{id:"167886",title:"Dr.",name:"F.B.",middleName:null,surname:"Olorunfemi",slug:"f.b.-olorunfemi",fullName:"F.B. Olorunfemi"},{id:"167887",title:"Dr.",name:"G.P.",middleName:null,surname:"Awotayo",slug:"g.p.-awotayo",fullName:"G.P. Awotayo"}]}],onlineFirstChaptersFilter:{topicId:"136",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82644",title:"Climate-Driven Temporary Displacement of Women and Children in Anambra State, Nigeria: The Causes and Consequences",slug:"climate-driven-temporary-displacement-of-women-and-children-in-anambra-state-nigeria-the-causes-and-",totalDownloads:24,totalDimensionsCites:0,doi:"10.5772/intechopen.104817",abstract:"With increasing periods of extreme wet seasons, low lying geographic position, with socioeconomic, and political factors; some communities in Anambra State, Nigeria experience heightened floods annually resulting in loss of shelter, displacement of people with breakdown of livelihoods, particularly in rural communities worsening their risks and vulnerabilities. In 2012, a major flood event in the state temporarily displaced about 2 million people. In this chapter, we used a community-based adaptation approach to investigate the causes and consequences of climate-related temporary displacement on community members in Ogbaru LGA, Anambra State following flood events. We used global positioning system to obtain the community’s ground control points and gathered our data via field observation, transects walks, focus group discussions, photography, and in-depth interviews. Our findings reveal a heightened magnitude of flood related disasters with decreased socio-economic activities, affecting their health and well-being. Also, the community members have a practice of returning to their land, after flood events, as a local mitigating risk management strategy. For multilevel humanitarian responses at the temporary shelter camps, it becomes imperative to meaningfully engage the community members on the challenging risks and vulnerabilities they experience following climate-driven temporary displacement to inform adaptation and resilience research, policy change and advocacy.",book:{id:"7724",title:"Climate Change in Asia and Africa - Examining the Biophysical and Social Consequences, and Society's Responses",coverURL:"https://cdn.intechopen.com/books/images_new/7724.jpg"},signatures:"Akanwa Angela Oyilieze, Ngozi N. Joe-Ikechebelu, Ijeoma N. Okedo-Alex, Kenebechukwu J. Okafor, Fred A. Omoruyi, Jennifer Okeke, Sophia N. Amobi, Angela C. Enweruzor, Chinonye E. Obioma, Princess I. Izunobi, Theresa O. Nwakacha, Chinenye B. Oranu, Nora I. Anazodo, Chiamaka A. Okeke, Uwa-Abasi E. Ugwuoke, Uche M. Umeh, Emmanuel O. Ogbuefi and Sylvia T. Echendu"},{id:"79637",title:"Evaluation of the Spatial Distribution of the Annual Extreme Precipitation Using Kriging and Co-Kriging Methods in Algeria Country",slug:"evaluation-of-the-spatial-distribution-of-the-annual-extreme-precipitation-using-kriging-and-co-krig",totalDownloads:54,totalDimensionsCites:0,doi:"10.5772/intechopen.101563",abstract:"In this chapter, we have conducted a statistical study of the annual extreme precipitation (AMP) for 856 grid cells and during the period of 1979–2012 in Algeria. In the first step, we compared graphically the forecasts of the three parameters of the generalized extreme value (GEV) distribution (location, scale and shape) which are estimated by the Spherical model. We used the Cross validation method to compare the two methods kriging and Co-kriging, based on the based on some statistical indicators such as Mean Errors (ME), Root Mean Square Errors (RMSE) and Squared Deviation Ratio (MSDR). The Kriging forecast error map shows low errors expected near the stations, while co-Kriging gives the lowest errors on average at the national level, which means that the method of co-Kriging is the best. From the results of the return periods, we calculate that after 50 years the estimated of the annual extreme precipitation will exceed the maximum AMP is observed in the 33-year.",book:{id:"7724",title:"Climate Change in Asia and Africa - Examining the Biophysical and Social Consequences, and Society's Responses",coverURL:"https://cdn.intechopen.com/books/images_new/7724.jpg"},signatures:"Hicham Salhi"},{id:"77854",title:"Flooding and Flood Modeling in a Typhoon Belt Environment: The Case of the Philippines",slug:"flooding-and-flood-modeling-in-a-typhoon-belt-environment-the-case-of-the-philippines",totalDownloads:162,totalDimensionsCites:0,doi:"10.5772/intechopen.98738",abstract:"Flooding is a perennial world-wide problem and is a serious hazard in areas where the amount of precipitable water has potential to dump excessive amount of water. The warming of the Earth’s climate due to the increase in greenhouse gases (GHGs) increases the availability of water vapor and hence, of extreme precipitation as observed and forecasted by researchers. With rainfall intensity too high, the torrential rains coupled with weather systems that enhances its effects, flooding not only submerges anything low-lying, it also washes away living and non-living things along the course of the river and the floodplain. The flooding is even worsened by the increase in velocity of flow caused by unsustainable urbanization and denudation of the watershed at the headwaters. Nature’s strength is an order of a magnitude that is way beyond that of the strength of men but human ingenuity enables us to transform our living environment into models that could help us better understand it. Flood modeling provides us decision support tools to deal better with nature. It also enables us to simulate the future especially nowadays that changes in our climate is imminent and even happening already in many parts of the world. Therefore, strategies on how to cope with our ever changing environment is very important particularly to countries that are at more risk to climate change such as the archipelagic Philippines.",book:{id:"7724",title:"Climate Change in Asia and Africa - Examining the Biophysical and Social Consequences, and Society's Responses",coverURL:"https://cdn.intechopen.com/books/images_new/7724.jpg"},signatures:"Fibor J. Tan"},{id:"77797",title:"Adapting to Climatic Extremes through Climate Resilient Industrial Landscapes: Building Capacities in the Southern Indian States of Telangana and Andhra Pradesh",slug:"adapting-to-climatic-extremes-through-climate-resilient-industrial-landscapes-building-capacities-in",totalDownloads:98,totalDimensionsCites:0,doi:"10.5772/intechopen.98732",abstract:"There is now greater confidence and understanding of the consequences of anthropogenic caused climate change. One of the many impacts of climate change, has been the occurrence of extreme climatic events, recent studies indicate that the magnitude, frequency, and intensity of hydro-meteorological events such as heat waves, cyclones, droughts, wildfires, and floods are expected to increase several fold in the coming decades. These climatic extremes are likely to have social, economic, and environmental costs to nations across the globe. There is an urgent need to prepare various stakeholders to these disasters through capacity building and training measures. Here, we present an analysis of the capacity needs assessment of various stakeholders to climate change adaptation in industrial parks in two southern states of India. Adaptation to climate change in industrial areas is an understudied yet highly urgent requirement to build resilience among stakeholders in the Indian subcontinent. The capacity needs assessment was conducted in two stages, participatory rural appraisal (PRA) and focus group discussion (FGD) were conducted among various stakeholders to determine the current capacities for climate change adaptation (CCA) for both, stakeholders and functional groups. Our analysis indicates that in the states of Telangana and Andhra Pradesh, all stakeholder groups require low to high levels of retraining in infrastructure and engineering, planning, and financial aspects related to CCA. Our study broadly supports the need for capacity building and retraining of functionaries at local and state levels in various climate change adaptation measures; likewise industry managers need support to alleviate the impacts of climate change. Specific knowledge, skills, and abilities, with regard to land zoning, storm water management, developing building codes, green financing for CCA, early warning systems for climatic extremes, to name a few are required to enhance and build resilience to climate change in the industrial landscapes of the two states.",book:{id:"7724",title:"Climate Change in Asia and Africa - Examining the Biophysical and Social Consequences, and Society's Responses",coverURL:"https://cdn.intechopen.com/books/images_new/7724.jpg"},signatures:"Narendran Kodandapani"},{id:"77460",title:"Changing Climatic Hazards in the Coast: Risks and Impacts on Satkhira, One of the Most Vulnerable Districts in Bangladesh",slug:"changing-climatic-hazards-in-the-coast-risks-and-impacts-on-satkhira-one-of-the-most-vulnerable-dist",totalDownloads:211,totalDimensionsCites:0,doi:"10.5772/intechopen.98623",abstract:"Changes in the climate due to anthropogenic and natural variation are indicated by parameters including temperature and rainfall. Climate change variability with changing trends of the two have been unpredictable and unprecedented globally leading to changing weather patterns, natural disasters, leading to sectoral impacts on food and water security, livelihood, human health among others. This research analyses the changing patterns of these parameters over the last 35/37 years of Satkhira district of Bangladesh to assess the state and trend across spatial and temporal dimensions. Such, the study validates to rationalize the observed seasonal changes that persist in Satkhira of Bangladesh. Both in terms of intensity and frequency of the occurrences of natural disasters, the series of natural events have been triangulated, with impacts and vulnerability being assessed from temperature variations, erratic rainfall, cyclone, flood and water logging etc. The study’s prime contribution remains in attribution of climate change in relation contextual circumstances in the region including sea level rise, salinity intrusion. Therefore, the risk and climatic hazards and its resulting impacts over time has been assessed to draw deeper connection between theoretical and practical values. The series of analyses also draw conclusion that assets are at risk from changing climatic condition.",book:{id:"7724",title:"Climate Change in Asia and Africa - Examining the Biophysical and Social Consequences, and Society's Responses",coverURL:"https://cdn.intechopen.com/books/images_new/7724.jpg"},signatures:"Md. Golam Rabbani, Md. Nasir Uddin and Sirazoom Munira"},{id:"76915",title:"The Impacts of Climate Change in Lwengo, Uganda",slug:"the-impacts-of-climate-change-in-lwengo-uganda",totalDownloads:101,totalDimensionsCites:0,doi:"10.5772/intechopen.97279",abstract:"Climate Change has become a threat worldwide. Vulnerable communities are at foremost risk of repercussions of climate change. The present study aimed at highlighting a case study of climate change impacts on Lwengo District of Uganda. Out of the total geographical area of the district, 85% hectares are under cultivation and most of its population depends majorly on the rain- fed agriculture sector to meet the food requirement and as a major income source. With the changing climatic conditions, agriculture is the major sector which is being impacted. The region has experienced disasters from some time, usually the second seasons rains used to result in such disasters but since 2016 both seasons have occurred disasters, which majorly include hailstorm, strong wind, long dry spells, pests and diseases. The situation became more severe due to shortage of availability of skilled human resources, quality equipment for disaster management, limited financial resources and weak institutional capacity, which resulted in increasing vulnerability of small farm holders. Some of the adaptation strategies are being taken up by the government but there is a need to understand prospects of decision-making that are site specific and more sustainable for smallholder communities. Climatic changes possess many obstacles to farming communities which require sustainable adaptation to enhance the adaptive capacities of the communities through continued production systems, which are more resilient to the vagaries of weather. 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