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He applied for two patents at the national level.",coeditorOneBiosketch:"Renowned researcher with a focus on developing energy-efficient heat- and/or water-driven temperature and humidity control systems for agricultural storage, greenhouse, agricultural livestock and poultry applications including HVAC, desiccant air-conditioning, adsorption, Maisotsenko cycle (M-cycle), and adsorption desalination.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"338219",title:"Dr.",name:"Fiaz",middleName:null,surname:"Ahmad",slug:"fiaz-ahmad",fullName:"Fiaz Ahmad",profilePictureURL:"https://mts.intechopen.com/storage/users/338219/images/system/338219.jpg",biography:"Fiaz Ahmad obtained his Ph.D. (2015) from Nanjing Agriculture University China in the field of Agricultural Bioenvironmental and Energy Engineering and Postdoc (2020) from Jiangsu University China in the field of Plant protection Engineering. He got the Higher Education Commission, Pakistan Scholarship for Ph.D. studies, and Post-Doctoral Fellowship from Jiangsu Government, China. During postdoctoral studies, he worked on the application of unmanned aerial vehicle sprayers for agrochemical applications to control pests and weeds. He passed the B.S. and M.S. degrees in agricultural engineering from the University of Agriculture Faisalabad, Pakistan in 2007. From 2007 to 2008, he was a Lecturer in the Department of Agricultural Engineering, Bahauddin Zakariya University, Multan-Pakistan. Since 2009, he has been an Assistant Professor in the Department of Agricultural Engineering, BZ University Multan, Pakistan. He is the author of 33 journal articles. He also supervised 6 master students and is currently supervising 5 master and 2 Ph.D. students. In addition, Dr. Ahmad completed three university-funded projects. 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In 2019, he did Postdoc as a Canadian Queen Elizabeth Advanced Scholar at Simon Fraser University (Canada) in the field of Mechatronic Systems Engineering. He received his Master\\'s in Environmental Engineering (2010) and Bachelor in Agricultural Engineering (2008) with distinctions, from the University of Agriculture, Faisalabad. He worked for Kyushu University International Institute for Carbon-Neutral Energy Research (WPI-I2CNER) for two years. Currently, he is working as an Assistant Professor at the Department of Agricultural Engineering, Bahauddin Zakariya University (Pakistan). He has supervised 10+ M.Eng./Ph.D. students so far and 10+ M.Eng./Ph.D. students are currently working under his supervision. He has published more than 70+ journal articles, 70+ conference articles, and a few magazine articles, with the addition of 2 book chapters and 2 edited/co-edited books. 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Most of these adverse events are related to surgery. The incidence of surgical complications has remained largely unchanged during the past two decades. Inherent complexity in surgery, new technology possibilities, increasing age and comorbidity in patients may contribute to this. The incidence of surgery-related adverse events combined with the increasing volume of surgery results in a relevant healthcare problem [1].
In a review of adverse events incidence, preventability, and outcome conducted by deVries and co-workers [2], the median incidence rate of adverse events was 9.2% with a probable preventability of 43.5%. Adverse events that led to permanent disabilities were 7%.
The most common surgical complications are related to surgical techniques, infections, and postoperative bleeding [3, 4]. Equipment-related failures contribute to a significant part of errors in the operating room and it has been observed that the use of checklists reduces equipment errors by 48.6 to 60.7% [5].
One of the first large- scale studies on checklists use in healthcare (the Keystone study) was carried out in Michigan in 108 intensive care units, where Provonost and co-workers introduced a series of interventions, including a checklist to improve communications [6]. The intervention reduced venous catheter-related bloodstream infections from 2.7 to 0 after 18 months. However, these results could not be replicated in a large-scale United Kingdom program, revealing a particular attention to the context and implementation strategies in improvement programs [7].
To improve care and safety for surgical patients, a checklist, similar to those used in aviation, aeronautics and product manufacturing, was developed by the World Health Organization (WHO). The Surgical Safety Checklist (SSC) consists of 19 items and it is used at three critical perioperative moments: induction, incision and before the patient leaves the operating room (Figure 1). The items contain an oral confirmation by the surgical team of the completion of some key steps necessary to ensure safe delivery of anesthesia, antibiotic prophylaxis, effective teamwork and other essential practices in surgery [8, 9].
World Health Organization- Surgical Safety Checklist (2008).
Although several investigators have challenged the efficacy of the SSC, it has shown repeated success in reducing preventable intraoperative and postoperative complications, length of hospital stay and overall mortality [10, 11, 12]. In addition, the investigators have concluded that the implementation of the SSC in multiple institutions has improved communication, efficiency, and attention to routine details in the operating room.
In a systematic review published on 2014 Bergs and co-workers [10] analyzed the results reported in six studies to assess the effectiveness of the WHO SSC. The results of this meta-analysis suggest that the WHO SSC reduced postoperative complications, including mortality. Meta-analysis demonstrated a significant effect of the checklist on any complication, mortality and surgical site infection. It also suggested that sites with adequate compliance with aspects of patient’s care related to the checklist were more likely to demonstrate a significant reduction in postoperative complications. Haynes and colleagues [13] showed that improvements in postoperative outcomes were associated with improved perception of teamwork and safety climate, suggesting that changes in this attitude may be partially responsible for the effect of the checklist. Also the team’s compliance with the checklist is as important as evaluating outcomes.
During the last decades we analyzed the complications occurring in our Spine Surgery Department and reported an overall incidence of complications of 17.3% during three years [14]. Indeed, spinal surgery complications are a relevant and unsolved problem. The incidence of complications in spinal surgery literature ranges between 7% and 20% [15, 16, 17, 18, 19, 20, 21, 22].
Nasser et al. [17] performed a systematic evidence-based review of 105 published studies (84 retrospective, 21 prospective) and found a higher incidence of complications (19.9%) in prospective studies compared with retrospective studies (16.1%). The incidence of complications varied widely in spinal surgery literature, even in prospective studies. Rampersaud et al. [23] reported an overall incidence of intraoperative adverse events of 14% (98 adverse events in 700 patients), but only 23 adverse events led to postoperative clinical sequelae. Yadla et al. [16] reported a very high rate of early complications, occurring within 30 days of surgery: global incidence of 53.2%, with a minor complication incidence of 46.4% and a major complication incidence of 21.3%.
It has been also observed that there is no standard definition of complications in spinal surgery literature [23], so it is difficult to compare studies. The Clavien-Dindo and SAVES capture and grading systems [24, 25, 26] divide the surgical complications into levels of severity based on the grade of treatment required to face the complication. Glassman et al. classified complications as major or minor: significant complications requiring reoperation or leading to permanent deficit were considered major complications. Other perioperative adverse events with time-limited effect were considered minor complications [27].
To date, few studies have evaluated the effect of complications on clinical outcomes [27, 28, 29]. Glassman et al. analyzed a prospective multicenter database for adult spinal deformity to investigate the effects of major and minor complications on disability, pain, postoperative quality of life at 1 year follow up and found that major complications negatively affected the quality of life [27]. However, Fritzell et al. found no significant differences of effects of major and minor complications on 2-years outcomes in three different types of fusion surgery [28]. Grainger et al. examined the relationship between severity of complications and outcomes following Clavien-Dindo classification of complications, and found that the severity of perioperative surgical complications does not appear to influence 1- or 2-years pain and disability outcomes [29]. Lambat et al. performed a large retrospective study and observed that ODI (Oswestry Disability Index) at 2- years follow up was not statistically different between patients having no complications, minor complications or major complications. However, the minimum clinically important difference (MCID) for ODI resulted significantly smaller in the major complication group (31%) than in the minor complication (51%) and no complication groups (65%), demonstrating an impact of complications on the functional outcome [20].
Chen et al. [30] recently performed a 10-week prospective study where SAVES V2 and OrthoSAVES capture systems were used by six orthopedic surgeons and two independent, non-MD clinical reviewers to record adverse events after all elective procedures. They compared the complications rate among groups of patients undergoing spine, hip, knee and shoulder surgery. The first relevant result of this study was the highest rate of complications in spinal surgery compared to the other surgeries; but the most important observation of this study was that overall 99 adverse events were captured by the reviewers, compared with 14 events captured by the surgeons. Surgeons adequately captured major adverse events, but failed to record minor events that were captured by the reviewers; in the spinal surgery group, reviewers captured 45 adverse events versus 8 events captured by surgeons [30].
Considering the high incidence of complications in spinal surgery and their relevant impact for the patients and the health system, during the last years several authors focused their attention on the risk factors related to the onset of complications and on predictive models of complications after spinal surgery [31, 32, 33, 34, 35].
Moreover, several preventive measures have been studied and recently described in order to reduce complications in spinal surgery, concerning intraoperative neuromonitoring, blood loss reduction, infections and thrombosis prophylaxis [36, 37, 38, 39, 40]. Sethi and co-workers [41] described the application of Lean methodology in spinal surgery. Lean methodology was developed in the manufacturing industry to increase output and decrease costs and then applied in many areas of health care. The authors illustrated a step-by-step process designed specifically to optimize and standardize preoperative, intraoperative and postoperative care for patients undergoing complex spine surgery and they reported a significant reduction of overall complication rate [41].
We proposed to analyze the impact of the introduction of the WHO Surgical Safety Checklist in our Spine Surgery Department, as preventive measure to reduce complications [14].
We retrospectively evaluated the clinical and radiological charts prospectively collected from 917 patients who underwent a spinal surgery procedure from January 2010 to December 2012. The aim of this study was to compare the incidence of complications between two periods, from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist) in order to assess the checklist’s effectiveness.
We found no correlation between diagnosis and overall complications’ incidence. We found a rate of early complications (arising within 1 month after surgery) of 43.3%, a rate of complications requiring surgical revision of 7.6% and a rate of neurological sequelae causing permanent damage of 2.4%. These types of complications have a relevant impact on the health system and, especially the last two categories, on the patients’ quality of life and clinical outcomes.
We observed a reduction of the overall incidence of complications following the introduction of the WHO Safety Surgical Checklist: in 2010 without the use of the checklist, the incidence of complications was 24.2%, while in 2011 and 2012 following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%).
Despite some limitations of our study, the WHO Surgical Safety Checklist resulted to be effective in reducing complications in our Centre.
We recent analyzed also the rate of re-admission and re-operation following spinal surgery. A systematic review [42] of the data concerning the “thirty-day readmission” in spinal surgery indicated percentages between 4.2% and 7.5%, with a variability associated to the presence of one or more centers in which the study takes place and to the type of vertebral pathologies treated. This high frequency is associated with a significant impact from a social and economic point of view, which primarily affects the patient and the National Health System. The most common cause of re-admission was wound complication (39.3%), even if a pooled analysis of risk factors and causes of re-admission was limited by the lack of reporting in spine literature.
Re-admission is very often associated with a re-intervention, or a re-intervention can also occur within the same hospitalization. Our Center treats a wide variety of spinal diseases of oncological, degenerative, traumatic and infectious origin. Therefore we proposed to analyze the rate of re-intervention and surgical revision in the treatment of these pathologies and the causes of these re-operations.
From January 2017 to December 2019, 1260 surgeries were performed at our Spine Surgery Department. Among these, two patients underwent 5 operations, four patients underwent 4 operations, twenty patients underwent 3 operations, 124 patients underwent 2 operations, for a total of 150 patients who underwent more than one spine surgery in a period of three years in the same center (10.7%).
We are now analyzing the causes of these re-operations, which can be a relapse of the disease in the case of oncological pathologies or, for all diagnosis, they can be complications occurring during the follow up period.
A surgical revision is a particularly relevant aspect in assessing the degree of severity of a complication, due to the impact on patient’s recovery, and it is relevant also for the economic impact on the National Health System.
We think that a checklist system should be introduced also during the pre-operative and post-operative phases, in order to highlight all the key steps where complications can arise, not only during surgery. The introduction and validation of these checklists, implemented for pre-operative, intra-operative and post-operative phases, should be followed by the identification of targeted actions to prevent complications, improve patients’ safety and reduce the economic impact.
Following the WHO Surgical Safety Checklist, a checklist for the complex process of ward round (WR) was developed by Caldwell et al. in 2011 [43] and it has been recently implemented and evaluated through different studies. The prime objective of ward round is to assess the clinical state of the inpatient and plan further management. For WR assessment it is fundamental the gathering of new information and reviewing of information already available. Additional information are provided by verbal communication with the patient and the family, nursing staff, medical colleagues, patient examination, clinical charts, pathology and radiological investigations. Such assessment allows a rational approach to further management including the alteration of therapy, arranging further investigations or surgery, referral to other specialists, planning the discharge. In a busy surgical ward round there is the potential to overlook important aspects of care, their documentation and communication. So the use of a checklist during medical ward round has been described by Caldwell [43] with consideration of key aspects of care being bedside consultation, patient safety, chart review, planning and appropriate documentation. Pitcher et al. [44] implemented and evaluated the WR checklist: they identified the deficiencies in general surgical WRs and the benefits of a checklist approach in overcoming this. Initially, members of the surgical team were unaware of the checklist and some deficiencies were detected. Subsequently, the team was prompted against the checklist and during the ward rounds a designated member of the team acted as ‘prompter’ if aspects of care were not considered according to the checklist. A structured ward round progress form was developed and it was assessed before and after specific education in its use. This form was based on the original checklist and became an integral part of the medical record. Following the use of the checklist and prompting during ward rounds, a significant improvement occurred for the majority of criteria included in the checklist, all of which reached statistical significance. The introduction of the structured progress form, even with prompting, did not initially improve documentation but this was substantially improved with specific education. The authors concluded that the use of a checklist during surgical ward rounds improved consideration of most key aspects of care and education in the completion of a structured progress form substantially improved documentation. A randomized controlled trial of the impact of surgical WR checklist conducted in a simulated environment showed improved standardization, evidence-based management of post-operative complications and quality of ward round [45].
A WR checklist was introduced also on orthopedic ward round and evaluated by a prospective cohort study [46]. The authors observed that after introduction of the checklist, daily documentation of surgical details improved from 38.6% to 85.3% of patient encounters. Fasting status documentation improved from 9.1% to 70.6% of patient encounters. Venous thromboembolism prophylaxis documentation increased from 6.8% to 92.6%. Documentation of weight-bearing status improved from 11.4% to 83.8%. Thus, the use of a structured checklist during orthopedic ward rounds led to significant improvement in both the consideration and the documentation of key aspects of surgical care.
These findings were recently confirmed by Krishnamohan and co-workers [47] who implemented and assessed a surgical WR checklist for daily surgical ward rounds. The authors observed that the overall documentation of the six parameters analyzed improved following implementation of the WR checklist (from 26% pre-checklist to 79% post-checklist). In particular, documentation of assessment of fluid balance improved from 8–76%. The key parameters analyzed were: VTE prescribed, Antibiotics reviewed, Fluid balance reviewed, Blood tests reviewed, Patient observations, Drug chart. These selected parameters were identified as often overlooked or inadequately reviewed during surgical WR. The checklist helped bring focus to these aspects of care and the number of adverse events reported decreased following WR checklist implementation. Subsequent audit at 3 months post-checklist implementation maintained improvement with documentation at 72%. The authors concluded that the WR checklist benefits patient safety. It improves communication, documentation and ensure that key issues are not missed at patient assessment on WRs.
The data reported underline the relevance of checklist systems to improve patients’ safety and clinical outcomes. Effects on morbidity and mortality after introduction of safety checklists have been investigated in several studies [10, 48, 49, 50, 51]. Systematic reviews find evidence in favor of checklist use having effects on patient outcomes such as reduced complications [10, 49, 50], wound infections [50] blood loss [50] and mortality rates [49, 50]. Checklist use suggested improved outcomes in high-risk pediatric surgery in developing countries [51].
Their use also contributes to improved information transfer and communication in different phases of surgery [52]. Very few studies report any negative patient outcome effects when using checklists [53], but implementation requires time and effort [2] because a “culture of safety” is required. Still, some studies report no reduction of complications or mortality [54, 55]. A more recent publication reported a lowered mortality rate but no changes in complication rates [56]. Russ et al. [57] observed that the quality of operating room teamwork and communication was improved due to more sharing of case critical information, better decision-making and team coordination, openness about knowledge gaps, and improved team cohesion. In a climate of greater safety for the patient and improved outcome, the use of checklists should influence the operating room (or ward round) work processes so as to have an impact on patient outcome and in this context the teamwork is crucial.
During the last decade, teamwork has been addressed as interprofessional practice or collaboration and described by attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration are considered as a strategy for effective organization of health care services because the complexity of healthcare requires integration of knowledge and practices from different professional groups. Health organizations in western countries are committed to improving patient safety through education of staff and teamwork education programs, including the use of checklists and other tools dedicated to improving clinical outcomes.
The authors thank Carlo Piovani for his helpful collaboration.
The authors declare no conflict of interest.
The research was partially funded by the grant “Ricerca Finalizzata 2016” from the Italian Ministry of Health.
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\\n\\n2.4 The Corresponding Author (on their own behalf and on behalf of each Co-Author) will not assert any rights under the Copyright, Designs and Patents Act 1988 to object to derogatory treatment of the Chapter as a consequence of IntechOpen's changes to the Chapter arising from translation of it, corrections and edits for house style, removal of problematic material and other reasonable edits.
\\n\\n3. CORRESPONDING AUTHOR'S DUTIES
\\n\\n3.1 When distributing or re-publishing the Chapter, the Corresponding Author agrees to credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen. The Corresponding Author warrants that each Co-Author will also credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen, when they are distributing or re-publishing the Chapter.
\\n\\n3.2 When submitting the Chapter, the Corresponding Author agrees to:
\\n\\nThe Corresponding Author will be held responsible for the payment of the Open Access Publishing Fees.
\\n\\nAll payments shall be due 30 days from the date of the issued invoice. The Corresponding Author or the payer on the Corresponding Author's and Co-Authors' behalf will bear all banking and similar charges incurred.
\\n\\n3.3 The Corresponding Author shall obtain in writing all consents necessary for the reproduction of any material in which a third-party right exists, including quotations, photographs and illustrations, in all editions of the Chapter worldwide for the full term of the above licenses, and shall provide to IntechOpen upon request the original copies of such consents for inspection (at IntechOpen's option) or photocopies of such consents.
\\n\\nThe Corresponding Author shall obtain written informed consent for publication from people who might recognize themselves or be identified by others (e.g. from case reports or photographs).
\\n\\n3.4 The Corresponding Author and any Co-Author shall respect confidentiality rights during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Corresponding Author and any Co-Author are confidential and are intended only for the recipient. The contents may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
\\n\\n4. CORRESPONDING AUTHOR'S WARRANTY
\\n\\n4.1 The Corresponding Author represents and warrants that the Chapter does not and will not breach any applicable law or the rights of any third party and, specifically, that the Chapter contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy. The Corresponding Author warrants and represents that: (i) the Chapter is the original work of themselves and any Co-Author and is not copied wholly or substantially from any other work or material or any other source; (ii) the Chapter has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) they themselves and any Co-Author are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) they themselves and any Co-Author have not assigned and will not during the term of this Publication Agreement purport to assign any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\\n\\nThe Corresponding Author also warrants and represents that: (i) they have the full power to enter into this Publication Agreement on their own behalf and on behalf of each Co-Author; and (ii) they have the necessary rights and/or title in and to the Chapter to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licenses expressed to be granted in this Publication Agreement. If the Chapter was prepared jointly by the Corresponding Author and any Co-Author, the Corresponding Author warrants and represents that: (i) each Co-Author agrees to the submission, license and publication of the Chapter on the terms of this Publication Agreement; and (ii) they have the authority to enter into this Publication Agreement on behalf of and bind each Co-Author. The Corresponding Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each such Co-Author.
\\n\\nThe Corresponding Author agrees to indemnify and hold IntechOpen harmless against all liabilities, costs, expenses, damages and losses and all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of or in connection with any breach of the aforementioned representations and warranties. This indemnity shall not cover IntechOpen to the extent that a claim under it results from IntechOpen's negligence or willful misconduct.
\\n\\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\\n\\n5. TERMINATION
\\n\\n5.1 IntechOpen has a right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Corresponding Author or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Corresponding Author or any Co-Author (being an individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Corresponding Author or any Co-Author (being a company) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for or enters into any compromise or arrangement with any of its creditors.
\\n\\nIn case of termination, IntechOpen will notify the Corresponding Author, in writing, of the decision.
\\n\\n6. INTECHOPEN’S DUTIES AND RIGHTS
\\n\\n6.1 Unless prevented from doing so by events outside its reasonable control, IntechOpen, in its discretion, agrees to publish the Chapter attributing it to the Corresponding Author and any Co-Author.
\\n\\n6.2 IntechOpen has the right to use the Corresponding Author’s and any Co-Author’s names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Chapter and has the right to contact the Corresponding Author and any Co-Author until the Chapter is publicly available on any platform owned and/or operated by IntechOpen.
\\n\\n6.3 IntechOpen is granted the authority to enforce the rights from this Publication Agreement, on behalf of the Corresponding Author and any Co-Author, against third parties (for example in cases of plagiarism or copyright infringements). In respect of any such infringement or suspected infringement of the copyright in the Chapter, IntechOpen shall have absolute discretion in addressing any such infringement which is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\\n\\n7. MISCELLANEOUS
\\n\\n7.1 Further Assurance: The Corresponding Author shall and will ensure that any relevant third party (including any Co-Author) shall, execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\\n\\n7.2 Third Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\\n\\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\\n\\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\\n\\n7.5 Variation: No variation of this Publication Agreement shall be effective unless it is in writing and signed by the parties (or their duly authorized representatives).
\\n\\n7.6 Severance: If any provision or part-provision of this Publication Agreement is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted.
\\n\\nAny modification to or deletion of a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\\n\\n7.7 No partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Corresponding Author or any Co-Author, nor authorize any party to make or enter into any commitments for or on behalf of any other party.
\\n\\n7.8 Governing law: This Publication Agreement and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with it or its subject matter or formation shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of or in connection with this Publication Agreement (including any non-contractual disputes or claims).
\\n\\nLast updated: 2020-11-27
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The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
\n\n1. DEFINITIONS
\n\nCorresponding Author: The Author of the Chapter who serves as a Signatory to this Agreement. The Corresponding Author acts on behalf of any other Co-Author.
\n\nCo-Author: All other Authors of the Chapter besides the Corresponding Author.
\n\nIntechOpen: IntechOpen Ltd., the Publisher of the Book.
\n\nBook: The publication as a collection of chapters compiled by IntechOpen including the Chapter. Chapter: The original literary work created by Corresponding Author and any Co-Author that is the subject of this Agreement.
\n\n2. CORRESPONDING AUTHOR'S GRANT OF RIGHTS
\n\n2.1 Subject to the following Article, the Corresponding Author grants and shall ensure that each Co-Author grants, to IntechOpen, during the full term of copyright and any extensions or renewals of that term the following:
\n\nThe aforementioned licenses shall survive the expiry or termination of this Agreement for any reason.
\n\n2.2 The Corresponding Author (on their own behalf and on behalf of any Co-Author) reserves the following rights to the Chapter but agrees not to exercise them in such a way as to adversely affect IntechOpen's ability to utilize the full benefit of this Publication Agreement: (i) reprographic rights worldwide, other than those which subsist in the typographical arrangement of the Chapter as published by IntechOpen; and (ii) public lending rights arising under the Public Lending Right Act 1979, as amended from time to time, and any similar rights arising in any part of the world.
\n\nThe Corresponding Author confirms that they (and any Co-Author) are and will remain a member of any applicable licensing and collecting society and any successor to that body responsible for administering royalties for the reprographic reproduction of copyright works.
\n\nSubject to the license granted above, copyright in the Chapter and all versions of it created during IntechOpen's editing process (including the published version) is retained by the Corresponding Author and any Co-Author.
\n\nSubject to the license granted above, the Corresponding Author and any Co-Author retains patent, trademark and other intellectual property rights to the Chapter.
\n\n2.3 All rights granted to IntechOpen in this Article are assignable, sublicensable or otherwise transferrable to third parties without the Corresponding Author's or any Co-Author’s specific approval.
\n\n2.4 The Corresponding Author (on their own behalf and on behalf of each Co-Author) will not assert any rights under the Copyright, Designs and Patents Act 1988 to object to derogatory treatment of the Chapter as a consequence of IntechOpen's changes to the Chapter arising from translation of it, corrections and edits for house style, removal of problematic material and other reasonable edits.
\n\n3. CORRESPONDING AUTHOR'S DUTIES
\n\n3.1 When distributing or re-publishing the Chapter, the Corresponding Author agrees to credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen. The Corresponding Author warrants that each Co-Author will also credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen, when they are distributing or re-publishing the Chapter.
\n\n3.2 When submitting the Chapter, the Corresponding Author agrees to:
\n\nThe Corresponding Author will be held responsible for the payment of the Open Access Publishing Fees.
\n\nAll payments shall be due 30 days from the date of the issued invoice. The Corresponding Author or the payer on the Corresponding Author's and Co-Authors' behalf will bear all banking and similar charges incurred.
\n\n3.3 The Corresponding Author shall obtain in writing all consents necessary for the reproduction of any material in which a third-party right exists, including quotations, photographs and illustrations, in all editions of the Chapter worldwide for the full term of the above licenses, and shall provide to IntechOpen upon request the original copies of such consents for inspection (at IntechOpen's option) or photocopies of such consents.
\n\nThe Corresponding Author shall obtain written informed consent for publication from people who might recognize themselves or be identified by others (e.g. from case reports or photographs).
\n\n3.4 The Corresponding Author and any Co-Author shall respect confidentiality rights during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Corresponding Author and any Co-Author are confidential and are intended only for the recipient. The contents may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
\n\n4. CORRESPONDING AUTHOR'S WARRANTY
\n\n4.1 The Corresponding Author represents and warrants that the Chapter does not and will not breach any applicable law or the rights of any third party and, specifically, that the Chapter contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy. The Corresponding Author warrants and represents that: (i) the Chapter is the original work of themselves and any Co-Author and is not copied wholly or substantially from any other work or material or any other source; (ii) the Chapter has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) they themselves and any Co-Author are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) they themselves and any Co-Author have not assigned and will not during the term of this Publication Agreement purport to assign any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\n\nThe Corresponding Author also warrants and represents that: (i) they have the full power to enter into this Publication Agreement on their own behalf and on behalf of each Co-Author; and (ii) they have the necessary rights and/or title in and to the Chapter to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licenses expressed to be granted in this Publication Agreement. If the Chapter was prepared jointly by the Corresponding Author and any Co-Author, the Corresponding Author warrants and represents that: (i) each Co-Author agrees to the submission, license and publication of the Chapter on the terms of this Publication Agreement; and (ii) they have the authority to enter into this Publication Agreement on behalf of and bind each Co-Author. The Corresponding Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each such Co-Author.
\n\nThe Corresponding Author agrees to indemnify and hold IntechOpen harmless against all liabilities, costs, expenses, damages and losses and all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of or in connection with any breach of the aforementioned representations and warranties. This indemnity shall not cover IntechOpen to the extent that a claim under it results from IntechOpen's negligence or willful misconduct.
\n\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\n\n5. TERMINATION
\n\n5.1 IntechOpen has a right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Corresponding Author or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Corresponding Author or any Co-Author (being an individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Corresponding Author or any Co-Author (being a company) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for or enters into any compromise or arrangement with any of its creditors.
\n\nIn case of termination, IntechOpen will notify the Corresponding Author, in writing, of the decision.
\n\n6. INTECHOPEN’S DUTIES AND RIGHTS
\n\n6.1 Unless prevented from doing so by events outside its reasonable control, IntechOpen, in its discretion, agrees to publish the Chapter attributing it to the Corresponding Author and any Co-Author.
\n\n6.2 IntechOpen has the right to use the Corresponding Author’s and any Co-Author’s names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Chapter and has the right to contact the Corresponding Author and any Co-Author until the Chapter is publicly available on any platform owned and/or operated by IntechOpen.
\n\n6.3 IntechOpen is granted the authority to enforce the rights from this Publication Agreement, on behalf of the Corresponding Author and any Co-Author, against third parties (for example in cases of plagiarism or copyright infringements). In respect of any such infringement or suspected infringement of the copyright in the Chapter, IntechOpen shall have absolute discretion in addressing any such infringement which is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\n\n7. MISCELLANEOUS
\n\n7.1 Further Assurance: The Corresponding Author shall and will ensure that any relevant third party (including any Co-Author) shall, execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\n\n7.2 Third Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\n\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\n\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\n\n7.5 Variation: No variation of this Publication Agreement shall be effective unless it is in writing and signed by the parties (or their duly authorized representatives).
\n\n7.6 Severance: If any provision or part-provision of this Publication Agreement is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted.
\n\nAny modification to or deletion of a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\n\n7.7 No partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Corresponding Author or any Co-Author, nor authorize any party to make or enter into any commitments for or on behalf of any other party.
\n\n7.8 Governing law: This Publication Agreement and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with it or its subject matter or formation shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of or in connection with this Publication Agreement (including any non-contractual disputes or claims).
\n\nLast updated: 2020-11-27
\n\n\n\n
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I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). 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