",isbn:"978-1-80356-303-9",printIsbn:"978-1-80356-302-2",pdfIsbn:"978-1-80356-304-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"dd28db91ac081287c5204f82e219d67e",bookSignature:"Prof. Xiaoyan Dong and Prof. Nanbert Zhong",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11722.jpg",keywords:"Asthma, Th1/Th2 Balance, Airway Inflammation, miRNA, lncRNA, Cytokines, Signaling Pathways, Steroid Resistance, Severe Asthma, Therapeutic Targets, Biomarker, Bacterial",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 15th 2022",dateEndSecondStepPublish:"April 19th 2022",dateEndThirdStepPublish:"June 18th 2022",dateEndFourthStepPublish:"September 6th 2022",dateEndFifthStepPublish:"November 5th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"a month",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Dong is a medical doctor director of respiratory in the Shanghai children's hospital. She has served as the pediatric branch of Chinese medical association respiratory group members, pediatric respiratory group of chronic cough in children's lung function, as well as China's maternal and child health association, deputy director of children's allergy branch committee member, breathing group leader.",coeditorOneBiosketch:"Dr. Zhong is the Founder Director of Peking University Center of Medical Genetics as well as the Founder Chairman of Dept. Medical Genetics of Peking University Health Science Center. His research studies have been founded by the NIH (USA), March of Dimes Foundation (USA), Batten Disease Support and Research Association (USA), New York State Research Foundation for Mental Hygiene (USA), Chinese Ministry of Science and Technology, Chinese Ministry of Education, Chinese Natural Science Foundation, and Shangha",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"344976",title:"Prof.",name:"Xiaoyan",middleName:null,surname:"Dong",slug:"xiaoyan-dong",fullName:"Xiaoyan Dong",profilePictureURL:"https://mts.intechopen.com/storage/users/344976/images/system/344976.jpg",biography:"A medical doctor, graduate student tutor, the Shanghai children's hospital, director of respiratory, graduated from Shanghai second medical university, served as the member of Chinese Medical Association, pediatric respiratory group, the member of a collaborative group of Chinese children chronic cough, the member of the collaborative group of lung function of children, and the member of the Professional Committee of Shanghai antibiotics,vice director of shanghai the collaborative group of lung function of children, the younger member of shanghai allergy group. as well as the members of China's maternal and child health association, deputy director of children's allergy branch committee member, leader of the respiratory group.",institutionString:"Shanghai Children's Hospital",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Shanghai Children's Hospital",institutionURL:null,country:{name:"China"}}}],coeditorOne:{id:"191541",title:"Prof.",name:"Nanbert",middleName:null,surname:"Zhong",slug:"nanbert-zhong",fullName:"Nanbert Zhong",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"As a tenured faculty member, I am currently directing the Molecular Neurogenetic Diagnostic Laboratory and Heading the Developmental Genetics Laboratory at the New York State Institute for Basic Research in Developmental Disabilities. I am also the Founder Director of Peking University Center of Medical Genetics as well as the Founder Chairman of Dept. Medical Genetics of Peking University Health Science Center. I have a broad research interest in perinatal health, including maternal-fetal medicine with a focus on prematurity, children development, mental retardation, and developmental disabilities, and birth defects with a focus on brain developmental-relevant disorders. I have published 140+ articles in peer-reviewed journals, including Lancet, Nature Genetics, American Journal of Human Genetics, American Journal of Medical Genetics, Clinical Genetics, Human Genetics, Genetics in Medicine, Journal of Medical Genetics, Neurogenetics, Molecular Genetics, and Metabolism, Advanced Genetics, Genetic Testing, Neurology, Neurological Science, Biochimica et Biophysica Acta - Proteins & Proteomics, Biochemical and Biophysical Research Communications, Behavior and Brain Function, Encyclopedia, J Community Genetics, J Chromatogr B, J Mol Neurosci, BMC Preg Childbirth, and Epidemiology and Infection, etc. I have been the peer reviewer for the American Journal of Human Genetics, American Journal of Medical Genetics, Clinical Genetics, Nucleic Acid Research, Human Biology, FEBS Lett, Biochimica et Biophysica Acta, Encyclopedia of Medical Genomics and Proteomics, Genet Testing, Mol Biol Report, African J. Pathology, Fertility and Sterility, BMC Public Health, Clinical and Experimental Dermatology, PLoS One, Reproductive BioMedicine (Online) and Reproductive Biology. My research studies have been founded by the NIH (USA), March of Dimes Foundation (USA), Batten Disease Support and Research Association (USA), New York State Research Foundation for Mental Hygiene (USA), Chinese Ministry of Science and Technology (Oversea Chinese Outstanding Young Investigator Award, and 973 High Tech project), Chinese Ministry of Education (211, 985 Projects), Chinese Natural Science Foundation, and Shanghai Municipal Government. My current research is focusing on the genetic and genomic study of prematurity including preterm birth and stillbirth, as well as the outcome of pregnancy, with an integrated “-omics” approach. I am also exploring rational strategies for the prevention and intervention of preterm birth with a longitudinal approach. 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1. Introduction
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Cluster headache (CH) is characterized by severe strictly unilateral headaches lasting 15–180 minutes, and accompanied by autonomic signs (rhinorrhea, lacrimation, and conjunctival injection). CH appears most commonly in its episodic form (pain bouts occurring from once every day to eight times a day, with pain periods lasting about 1–2 months). The chronic form of CH (CCH) is instead characterized by pain attacks which recur over >1 year without remission periods or with remission periods lasting <1 month [1]. Some patients affected from the chronic form become drug-resistant, with subsequent severe disability in activity of daily life. In the past, different ablative surgical procedures have been employed, but with overall poor results due to the high incidence of adverse events [2]. For more than a decade, deep brain stimulation of the posterior hypothalamic region (pHyp) has been employed to treat such patients at several centers, with encouraging results [3]. In the past years, however, a less invasive procedure, occipital nerve stimulation (ONS), has been effective as well [4–7]. Such procedure is now currently proposed as first-line surgical treatment, before the employment of deep brain stimulation (DBS). At present, no prospective randomized controlled trial is available for either procedure, although one such study is ongoing at present with regard to ONS [8]. It is thus not possible at the moment to draw any certain conclusion about the predictive factors which could influence the outcome in both procedures, but results available to date are encouraging. Correct selection criteria, however, appear of utmost importance to maximize results.
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1.1. Occipital nerve stimulation
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The rationale for the employment of electrical current applied to the great occipital nerve to treat headache relies on the evidence of convergence of trigeminal and cervical afferents on second-order neurons located on the so-called trigeminocervical complex (neural columns extending from the trigeminal nucleus caudalis to the C2 spinal segment) [9]; furthermore, steroids injected into the suboccipital region were able to improve some types of headaches, including CH [10]. Several reports suggest that ONS is an effective procedure for drug-resistant chronic CH patients [4–7]. We began to use this surgical procedure in 2004 at our Institution, proposing it before the more invasive DBS.
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2. Materials and methods
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Inclusion criteria for ONS at our Institution were drug-resistant CCH, that is daily or almost daily attacks in the past year and resistance to all known prophylactic drugs for such condition, including verapamil, lithium carbonate, methysergide, valproate, topiramate, gabapentin, melatonin, pizotifen, indomethacin, and others including sphenopalatine ganglion blockade [11, 12]. Long-term steroid cycles were also used in all patients at the expense of development of well-known related side effects (arterial hypertension, peptic ulcers, bone fractures, weight increase, insomnia, psychosis, glaucoma, and skin eruptions). Although we think successful occipital nerve blockade was one of the factors which initially encouraged the use of the procedure in CH, it was not used as a selection criterion at our center (and the same applies to external ONS trial) due to the uncertainty with regard to its predictive positive effect.
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Twenty-eight patients satisfied the criteria underwent ONS system implantation at our Institute from March 2004 to February 2013. They included 23 men and 5 women. The mean age at operation was 43 years, the mean duration of chronic CH was 6.6 years (range: 1–27), and the mean number of attacks per day was 5.4 (range: 2–10) (Table 1). All patients had normal neurological examination and normal cerebral MRI; psychiatric and psychological evaluations were negative in all cases. The five women included were not pregnant. All patients gave written informed consent to the procedure.
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Table 1.
Clinical and outcome features in ONS patients
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The first five implanted patients received ONS for less than 6 months with poor results, so we decided to offer them hypothalamic stimulation; at that time, it was shown that in neurovascular headaches ONS was only effective at short-term follow-up [13]. These five patients are not considered in the analysis.
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3. Surgery
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The ONS surgical procedure varies from center to center. We here describe the procedure employed at our Institution, taking into account the validity and safety of other methodologies. Ours has also been described in a previous report [14]. The patient is placed in a prone position, and the Mayfield head holder system is used to fix the head. Bony prominences must be padded to prevent postoperative lesions of nondependent skin and nerves. The head is positioned in line with the neck and posterior thoracic region and chest to avoid skin creases and curvatures, which could be cumbersome and lengthen the procedure. The Mayfield head holder is positioned in the parietal region bilaterally so as not to interfere with the leads’ positioning. We always perform bilateral ONS to anticipate eventual side shift of symptomatology. Quadripolar bilateral electrodes or one longer octopolar electrode is employed. A vertical skin incision is made in the posterior cervical region in the midline from 1 cm above to 1 cm below the external occipital protuberance (EOP). The greater occipital nerve (GON) is usually present about 4 cm lateral to the midline turning in a slight mediolateral direction before dividing into a medial and a lateral branch about 1 cm above the EOP (Figure 1). Two symmetric vertical incisions are then made 7 cm lateral to the EOP bilaterally. The cervical fascia located superficial to the trapezius and splenius capitis muscles is exposed after blunt dissection of subcutaneous tissue in the region.
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Figure 1.
Preoperative GON localization.
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A Tuohy needle is then inserted from each lateral incision to the midline incision, allowing the insertion of the electrode after the removal of the stylet. The wires connected to the electrodes are then tunneled together in a caudal direction along the occipital and neck midline until about the middle dorsal level.
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We do not use anchorage devices but in the cervical region we fix both electrodes to the underlying fascia with nonresorbable stitches to prevent their caudal dislodgement; and relief loops are made at both this site and at more subcutaneous caudal sites during tunneling passages to prevent excessive discomfort to the patient, and possible leads’ fracture. For the same purpose (avoid excessive strain on the system), we use 95 cm length connection wires. We create a little subcutaneous pocket at the level of the connectors (whenever present) between main leads and connection cables to avoid possible skin erosions underlying them. Another incision is made in the midline at the lumbar level and, at this point, the two connection cables diverge on each side to the site of the subcutaneous pockets where internal pulse generators (IPGs) will be located.
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One or two IPGs (Soletra, Medtronic, Libra, St Jude, Activa PC, Medtronic, Libra xp, St Jude) can be used. Of course, we leave the connection cables and the IPGs in site, when it becomes necessary to convert ONS into hypothalamic deep brain stimulation. Subcutaneous pockets for IPGs are made approximately 4 cm above the iliac crest at the level of the external oblique muscle, paying attention not to jeopardize the latter muscle and not to cause excessive bleeding and postoperative pain.
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In the postoperative period, all patients underwent plain cranial radiographies to verify the adequate leads’ positioning, and IPGs were switched on, progressively increasing voltage or current intensity until adequate paresthesia coverage was reached in the somatic GON territory.
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4. Results
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Following implant, we turned on IPGs after a median of 3.3 days (range: 0–14 days) because of the lack of attacks in such postoperative period. Stimulation was started once attacks reappeared and improvement occurred after a median of 6.7 weeks (range: 1–37 weeks; Table 1).
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All patients perceived paresthesias in somatic areas innervated by the occipital nerve. Stimulation parameters were set according to the patient’s tolerability. When induced perceived paresthesia became unbearable for the patient at some time after activation the amplitude was reduced accordingly. No specific stimulation pattern was found to be predictive of long-term efficacy; in fact, many stimulation adjustments were necessary to achieve optimal results.
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After a median follow-up of 5.2 years (range: 2.8–10), 15 (65%) patients had ≥50% reduction in headache number per day (responders). Eleven (47%) responders have a stable condition with only sporadic attacks; in three other patients, chronic CH turned into episodic CH; the remaining responder had a 60% reduction in headache number per day (Table 1).
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Eight (34.7%) patients were nonresponders. Five of these showed a ≥50% reduction in headache number per day in the first months after implant: in four patients the initial improvement lasted up to 12 months after ONS; in the remaining patient such improvement lasted 48 months.
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After ONS 15 (65%) patients stopped steroidal treatment while the remaining eight received short-term steroid courses. All patients needed to maintain prophylactic treatment for CH.
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5. Discussion
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As stated above, at long follow-up examinations, our results show that ONS is able to produce long-lasting improvement in a large number of patients (65%); more importantly, in 47% of patients a stable condition with sporadic attacks is reported.
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It is well known that a placebo effect cannot be excluded in CH patients [15], and it is not possible to rule out that the improvement observed is part of the natural course of the disease; furthermore, for long-term observational purposes, blinding in such cases is not possible because paresthesias are necessary to achieve positive results. Anyway, two elements point to a real effectiveness of ONS: the long-term follow-up of the present series (and of other series reported in literature) and the relapse of symptoms at battery’s exhaustion.
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Several studies report different long-term outcomes. In the study of Magis et al. [5] of 2011, responders’ rate was as high as 78.6% (11 of 14 patients) after a mean follow-up of 36.8 months. The same author recently published a very long term follow-up extension of such study including 10 patients [7]; of these, four (40%) evolved to an episodic form and six (60%) remained chronic but with a reduction of about 70%. Fontaine et al. [6] reported a responders’ rate of 76.9% (11 of 13 patients) after a mean follow-up of 14.6 months and Muller et al. [4] reported a responders’ rate of 90% (9 of 10 patients) after a mean follow-up of 12 months. A lower percentage of responders, 35.7% (5 of 14 patients), after a median follow-up of 17. 5 months has been reported in another study [16]. Such differences in outcome could most probably reflect differences in follow-up lengths (given the substantial standardization of the procedure). Note that in our study five patients became resistant after several months of improvement; one patient became resistant to ONS after a 4-year improvement. Our experience thus witnesses the possibility of developing tolerance to ONS, but unfortunately we did not find any significant factor which could be considered a reliable predictor of tolerance or unresponsiveness.
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All the patients considered responders in our series could stop steroid therapy and only one third of them needed steroids for short periods. It is worth noticing that the daily Sumatriptan injection consumption was markedly reduced after ONS. It is well known that the prolonged use of these drugs can lead to life-threatening side effects, and in fact this is actually considered among selection criteria for ONS in drug-resistant chronic CH patients.
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Empty batteries were the most common AE (adverse event) (and it is in the existent literature). This is due to the high voltage or current intensity necessary to obtain satisfactory results; anyway, in long-term responders, we have begun to implant rechargeable IPGs in such patients.
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The exact mechanisms underlying the beneficial effects of ONS in drCCH patients are still under investigation; the co-presence of trigeminal and cervical somatic input to second-order neurons located in the so-called trigeminocervical complex, extending from the trigeminal nucleus caudalis to the C2 cervical nuclear complex, could explain the role of modulating the myelomere C2 in the beneficial effect of ONS [17]; Magis et al. [18] in 2011 investigated the FDG-PET modifications in 10 patients submitted to ONS after a minimum of 6-month follow-up. In CCH patients at baseline (compared to healthy subjects), hypermetabolism was noticed in the ipsilateral hypothalamus, midbrain, and ipsilateral lower pons. In all patients, this picture normalized after ONS, and the hypothalamus was the only exception. It was also noticed that the metabolism of perigenual anterior cingulate cortex (PACC) was hyperactive in ONS responders compared to nonresponders. The authors thus hypothesized the pure symptomatic role of ONS in CCH patients (given the lack of changes in the hypothalamus), a slow neuromodulatory role of ONS on the “pain neuromatrix” (also involving the pACC), and, as such, a specific analgesic effect acting at central dysfunctional pain control centers.
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6. pHyp DBS
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Two main original observations initially led to the identification of the posterior hypothalamus as having a pivotal role in the genesis of cluster headache: its activation, as revealed in brain PET studies, during CH attacks [19], and the evidence of an increased neuronal density at this site measured with voxel-based MRI morphometry [20]. Furthermore, CH attacks often recur following a certain circadian rhythm and cluster periods occur circannually. So, it was initially hypothesized that hypothalamic “biologic clocks” may be involved in the pathogenesis of CH [21]. The aim of the stereotactic procedure (pHyp DBS) performed at our Institute was thus to inhibit the posterior hypothalamic neuronal pools, thought to be responsible (when hyperactive) for the disease. Several institutional experiences have been reported since our initial observations, and overall results are encouraging. To date, pHyp DBS is offered to patients not responding to ONS, since the first obviously constitutes a more risky and invasive surgical procedure.
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7. Materials and methods
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Selection criteria for pHyp DBS are quite uniform among all centers employing such technique; at our Institution, we use the following criteria: (1) the presence of diagnostic criteria for CCH according to the International Headache Society [1]; (2) inadequate relief from prophylactic therapy, including verapamil, lithium, sodium valproate, methysergide, topiramate, gabapentin, nonsteroidal anti-inflammatory drugs such as indomethacin, and corticosteroids; (3) CCH lasting at least 2 years; (4) unsatisfactory relief from abortive therapy, including oxygen, Sumatriptan, and opioids; and (5) failure of occipital nerve stimulation therapy for at least 1 year.
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At our Institution, 19 patients satisfying such criteria (15 men; mean age at surgery: 42 years; mean duration of CCH: 3 years) underwent pHyp DBS. Psychiatric and neuropsychological examinations were normal in all of them. All patients gave written informed consent for the procedure.
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8. Surgery
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Brain MRI images, obtained preoperatively, were transferred to the operating room workstation (StealthStation; Medtronic Sofamor Danek, Memphis, TN). After positioning of the stereotactic frame around the patient’s head, computed tomographic (CT) scans were taken. MRI and CT images were then merged using the Framelink 4.0 software (Medtronic). From the resulting three-dimensional reconstruction, the exact position of the anterior commissure-posterior commissure line and the coordinates of the target were derived. pHyp region’s coordinates were 3 mm behind the midcommissural point (Y), 5 mm below the midcommissural point (Z) , and 2 mm lateral to the midline. A 7 mm hand-driven burr hole is then made at 3 cm lateral to the scalp midline and about 2 cm anterior to the coronal suture; after coagulation of the dura mater a rigid cannula is inserted to within 10 mm of the target; the quadripolar electrode was then inserted to the target. We usually perform intraoperative stimulation (beginning at 60 μs, 180 Hz, up to 7 V) to verify tolerability and side effects. Amplitudes above 4 V usually produced ipsilateral eye version with consequent diplopia. Throughout the procedure, pupils, heart rate, blood pressure, electroencephalogram, body temperature, and respiratory function were monitored. Cerebral CT was performed immediately after implant; MRI was performed within 48 hours after surgery and merged with postoperative CT scan to accurately verify the position of electrode’s contacts (Figures 2 and 3). Postoperatively, patients were left without active stimulation till insurgence of CH attacks; they were not provided prophylactic medication in the meantime.
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Figure 2.
Postoperative MRI showing bilateral pHyp electrodes’ tips localization in a CCH patient.
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Hospitalization lasted about 10–20 days in order to allow for monitoring of CH attacks, blood pressure, heart rate and function, temperature, sleep-wake cycle, body weight, electrolyte balance, and hormone levels. These variables were checked at regular intervals after discharge.
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Patients also kept a diary reporting headache attacks, drug use, and adverse events. Parameters’ settings (in particular amplitude and current intensity) were then programmed taking into account the minimum level providing efficacy or the maximum level tolerated.
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Figure 3.
Upper: our institutional localization system applied to posterior hypothalamic region. Lower: Postoperative MRI-CT merged image showing the localization of bilateral posterior hypothalamic electrodes.
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9. Results
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Outcomes relating to our series and related details can be more systematically found by Leone [21] (Table 2). Briefly, the median follow-up was 8.7 years; one of our patients died of septic shock caused by Legionella infection. He was, however, free of CH bouts. Due to the infection, the entire DBS system was removed from another patient. In the remaining 17 patients, 6 (35%) subsequently had fewer than one attack every 3 months; in 5 of them, the IPG had been off (unactivated) for a median of 3 years, after a median of 6.4 years of active stimulation with continuous improvement. Another 6 patients (35%) did not experience daily attacks, instead suffering from attacks lasting from 2 to 5 months, followed by remission lasting from 5 to 10 months.
\n
Five of 17 patients (30%) were not responders despite experiencing daily CH attacks after an initial improvement period. After DBS implantation, patients remained unstimulated for a median of two days (range: 0–12 days), given the lack of pain bouts in this period. Stimulation was initiated once pain attacks reappeared; improvement occurred 2–16 weeks later. As for ONS, several parameter adjustments were necessary to optimize clinical results.
\n
Table 2.
Clinical and outcome fatures in DBS patients.
\n
\n
\n
10. Discussion
\n
Our experience has shown that hypothalamic stimulation produces long-lasting improvement in a high proportion of patients (70%). Stimulation seems to be tolerated for years after implantation. It is worth noticing that in some patients, after several years of stimulation, a persistent, almost pain-free, condition could be maintained in off stimulation conditions. Bilateral chronic CH seems to predict poor response to hypothalamic stimulation. After a median of almost 9 years (range: 6–12 years), 70% of our patients were improved: six patients (35%) were in a persistent almost pain-free state, and in six patients (35%), CCH condition turned into episodic CH. In most patients, prophylactic drugs were required to maintain improvement, whereas they were ineffective before surgery. High-dose steroids led to some relief, although accompanied by adverse effects. The 12 improved patients discontinued steroid therapy. When the stimulator was switched off (condition blinded to the patient), the crises returned and the same thing occurred when the stimulator batteries ran down. After IPGs replacement, these patients improved again. Worsening of attacks also occurred after electrode displacement in two patients. Taking into account these findings, a placebo effect seems unlikely. So far, over 50 chronic drug-resistant CH patients are documented to have received hypothalamic stimulation; marked improvements have occurred in 50–100% of cases (with a median follow-up of 15.8 months) (range: 12–33 months) [22–25].
\n
It is noteworthy that in five of six of our persistently almost pain-free patients, this state is now maintained even though the stimulator has been off for several years. It should thus be proposed that after a long period of stimulation (median 6.4 years), in long-term responsive patients turning off stimulation should be tried. In five cases, headache frequency did not worsen. Such patients could tolerate a low-frequency attack (which was much better than the previous situation of intractable attacks several times daily), which also responded promptly to Sumatriptan injection.
\n
This was not the case in the early years after implantation, when in all cases attacks reappeared when the stimulator was turned off. In six patients, the condition reverted to episodic CH but the patient needed to continue stimulation. The outcomes in these two subgroups suggest that years of continuous hypothalamic stimulation can change the course of the illness. Five of our patients (30%) were not responders. Patients without response to hypothalamic stimulation have been reported by other authors [22–25], but no reliable predictive factor is available so far. Four (80%) of our unsuccessful cases had bilateral CH, and three developed tolerance to hypothalamic stimulation after 1–2 years of improvement.
\n
These observations suggest that bilateral CH predicts poor response to hypothalamic stimulation. As far as coordinates are concerned, Seijo et al. [26] modified them to avoid the lateral ventricle wall, also extending the stimulated brain area to the lateral hypothalamus implicated in pain modulation. The good results in this small series are encouraging, but longer follow-up is required. Our experience is that small changes in contacts and electrode position do not have influence on therapeutic response.
\n
\n
\n
11. Conclusions
\n
ONS and pHyp DBS should be proposed to drug-refractory CCH patients according to the above-mentioned criteria; a randomized trial is actually ongoing to determine the effectiveness of ONS in such patients [8], but, to date, no prospective and randomized trial is available for both procedures to determine eventual positive or negative predictive factors in the outcome of the disease; thus, our observations could be still considered useful until new findings will come.
\n
The role of a pure symptomatic role of ONS seems to be a likely observation, whereas long-term effectiveness of pHyp DBS, especially considering patients with positive results despite off-stimulation condition, suggests a possible role in plastic neuronal changes induced by such procedure. Prospective and randomized studies are, of course, necessary, to date, to clarify the issue of nonresponder patients, thus refining the selection criteria and improving outcome in more carefully selected drug-resistant CCH patients.
\n
\n\n',keywords:"cluster headache, occipital nerve stimulation, deep brain stimulation, hypothalamus",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/51756.pdf",chapterXML:"https://mts.intechopen.com/source/xml/51756.xml",downloadPdfUrl:"/chapter/pdf-download/51756",previewPdfUrl:"/chapter/pdf-preview/51756",totalDownloads:1406,totalViews:148,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,impactScore:0,impactScorePercentile:9,impactScoreQuartile:1,hasAltmetrics:0,dateSubmitted:"December 16th 2015",dateReviewed:"June 2nd 2016",datePrePublished:null,datePublished:"September 28th 2016",dateFinished:"July 22nd 2016",readingETA:"0",abstract:"Research focus: Chronic cluster headache (CCH) is a pathological entity leading to a severe degree of disability. It is characterized by pain attacks occurring daily or spaced out by remission periods of <1 month, contrarily to the episodic form. When the condition results to be refractory to conservative treatments (both prophylactic and abortive treatments) and when such condition is present for at least 2 years, surgical treatment is suggested.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/51756",risUrl:"/chapter/ris/51756",book:{id:"5234",slug:"from-bench-to-bedside-trauma-tumors-spine-functional-neurosurgery"},signatures:"Giuseppe Messina, Angelo Franzini, Alberto Proietti Cecchini and\nMassimo Leone",authors:[{id:"36275",title:"Dr.",name:"Giuseppe",middleName:null,surname:"Messina",fullName:"Giuseppe Messina",slug:"giuseppe-messina",email:"giusmex@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"184085",title:"Dr.",name:"Massimo",middleName:null,surname:"Leone",fullName:"Massimo Leone",slug:"massimo-leone",email:"massimo.leone@istituto-besta.it",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"184086",title:"Dr.",name:"Angelo",middleName:null,surname:"Franzini",fullName:"Angelo Franzini",slug:"angelo-franzini",email:"angelo@angelofranzini.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"184087",title:"Dr.",name:"Alberto",middleName:null,surname:"Proietti Cecchini",fullName:"Alberto Proietti Cecchini",slug:"alberto-proietti-cecchini",email:"Alberto.Proietti@istituto-besta.it",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1. Occipital nerve stimulation",level:"2"},{id:"sec_3",title:"2. Materials and methods",level:"1"},{id:"sec_4",title:"3. Surgery",level:"1"},{id:"sec_5",title:"4. Results",level:"1"},{id:"sec_6",title:"5. Discussion",level:"1"},{id:"sec_7",title:"6. pHyp DBS",level:"1"},{id:"sec_8",title:"7. Materials and methods",level:"1"},{id:"sec_9",title:"8. Surgery",level:"1"},{id:"sec_10",title:"9. Results",level:"1"},{id:"sec_11",title:"10. Discussion",level:"1"},{id:"sec_12",title:"11. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'\nHeadache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004; 24 (Supplement 1): 1–160.\n'},{id:"B2",body:'\nO’Brien M, Kirpatrick PJ, MacCabe JJ. Trigeminal nerve section for chronic migraine neuralgia. In: Cluster Headache and Related Conditions. Olesen J, Goadsby PJ (Eds.) Oxford University Press, Oxford, UK, 1999; 291–295.\n'},{id:"B3",body:'\nFranzini A, Messina G, Cordella R, Marras C, Broggi G. Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. Neurosurg Focus 2010; 29(2): E13.\n'},{id:"B4",body:'\nMueller OM, Gaul C, Katsarava Z, Diener HC, Sure U, Gasser T. Occipital nerve stimulation for the treatment of chronic cluster headache—lessons learned from 18 months experience. Cent Eur Neurosurg 2011; 72(2): 84–89.\n'},{id:"B5",body:'\nMagis D, Gerardy PY, Remacle JM, Schoenen J. Sustained effectiveness of occipital nerve stimulation in drug-resistant chronic cluster headache. Headache 2011; 51(8): 1191–1201.\n'},{id:"B6",body:'\nFontaine D, Christophe Sol J, Raoul S, Fabre N, Geraud G, Magne C, Sakarovitch C, Lanteri-Minet M. Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation. Cephalalgia 2011; 31(10): 1101–1105.\n'},{id:"B7",body:'\nMagis D, Gérard P, Schoenen J. Invasive occipital nerve stimulation for refractory chronic cluster headache: what evolution at long-term? Strengths and weaknesses of the method. J Headache Pain 2016; 17(1): 8.\n'},{id:"B8",body:'\nWilbrink LA, Teernstra OP, Haan J, van Zwet EW, Evers SM, Spincemaille GH, Veltink PH, Mulleners W, Brand R, Huygen FJ, Jensen RH, Paemeleire K, Goadsby PJ, Visser-Vandewalle V, Ferrari MD. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study: rationale and protocol of a randomised trial. . Cephalalgia 2013; 33(15): 1238–1247.\n'},{id:"B9",body:'\nPiovesan EJ, Kowacs PA, Oshinsky ML. Convergence of cervical and trigeminal sensory afferents. Curr Pain Headache Rep 2003; 7(5): 377–383.\n'},{id:"B10",body:'\nAmbrosini A, Vandenheede M, Rossi P, Aloj F, Sauli E, Pierelli F, Schoenen J. Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 2005; 118(1–2): 92–96.\n'},{id:"B11",body:'\nLeone M, May A, Franzini A, Broggi G, Dodick D, Rapoport A, Goadsby PJ, Schoenen J, Bonavita V, Bussone G. Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection. Cephalalgia 2004; 24 (11): 934–937.\n'},{id:"B12",body:'\nMay A, Leone M, Áfra J, Frese A, Linde M, Sándor PS, Evers S, Goadsby PJ. EFNS guideline on the treatment of cluster headache and other trigemino-autonomic cephalgias. Eur J Neurol 2006; 13: 1066–1077.\n'},{id:"B13",body:'\nMatharu MS, Bartsch T, Ward N, Frackowiak RS, Weiner R, Goadsby PJ. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 2004; 127(Pt 1): 220–230.\n'},{id:"B14",body:'\nFranzini A, Messina G, Leone M, Broggi G. Occipital nerve stimulation (ONS). Surgical technique and prevention of late electrode migration. Acta Neurochir (Wien) 2009; 151(7): 861–865.\n'},{id:"B15",body:'\nLaw S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database Syst Rev 2014; (4): CD008042.\n'},{id:"B16",body:'\nBurns B, Watkins L, Goadsby PJ. Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients. Neurology 2009; 72(4): 341–345.\n'},{id:"B17",body:'\nLe Doare K, Akerman S, Holland PR, Lasalandra MP, Bergerot A, Classey JD, Knight YE, Goadsby PJ. Occipital afferent activation of second order neurons in the trigeminocervical complex in rat. Neurosci Lett 2006, 403: 73–77.\n'},{id:"B18",body:'\nMagis D, Bruno MA, Fumal A, Gérardy PY, Hustinx R, Laureys S, Schoenen J. Central modulation in cluster headache patients treated with occipital nerve stimulation: an FDG-PET study. BMC Neurol 2011; 11: 25.\n'},{id:"B19",body:'\nMay A, Bahra A, Büchel C, Frackowiak RS, Goadsby PJ. Hypothalamic activation in cluster headache attacks. Lancet 1998; 352(9124): 275–278.\n'},{id:"B20",body:'\nMay A, Ashburner J, Büchel C, McGonigle DJ, Friston KJ, Frackowiak RS, Goadsby PJ. Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 1999; 5(7): 836–838.\n'},{id:"B21",body:'\nLeone M, Proietti Cecchini A. Deep brain stimulation in headache. Cephalalgia 2015-in press.\n'},{id:"B22",body:'\nLeone M, Franzini A, Broggi G, Bussone G. Hypothalamic stimulation for intractable cluster headache: long-term experience. Neurology 2006; 67: 150–152.\n'},{id:"B23",body:'\nBartsch T, Pinsker MO, Rasche D, Kinfe T, Hertel F, Diener HC, Tronnier V, Mehdorn HM, Volkmann J, Deuschl G, Krauss JK. Hypothalamic deep brain stimulation for cluster headache—experience from a new multicase series. Cephalalgia 2008; 28: 285–295.\n'},{id:"B24",body:'\nFontaine D, Lazorthes Y, Mertens P, Blond S, Géraud G, Fabre N, Navez M, Lucas C, Dubois F, Gonfrier S, Paquis P, Lantéri-Minet M. Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo controlled double-blind trial followed by a 1-year open extension. J Headache Pain 2010; 11: 23–31.\n'},{id:"B25",body:'\nSchoenen J, Di Clemente L, Vandenheede M, Fumal A, De Pasqua V, Mouchamps M, Remacle JM, de Noordhout AM. Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action. Brain 2005; 128: 940–947.\n'},{id:"B26",body:'\nSeijo F, Saiz A, Lozano B, Santamarta E, Alvarez-Vega M, Seijo E, Fernández de León R, Fernández-González F, Pascual J. Neuromodulation of the posterolateral hypothalamus for the treatment of chronic refractory cluster headache: experience in five patients with a modified anatomical target. Cephalalgia 2011; 31: 1634–1641.\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Giuseppe Messina",address:"giusmex@gmail.com",affiliation:'
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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1. Introduction
The direct piezoelectric effect creates an electric polarization on a continuum medium due to applied stress. The polarization can be macroscopic (effect over continuum medium) and nanoscopic and microscopy scales (effect over atoms, molecules, and electrical domains). Once the Curie brothers discovered the piezoelectric effect in 1880 [1], piezoelectricity investigations led to more data and constructed models based on crystallography to explain the electricity generation since electro-optics and thermodynamic. Voigt in 1894 proposed a piezoelectric parameter related to the strain of material; since the thermodynamic theory, he constructed a non-linear model and expressed the free energy of a piezoelectric crystal in terms of the electric field, strain, electric and elastic deformation potentials, temperature, pyroelectric and piezoelectric parameters [2]. Currently, we can see these constants in the constitutive equations of piezoelectricity. During 1956 and 1963, Toupin and Eringen used a variational formulation to construct a functional in terms of internal energy and derive the constitutive equations [3, 4]. Then, in 1971 Tiersten proposed to use the conservation equations of mass, electrical charge, linear momentum, angular momentum, and energy, adding a Legendre transformation to include a thermodynamic functional in terms of the free energy, achieving a reduction of the number of constitutive equations from 7 to 4 to facilitate theoretical calculations [5]. These constitutional equations and their linear approach gave support to the theoretical calculus of piezoelectric parameters of crystalline structures, e.g., zinc-blende [6, 7], zinc oxide [8, 9], and other crystals with similar symmetric of quartz [10, 11]. Finally, between 1991 and 2017, Yang has proposed modifications for the Legendre transformation of Tiersten, and he has included two models to describe the polarization in a deformable continuum medium [12, 13].
According to electrostatic theory, the macroscopic polarization P→ can be written in terms of electric charge distribution likewise with the electric field E→ induced into the continuum medium. Besides, the polarization starts with continuum medium deformation S→ for applied stress. Considering: (i) Uniqueness for the parameters that relate the polarization and the electric field, (ii) Stress produces equal deformations in each cell of crystal, (iii) The deformations lead dipole and quadrupole moments affecting the piezoelectric parameters directly. Based on the above considerations, the linear constitutive equations of piezoelectricity can be written, as Martin said [6].
This chapter book is thought to be a working example that connects the piezoelectricity theory and experimental data of electromechanical and electrical properties. These data were obtained on cement paste mixed with gold nanoparticles.
2. Constitutional equations in detail and correlation with the piezoelectricity of cement-based composites
In this section, we have selected Yang’s differential approach to obtain the constitutional equations of piezoelectricity. The differential derivation shows the physics involved in the conservation laws differently. For example, it shows that the electric body couple and the Cauchy stress tensor are asymmetric. Also, it relates the local electric field with the electric interaction between the differential elements of the lattice continuum and the electronic continuum.
2.1 Conservation laws applied to a polarized continuum from differential approximation
Regarding the study of the piezoelectric properties of cement paste, it is necessary to describe the material separately as two continua medium, as from the piezoelectric phenomenon, the crystal and their symmetry would have a lattice (positive charge) and an electronic component (negative charge) Those continua can be separated by mechanical stress. Their physical properties could change according to the coordinate systems or states. Therefore, the body will study in two states (reference state and current state), as is shown in Figure 1.
Figure 1.
States of a deformable and polarizable continuum.
2.1.1 Electric charge conservation
The conservation electric charge in the body takes importance with an infinitesimal displacement on the medium’s current state to get polarization. For this reason, the phenomenon described in the above state is known as the two continuum medium model. The electronic continuum comes under an infinitesimal displacement η respect to the lattice. It is produced by body deformation, as described in Figure 2. From the assumption of the lattice and electronic continuum, the medium have equal volumes, some variation of infinitesimal displacement respect coordinates in the current state should be zero and can be written as
Figure 2.
Volume elements of electronic and lattice continuum medium.
ηk,k=∂ηky∂yk=0E1
Furthermore, if it is taken the two continuous mediums, the electric charge density must be neutral to consider only the piezoelectric effect.
μly→+μey→+η→=0E2
We can show that the gradient of infinitesimal displacement Eq. (1) and the neutrality condition of electric charge density Eq. (2) are sufficient to explain the polarization in a deformable continuum
P→=μly→−η→y→=μey→+η→η→≈μey→η→E3
2.1.2 Energy conservation
Once the body is deformed, electronic and lattice continua electric charges apply a quasi-static electric field. Tiersten et al. called it Maxwelliam electric field Ek. It is interacting on two continuum mediums producing an electrical force on each one. The other forces acting on the body are traction and body forces. The traction force tk per unit, the area is working on the surfaces of volume elements of the lattice (see Figure 2). Also, it can be written in terms of Cauchy stress tensor τjk as tk=njτjk, where nj is the normal vector. Moreover, body force refers to an external force acting on the body, for example, gravity. The previous three forces are necessary to get the conservation laws, including energy.
From the three forces above, it is possible to construct the Eqs. (4) and (5), linear and angular momentum conservation, respectively.
ρu̇k=fkE+τmk,m+ρfkE4
ciE+εijkτjky→=0E5
where fkE is the electric force on the body and start from the dot product of polarization Pj with the electric field gradient Ek,i; Besides, ciE is called electric coupling, and it is the cross product of Pj with Ek; finally, fk is the external force on the body per unit mass.
Then, replacing the electric coupling ciE by the cross product between Pj and Ek, we can rewrite Eq. (5) as follow
εijkPjEky→+εijkτjky→=0E6
Factoring the permutation tensor εijk
εijkPjEk+τjk=0E7
The term in square brackets from Eq. (7) is a symmetry tensor that can be written as
τSjk=PjEk+τjkE8
The term PjEk is called the Maxwell stress tensor TEjk. On the other hand, multiplying Eq. (5) by εiqr is obtain
From Eq. (9) we can conclude that the Cauchy stress tensor (tk=njτjk) is asymmetry. Now, we get the total energy inside the continuum medium as a combination of kinetic and internal energy εin [13], both per mass unit. Here is performed the powers added due to the three forces above.
The following steps from Eq. (10) conduct to develop conservation energy law. In the first step, we work on the total energy term. Then, the product rule to the total energy term is applied:
The second-order term ηiη̇k=ηiη̇i=12ddtηi2≈0 is zero, taking into account the infinitesimal displacement. Then, factorize Eky→uky→dv in Eq. (15), it takes a form:
In Eq. (18), the term μey→+η→Eky→η̇k is called the electric power of the body wE And the term PiEk,i is the electric force between the lattice and electronic volume elements. It was defined in Eq. (4) above.
Now, we apply Taylor’s expansion to Cauchy stress tensor τ1k and velocity uk. Next, the last result will be implemented in the components: two τ2k and three τ3k
From Eq. (28), the term in the square bracket is null by Eq. (4). Then, we obtain Eq. (29) for energy conservation that depends on internal energy.
ρε̇in=wE+τmky→uk,my→E29
Remember from Eq. (19) that electric power can be written as:
wE=μey→+η→Emy→dηmdt=Emy→ddtμey→+η→ηm−dμey→+η→dtηm
wE=Emy→Ṗm−μ̇ey→+η→ηmE30
Another form of electric charge conservation is μ̇ey→+η→+μey→+η→ui,i=0, it will simplify the Eq. (30) to:
wE=Emy→Ṗm+μey→+η→ui,iηmE31
The mass conservation ρ̇+ρui,i=0 has a similar mathematical structure as charge conservation. Therefore, the gradient of the speed ui,i in Eq. (31) was replaced
With Legendre transformation showing in Eq. (34), Tiersten replaced the internal energy εin by free energy χ [5]. This transformation diminishes the number of constitutional equations. Besides, it offers a quantitative interpretation that can not get from the internal energy resulting in more useful for those who perform piezoelectricity experiments. After Section 2.3, we could see the χ will depend on the gradient of potential in the reference state and deformation tensor.
χ=εin−EmPmρE34
Upon differentiating respect to time the Eq. (34).
The similar terms EmṖm and −Emρ̇Pmρ in Eq. (37), are clear. Finally, we have rewritten energy conservation in terms of free energy, electrical (electric field and polarization vector), and mechanical (Cauchy stress tensor) components, as is shown in Eq. (38).
ρχ̇=τmky→uk,my→−ĖmPmE38
2.2 Transformation of fundamental physical quantities in piezoelectricity to the reference state
There are several reasons to consider two coordinate systems (reference and current state) for continuum. Firstly, it is not mathematically simple to describe the movement of each particle that compounds a continuum as seen on the gradient of velocity uk,m in Eq. (38); it is more appropriate to propose a coordinate system that describes the continuum in the reference system. The material behavior could be affected by the characteristics of the current state, too. For example, fluids and solids can change their mechanical behavior while changing the shape [14]. Hence, we refer to our study material (cement-based composites) whom we know the physical properties in the reference state XL. To explain the behavior of a material, we must include physical quantities respect the reference state XL: potential gradient WK, polarization PL, electric displacement DL, volume free charge density ρE, mass density ρ0 and the second Piola-Kirchhoff stress TSKL [15]. It raises by the transformation of symmetric tensor τSmk in the current state to reference state, and relate the traction force with areas, both in the reference state. While the first Piola-Kirchhoff stress is connecting the traction force and electric force in the current state with regions in the reference state.
This section will describe the transformation of energy conservation from the current state to the reference state, using Eq. (8), the symmetric tensor modifies Eq. (38).
ρχ̇=τSmkuk,m−PmEkuk,m−ĖmPmE39
2.2.1 Electric field and gradient of potential
To transform the electric field to a reference state, here will use follow:
WK=Emym,KE40
The gradient of the potential WK is multiplying both sides by XK,m
WKXK,m=Emym,KXK,m=Em∂ym∂XK∂XK∂ymE41
Therefore,
Em=WKXK,mE42
The derivative respect to time of Em becomes
Ėm=ddtWKXK,m=ddtWKXK,m+WKddtXK,mE43
The term XK,m from Eq. (43) is developed as follow
With m=k the term 12ym,Kyk,L−δKL is known as the finite strain tensor EKL in the reference state, and Ę whit an uppercase index will represent the electric field vector in the reference state. Then, we reduce ym,Kyk,Ldmk to:
Multiplying both sides into Eq. (68) by the Jacobian gives
Jρχ̇=JJ−1TSKLĖKL−PKẆKE69
Using mass transformation to the reference state ρ0=ρJ into Eq. (69), we get a new equation for energy conservation in terms of physical quantities in the reference state. Symmetric tensor TSKL, strain tensor EKL, polarization PK and gradient of potential WK.
ρ0χ̇=TSKLĖKL−PKẆKE70
2.3 Constitutional equations from free energy
The conservation laws are valid for any piezoelectric material, including cement-based composites. However, a specific material’s piezoelectric properties are determined by a set of functions that describes free energy, symmetric tensor, and polarization. Once we replace these functions into Eq. (70), we will get the piezoelectricity’s constitutional equations. Take into account Eq. (70), we can propose the next dependence to the functions
χ=χEKLWKTSKL=TSKLEKLWKPK=PKEKLWKE71
Derivation respect to time the free energy into Eq. (71) as follow
Both sides of Eq. (73) were compared to deduce two transformations, which resulting symmetric tensor TSKL and polarization PK. The transformations use free energy as a generating function, as shown in Eq. (75).
TSKL=ρ0∂χ∂EKLE74
PK=−ρ0∂χ∂WKE75
The mathematical structure of the free energy function will define the order of constitutional equations. There are functions for the free energy of piezoelectric materials from order 1 to order 3 [15]. It means that piezoelectric material behavior depends on the free energy function and its parameters. Here is an example of free energy function with order three
The parameters are called elasticity c, piezoelectric e, electric permeability χE, odd electrolytic d, electrostrictive b, and electroelastic force even a.
2.3.1 The linear approach of piezoelectricity
We take on order one approach from Eq. (76) to free energy χ. Then, replacing it in Eq. (74) and Eq. (75) to obtain
TSAB=∂∂EAB12cABCDEABECD−eABCWAEBC−12χEABWAWBE77
PA=−∂∂WA12cABCDEABECD−eABCWAEBC−12χEABWAWBE78
The approximation is possible if we consider an infinitesimal deformation, weak electric field, and low amplitude displacements around the reference state. Hence, it approaches require a nomenclature exchange for physical quantities. Thus, second Piola-Kirchhoff stress will be replaced by infinitesimal Cauchy stress tensor TSKL→Tij; finite strain tensor will be exchanged by infinitesimal strain tensor EKL→Skl; potential gradient, polarization, and displacement electric vector are similar either reference or current state: WK→Ek, PL→Pi, and DL→Di. Then, Eqs. (77) and (78) follow:
Tij=∂∂Sij12cijklSijSkl−eijkEiSjk−12χEijEiEjE79
Pi=−∂∂Ei12cijklSijSkl−eijkEiSjk−12χEijEiEjE80
Here is considering symmetry to parameters elastic cijkl, piezoelectric ekij, and electric χik when they have odd permutations. Differentiating the Eq. (79) and Eq. (80), we obtain
Tij=cijklSkl−ekijEkE81
Pi=eiklSkl+χEikEkE82
The polarization can be written in terms of electric displacement vector too.
where the term ε0δik+χEik is defined as dielectric constant εik. Finally, we have the linear constitutional equation for the electric displacement vector.
Di=eiklSkl+εikEkE87
We have seen several forms to present the linear constitutional equations in piezoelectricity. Next, we include another form of constitutional equations shown in the IEEE standard for piezoelectricity. It can be obtained inverting the matrix formed by Eq. (81) and Eq. (82).
Di=diklSkl+εikTEkE88
Sij=sijklDTkl+gkijDkE89
The electromechanical properties are defined by piezoelectric charge dikl and voltage gkij constants. Unlike parameters cijkl and eikl These new piezoelectric constants are taken out directly from experiments, as shown in the next section.
2.4 Electromechanical and electrical properties of cement-based composites
Incorporating piezoelectric nanocomposites into cement paste improves its piezoelectric and mechanical properties [16] due to increased deformable crystal structures. Zeolites, oxides, and carbon nanotubes are the most used cement-based composites to improve these properties [17]. Chen et al. also report some piezoelectric parameters of cement-based composites such as piezoelectric charge d33, voltage g33. And the coupling factor Kt. As was mentioned in the previous section, these piezoelectric parameters come from linear piezoelectricity theory. However, the crystalline structure of Calcium Silicate Hydrate (C-S-H) that compose the cement is a complex system described by linear theory. It could also be combined with statistical physics and mean-field homogenization theory tools to get the macroscale properties [18]. Here are show piezoelectric and electrical parameters of gold nanoparticles mixed to cement paste, which we hope to lead to our system’s constitutional equations.
Next, we introduce a brief description of the gold nanoparticles’ physical synthesis [19, 20]. They are produced by laser ablation at 532 nm. A gold plate at 99.9999% purity is put inside a beaker filled with 50 mL of ultrapure water. Then, the pulse laser spot with an energy of 30 mJ beats the gold plate by 10 minutes, as shown in Figure 3.
Figure 3.
Scheme of nanoparticle physical synthesis by laser ablation.
At the time, the gold nanoparticles were brought to be characterized by dynamical light scattering (DLS). If not done quickly, the gold nanoparticles were agglomerated. These measures are required because the gold nanoparticles directly affect the piezoelectric properties of cement cylinders. Some results of gold nanoparticle sizes are shown in Figure 4.
Figure 4.
The particle size distribution of gold nanoparticles suspended in water to concentration 442 ppm.
Also, the gold nanoparticles in water must be mixed quickly with the cement. The ratio of water/cement used was 0.47 mL/g. Then, the admixture was poured into cylindrical molds that contained copper wires as follows in Figure 5.
Figure 5.
Molds and dimensions of cement cylinders.
The cement cylinders were dried one day. Then it leaves curing for 28 days and finally to thermal treatment one day more. After 14 days, electromechanical measurements were performed, as shown in Figure 6.
Figure 6.
Experimental setup of electromechanical measurements.
Electromechanical measurements consist of two measurements performed in parallel: the cement cylinders under compressive strength test in the axial direction, open circuit potential (OCP) measurements in the electrodes of cement cylinders. From mechanical and electrical data, we calculated an electroelastic parameter with units mV/kN, it has the same interpretation of piezoelectric parameter e in linear theory. From Figure 7, an example of voltage-force curves for identically cement samples with gold nanoparticles is shown. We did get from the above measurements the axial elasticity parameter:
Figure 7.
OCP-force curves from cement cylinders with gold nanoparticles concentrated to 658 ppm.
Y=323.5±75.3kN/m2E90
The axial piezoelectric parameter:
γ=−20.5±6.9mV/kN.E91
For a total deformation S=0.57±0.09mm in the axial direction.
The electrical properties of cement cylinders were obtained from the imaginary part of impedance; an example of these curves in Figure 8. From impedance data can perform a transformation to get a real part of the capacitance C′. It has frequency dependence as follow
Figure 8.
The imaginary part of electrical impedance represented in a Bode plot was performed on two cement cylinders with gold nanoparticles concentrated to 658 ppm.
C′ω=1ωZ′′E92
The geometry of copper electrodes (an approximation to parallel plates) is related to capacitance. Therefore, we can calculate the dielectric parameter ε since 1 MHz; this parameter is a real number that depends on the frequency and is given by
εωε0=d∗C′AE93
where ε0 is the electric permittivity of free space, A is the transversal section, and d is the thickness between electrodes.
Where ε0 has unit F/m. The piezoelectric and electrical properties of cement paste mixed with gold nanoparticles exhibit reproducibility and linearity of the piezoelectric parameter.
2.5 Future studies and remarks
The Piezoelectric parameters are an initial point to beginning a new connection with piezoelectricity theory by inverse modeling and constructing new free energy functions and constitutional equations. To catch out with researchers in this scope, we suggest thinking about the next research questions; how is the piezoelectric parameter presented related to the piezoelectric parameter formulated by linear theory for piezoelectricity? Is the free energy function of order one sufficient to describe cement paste’s piezoelectric with gold nanoparticles? How to develop a new function for free energy that models cement paste’s piezoelectric behavior of cement paste with gold nanoparticles?
In this chapter, we have intended to contribute to the theory of piezoelectricity for large deformations without including an energy function. Figure 9 shows a possible use around IoT as intelligent sensing of devices based on cement-based composites’ piezoresistivity. Without reaching into depth in the technical and engineering aspect that smart construction, active sensing system entails; we highlight how the Eqs. (88) and (89) that relate the electromechanical properties and that are defined by piezoelectric charge dikl and voltage gkij constants are present as indicators to improve the detection resolution in large structures with large deformations.
Figure 9.
The image shows a network of IoT sensors based on cement-based composites piezoresistivity as an active part of smart construction.
The sensors analyze the deformations, temperature, relative humidity, and other critical parameters of the concrete in real-time. This data is captured via wireless communication (WAN/BLE) and deployed on a secure and scalable platform (Cloud) capable of collecting data to facilitate remote decision making with information from deep within the concrete. The experimental control of the NPs embedded within the cement paste’s dispersions and piezoresistive responses is essential to have a good signal-to-noise ratio within the sensing. Knowing the coupling between the electromechanical equations from a theoretical approach is another crucial factor in making viable these technological solutions.
3. Conclusions
This chapter proposed a mathematical physicist construction of the linear theory of piezoelectricity since classical movement laws and the conservation of their physical quantities (mass, charge, linear momentum, angular momentum, and energy) over time. This construction takes parts of Eringen, Tiersten, and Yang’s research without including the variational formulation or energy functional to deduce the constitutional equations. We have also presented some results of piezoelectric and dielectric constants obtained for cement mixed to gold nanoparticles. We got the axial elasticity parameter Y=323.5±75.3kN/m2, the electroelastic parameter γ=−20.5±6.9 [mV/kN], and dielectric constant ε=939.6±82.9ε0F/m, which can be compared with parameters sijklD, gkij and εikT respectively presents into constitutional equations discussed in the chapter.
Acknowledgments
We would like to thank the Vice-rector for research in project N 2676 of the Universidad Industrial de Santander, the CIMBIOS research group for the ablation laser system (Universidad Industrial de Santander), and the CA Perez-Lopez for his support in the editing of images of the Department of Electrical and Electronic Engineering of the Universidad de los Andes Colombia.
Conflict of interest
The authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this book chapter.
Appendices and nomenclature
In the reference state, the continuum has a volume V, and mass density ρ0.
In the current state, the continuum has a volume v, mass density ρ, electronic charge density μe and lattice charge density μl. Besides, In the current state with infinitesimal displacement η, the electronic charge does not change its volume.
The capital letter in the index is for the reference state XK And the lowercase letters to the current state yi. Also, the index in the physics quantities can denote a vector. For example XK, yi, ui; or a tensor, for example EKL, τjk. Another form to present a vector quantity is the right-pointing arrow y→.
The velocity of the continuum is denoted by lower case letter u, and just makes sense in the current state.
The partial derivate is denoted by comma separation in the indexes. For example yi,i.
\n',keywords:"piezoelectricity, cement-based, nano-composites, constitutional equations, impedance spectroscopy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/74595.pdf",chapterXML:"https://mts.intechopen.com/source/xml/74595.xml",downloadPdfUrl:"/chapter/pdf-download/74595",previewPdfUrl:"/chapter/pdf-preview/74595",totalDownloads:322,totalViews:0,totalCrossrefCites:0,dateSubmitted:"August 25th 2020",dateReviewed:"November 27th 2020",datePrePublished:"February 4th 2021",datePublished:"June 9th 2021",dateFinished:"December 28th 2020",readingETA:"0",abstract:"The linear theory of piezoelectricity has widely been used to evaluate the material constants of single crystals and ceramics, but what happens with amorphous structures that exhibit piezoelectric properties such as cement-based? In this chapter, we correlate the theoretical and experimental piezoelectric parameters for small deformations after compressive stress–strain, open circuit potential, and impedance spectroscopy on cement-based. Here, in detail, we introduce the theory of piezoelectricity for large deformations without including a functional for the energy; also, we show two generating equations in terms of a free energy’s function for later it will be reduced to constitutional equations of piezoelectricity for infinitesimal deformations. Finally, here is shown piezoelectric and electrical parameters of gold nanoparticles mixed to cement paste: the axial elasticity parameter Y=323.5±75.3kN/m2, the electroelastic parameter γ=−20.5±6.9mV/kN, and dielectric constant ε=939.6±82.9ε0F/m, which have an interpretation as linear theory parameters sijklD, gkij and εikT discussed in the chapter.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/74595",risUrl:"/chapter/ris/74595",signatures:"Daniel A. Triana-Camacho, Jorge H. Quintero-Orozco and Jaime A. 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Introduction",level:"1"},{id:"sec_2",title:"2. Constitutional equations in detail and correlation with the piezoelectricity of cement-based composites",level:"1"},{id:"sec_2_2",title:"2.1 Conservation laws applied to a polarized continuum from differential approximation",level:"2"},{id:"sec_2_3",title:"2.1.1 Electric charge conservation",level:"3"},{id:"sec_3_3",title:"2.1.2 Energy conservation",level:"3"},{id:"sec_5_2",title:"2.2 Transformation of fundamental physical quantities in piezoelectricity to the reference state",level:"2"},{id:"sec_5_3",title:"2.2.1 Electric field and gradient of potential",level:"3"},{id:"sec_6_3",title:"2.2.2 Polarization vector",level:"3"},{id:"sec_7_3",title:"2.2.3 Second Piola-Kirchhoff stress",level:"3"},{id:"sec_9_2",title:"2.3 Constitutional equations from free energy",level:"2"},{id:"sec_9_3",title:"2.3.1 The linear approach of piezoelectricity",level:"3"},{id:"sec_11_2",title:"2.4 Electromechanical and electrical properties of cement-based composites",level:"2"},{id:"sec_12_2",title:"2.5 Future studies and remarks",level:"2"},{id:"sec_14",title:"3. Conclusions",level:"1"},{id:"sec_15",title:"Acknowledgments",level:"1"},{id:"sec_18",title:"Conflict of interest",level:"1"},{id:"sec_15",title:"Appendices and nomenclature",level:"1"}],chapterReferences:[{id:"B1",body:'Katzir, S. The beginnings of piezoelectricity: A study in mundane physics. Springer Science & Business Media; 2007. 273 p. DOI: 10.1007/978-1-4020-4670-4'},{id:"B2",body:'Voigt, W. Piezo-und pyroelectricität, dielectrische influenz und electrostriction bei krystallen ohne symmetriecentrum. Annalen Der Physik. 1985;291(8):701-731. DOI: 10.1002/andp.18952910812'},{id:"B3",body:'Eringen, A. C. On the foundations of electroelastostatics. 1963;1(1):127-153. DOI: 10.1016/0020-7225(63)90028-4'},{id:"B4",body:'Toupin, R. A. The elastic dielectric. Journal of Rational Mechanics and Analysis. 1956;5(6):849-915. Retrieved from http://www.jstor.org/stable/24900192'},{id:"B5",body:'Tiersten, H. F. On the non-linear equations of thermo-electroelasticity. 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Physical Review, 1958;110(1):1060-1061. DOI: 10.1103/PhysRev.110.1060'},{id:"B11",body:'Tiersten, H. F. Linear piezoelectric plate vibrations: Elements of the linear theory of piezoelectricity and the vibrations piezoelectric plates. Springer, Boston, MA. 2013. DOI: 10.1007/978-1-4899-6453-3'},{id:"B12",body:'Yang, J. On the derivation of electric body force, couple and power in an electroelastic body. Acta Mechanica Solida Sinica. 2015;28(6):613-617'},{id:"B13",body:'Yang, J. Differential derivation of momentum and energy equations in electroelasticity. Acta Mechanica Solida Sinica. 2017;30(1), 21-26'},{id:"B14",body:'Abeyaratne, R., & Knowles, J. K. A continuum model of a thermoelastic solid capable of undergoing phase transitions. Journal of the Mechanics and Physics of Solids. 1993;41(3):541-571. DOI: 10.1016/0022-5096(93)90048-K'},{id:"B15",body:'Tiersten, H. F. Non-linear electroelastic equations cubic in the small field variables. The Journal of the Acoustical Society of America. 1975;57(3):660-666. DOI:10.1121/1.380490'},{id:"B16",body:'Chen, J., Qiu, Q., Han, Y., & Lau, D. Piezoelectric materials for sustainable building structures: Fundamentals and applications. Renewable and Sustainable Energy Reviews. 2019;101:14-25. DOI: 10.1016/j.rser.2018.09.038'},{id:"B17",body:'Paul, S. C., van Rooyen, A. S., van Zijl, Gideon P. A. G., & Petrik, L. F. Properties of cement-based composites using nanoparticles: A comprehensive review. Construction and Building Materials. 2018;189:1019-1034. DOI: 10.1016/j.conbuildmat.2018.09.062'},{id:"B18",body:'Qomi, M. J. A., Ulm, F. J., & Pellenq, R. J. M. Physical origins of thermal properties of cement paste. Physical Review Applied. 2015;3(6):064010. DOI: 10.1103/PhysRevApplied.3.064010'},{id:"B19",body:'Yan, Z., & Chrisey, D. B. Pulsed laser ablation in liquid for micro-/nanostructure generation. Journal of Photochemistry and Photobiology C: Photochemistry Reviews. 2012;13(3):204-223. DOI:10.1016/j.jphotochemrev.2012.04.004'},{id:"B20",body:'Huang, H., Lai, J., Lu, J., & Li, Z. Pulsed laser ablation of bulk target and particle products in liquid for nanomaterial fabrication. AIP Advances. 2019;9(1):015307. DOI: 10.1063/1.5082695'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Daniel A. Triana-Camacho",address:null,affiliation:'
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Scientific publications in international height inaugurated before this and at this moment a lots of his publications have occurred. Eight Ph.D. students are perusing their research work under his esteemed guidance. Dr. Roy has performed as reviewer in International and National Journals. He has served in Government colleges in different parts of West Bengal, India. Now, he is engaged at teaching in the Faculty of Science, Jadavpur University since 2008. Dr. Roy was also invited to deliver his impressive lectures in a variety of Indian Universities, Institutes and abroad also. He has been selected as an eminent member in different National and International Societies like Bio mathematical Society of India and IAENG. He has completed some Research Projects and three major Research Projects are continuing under his pioneer supervision, sponsored by various India Government agencies. Dr. Roy has received Best Paper Award in World Congress on Engineering 2010 which was held in London, UK. He has been selected as an Indian Scientist for nomination under International Collaboration/Exchange Programme2011-2012 by INSA. He is served as an organizing secretary in different National and International Conference. He is now working the research on the chronic disease Psoriasis, HIV Infection and Control Therapeutic Approach and Host Pathogen Interaction very progressively.",institutionString:null,institution:{name:"Jadavpur University",institutionURL:null,country:{name:"India"}}},{id:"99914",title:"Mr.",name:"Tabish",surname:"Qidwai",slug:"tabish-qidwai",fullName:"Tabish Qidwai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Department of Biotechnology",institutionURL:null,country:{name:"India"}}},{id:"100004",title:"Dr.",name:"Xin",surname:"Pan",slug:"xin-pan",fullName:"Xin Pan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100701",title:"MSc.",name:"Sonia",surname:"Chowdhury",slug:"sonia-chowdhury",fullName:"Sonia Chowdhury",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jadavpur University",institutionURL:null,country:{name:"India"}}},{id:"100702",title:"Dr.",name:"Amarnath",surname:"Chatterjee",slug:"amarnath-chatterjee",fullName:"Amarnath Chatterjee",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jadavpur University",institutionURL:null,country:{name:"India"}}},{id:"100703",title:"Dr.",name:"Sutapa",surname:"Biswas Majee",slug:"sutapa-biswas-majee",fullName:"Sutapa Biswas Majee",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/100703/images/4725_n.jpg",biography:"Dr. Sutapa Biswas Majee is actively engaged in exploring\nthe role of natural and synthetic polymers in modulating drug\nrelease from various dosage forms. She is also keenly involved\nin mathematical modeling of different diseases. She acquired\nMPharm (Pharmaceutics) and PhD degrees from Jadavpur University, India. She\ncarried out her post-doctoral research on Parasitology, Phytochemistry and Microbiology\nfrom Bose Institute and Jadavpur University, India and published peer-reviewed\nresearch articles and reviews in various national and international journals.\nShe authored/co-authored book chapters and complete books on various topics\npertaining to modulation of drug release and study of release kinetics from drug\ndelivery devices and also on mathematical modeling.",institutionString:null,institution:null},{id:"100839",title:"Dr.",name:"Nigel",surname:"Silman",slug:"nigel-silman",fullName:"Nigel Silman",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Health Protection Agency",institutionURL:null,country:{name:"United Kingdom"}}},{id:"136225",title:"Dr.",name:"Sangram",surname:"Singh",slug:"sangram-singh",fullName:"Sangram Singh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"our-story",title:"Our story",intro:"
The company was founded in Vienna in 2004 by Alex Lazinica and Vedran Kordic, two PhD students researching robotics. While completing our PhDs, we found it difficult to access the research we needed. So, we decided to create a new Open Access publisher. A better one, where researchers like us could find the information they needed easily. The result is IntechOpen, an Open Access publisher that puts the academic needs of the researchers before the business interests of publishers.
",metaTitle:"Our story",metaDescription:"The company was founded in Vienna in 2004 by Alex Lazinica and Vedran Kordic, two PhD students researching robotics. While completing our PhDs, we found it difficult to access the research we needed. So, we decided to create a new Open Access publisher. A better one, where researchers like us could find the information they needed easily. The result is IntechOpen, an Open Access publisher that puts the academic needs of the researchers before the business interests of publishers.",metaKeywords:null,canonicalURL:"/page/our-story",contentRaw:'[{"type":"htmlEditorComponent","content":"
We started by publishing journals and books from the fields of science we were most familiar with - AI, robotics, manufacturing and operations research. Through our growing network of institutions and authors, we soon expanded into related fields like environmental engineering, nanotechnology, computer science, renewable energy and electrical engineering, Today, we are the world’s largest Open Access publisher of scientific research, with over 4,200 books and 54,000 scientific works including peer-reviewed content from more than 116,000 scientists spanning 161 countries. Our authors range from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery.
\\n\\n
In the same year that IntechOpen was founded, we launched what was at the time the first ever Open Access, peer-reviewed journal in its field: the International Journal of Advanced Robotic Systems (IJARS).
\\n\\n
The IntechOpen timeline
\\n\\n
2004
\\n\\n
\\n\\t
Intech Open is founded in Vienna, Austria, by Alex Lazinica and Vedran Kordic, two PhD students, and their first Open Access journals and books are published.
\\n\\t
Alex and Vedran launch the first Open Access, peer-reviewed robotics journal and IntechOpen’s flagship publication, the International Journal of Advanced Robotic Systems (IJARS).
\\n
\\n\\n
2005
\\n\\n
\\n\\t
IntechOpen publishes its first Open Access book: Cutting Edge Robotics.
\\n
\\n\\n
2006
\\n\\n
\\n\\t
IntechOpen publishes a special issue of IJARS, featuring contributions from NASA scientists regarding the Mars Exploration Rover missions.
\\n
\\n\\n
2008
\\n\\n
\\n\\t
Downloads milestone: 200,000 downloads reached
\\n
\\n\\n
2009
\\n\\n
\\n\\t
Publishing milestone: the first 100 Open Access STM books are published
\\n
\\n\\n
2010
\\n\\n
\\n\\t
Downloads milestone: one million downloads reached
\\n\\t
IntechOpen expands its book publishing into a new field: medicine.
\\n
\\n\\n
2011
\\n\\n
\\n\\t
Publishing milestone: More than five million downloads reached
\\n\\t
IntechOpen publishes 1996 Nobel Prize in Chemistry winner Harold W. Kroto’s “Strategies to Successfully Cross-Link Carbon Nanotubes”. Find it here.
\\n\\t
IntechOpen and TBI collaborate on a project to explore the changing needs of researchers and the evolving ways that they discover, publish and exchange information. The result is the survey “Author Attitudes Towards Open Access Publishing: A Market Research Program”.
\\n\\t
IntechOpen hosts SHOW - Share Open Access Worldwide; a series of lectures, debates, round-tables and events to bring people together in discussion of open source principles, intellectual property, content licensing innovations, remixed and shared culture and free knowledge.
\\n
\\n\\n
2012
\\n\\n
\\n\\t
Publishing milestone: 10 million downloads reached
\\n\\t
IntechOpen holds Interact2012, a free series of workshops held by figureheads of the scientific community including Professor Hiroshi Ishiguro, director of the Intelligent Robotics Laboratory, who took the audience through some of the most impressive human-robot interactions observed in his lab.
\\n
\\n\\n
2013
\\n\\n
\\n\\t
IntechOpen joins the Committee on Publication Ethics (COPE) as part of a commitment to guaranteeing the highest standards of publishing.
\\n
\\n\\n
2014
\\n\\n
\\n\\t
IntechOpen turns 10, with more than 30 million downloads to date.
\\n\\t
IntechOpen appoints its first Regional Representatives - members of the team situated around the world dedicated to increasing the visibility of our authors’ published work within their local scientific communities.
\\n
\\n\\n
2015
\\n\\n
\\n\\t
Downloads milestone: More than 70 million downloads reached, more than doubling since the previous year.
\\n\\t
Publishing milestone: IntechOpen publishes its 2,500th book and 40,000th Open Access chapter, reaching 20,000 citations in Thomson Reuters ISI Web of Science.
\\n\\t
40 IntechOpen authors are included in the top one per cent of the world’s most-cited researchers.
\\n\\t
Thomson Reuters’ ISI Web of Science Book Citation Index begins indexing IntechOpen’s books in its database.
\\n
\\n\\n
2016
\\n\\n
\\n\\t
IntechOpen is identified as a world leader in Simba Information’s Open Access Book Publishing 2016-2020 report and forecast. IntechOpen came in as the world’s largest Open Access book publisher by title count.
\\n
\\n\\n
2017
\\n\\n
\\n\\t
Downloads milestone: IntechOpen reaches more than 100 million downloads
\\n\\t
Publishing milestone: IntechOpen publishes its 3,000th Open Access book, making it the largest Open Access book collection in the world
We started by publishing journals and books from the fields of science we were most familiar with - AI, robotics, manufacturing and operations research. Through our growing network of institutions and authors, we soon expanded into related fields like environmental engineering, nanotechnology, computer science, renewable energy and electrical engineering, Today, we are the world’s largest Open Access publisher of scientific research, with over 4,200 books and 54,000 scientific works including peer-reviewed content from more than 116,000 scientists spanning 161 countries. Our authors range from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery.
\n\n
In the same year that IntechOpen was founded, we launched what was at the time the first ever Open Access, peer-reviewed journal in its field: the International Journal of Advanced Robotic Systems (IJARS).
\n\n
The IntechOpen timeline
\n\n
2004
\n\n
\n\t
Intech Open is founded in Vienna, Austria, by Alex Lazinica and Vedran Kordic, two PhD students, and their first Open Access journals and books are published.
\n\t
Alex and Vedran launch the first Open Access, peer-reviewed robotics journal and IntechOpen’s flagship publication, the International Journal of Advanced Robotic Systems (IJARS).
\n
\n\n
2005
\n\n
\n\t
IntechOpen publishes its first Open Access book: Cutting Edge Robotics.
\n
\n\n
2006
\n\n
\n\t
IntechOpen publishes a special issue of IJARS, featuring contributions from NASA scientists regarding the Mars Exploration Rover missions.
\n
\n\n
2008
\n\n
\n\t
Downloads milestone: 200,000 downloads reached
\n
\n\n
2009
\n\n
\n\t
Publishing milestone: the first 100 Open Access STM books are published
\n
\n\n
2010
\n\n
\n\t
Downloads milestone: one million downloads reached
\n\t
IntechOpen expands its book publishing into a new field: medicine.
\n
\n\n
2011
\n\n
\n\t
Publishing milestone: More than five million downloads reached
\n\t
IntechOpen publishes 1996 Nobel Prize in Chemistry winner Harold W. Kroto’s “Strategies to Successfully Cross-Link Carbon Nanotubes”. Find it here.
\n\t
IntechOpen and TBI collaborate on a project to explore the changing needs of researchers and the evolving ways that they discover, publish and exchange information. The result is the survey “Author Attitudes Towards Open Access Publishing: A Market Research Program”.
\n\t
IntechOpen hosts SHOW - Share Open Access Worldwide; a series of lectures, debates, round-tables and events to bring people together in discussion of open source principles, intellectual property, content licensing innovations, remixed and shared culture and free knowledge.
\n
\n\n
2012
\n\n
\n\t
Publishing milestone: 10 million downloads reached
\n\t
IntechOpen holds Interact2012, a free series of workshops held by figureheads of the scientific community including Professor Hiroshi Ishiguro, director of the Intelligent Robotics Laboratory, who took the audience through some of the most impressive human-robot interactions observed in his lab.
\n
\n\n
2013
\n\n
\n\t
IntechOpen joins the Committee on Publication Ethics (COPE) as part of a commitment to guaranteeing the highest standards of publishing.
\n
\n\n
2014
\n\n
\n\t
IntechOpen turns 10, with more than 30 million downloads to date.
\n\t
IntechOpen appoints its first Regional Representatives - members of the team situated around the world dedicated to increasing the visibility of our authors’ published work within their local scientific communities.
\n
\n\n
2015
\n\n
\n\t
Downloads milestone: More than 70 million downloads reached, more than doubling since the previous year.
\n\t
Publishing milestone: IntechOpen publishes its 2,500th book and 40,000th Open Access chapter, reaching 20,000 citations in Thomson Reuters ISI Web of Science.
\n\t
40 IntechOpen authors are included in the top one per cent of the world’s most-cited researchers.
\n\t
Thomson Reuters’ ISI Web of Science Book Citation Index begins indexing IntechOpen’s books in its database.
\n
\n\n
2016
\n\n
\n\t
IntechOpen is identified as a world leader in Simba Information’s Open Access Book Publishing 2016-2020 report and forecast. IntechOpen came in as the world’s largest Open Access book publisher by title count.
\n
\n\n
2017
\n\n
\n\t
Downloads milestone: IntechOpen reaches more than 100 million downloads
\n\t
Publishing milestone: IntechOpen publishes its 3,000th Open Access book, making it the largest Open Access book collection in the world
\n
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. 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. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. 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. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. 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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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However, the current system evaluation toolkit does not recommend specific areas required for further improvement. The objective of this chapter was to identify those constructs and their attributes that were the most suitable candidates for managerial intervention by applying partial least squares structural equation modeling. In doing so, the quantitative survey was adopted from the past studies together with new items creation representing system quality, records quality, service quality, and knowledge quality as the predictors while effective use and user performance as the outcomes. When extending the findings in importance‐performance map analysis, two‐system quality attributes (workflows fit and work styles fit) and all‐knowledge quality attributes exhibited higher importance rank for managerial actions. The chapter also provides a valuable recommendation for the policy and decision‐makers at the managerial level on how to apply the proposed system evaluation method in producing more efficient strategic‐planning strategies for further system upgrades and new implementation at health facilities.",book:{id:"5808",slug:"advances-in-health-management",title:"Advances in Health Management",fullTitle:"Advances in Health Management"},signatures:"Mohd Idzwan Mohd Salleh, Rosni Abdullah and Nasriah Zakaria",authors:[{id:"198049",title:"Mr.",name:"Mohd Idzwan",middleName:null,surname:"Mohd Salleh",slug:"mohd-idzwan-mohd-salleh",fullName:"Mohd Idzwan Mohd Salleh"},{id:"205599",title:"Prof.",name:"Rosni",middleName:null,surname:"Abdullah",slug:"rosni-abdullah",fullName:"Rosni Abdullah"},{id:"205600",title:"Dr.",name:"Nasriah",middleName:null,surname:"Zakaria",slug:"nasriah-zakaria",fullName:"Nasriah Zakaria"}]},{id:"54483",doi:"10.5772/67818",title:"Assessment of Avoidable Mortality Concepts in the European Union Countries, Their Benefits and Limitations",slug:"assessment-of-avoidable-mortality-concepts-in-the-european-union-countries-their-benefits-and-limita",totalDownloads:1357,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"The concept of avoidable mortality is intended to assessing health care system performance. It is defined as premature deaths from selected disease groups that are considered either treatable through the timely and effective health care (amenable mortality), or preventable by public health interventions (preventable mortality). The purpose of study is to analyse the impact of four lists of causes of death created by researchers on amenable mortality by country, sex and cause of death. Data on deaths were obtained from the WHO database for 20 European Union countries in 2014. We applied the method of direct standardisation using the European Standard Population, Spearman rank‐order correlation with statistical significance tests and confidence intervals. We found that the selection of diseases considered as amenable has not significantly impact on the cross‐country comparison, but the weight of selected list of causes of death is significant at the national level. The concept has several limitations relating to selection of diseases and setting age threshold over time, availability of health care resources, prevalence of diseases or variation of causes of death coding among countries. However, indicator of avoidable mortality offers a way of the evaluating effectiveness of health systems in maintaining and improving population health.",book:{id:"5808",slug:"advances-in-health-management",title:"Advances in Health Management",fullTitle:"Advances in Health Management"},signatures:"Beata Gavurova and Tatiana Vagasova",authors:[{id:"197261",title:"Prof.",name:"Beata",middleName:null,surname:"Gavurova",slug:"beata-gavurova",fullName:"Beata Gavurova"},{id:"201172",title:"Dr.",name:"Tatiana",middleName:null,surname:"Vagasova",slug:"tatiana-vagasova",fullName:"Tatiana Vagasova"}]},{id:"54609",doi:"10.5772/67817",title:"The Efficiency of Post‐Communist Countries’ Health Systems",slug:"the-efficiency-of-post-communist-countries-health-systems",totalDownloads:1237,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Health‐care costs are a major financial burden for the transition economies, which have experienced rapidly increasing demand for health‐care services. The former communist countries of the Central and Eastern Europe and Central Asia needed to reform the financing of their health‐care systems and make efforts to strengthen the role of primary care while limiting the role of hospital care. The growing health needs and, consequently, costs resulted in the increased attention paid to the performance of health systems. The aim of this chapter is to determine the efficiency of health systems in post‐communist countries. The data envelopment analysis method was used. The effective health systems were identified and recommendations for the inefficient countries were formulated.",book:{id:"5808",slug:"advances-in-health-management",title:"Advances in Health Management",fullTitle:"Advances in Health Management"},signatures:"Justyna Kujawska",authors:[{id:"198853",title:"Dr.",name:"Justyna",middleName:null,surname:"Kujawska",slug:"justyna-kujawska",fullName:"Justyna Kujawska"}]},{id:"56415",doi:"10.5772/intechopen.69954",title:"Low-Cost Health/Medical Tourism of Italians",slug:"low-cost-health-medical-tourism-of-italians",totalDownloads:1149,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"In recent years, becoming a form of spatial mobility of people is mainly called “medical tourism or health tourism”. In Italy the adoption of the expression “turismo sanitario” is often used as an international expression synonymous with “medical tourism or health tourism”: this situation raises a number of conceptual problems. In fact, the Italian public health service is one of the most developed in the world and is distinguished by many nations to the fact to offer its citizens free of charge and many health care services. In this situation, the Italian citizen in need of medical care is not convenient to travel to other places and is not obliged to do so. In fact, the Italian citizen tends to move for medical and health care that the Italian public health service does not deliver at no charge: such as dental care, we will deal with this case illustrating some examples of dental tourism low cost of the Italians. However, from our point of view, tourism period may be coupled to the trips to the health or well-being only in cases where the journey is “voluntary.” All this will be discussed in this paper.",book:{id:"5808",slug:"advances-in-health-management",title:"Advances in Health Management",fullTitle:"Advances in Health Management"},signatures:"Tullio Romita and Antonella Perri",authors:[{id:"204991",title:"Dr.",name:"Tullio",middleName:null,surname:"Romita",slug:"tullio-romita",fullName:"Tullio Romita"},{id:"213614",title:"Dr.",name:"Antonella",middleName:null,surname:"Perri",slug:"antonella-perri",fullName:"Antonella Perri"}]},{id:"73241",doi:"10.5772/intechopen.93604",title:"Epidemiology of Obesity in Children and Adolescents",slug:"epidemiology-of-obesity-in-children-and-adolescents",totalDownloads:686,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The childhood overweight and obesity epidemic has become a global emergency in public health and a crucial challenge of the twenty-first century. Nowadays, childhood and adolescent obesity represent a significant public health problem both in developing and developed countries. Globally, above 340 million children and adolescents aged 5–19 years were overweight or obese in 2016. Childhood obesity is a critical burden because it can be associated with a higher possibility of obesity, premature death, and disability in adults, as well as early markers of cardiovascular disease. In Europe, childhood obesity remains a significant health challenge and is distributed disparately across and between countries and population groups. In 2019, over 398,000 children aged 6–9 years were severely obese in Europe. Particularly, Southern European countries such as Greece, Italy, Malta, San Marino, and Spain had one in five children obese in 2018. In Europe, different initiatives and actions have been launched in recent years to fight childhood obesity. However, the progress on combating obesity in children has been slow and inconsistent across the region. In this chapter, we have discussed the prevalence of obesity in children and existing policies to combat childhood obesity in the World Health Organization (WHO) European Region.",book:{id:"9559",slug:"teamwork-in-healthcare",title:"Teamwork in Healthcare",fullTitle:"Teamwork in Healthcare"},signatures:"Giulio Nittari, Stefania Scuri, Getu Gamo Sagaro, Fabio Petrelli and Iolanda Grappasonni",authors:[{id:"322429",title:"Dr.",name:"Giulio",middleName:null,surname:"Nittari",slug:"giulio-nittari",fullName:"Giulio Nittari"},{id:"322447",title:"Prof.",name:"Iolanda",middleName:null,surname:"Grappasonni",slug:"iolanda-grappasonni",fullName:"Iolanda Grappasonni"},{id:"322448",title:"Dr.",name:"Stefania",middleName:null,surname:"Scuri",slug:"stefania-scuri",fullName:"Stefania Scuri"},{id:"323556",title:"Prof.",name:"Fabio",middleName:null,surname:"Petrelli",slug:"fabio-petrelli",fullName:"Fabio Petrelli"},{id:"323558",title:"Dr.",name:"Getu Gamo",middleName:null,surname:"Sagaro",slug:"getu-gamo-sagaro",fullName:"Getu Gamo Sagaro"}]}],mostDownloadedChaptersLast30Days:[{id:"73280",title:"Teamwork in a Surgical Department",slug:"teamwork-in-a-surgical-department",totalDownloads:1114,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Teamwork is essential in surgery. A surgeon alone cannot fulfill his daily tasks. Surgical departments are divided into surgical teams: the surgical team in the operating theater, the surgical ward team, and the surgical emergency team. The common task of those teams is adequate patient care. The characteristics of team members describe necessary abilities such as: open communication, effective coordination skills, collaboration willingness, interdependency, mutual performance monitoring, backup behavior, adaptability, team orientation, and personality type. Team processes are recurring and ongoing short-term courses that occur in the team. The team developmental model separates the development of a team in four stages over a longer period of time. In the last stage, the team reaches the highest level of teamwork performance. Each team must be assessed for their nontechnical skills with team measurement tools. Surgical teams are insufficiently measured. There are possible disadvantages in teamwork, which must be considered and discussed versus the obvious benefits. Leadership is a process where the leading team member sets the direction for the others. There are different styles of leadership, whereby the dominant role of the leader is more or less pronounced. Leadership and teamwork are not contradicting characteristics of teams in the surgical department.",book:{id:"9559",slug:"teamwork-in-healthcare",title:"Teamwork in Healthcare",fullTitle:"Teamwork in Healthcare"},signatures:"Nikolai Ramadanov",authors:[{id:"322676",title:"Dr.",name:"Nikolai",middleName:null,surname:"Ramadanov",slug:"nikolai-ramadanov",fullName:"Nikolai Ramadanov"}]},{id:"54844",title:"Extending Health Information System Evaluation with an Importance‐Performance Map Analysis",slug:"extending-health-information-system-evaluation-with-an-importance-performance-map-analysis",totalDownloads:1446,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"Evaluation of a health information system is necessary for determining effective use and for enhancing the productivity of medical practitioners. However, the current system evaluation toolkit does not recommend specific areas required for further improvement. The objective of this chapter was to identify those constructs and their attributes that were the most suitable candidates for managerial intervention by applying partial least squares structural equation modeling. In doing so, the quantitative survey was adopted from the past studies together with new items creation representing system quality, records quality, service quality, and knowledge quality as the predictors while effective use and user performance as the outcomes. When extending the findings in importance‐performance map analysis, two‐system quality attributes (workflows fit and work styles fit) and all‐knowledge quality attributes exhibited higher importance rank for managerial actions. The chapter also provides a valuable recommendation for the policy and decision‐makers at the managerial level on how to apply the proposed system evaluation method in producing more efficient strategic‐planning strategies for further system upgrades and new implementation at health facilities.",book:{id:"5808",slug:"advances-in-health-management",title:"Advances in Health Management",fullTitle:"Advances in Health Management"},signatures:"Mohd Idzwan Mohd Salleh, Rosni Abdullah and Nasriah Zakaria",authors:[{id:"198049",title:"Mr.",name:"Mohd Idzwan",middleName:null,surname:"Mohd Salleh",slug:"mohd-idzwan-mohd-salleh",fullName:"Mohd Idzwan Mohd Salleh"},{id:"205599",title:"Prof.",name:"Rosni",middleName:null,surname:"Abdullah",slug:"rosni-abdullah",fullName:"Rosni Abdullah"},{id:"205600",title:"Dr.",name:"Nasriah",middleName:null,surname:"Zakaria",slug:"nasriah-zakaria",fullName:"Nasriah Zakaria"}]},{id:"73241",title:"Epidemiology of Obesity in Children and Adolescents",slug:"epidemiology-of-obesity-in-children-and-adolescents",totalDownloads:688,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The childhood overweight and obesity epidemic has become a global emergency in public health and a crucial challenge of the twenty-first century. Nowadays, childhood and adolescent obesity represent a significant public health problem both in developing and developed countries. Globally, above 340 million children and adolescents aged 5–19 years were overweight or obese in 2016. Childhood obesity is a critical burden because it can be associated with a higher possibility of obesity, premature death, and disability in adults, as well as early markers of cardiovascular disease. In Europe, childhood obesity remains a significant health challenge and is distributed disparately across and between countries and population groups. In 2019, over 398,000 children aged 6–9 years were severely obese in Europe. Particularly, Southern European countries such as Greece, Italy, Malta, San Marino, and Spain had one in five children obese in 2018. In Europe, different initiatives and actions have been launched in recent years to fight childhood obesity. However, the progress on combating obesity in children has been slow and inconsistent across the region. In this chapter, we have discussed the prevalence of obesity in children and existing policies to combat childhood obesity in the World Health Organization (WHO) European Region.",book:{id:"9559",slug:"teamwork-in-healthcare",title:"Teamwork in Healthcare",fullTitle:"Teamwork in Healthcare"},signatures:"Giulio Nittari, Stefania Scuri, Getu Gamo Sagaro, Fabio Petrelli and Iolanda Grappasonni",authors:[{id:"322429",title:"Dr.",name:"Giulio",middleName:null,surname:"Nittari",slug:"giulio-nittari",fullName:"Giulio Nittari"},{id:"322447",title:"Prof.",name:"Iolanda",middleName:null,surname:"Grappasonni",slug:"iolanda-grappasonni",fullName:"Iolanda Grappasonni"},{id:"322448",title:"Dr.",name:"Stefania",middleName:null,surname:"Scuri",slug:"stefania-scuri",fullName:"Stefania Scuri"},{id:"323556",title:"Prof.",name:"Fabio",middleName:null,surname:"Petrelli",slug:"fabio-petrelli",fullName:"Fabio Petrelli"},{id:"323558",title:"Dr.",name:"Getu Gamo",middleName:null,surname:"Sagaro",slug:"getu-gamo-sagaro",fullName:"Getu Gamo Sagaro"}]},{id:"73609",title:"Spiritual Environment Management Tool",slug:"spiritual-environment-management-tool",totalDownloads:536,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter is about the spiritual environment management tool, which includes spirituality at work and spiritual practices. This management tool is divided into two steps: diagnostic of the worker’s perceptions about spirituality at work (first step) and spiritual practices design (second step). By meaning, spirituality at work can help healthcare managers to build effective teamwork in medicine. Spirituality at work has a multidimensional and measurable nature and is aligned with the three principles of the World Health Organization, based on two arguments: the new approach should be preventive and should promote partnership. This fact allows the managers as well the human resource department to classify the organizational environment on the next spiritual issues in the first step: meaningful work; opportunities for inner life; the sense of community; alignment with the organization’s value; emotional balance and inner peace. The reduction of medical errors to improve patient safety require the performance of multistep tasks of the great complexity of healthcare professionals, and this chapter pretends to show how the spiritual environment management tool can contribute with the “all working together” goal through a multi-disciplinary care team.",book:{id:"9559",slug:"teamwork-in-healthcare",title:"Teamwork in Healthcare",fullTitle:"Teamwork in Healthcare"},signatures:"Maria Joelle",authors:[{id:"230270",title:"Dr.",name:"Maria",middleName:null,surname:"Joelle",slug:"maria-joelle",fullName:"Maria Joelle"}]},{id:"54168",title:"European Health System Typologies: Last 30 Years Under Review",slug:"european-health-system-typologies-last-30-years-under-review",totalDownloads:1652,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The quest of the researcher to classify national health systems into homogeneous groups has a long history. In this paper, the last 30 years are divided in two periods (1985–2000 and 2000–2015) in order to present and briefly describe the most influential national health system typologies.",book:{id:"5808",slug:"advances-in-health-management",title:"Advances in Health Management",fullTitle:"Advances in Health Management"},signatures:"Aida Isabel Pereira Tavares",authors:[{id:"196819",title:"Prof.",name:"Aida Isabel",middleName:null,surname:"Tavares",slug:"aida-isabel-tavares",fullName:"Aida Isabel Tavares"}]}],onlineFirstChaptersFilter:{topicId:"461",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:288,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Bacterial Infectious Diseases",value:3,count:2},{group:"subseries",caption:"Parasitic Infectious Diseases",value:5,count:4},{group:"subseries",caption:"Viral Infectious Diseases",value:6,count:7}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2020",value:2020,count:3},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:230,paginationItems:[{id:"61139",title:"Dr.",name:"Sergey",middleName:null,surname:"Tkachev",slug:"sergey-tkachev",fullName:"Sergey Tkachev",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61139/images/system/61139.png",biography:"Dr. Sergey Tkachev is a senior research scientist at the Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia, and at the Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia. He received his Ph.D. in Molecular Biology with his thesis “Genetic variability of the tick-borne encephalitis virus in natural foci of Novosibirsk city and its suburbs.” His primary field is molecular virology with research emphasis on vector-borne viruses, especially tick-borne encephalitis virus, Kemerovo virus and Omsk hemorrhagic fever virus, rabies virus, molecular genetics, biology, and epidemiology of virus pathogens.",institutionString:"Russian Academy of Sciences",institution:{name:"Russian Academy of Sciences",country:{name:"Russia"}}},{id:"310962",title:"Dr.",name:"Amlan",middleName:"Kumar",surname:"Patra",slug:"amlan-patra",fullName:"Amlan Patra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/310962/images/system/310962.jpg",biography:"Amlan K. Patra, FRSB, obtained a Ph.D. in Animal Nutrition from Indian Veterinary Research Institute, India, in 2002. He is currently an associate professor at West Bengal University of Animal and Fishery Sciences. He has more than twenty years of research and teaching experience. He held previous positions at the American Institute for Goat Research, The Ohio State University, Columbus, USA, and Free University of Berlin, Germany. His research focuses on animal nutrition, particularly ruminants and poultry nutrition, gastrointestinal electrophysiology, meta-analysis and modeling in nutrition, and livestock–environment interaction. He has authored around 175 articles in journals, book chapters, and proceedings. Dr. Patra serves on the editorial boards of several reputed journals.",institutionString:null,institution:{name:"West Bengal University of Animal and Fishery Sciences",country:{name:"India"}}},{id:"53998",title:"Prof.",name:"László",middleName:null,surname:"Babinszky",slug:"laszlo-babinszky",fullName:"László Babinszky",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/53998/images/system/53998.png",biography:"László Babinszky is Professor Emeritus, Department of Animal Nutrition Physiology, University of Debrecen, Hungary. He has also worked in the Department of Animal Nutrition, University of Wageningen, Netherlands; the Institute for Livestock Feeding and Nutrition (IVVO), Lelystad, Netherlands; the Agricultural University of Vienna (BOKU); the Institute for Animal Breeding and Nutrition, Austria; and the Oscar Kellner Research Institute for Animal Nutrition, Rostock, Germany. In 1992, Dr. Babinszky obtained a Ph.D. in Animal Nutrition from the University of Wageningen. His main research areas are swine and poultry nutrition. He has authored more than 300 publications (papers, book chapters) and edited four books and fourteen international conference proceedings.",institutionString:"University of Debrecen",institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"201830",title:"Dr.",name:"Fernando",middleName:"Sanchez",surname:"Davila",slug:"fernando-davila",fullName:"Fernando Davila",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201830/images/5017_n.jpg",biography:"I am a professor at UANL since 1988. My research lines are the development of reproductive techniques in small ruminants. We also conducted research on sexual and social behavior in males.\nI am Mexican and study my professional career as an engineer in agriculture and animal science at UANL. Then take a masters degree in science in Germany (Animal breeding). Take a doctorate in animal science at the UANL.",institutionString:null,institution:{name:"Universidad Autónoma de Nuevo León",country:{name:"Mexico"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",slug:"miguel-quaresma",fullName:"Miguel Quaresma",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309250/images/9059_n.jpg",biography:"Miguel Nuno Pinheiro Quaresma was born on May 26, 1974 in Dili, Timor Island. He is married with two children: a boy and a girl, and he is a resident in Vila Real, Portugal. He graduated in Veterinary Medicine in August 1998 and obtained his Ph.D. degree in Veterinary Sciences -Clinical Area in February 2015, both from the University of Trás-os-Montes e Alto Douro. He is currently enrolled in the Alternative Residency of the European College of Animal Reproduction. He works as a Senior Clinician at the Veterinary Teaching Hospital of UTAD (HVUTAD) with a role in clinical activity in the area of livestock and equine species as well as to support teaching and research in related areas. He teaches as an Invited Professor in Reproduction Medicine I and II of the Master\\'s in Veterinary Medicine degree at UTAD. Currently, he holds the position of Chairman of the Portuguese Buiatrics Association. He is a member of the Consultive Group on Production Animals of the OMV. He has 19 publications in indexed international journals (ISIS), as well as over 60 publications and oral presentations in both Portuguese and international journals and congresses.",institutionString:"University of Trás-os-Montes and Alto Douro",institution:{name:"University of Trás-os-Montes and Alto Douro",country:{name:"Portugal"}}},{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",country:{name:"Portugal"}}},{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/283019/images/system/283019.png",biography:"Dr. Kerro Dego is a veterinary microbiologist with training in veterinary medicine, microbiology, and anatomic pathology. Dr. Kerro Dego is an assistant professor of dairy health in the department of animal science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. He received his D.V.M. (1997), M.S. (2002), and Ph.D. (2008) degrees in Veterinary Medicine, Animal Pathology and Veterinary Microbiology from College of Veterinary Medicine, Addis Ababa University, Ethiopia; College of Veterinary Medicine, Utrecht University, the Netherlands and Western College of Veterinary Medicine, University of Saskatchewan, Canada respectively. He did his Postdoctoral training in microbial pathogenesis (2009 - 2015) in the Department of Animal Science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. Dr. Kerro Dego’s research focuses on the prevention and control of infectious diseases of farm animals, particularly mastitis, improving dairy food safety, and mitigation of antimicrobial resistance. Dr. Kerro Dego has extensive experience in studying the pathogenesis of bacterial infections, identification of virulence factors, and vaccine development and efficacy testing against major bacterial mastitis pathogens. Dr. Kerro Dego conducted numerous controlled experimental and field vaccine efficacy studies, vaccination, and evaluation of immunological responses in several species of animals, including rodents (mice) and large animals (bovine and ovine).",institutionString:"University of Tennessee at Knoxville",institution:{name:"University of Tennessee at Knoxville",country:{name:"United States of America"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón",slug:"juan-carlos-gardon",fullName:"Juan Carlos Gardón",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:"Catholic University of Valencia San Vicente Mártir, Spain",institution:null},{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/125292/images/system/125292.jpeg",biography:"Katy Satué Ambrojo received her Veterinary Medicine degree, Master degree in Equine Technology and doctorate in Veterinary Medicine from the Faculty of Veterinary, CEU-Cardenal Herrera University in Valencia, Spain. She is a Full Professor at the Department of Medicine and Animal Surgery at the same University. She developed her research activity in the field of Endocrinology, Hematology, Biochemistry and Immunology of horses. She is a scientific reviewer of several international journals : American Journal of Obstetrics and Gynecology, Comparative Clinical Pathology, Veterinary Clinical Pathology, Journal of Equine Veterinary Science, Reproduction in Domestic Animals, Research Veterinary Science, Brazilian Journal of Medical and Biological Research, Livestock Production Science and Theriogenology. Since 2014, she has been the Head of the Clinical Analysis Laboratory of the Hospital Clínico Veterinario from the Faculty of Veterinary, CEU-Cardenal Herrera University.",institutionString:"CEU-Cardenal Herrera University",institution:{name:"CEU Cardinal Herrera University",country:{name:"Spain"}}},{id:"309529",title:"Dr.",name:"Albert",middleName:null,surname:"Rizvanov",slug:"albert-rizvanov",fullName:"Albert Rizvanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309529/images/9189_n.jpg",biography:'Albert A. Rizvanov is a Professor and Director of the Center for Precision and Regenerative Medicine at the Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU), Russia. He is the Head of the Center of Excellence “Regenerative Medicine” and Vice-Director of Strategic Academic Unit \\"Translational 7P Medicine\\". Albert completed his Ph.D. at the University of Nevada, Reno, USA and Dr.Sci. at KFU. He is a corresponding member of the Tatarstan Academy of Sciences, Russian Federation. Albert is an author of more than 300 peer-reviewed journal articles and 22 patents. He has supervised 11 Ph.D. and 2 Dr.Sci. dissertations. Albert is the Head of the Dissertation Committee on Biochemistry, Microbiology, and Genetics at KFU.\nORCID https://orcid.org/0000-0002-9427-5739\nWebsite https://kpfu.ru/Albert.Rizvanov?p_lang=2',institutionString:"Kazan Federal University",institution:{name:"Kazan Federal University",country:{name:"Russia"}}},{id:"210551",title:"Dr.",name:"Arbab",middleName:null,surname:"Sikandar",slug:"arbab-sikandar",fullName:"Arbab Sikandar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210551/images/system/210551.jpg",biography:"Dr. Arbab Sikandar, PhD, M. Phil, DVM was born on April 05, 1981. He is currently working at the College of Veterinary & Animal Sciences as an Assistant Professor. He previously worked as a lecturer at the same University. \nHe is a Member/Secretory of Ethics committee (No. CVAS-9377 dated 18-04-18), Member of the QEC committee CVAS, Jhang (Regr/Gen/69/873, dated 26-10-2017), Member, Board of studies of Department of Basic Sciences (No. CVAS. 2851 Dated. 12-04-13, and No. CVAS, 9024 dated 20/11/17), Member of Academic Committee, CVAS, Jhang (No. CVAS/2004, Dated, 25-08-12), Member of the technical committee (No. CVAS/ 4085, dated 20,03, 2010 till 2016).\n\nDr. Arbab Sikandar contributed in five days hands-on-training on Histopathology at the Department of Pathology, UVAS from 12-16 June 2017. He received a Certificate of appreciation for contributions for Popularization of Science and Technology in the Society on 17-11-15. He was the resource person in the lecture series- ‘scientific writing’ at the Department of Anatomy and Histology, UVAS, Lahore on 29th October 2015. He won a full fellowship as a principal candidate for the year 2015 in the field of Agriculture, EICA, Egypt with ref. to the Notification No. 12(11) ACS/Egypt/2014 from 10 July 2015 to 25th September 2015.; he received a grant of Rs. 55000/- as research incentives from Director, Advanced Studies and Research, UVAS, Lahore upon publications of research papers in IF Journals (DR/215, dated 19-5-2014.. He obtained his PhD by winning a HEC Pakistan indigenous Scholarship, ‘Ph.D. fellowship for 5000 scholars – Phase II’ (2av1-147), 17-6/HEC/HRD/IS-II/12, November 15, 2012. \n\nDr. Sikandar is a member of numerous societies: Registered Veterinary Medical Practitioner (life member) and Registered Veterinary Medical Faculty of Pakistan Veterinary Medical Council. The Registration code of PVMC is RVMP/4298 and RVMF/ 0102.; Life member of the University of Veterinary and Animal Sciences, Lahore, Alumni Association with S# 664, dated: 6-4-12. ; Member 'Vets Care Organization Pakistan” with Reference No. VCO-605-149, dated 05-04-06. :Member 'Vet Crescent” (Society of Animal Health and Production), UVAS, Lahore.",institutionString:"University of Veterinary & Animal Science",institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311663/images/13261_n.jpg",biography:null,institutionString:null,institution:{name:"National Dairy Research Institute",country:{name:"India"}}},{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",country:{name:"United Kingdom"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",biography:"Samir El-Gendy is a Professor of anatomy and embryology at the faculty of veterinary medicine, Alexandria University, Egypt. Samir obtained his PhD in veterinary science in 2007 from the faculty of veterinary medicine, Alexandria University and has been a professor since 2017. Samir is an author on 24 articles at Scopus and 12 articles within local journals and 2 books/book chapters. His research focuses on applied anatomy, imaging techniques and computed tomography. Samir worked as a member of different local projects on E-learning and he is a board member of the African Association of Veterinary Anatomists and of anatomy societies and as an associated author at local and international journals. Orcid: https://orcid.org/0000-0002-6180-389X",institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"246149",title:"Dr.",name:"Valentina",middleName:null,surname:"Kubale",slug:"valentina-kubale",fullName:"Valentina Kubale",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246149/images/system/246149.jpg",biography:"Valentina Kubale is Associate Professor of Veterinary Medicine at the Veterinary Faculty, University of Ljubljana, Slovenia. Since graduating from the Veterinary faculty she obtained her PhD in 2007, performed collaboration with the Department of Pharmacology, University of Copenhagen, Denmark. She continued as a post-doctoral fellow at the University of Copenhagen with a Lundbeck foundation fellowship. She is the editor of three books and author/coauthor of 23 articles in peer-reviewed scientific journals, 16 book chapters, and 68 communications at scientific congresses. Since 2008 she has been the Editor Assistant for the Slovenian Veterinary Research journal. She is a member of Slovenian Biochemical Society, The Endocrine Society, European Association of Veterinary Anatomists and Society for Laboratory Animals, where she is board member.",institutionString:"University of Ljubljana",institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",biography:"Dr. Fonseca-Alves earned his DVM from Federal University of Goias – UFG in 2008. He completed an internship in small animal internal medicine at UPIS university in 2011, earned his MSc in 2013 and PhD in 2015 both in Veterinary Medicine at Sao Paulo State University – UNESP. 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