Most common causes of death worldwide by age group, 2002 (adapted from WHO prehospital trauma care systems) [2].
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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The most typical fields for the application of virtual reality are medicine and engineering. The reviews in this book describe the latest virtual reality-related knowledge in these two fields such as: advanced human-computer interaction and virtual reality technologies, evaluation tools for cognition and behavior, medical and surgical treatment, neuroscience and neuro-rehabilitation, assistant tools for overcoming mental illnesses, educational and industrial uses. In addition, the considerations for virtual worlds in human society are discussed. This book will serve as a state-of-the-art resource for researchers who are interested in developing a beneficial technology for human society.',isbn:null,printIsbn:"978-953-307-518-1",pdfIsbn:"978-953-51-4532-5",doi:"10.5772/553",price:159,priceEur:175,priceUsd:205,slug:"virtual-reality",numberOfPages:688,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:null,bookSignature:"Jae-Jin Kim",publishedDate:"January 8th 2011",coverURL:"https://cdn.intechopen.com/books/images_new/20.jpg",numberOfDownloads:96994,numberOfWosCitations:133,numberOfCrossrefCitations:86,numberOfCrossrefCitationsByBook:9,numberOfDimensionsCitations:197,numberOfDimensionsCitationsByBook:10,hasAltmetrics:1,numberOfTotalCitations:416,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 7th 2010",dateEndSecondStepPublish:"May 5th 2010",dateEndThirdStepPublish:"September 9th 2010",dateEndFourthStepPublish:"October 9th 2010",dateEndFifthStepPublish:"December 8th 2010",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"14702",title:"Prof.",name:"Jae-Jin",middleName:null,surname:"Kim",slug:"jae-jin-kim",fullName:"Jae-Jin Kim",profilePictureURL:"https://mts.intechopen.com/storage/users/14702/images/1652_n.jpg",biography:"Jae-Jin Kim received the M.D. (1987) and Ph.D. (2002) degrees in psychiatry from Seoul National University, Seoul, Korea. He currently works as a professor and a chair at the Department of Psychiatry, Yonsei University Gangnam Severance Hospital, and as s director at the Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea. His research interests are to develop the virtual reality programs for improving social functions in psychiatric patients such as schizophrenia and social phobia, and to investigate the pathophysiology of social deficits using the fMRI and PET. He has published a lot of papers about virtual reality and neuroimaging, and recently won the best researcher award, Yonsei University Gangnam Severance Hospital (Oct, 2010).",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"573",title:"Virtual Computer System",slug:"virtual-computer-system"}],chapters:[{id:"12761",title:"Brain-Computer Interface Systems Used for Virtual Reality Control",doi:"10.5772/13467",slug:"brain-computer-interface-systems-used-for-virtual-reality-control",totalDownloads:3976,totalCrossrefCites:10,totalDimensionsCites:18,hasAltmetrics:0,abstract:null,signatures:"Gert Pfurtscheller, Robert Leeb, Josef Faller and Christa Neuper",downloadPdfUrl:"/chapter/pdf-download/12761",previewPdfUrl:"/chapter/pdf-preview/12761",authors:[{id:"14806",title:"Dr.",name:"Gert",surname:"Pfurtscheller",slug:"gert-pfurtscheller",fullName:"Gert Pfurtscheller"}],corrections:null},{id:"12762",title:"Hapto-Acoustic Interaction Metaphors in 3D Virtual Environments for Non-Visual Settings",doi:"10.5772/13116",slug:"hapto-acoustic-interaction-metaphors-in-3d-virtual-environments-for-non-visual-settings",totalDownloads:2424,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Fabio De Felice, Floriana Renna, Giovanni Attolico and Arcangelo Distante",downloadPdfUrl:"/chapter/pdf-download/12762",previewPdfUrl:"/chapter/pdf-preview/12762",authors:[{id:"13846",title:"Dr.",name:"Floriana",surname:"Renna",slug:"floriana-renna",fullName:"Floriana Renna"},{id:"13901",title:"Dr.",name:"Giovanni",surname:"Attolico",slug:"giovanni-attolico",fullName:"Giovanni Attolico"},{id:"15132",title:"Dr.",name:"Fabio",surname:"De Felice",slug:"fabio-de-felice",fullName:"Fabio De Felice"},{id:"15133",title:"Dr.",name:"Arcangelo",surname:"Distante",slug:"arcangelo-distante",fullName:"Arcangelo Distante"}],corrections:null},{id:"13644",title:"Collaborative 3D Interaction in Virtual Environments: a Workflow-based Approach",doi:"10.5772/13013",slug:"collaborative-3d-interaction-in-virtual-environments-a-workflow-based-approach",totalDownloads:2653,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Christophe Domingues, Frederic Davesne, Malik Mallem and Samir Otmane",downloadPdfUrl:"/chapter/pdf-download/13644",previewPdfUrl:"/chapter/pdf-preview/13644",authors:[{id:"13679",title:"Dr.",name:"Samir",surname:"Otmane",slug:"samir-otmane",fullName:"Samir Otmane"},{id:"15075",title:"Dr.",name:"Christophe",surname:"Domingues",slug:"christophe-domingues",fullName:"Christophe Domingues"},{id:"15076",title:"Dr.",name:"Frederic",surname:"Davesne",slug:"frederic-davesne",fullName:"Frederic Davesne"},{id:"15077",title:"Prof.",name:"Malik",surname:"Mallem",slug:"malik-mallem",fullName:"Malik Mallem"}],corrections:null},{id:"13645",title:"Virtual Reality to Simulate Visual Tasks for Robotic Systems",doi:"10.5772/12875",slug:"virtual-reality-to-simulate-visual-tasks-for-robotic-systems",totalDownloads:3100,totalCrossrefCites:4,totalDimensionsCites:6,hasAltmetrics:1,abstract:null,signatures:"Manuela Chessa, Fabio Solari and Silvio P. 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\r\n\tA quantum dot is a very small structure (2 to 10 nm), e.g. a semiconductor nanocrystal embedded in another semiconductor material, which can confine electrons or other carriers in all three dimensions and with their electronic characteristics depending on their size and shape. The particles differ in colour depending on the size of different nanocrystals. Quantum dots emit light when excited, smaller dots emit higher energy light. Manufacturers can accurately control the size of a quantum dot and as a result, they are able ‘tune’ the wavelength of the emitted light to a specific colour. Quantum dots find applications in several areas such as solar cells, transistors, LEDs, medical imaging, and quantum computing, thanks to their unique electronic properties. The properties of quantum dots have caused researchers and companies to consider using them in several fields like Optical Applications, Quantum dot light-emitting diodes (QD-LED) and ‘QD-White LED’, Quantum dot photodetectors (QDPs), Quantum dot solar cells (Photovoltaics), Biological Applications (to study intracellular processes, tumor targeting, in vivo observation of cell trafficking, diagnostics and cellular imaging at high resolutions), Quantum Computing (quantum bits or ‘qubits’), The Future of Quantum Dots (broad range of real-time applications), etc... The following survey of quantum dot applications introduces many of these uses. They have characteristically low energy consumption, small size, longer lifetime, and faster switching and because of that, they have a wide palette of applicability. Over the years semiconductor technology has advanced to bigger heights. The result is what we see around us in the form of smart gadgets. This book would form the basis for a better widespread understanding of the capabilities and limitations of each category of the quantum dots, and may also suggest better, cheaper, or alternative lithography technologies are considered for their applications.
\r\n\r\n\tThe area of interest and scope of the project can be described with (but are not limited to) the following keywords: The Quantum dots can be lingering further into seven major categories:
\r\n\t(i) Quantum dots of very high-quality optical applications, Quantum dot light-emitting diodes (QD-LED) and ‘QD-White LED’, Quantum dot photodetectors (QDPs), Quantum dot solar cells (Photovoltaics).
\r\n\t(ii) Quantum Computing (quantum bits or ‘qubits’), (vii) The Future of Quantum Dots (broad range of real-time applications, magnetic quantum dots & graphene quantum dots), Superconducting Loop, Quantum Entanglement, Quantum Fingerprints.
\r\n\r\n\t(iii) Biomedical and Environmental Applications (to study intracellular processes, tumor targeting, in vivo observation of cell trafficking, diagnostics and cellular imaging at high resolutions), Bioconjugation, Cell Imaging, Photoelectrochemical Immunosensor, Membranes and Bacterial Cells, Resonance Energy-Transfer Processes, Evaluation of Drinking Water Quality, Water and Wastewater Treatment, Pollutant Control.
",isbn:"978-1-80356-594-1",printIsbn:"978-1-80356-593-4",pdfIsbn:"978-1-80356-595-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"0dd5611c62c91569bd2819e68852002a",bookSignature:"Prof. Jagannathan Thirumalai",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11756.jpg",keywords:"LED, Organic LEDs, Dyes & Pigments, Solar Cells, Laser Photonics, Electronic Switching Devices, Qubits, Josephson Junction, Bioconjugation, Cell Imaging, Photoelectrochemical Immunosensor, Membranes, and Bacterial Cells",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 16th 2022",dateEndSecondStepPublish:"May 27th 2022",dateEndThirdStepPublish:"July 26th 2022",dateEndFourthStepPublish:"October 14th 2022",dateEndFifthStepPublish:"December 13th 2022",remainingDaysToSecondStep:"7 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. J. Thirumalai received his Ph.D. from Alagappa University, Karaikudi, He was also awarded the Post-doctoral Fellowship from Pohang University of Science and Technology (POSTECH), the Republic of Korea. His research interests focus on luminescence, self-assembled nanomaterials, and thin-film optoelectronic devices. He has published more than 60 SCOPUS/ISI indexed papers and 11 book chapters, edited 4 books, and member of several national and international societies like RSC, OSA, etc. His h-index is 19.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"99242",title:"Prof.",name:"Jagannathan",middleName:null,surname:"Thirumalai",slug:"jagannathan-thirumalai",fullName:"Jagannathan Thirumalai",profilePictureURL:"https://mts.intechopen.com/storage/users/99242/images/system/99242.png",biography:"Dr. J. Thirumalai received his Ph.D. from Alagappa University, Karaikudi in 2010. He was also awarded the Post-doctoral Fellowship from Pohang University of Science and Technology (POSTECH), Republic of Korea, in 2013. He worked as Assistant Professor of Physics, B.S. Abdur Rahman University, Chennai, India (2011 to 2016). Currently, he is working as Senior Assistant Professor of Physics, Srinivasa Ramanujan Centre, SASTRA Deemed University, Kumbakonam (T.N.), India. His research interests focus on luminescence, self-assembled nanomaterials, and thin film opto-electronic devices. He has published more than 60 SCOPUS/ISI indexed papers and 11 book chapters, edited 4 books and member in several national and international societies like RSC, OSA, etc. Currently, he served as a principal investigator for a funded project towards the application of luminescence based thin film opto-electronic devices, funded by the Science and Engineering Research Board (SERB), India. 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Despite apparent differences in understanding and use of the concept in different settings, international health security, in its most general sense, prioritizes cross-border threats to the modern and future achievements of nations such as the emergence of disease epidemics, bioterrorism, and climate change [1]. The gravity of these threats and their potential impact on people the world over has fostered greater health diplomacy between nations. There is greater cooperation and health information sharing now than in any other time in history, allowing for an evaluation of the impact contemporary systems of care may have on international health security. While global public health achievements in large part stem from greater ability to prevent and control the spread of infectious disease, this is not the sole determinate of global health and life expectancy. In the modern era, the leading causes of mortality worldwide are not infectious (Table 1). Cardiovascular disease is, in fact, the number one cause of mortality worldwide, inclusive of all ages and demographics. Cerebrovascular disease is the second most common cause of death. Out-of-hospital cardiac arrest, traumatic injury, and peripartum complications leading to neonatal death continue to have a significant impact on global mortality. Emergency medical services and programs such as ATLS, Advanced Cardiac Life Support (ACLS), and the Neonatal Resuscitation Program (NRP) were created to help deliver essential knowledge and skills to communities with low resources and increased disease burden. In this chapter, we will review the impact of these programs and initiatives aimed at improving health outcomes globally.
\nRank | \n0–4 years | \n5–14 years | \n15–29 years | \n30–44 years | \n45–59 years | \n≥60 years | \nAll ages | \n
---|---|---|---|---|---|---|---|
1 | \nLower respiratory infections 1,890,008 | \nChildhood cluster diseases 219,434 | \nHIV/AIDS 707,277 | \nHIV/AIDS 1,178,856 | \nIschemic heart disease 1,043,978 | \nIschemic heart disease 5,812,863 | \nIschemic heart disease7,153,056 | \n
2 | \nDiarrheal diseases 1,577,891 | \nRoad traffic injuries 130,835 | \nRoad traffic injuries 302,208 | \nTuberculosis 390,004 | \nCerebrovascular diseases 623,099 | \nCerebrovascular diseases 4,685,722 | \nCerebrovascular diseases5,489,591 | \n
3 | \nLow birth weight 1,149,168 | \nLower respiratory infections 127,782 | \nSelf-inflicted injuries 251,806 | \nRoad traffic injuries 285,457 | \nTuberculosis 400,708 | \nCOPD 2,396,739 | \nLower respiratory infections 3,764,415 | \n
4 | \nMalaria 1,098,446 | \nHIV/AIDS 108,090 | \nTuberculosis 245,818 | \nIschemic heart disease 231,340 | \nHIV/AIDS 390,267 | \nLower respiratory infections 1,395,611 | \nHIV/AIDS 2,818,762 | \n
5 | \nChildhood cluster diseases 1,046,177 | \nDrowning 86,327 | \nInterpersonal violence 216,169 | \nSelf-inflicted injuries 230,490 | \nCOPD 309,726 | \nCancers of respiratory system 927,889 | \nCOPD 2,743,509 | \n
6 | \nBirth asphyxia and birth trauma 729,066 | \nTropical cluster diseases 35,454 | \nLower respiratory infections 92,522 | \nInterpersonal violence 165,796 | \nCancers of respiratory system 261,860 | \nDiabetes 749,977 | \nDiarrheal diseases 1,766,447 | \n
7 | \nHIV/AIDS 370,706 | \nFires 33,046 | \nFires 90,845 | \nCerebrovascular diseases 124,417 | \nCirrhosis of the liver 250,208 | \nHypertensive heart disease 732,262 | \nTuberculosis 1,605,063 | \n
8 | \nCongenital heart disease 223,569 | \nTuberculosis 32,762 | \nDrowning 87,499 | \nCirrhosis of the liver 100,101 | \nRoad traffic injuries 221,776 | \nStomach cancer 605,395 | \nChildhood cluster diseases 1,359,548 | \n
9 | \nProtein energy malnutrition 138,197 | \nProtein energy malnutrition 30,763 | \nWar 71,680 | \nLower respiratory infections 98,232 | \nSelf-inflicted injuries 189,215 | \nTuberculosis 495,199 | \nCancers of respiratory system 1,238,417 | \n
10 | \nSTDs (except HIV) 76,871 | \nMeningitis 30,694 | \nHypertensive heart disease 61,711 | \nPoisoning 81,930 | \nStomach cancer 185,188 | \nColon or rectal cancer 476,902 | \nMalaria 1,221,432 | \n
Most common causes of death worldwide by age group, 2002 (adapted from WHO prehospital trauma care systems) [2].
An organized procedure was followed to ensure a high quality review of the literature regarding the subject of interest. First, a comprehensive search of peer-reviewed journals was completed based on a wide range of key terms including, but not limited to, “global health,” “health security,” and “health systems.” Databases searched included PubMed, Ovid, and Google Scholar. Next, a search of websites such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) was conducted for policy and review statements on major threats to health security and leading cause of mortality worldwide. Based on these findings, further literature review was conducted using key terms such as “Trauma,” “Cardiovascular Disease,” “Stroke,” “Maternal Health,” “ATLS,” “ACLS,” “EMS,” and “NRP.” Literature review continued with articles identified as having potential for further review from the references sections of articles previously collected. The literature search ultimately generated 109 articles referenced in this review, which were published between 1980 and 2019. The collective information gained from this literature review was synthesized to identify the impact of programs and initiatives aimed at improving outcomes from the greatest threats to health security. These were organized into sections and are presented as examples of the extent to which these systems of care impact health security internationally.
\nTraumatic injury is a disease without boundaries; it is one of the leading causes of morbidity and mortality worldwide and places a particularly heavy burden upon countries with limited resources. Road injuries alone killed 1.4 million people in 2016, about three-quarters (74%) of whom were men and boys [3]. Despite greater knowledge of injury causes and prevention, the growing global population, traffic, and urbanization cause morbidity and mortality secondary to trauma to remain a major health concern worldwide. Ensuring timely access to advanced trauma care as an international health security measure requires an organized network of prehospital emergency care and a standardized system of trauma care that can be replicated and delivered to patients in rural community hospitals and major academic tertiary care centers alike.
\nOne of the largest initiatives in improving trauma care to-date has been the Advanced Trauma Life Support (ATLS) course. This training program was developed in 1978 by the American College of Surgeons following the tragic event of an orthopedic surgeon piloting his plane, who crashed into a Nebraska cornfield with his family, killing his wife and severely injuring his three children [4]. Insufficiency in the system of emergency medical care was recounted by this surgeon, who called for a system change to improve the care for trauma victims everywhere. ATLS focuses on the initial stabilization and resuscitation of the trauma patient, referencing the “Golden Hour” as the most important, as 30% of all trauma deaths occur within 60 minutes of injury [5]. Despite a paucity of data on the effect ATLS has on trauma mortality, existing evidence supports its practice as a means of decreasing mortality and improving systems of care globally [6, 7].
\nOver 90% of deaths related to injury occur in low-income countries where the availability of prevention programs, emergency services, and centers capable of prompt, advanced resuscitation is limited. The majority of these deaths are caused by road traffic injuries [8]. Establishing early advanced trauma care is essential to decreasing global morbidity and mortality due to trauma and is, in part, accomplished with the dissemination of trauma education programs [9]. Studies have shown that as the number of ATSL-trained professional increases, the rates of preventable and potentially preventable deaths decreases (Figure 1) [10].
\nChange in mortality over time with increasing number of ATLS-trained providers (adapted from Navarro et al. [
One study of trauma-related deaths before and after the implementation of focused trauma education courses in the capital of Rwanda, including ATLS, found the mortality of severely injured patients decreased significantly in the 6 months following their initiation [7]. Another study reported improved management of trauma patients by practitioners from countries throughout East, Central, and Southern Africa after institution of a primary trauma care course [11]. In the Netherlands, the introduction of ATLS resulted in a significantly improved trauma outcome in the first hour after admission [12]. A study on the impact of mandatory ATLS training on processes of care in rural America found improvement after categorization of trauma centers [6]. Improvement in trauma patient outcomes has also been reported after ATLS training in Trinidad and Tobago [13].
\nSince its inception, ATLS has gone through several iterations. Its principles have become standard of care in over 50 countries worldwide, with over 1 million physicians trained since the mid-1990s [14, 15, 16]. ATLS has developed into a global resuscitation program, with confirmed results in terms of improved patient outcomes, processes of care, and teaching.
\nCardiovascular disease (CVD) is by far the leading cause of death worldwide. An estimated 17.9 million people died from CVD in 2016, representing 31% of all global deaths, 85% of which are due to heart attack and stroke [3, 17]. Over three-quarters of CVD deaths take place in low-income countries, illustrating a disparity in care and the need for further resource allocation and education. Despite the global burden of CVD, there have been remarkable advances in treatment and prevention. The field of resuscitation has been evolving for more than two centuries with the American Heart Association (AHA) formally endorsing cardiopulmonary resuscitation (CPR) in 1963 [18].
\nBasic life support (BLS) and advanced cardiac life support (ACLS) guidelines have evolved over the past several decades based on a combination of scientific evidence and expert consensus. The AHA and European Resuscitation Council developed the most recent ACLS Guidelines in 2010 using a comprehensive review of resuscitation literature performed by the International Liaison Committee on Resuscitation (ILCOR). These were updated in 2015 and 2018 [19, 20, 21, 22, 23, 24, 25, 26]. The efficacy of these guidelines is well borne out in the literature with clear reductions in in-hospital and out-of-hospital mortality when the most critical interventions (e.g., defibrillation, CPR, and rapid transport to an advanced care) are initiated early (Figure 2) [24, 27, 28, 29, 30, 31].
\nExposure to prehospital bystander interventions among patients who achieved neurologically intact survival. EMS = emergency medical services; apatients received both bystander and EMS defibrillation (adapted from Nakahara et al. [
Numerous large-scale randomized clinical trials have demonstrated the benefit of timely interventions as well, including antiplatelet therapy, thrombolysis, and cardiac catheterization [17, 32]. Results from these trials have been incorporated into guidelines for inpatient and outpatient cardiac care internationally [33, 34].
\nDespite these well-established guidelines for the management of ACS, there are still strong differences with regard to the epidemiology, diagnosis, and treatment of patients with ACS, leading to diverging morbidity and mortality rates throughout the globe [17]. Reasons for such differences among different global populations are multifactorial and include differences in population genetics, access to care, diet, socioeconomic status, and treatment modalities employed regionally (i.e., invasive vs. non-invasive strategies) [35, 36]. To address these disparities, much work has been done to universalize treatment protocols by bringing systems of care to areas most in need.
\nStent for Life (SFL), a European Association of Percutaneous Cardiovascular Interventions (EAPCI) and Congress of the European Association of Percutaneous Cardiovascular Interventions (EuroPCR) coalition, was established in 2008 as a non-profit international network of national cardiac societies and partnering organizations. The mission of SFL was to address inequalities in ST-elevation acute myocardial infarction (STEMI) patients’ access to a life-saving revascularization treatment throughout Europe.
\nEffective from 2008 to 2016 in 23 countries, mainly in Europe, this initiative significantly improved the delivery of guideline-compliant therapy and patient access to primary percutaneous coronary intervention (p-PCI), thereby reducing mortality and morbidity in patients suffering from acute myocardial infarction (AMI) [37, 38]. Since 2017, the Stent—Save a Life Initiative (SSLI) was founded as the global extension and continuation of Stent for Life. The SSLI works to identify regions and countries with an unmet medical need in the optimal treatment of ACS and implement an action program to increase patient access to primary PCI where indicated.
\nThe advancement of international health security is seen in the work of these and similar organizations which work to identify opportunities and challenges in building systems of care in emerging countries, such as India, China, South Africa, and Mexico, where CAD mortality is increasing and becoming a significant healthcare problem [39, 40, 41, 42]. Geographic mapping and situational analyses have shown that adherence to STEMI guidelines is influenced by many factors and varies from country to country, from region to region, and no one model fits all communities. Greater understanding of system-level barriers and unique challenges in the regional context will facilitate the development of more effective strategies for improving the treatment and preventing CVD globally.
\nCerebrovascular disease and acute stroke syndromes are a leading cause of mortality and disability worldwide. According to the Global Burden of Disease Study published in December, 2018 the estimated lifetime risk of stroke for a 25 year old during their remaining lifespan is 25% [43]. Stroke is the third leading cause of death and first leading cause of major disability in North America. Over the last several decades developed countries have experienced reductions in stroke-related morbidity and mortality [44]. Mortality from stroke has decreased by 60% in the United States alone, but remains the fifth leading cause of death [45, 46, 47]. For most developed countries, this experience has been similar. Over the last 20 years, high-income countries have experienced an age-standardized decrease in incidence, mortality and disease burden (as measured by disability-adjusted life year loss rates) of 13, 37, and 21%, respectively [48, 49]. Nonetheless, Stroke accounts for almost 5% of all disability-adjusted life-years and 10% of all deaths worldwide [50].
\nWhile progress has been made in stroke care in developed countries, the global experience of cerebrovascular disease is less encouraging. In 2013, 6.4 million deaths (11.8% of all global deaths) were a result of stroke [51]. Stroke remains the third leading cause of years-of-potential-life lost worldwide [52]. Between 1990 and 2010, the incidence of ischemic stroke increased by 37% and that of hemorrhagic stroke increased by 47%; the total number of deaths attributable to ischemic and hemorrhagic stroke increased by 20% over that same period [48]. By 2030 there could be as many as 12 million stroke deaths, 70 million stroke survivors, and >200 million disability-adjusted life years lost from stroke each year [44]. Not surprisingly, the majority of the burden of disease is borne by low- and middle income countries at the center of the global stroke epidemic [53]. While high-income, developed countries have been experiencing significant declines in stroke incidence in recent years, undeveloped, low-income countries have experienced increases in incidence by as much as 100% [54]. The substantial regional and country-level variation in stroke disease, with hotspots of particularly high-stroke incidence, mortality, and morbidity in Eastern Europe, East and Southeast Asia, Central Africa, and Oceania has become known as the “Global Stroke Belt” [55]. The most affected countries in the global stroke belt have a >10-fold higher age-standardized stroke mortality rate than the least affected countries [56].
\nThere have been significant advances in stroke care in recent years. Timely revascularization has been by far the most powerful predictor of improved outcome in patients with acute ischemic stroke [57]. Given the time-sensitive nature of therapeutic interventions and the specialized care required by those affected, regional systems of care have evolved in different forms to provide patients the best functional outcomes possible. The emergence of advanced imaging modalities and endovascular interventions have had a significant impact on the organization of acute stroke care, as communities strive to deliver the most up-to-date, evidence-based treatments effectively.
\nEvidence shows that organized care within specialized stroke units is associated with better quality of care and reduced rates of death and disability [58]. There is significant variation, however, within and between countries in access to stroke care and the organizational models of such care [59]. In several countries, acute stroke services are being centralized into “hub and spoke” systems in which hospital providing different levels of care work together to create a centralized system in which all patients with acute ischemic stroke are taken to specialized centers, rather than the nearest hospital [60]. Research suggests that in countries where such models exist (e.g., the United States, Canada, the Netherlands, Denmark, and Australia), there is greater provision of evidence-based therapies by increasing access to specialist care and thrombolysis [61, 62, 63]. Other countries, such as the United Kingdom, have found decreases in mortality and hospital length-of-stay where hyperacute stroke services were centralized to a small number of highly specialized, high-volume centers [64]. In other countries, such as Greece, a centrally administered rotation system for 24-hour on-call services exists for specialized stroke care [65].
\nIn the United States (U.S.), regionalization of care around specialized centers played a large role in stroke dropping from the third to the fifth most common cause of death [55]. In the year 2000, the Brain Attack Coalition recommended the establishment of primary stroke centers (PSCs). Primary Stroke Center certification recognizes hospitals that meet standards to support better outcomes for stroke care. Studies from the American Heart Association/American Stroke Association Get With The Guidelines-Stroke Program have demonstrated that PSC certification improves many key process measures of stroke care [66].
\nStudies have shown that not only do hospitals with PSC certification experience lower mortality rates but also the mortality benefit appears to be independent of hospital size or time since certification (Figure 3) [67, 68]. This suggests that the process of obtaining certification in advanced stroke care alone may improve outcomes, regardless of hospital size. Since 2012, hospitals may become certified as comprehensive stroke centers (CSCs), another designation based on the Brain Attack Foundation’s recommendations for establishing systems of stroke care which requires an ability to provide more-complex services, including 24/7 availability of endovascular procedures. According to a large national study of stroke centers in the U.S., CSCs were significantly better at providing prompt acute treatment (i.e., thrombolysis and endovascular clot retrieval) for patients with acute ischemic stroke, but in-hospital mortality was similar between hospital settings [69]. The fact that less technically sophisticated centers provided non-inferior care to larger, more advanced centers has significant implications. For communities with evolving systems of care and in nations where resources are limited, a focus on providing established medical therapies to the most number of people in the most timely manner possible may be more beneficial than investing in expensive advanced technologies.
\nMortality at designated stroke centers and nondesignated hospitals. CI = confidence interval; anegative values indicate lower mortality rates at designated vs. nondesignated hospitals (adapted from Xian et al. [
The health of women and children is vital to creating a healthy world. Ensuring access to appropriate perinatal care is vital to international health security. Despite great progress, there are still too many mothers and children dying—mostly from causes that could have been prevented. Every day, there are approximately 800 deaths from preventable causes related to pregnancy and childbirth, 99% of which occur in developing countries. Despite decreasing rates of childhood mortality worldwide, neonatal deaths account for nearly half of all deaths in children less than 5 years old [70]. Intrapartum-related events such as birth asphyxia contribute to approximately one-quarter of neonatal deaths, many of which can be decreased by simple resuscitative and newborn care maneuvers. Neonatal deaths now comprise ~45% of all childhood deaths in children less than 5 years old, resulting in 2.7 million lives lost each year [71].
\nThe challenge of delivering neonatal resuscitative interventions is complicated by the fact that childbirth often occurs outside of healthcare facilities; up to 60% in some parts of the world [72]. Implementation of properly performed neonatal resuscitation remains low in countries with the highest neonatal mortality rates [72]. Adequate basic neonatal resuscitation can prevent many intrapartum deaths. Studies suggest that an additional 20–40% of lives would be saved with the institution of basic neonatal resuscitation where it is needed most [73, 74].
\nUnderstanding the impact that neonatal resuscitation delivered by trained healthcare workers can have on mortality is essential to improving international health security. Implementation of neonatal resuscitation programs has been shown to decrease intrapartum stillbirth rates and early neonatal mortality. Skilled birth attendance and newborn resuscitation are evidence-based interventions directed at the moment when the lifetime risk for mortality is highest [73, 74].
\nThe American Academy of Pediatrics released the Neonatal Resuscitation Program (NRP) in 1997, the first standardized training program for neonatal resuscitation of its kind. The NRP is an educational program that translates the science of resuscitation into practice. The initial goals of the NRP were to promote evidence-based care for newborns and to ensure the presence of at least one professional trained in neonatal resuscitation at every delivery in the United States (US) [75]. Hands-on learning with mannequins and a simple, transportable program structure led to widespread adoption outside the US. The use of NRP has spread globally with countries adapting the program to function within the context of their own healthcare environments [76]. NRP continues to be a driving force for the development of initiatives to reduce newborn mortality by promoting an action-oriented approach that trains a variety of providers, aids in the acquisition of resuscitation equipment, and promotes the importance of newborn health to proper authorities [77]. Implementation of NRP in various countries has resulted in a reduction in birth asphyxia-related mortality, in addition to increased use of bag-mask ventilation in newborn resuscitation [78, 79].
\nDrawbacks of the NRP, however, exist, and are primarily related to its complexity, which necessitates training in well-resourced settings. This has also been shown to result in inadequate skills retention after training when the learner does not practice neonatal resuscitation regularly [80]. These and other challenges to the adoption of NRP in low-resource settings may lead to the assumption that resuscitation cannot be accomplished without advanced equipment and facilities [81]. Research over the last two decades, however, has shown that over 98% of babies respond with spontaneous breathing after basic resuscitation, including drying, warmth, stimulation, and bag-mask ventilation [72, 82].
\nThus, NRP courses taught in resource-limited settings have been modified to focus on the initial steps of resuscitation while omitting discussion of more complex interventions such as intubation, medications, and umbilical line placement. Adaptations of NRP have improved both educational outcomes and skills when used to teach providers in low-resource settings [79, 83, 84]. They also have led to decreases in perinatal mortality. In a multinational randomized trial of 62,366 births in rural communities, utilization of a modified NRP and newborn care package resulted in a 30% reduction in still birth rates [85]. Such experiences demonstrate that low-resource settings require a curriculum specifically designed and targeted for their needs.
\nWith the goal of equipping caretakers in all practice settings with the basic knowledge and skills necessary to perform adequate neonatal resuscitation, a task force organized by the American Academy of Pediatrics set out to develop a simplified, standardized curriculum based on NRP. The result was the Helping Babies Breathe (HBB) program, which became available in 2010. The HBB curriculum is portable, low cost, and teaches a simpler algorithm than NRP, focusing on stimulation, drying, clearing the airway, and bag-mask ventilation. Instead of spending time evaluating a baby’s condition, interventions begin immediately with sequential evaluation of crying, breathing, and heart rate. Elements of essential newborn care are incorporated into the curriculum, including encouragement of breastfeeding, cleanliness, and warmth at delivery. The World Health Organization (WHO) released guidelines on basic newborn resuscitation in 2012, which were largely consistent with the recommendations and action plan of HBB [86].
\nEducational evaluations of HBB in developing countries have shown the course to be well received since their dissemination workshops in HBB have been shown to improve knowledge and skills in basic neonatal resuscitation immediately after training [87, 88, 89, 90, 91]. Most encouraging for the further spread of the program have been studies evaluating differences in performance based on the type of provider. While physicians perform better in pre-workshop assessments of both knowledge and skills of basic resuscitation, after HBB training, nurses perform as well in simulation as physicians [89, 91]. This and similar evidence support the training of doctors, nurses, midwives, and all others involved in newborn care. This is vital as, globally, midwives and other non-physicians care for the majority of deliveries.
\nSince the introduction of HBB, over 300,000 providers have been trained in 77 countries [92]. Fifty-two countries have established nationally led programs. Analysis of 80,000 births after HBB training demonstrated a 47% reduction in early neonatal deaths and a 24% reduction in fresh stillbirth rates (Figure 4) [94].
\nStillbirth and intrapartum mortality rates overtime during implementation of HBB in a Nepalese tertiary care center. QIC = quality improvement cycle; QIT = quality improvement team (adapted from Kc et al. [
Studies in developing countries where HBB was adopted have shown a decrease in perinatal mortality and in stillbirth rates [93, 95]. A systematic review evaluating whether the implementation of a standardized formal neonatal resuscitation training program in low- and middle-income countries improved neonatal outcomes found that early neonatal mortality (first week of life) decreased by 15% and reduction of 28-day mortality by 45% [96].
\nOn a global scale, many successes have been achieved with the implementation of neonatal resuscitation: decreased neonatal mortality, decreased still birth rates, and increased use of alternative providers. Despite the successes of implementation of neonatal resuscitation education, training providers in and of itself is insufficient to close the gaps in quality of newborn care. An estimated two-thirds of the world’s 2.7 million newborn deaths may be prevented with basic pre- and postnatal care [97]. While there may be successes to celebrate, there is still much work to be done to improve newborn care and reduce neonatal mortality globally.
\nAn emergency medical service can be described as a comprehensive system, which provides the arrangements of personnel, facilities, and equipment for the effective, coordinated, and timely delivery of health and safety services to victims of sudden illness or injury [98]. The goal of EMS is to provide timely health care for out-of-hospital medical emergencies in order to prevent unnecessary mortality or long-term morbidity [2].
\nTimely access to healthcare in an emergency situation is a fundamental component of health security. Prompt provision of prehospital emergency care coupled with rapid movement of the ill and injured to a health-care facility can save lives, reduce the incidence of short-term disability, and markedly improve long-term outcomes. The World Health Organization regards EMS system as an integral part of any effective and functional health care system [99]. In developed nations, emergency medical service (EMS) has evolved into a key link in the chain of survival for those suffering out-of-hospital illness or injury, and contributes significantly to the overall function of a healthcare system and health of a society. The birth and evolution of emergency medical services has, however, been a very slow process and has occurred on different timelines around the world.
\nAlthough modern EMS initially developed during Napoleon’s time to aid injured soldiers, few major changes occurred in EMS until the 1960s. The adaptation of prehospital care and transport principles from the military to the civilian arena accelerated after the Vietnam War, as returning veterans helped raise awareness of the disparities in care. By the end of the conflict, gunshot victims had better chances of survival in the jungles of Vietnam than they had in the streets of major cities across America. Between 1960 and 1970, a number of medical, historical, and social forces converged, leading to the development of a more structured EMS system in the United States and abroad [100].
\nSince the 1970s, emergency health care delivery has evolved from two different models with different philosophies and distinct features, referred to as the Anglo-American and Franco-German models of care [2]. Although the categorical distinctions between these two models were more obvious leading up to the twentieth century, modern EMS systems around the world have evolved along one of these two frameworks while adopting various components of the other.
\nThe Franco-German model is based on a “stay and stabilize” philosophy where advanced medical care is brought to the patient. Emergency services are run by physicians who respond to patient’s homes or the scene of an accident where they provide advanced care. Patients are either stabilized and provided follow-up directions or are transported to the hospital for admission. This results in fewer EMS transports and fewer patients being seen and treated in emergency departments. This approach to prehospital care, where EMS is an extension of the hospital, is widely implemented in continental Europe (e.g., France, Germany, Greece, Malta, and Austria) where emergency medicine is a young specialty.
\nBy contrast, the Anglo-American model of EMS care is based on a “scoop and run” philosophy [101]. The objective in this model is to rapidly bring patients to the hospital with less time spent on prehospital treatment and interventions. Here, EMS services are allied with public safety services such as fire or police departments rather than public health services or hospitals [102]. Specialized emergency medical technicians (EMTs) and paramedics provide direct patient care with remote physician oversight. In countries where this model prevails, emergency medicine is well developed and recognized as a separate medical specialty [103]. Patients are transported to emergency departments (EDs) where the majority of evaluation and treatment is begun. Patients are then either discharged or admitted to the wards for further treatment. Examples of countries utilizing this model include the United States, Canada, New Zealand, and Australia.
\nWhile both models of EMS share a similar focus for the severely ill and injured (i.e., stabilization and transport), it is the delivery of non-life-threatening care where the greatest difference is found. Whereas the Franco-German model places more emphasis on treating patients in their homes and avoiding transport when possible, the Anglo-American model transports the majority of patients for evaluation in an emergency department [104]. Given the significant differences in these systems, much comparative research has been done on patient outcome and cost-effectiveness between the two models. Outcomes, however, are difficult to interpret because of the disparate nature of each model. Each operates in a different context with different goals. The lack of unified standards makes direct comparison difficult and there is no evidence that one model is better than the other [105, 106, 107].
\nUnfortunately, to this day, the capacity to provide the most basic level of prehospital emergency care is lacking in many countries around the world. While EMS providers have developed an extended role in dealing with medical emergencies and have access to advanced clinical technologies in some countries, in others their education and training is much more limited due to a lack of funding, resources, and organizational guidance. Regardless of how simple or sophisticated a prehospital care system may be, the essential elements of an effective model are not outside the capabilities of developing nations. These elements, shown to decrease morbidity and mortality, include prompt communication and activation of the prehospital emergency response system, immediate system response, and simultaneous treatment and transport to formal medical care [99]. It is important to note that there is little evidence that advanced prehospital interventions benefit more than a small subset of the most critically ill or injured. Studies have shown that the majority of cases require treatment within the skill set of responders trained only in basic life support [102]. This has major implications for nations with limited resources, where advanced life support materials and programs may harm a system by diverting precious resources from less glamorous, but more effective measures that benefit a larger number of people. Ultimately, the model chosen for creating and administering an EMS system best suited to a particular demographic will be influenced by regional resources, culture and values, but should always be the result of local and national governments working together toward a common goal of greater health security [108].
\nIn an increasingly interconnected world, the potential for threats to international health security such as pandemics, bioterrorism, and radionuclear exposure are of increasing concern. The research and design of medical countermeasures in the form of vaccines, antimicrobials, therapeutics, and diagnostics that address the public health and medical consequences of chemical, biological, radiological, and nuclear events is an area of active research and development. In 2014, the United States in partnership with international organizations and nearly 30 partner countries launched the Global Health Security Agenda (GHSA) to accelerate progress to improve prevention, detection, and response capabilities for public health emergencies [109]. The GHSA calls for improved global access to medical countermeasures and establishes as a target the development of national policy frameworks for sending and receiving medical countermeasures from and to international partners during public health emergencies. International health countermeasures such as vaccines, antidotes, and decontamination supplies are now stockpiled by several countries to protect their own populations and by international organizations such as the WHO for the benefit of the international community (typically those with limited resources). Much work remains, however. During the H1N1 influenza pandemic in 2009, legal, regulatory, logistical, and funding barriers slowed the spread of vaccine and revealed how implementing health security measures on a global scale remains a significant challenge [109]. While imperfect in its implementation, the network established by the GHSA continues to evolve and help combat future threats to international health security. Greater efforts are needed to develop a framework to deploy medical countermeasures internationally, thus increasing global capacity to respond to public health emergencies.
\nThe concept of health security means different things to different people. In developed nations, the concept is that of addressing threats to public health such as the spread of disease and bioterrorism. In developing nations, threats to health also include access to care and modern therapies. In order to address health security on a global scale, government authorities and public health institutions must incorporate access to modern systems of care addressing the major determinants of health and primary causes of mortality into the focus of international health security. In this chapter, we have discussed how organized systems of care stand to improve the health of communities on a global scale. With greater emphasis on establishing these and other systems in developing countries, greater health security can be brought to communities that need it most.
\nACLS | advanced cardiac life support |
ACS | acute coronary syndrome |
AHA | American Heart Association |
AMI | acute myocardial infarction |
ATLS | Advanced Trauma Life Support |
BLS | basic life support |
CDC | Centers for Disease Control and Prevention |
CPR | cardiopulmonary resuscitation |
CSC | comprehensive stroke center |
CVD | cardiovascular disease |
EAPCI | European Association of Percutaneous Cardiovascular Interventions |
ED | emergency department |
EMS | emergency medical services |
EMT | emergency medical technician |
EuroPCR | Congress of the European Association of Percutaneous Cardiovascular Interventions |
GHSA | Global Health Security Agenda |
HBB | Helping Babies Breath |
IHS | international health security |
ILCOR | International Liaison Committee on Resuscitation |
NIH | National Institutes for Health |
NRP | Neonatal Resuscitation Program |
PSC | Primary Stroke Center |
p-PCI | primary percutaneous coronary intervention |
SFL | Stent for Life |
STEMI | ST-elevation acute myocardial infarction |
SSLI | Stent-Save a Life Initiative |
WHO | World Health Organization |
Rumen inhabits several microbial populations, that is, bacteria, protozoa, fungi, bacteriophages, yeasts, and methanogens symbiotically, which are very dynamic, plastic, and redundant in function with the changes in diets though core microbiota persists, which has probably evolved by host-microbiota interaction in the evolutionary pressure over thousands of years [1]. A symbiotic relationship exists between rumen microbes and host animals in which both provide desirable substrates to each other mainly through these ways—1) physical breakdown of feed particles by mastication and rumination expands their surface area for microbial attachment and degradation, and consequently, microbes secrete various enzymes for dietary substrate degradation, 2) ruminal movements bring microbes in contact with the dietary substrate by mixing of digesta and consequently produce fermentation products (e.g., H2, CO2, ammonia, short-chain fatty acids (SCFAs), and 3) utilization (absorption and consumption) of the fermentation products for keeping optimal ruminal conditions (e.g., pH) to maintain microbial growth and microbial protein synthesis [2]. Therefore, due to the interactive ecosystem of the rumen, any modification to one component of this system has several effects on other components. The fermentation end products of any diet are incorporated into the final animal products (meat or milk). Thus, manipulation of the ruminal fermentation pathways is the most effective approach to improve ruminant health and production efficiency without exaggerated increases in nutrient supply. This in particular should help the small livestock holders in developing countries for continued production.
The literature explored various manipulation strategies including enhancing or inhibiting the growth or the metabolic activity of specific rumen microbiota (e.g., archaea for methanogenesis) and/or altering the ruminal fermentation toward specific pathways (e.g, decreasing H2 production and increasing short-chain fatty acids (SCFAs) production [3, 4]. Extensive literature supports the supplementations of various rumen modifiers; however, efforts are still underway to find appropriate methods to simultaneously improve livestock production while reducing greenhouse effects on the environment. Through the following aspects, the most common methodologies for modifying the ruminal microbiome and fermentation characteristics are discussed in this chapter.
Lignocellulose (complex polymers of cellulose, hemicellulose, pectin, and lignin) makes up the majority of the ruminant diet. Generally, forages, including crop residues, provide the main source of nutrition to ruminants that contribute to the food security and primary source of income of smallholder farmers in the developing countries [5, 6, 7]. This is also true where grazing animals are common in the developed countries. Hence, forage is virtually the only source of nutrition in the main beef-producing northern Australia, North and South America [8].
Although ruminants can digest fibrous feedstuffs, dietary cell wall polysaccharides are rarely completely degraded in the rumen. Less than 50% of the plant cell wall of most forage grasses are digested and utilized. This is attributed to the combination of the biochemical and physical barriers present in the ingested fibrous feedstuffs and retention time limitations of the ingested dietary substances in the rumen [9], resulting in excessive nutrient excretion, low nutrient intake, and a significant loss of dietary energy in the form of CH4 emission [10]. Therefore, enhancing the rumen microbiota to degrade plant cell walls usually leads to improve animal productivity.
Ruminants cannot degrade lignocellulose themselves. An involved community of fibrolytic microorganisms catalyzes the degradation of the plant cell walls in the rumen. The major classical fibrolytic bacteria involved in fiber degradation are
There are various well-established procedures that can be used to improve forage utilization including modifying ruminal microbial fermentation toward more fiber degradation. These include mechanical and chemical processing of forages and genetically engineering of plants for cell wall composition. However, we will focus on ruminal fibrolytic microorganisms and their products in the following sections of the chapter.
The manipulation of genes in genetically engineered organisms can produce a product with novel specific characteristics that may have significant value. This concept was exploited in developing genetically modified fiber-degrading bacteria to optimize their activity by producing the correct mixture of fibrolytic enzymes to maximize plant cell wall degradation.
As early as 1995, Miyagi et al. [14] suggested that inoculation of genetically marked
The concept of direct-fed microbials is different from the term probiotics. Probiotics were identified by any live microbial feed additive that may beneficially influence the host animals upon ingestion by improving microbial balance in the intestine [18]. Viable microbial communities, enzyme preparations, culture extracts, or combinations of those products were included in the concept of probiotic supplements [19]. The DFM has a narrower definition than probiotics as it is defined as a source of life, naturally occurring microorganisms alive, naturally occurring microorganisms that improve the digestive function of livestock. The DFM includes three main categories; bacterial, fungal, and a combination of both [20]. DFM must be alive to impact ruminal fermentation; thus, the viability and number of organisms fed must be ensured at the time of feeding. Lactic acid-producing and utilizing bacterial species of
DFM can grow under ruminal conditions and manipulate the microbial ecosystem. Various factors may affect the activity of DFM including microbial strains, time of feeding, feeding system, treatment period, physiological conditions, and dosages [20, 22]. The microbial strains seem to be the main influencer—DFM containing mainly lactic acid-producing and utilizing bacteria can manipulate the growth of microorganisms adapted to lactic acid in the rumen while preventing the drastic pH drops, for example,
Direct-fed microbials, based on fungal cultures, mainly contain
Products of exogenous fibrolytic enzymes (EFE) that contain primarily cellulolytic and xylanolytic activities can manipulate the ruminal fiber degradation, and improve feed conversion efficiency and thus lead to enhanced productive efficiency of ruminants [9]. Published literature suggests that the mode of actions of EFE products are likely different than that of DFM products. The activities introduced to the rumen by EFE are not novel to the ruminal ecosystem as they would act upon the same sites of the feed substrate particles as endogenous fibrolytic enzymes [25]. The release of reducing sugars by EFE is probably an essential mechanism by which EFE operates [26]. The degree of sugar release is dependent on the substrate types as well as the type of enzymes. The released sugars can attract secondary ruminal microbial colonization, or remove barriers to the microbial attachment to substrate feed particles by cleaving the linkage between phenolic compounds and polysaccharides [9]. As a result, the most significant effects of EFE probably occur in the interval between the arrival of the feed particles into the rumen and its colonization by ruminal microorganisms, as only the rate, not the extent, of cell wall degradation, has been improved [25]. EFE can also manipulate the rumen fibrolytic microorganisms by enhancing their endogenous fibrolytic activities.
Genes from ruminal fungi encoding cellulases, xylanases, mannanases, and endoglucanases have been successfully isolated. Protein bioengineering has been employed to improve the catalytic activity and substrate diversity of fibrolytic enzymes from ruminants. This has resulted in fibrolytic enzymes with up to 10 times higher specific activity, pH and temperature optima, and enhanced fiber-substrate binding activity than the original enzymes [27]. This, together with the low manufacturing cost, has led to more recent developments in the enzyme production industry, and as a result, a wide range of commercial EFE products is now available. Frequently the manufactures’ recommended doses of most commercial EFE products have been measured under wide ranges of pH (4.2–6.5) and temperatures (40–57°C), which are not always close to typical ruminal conditions. Moreover, most of the commercial EFE products for ruminants are often referred to as xylanases or cellulases. However, none of these products comprise single enzymes; secondary enzyme activities are invariably present, namely, proteases, amylases, or pectinases [9]. A wide variety of feed substrates can be targeted by a single EFE product. Thus, the random addition of these products to ruminant diets without consideration for specific rumen conditions (pH 6.0–6.5 and 39°C) and the not yet tested efficiency for specific substrate will result in unpredictable effects and thus discouraging the adoption of the EFE technology [28, 29].
In general, enhancing the rumen microbiota to degrade the dietary fibers through the above-discussed strategies may lead to accelerating the energy production in the forms of short-chain fatty acids (SCFAs) and/or microbial protein synthesis. At the same time, it may also produce high amounts of CO2 and CH4.
The ruminal fermentation is the primary source of CH4 emission from livestock; it is one of the most potent greenhouse gases featured by short atmospheric mean lifetime. Furthermore, a significant proportion of the ingested feed energy is also lost as CH4 [40]. Methane is produced by methanogens mainly by reduction of CO2 through the hydrogenotrophic pathway. Formic acid and methylamines produced by other ruminal bacteria are also reduced to CH4 by some methanogens. Therefore, methanogens interact with other ruminal microorganisms (e.g., protozoa, bacteria, and fungi) through interspecies H2 transfer [4]. Thus, maximizing metabolic H2 flow away from CH4 toward SCFAs production could improve production efficiency in ruminants and decrease environmental impact. There are various direct and indirect strategies to manipulate rumen methanogenesis; among these options, inhibiting the growth or the metabolic activity of methanogens seems to be the most effective approach. The efficiency of these strategies mainly depends on where methanogens reside. It can be seen from the smaller number of archaeal 16S rRNA gene sequences (461 vs. 8162) recovered from protozoa than from ruminal content or fluid [4]. Free methanogens are mainly integrated into the biofilm on the surfaces of feed particles where H2-producing bacteria actively produce H2. These methanogens protected by the biofilm may not be inhibited to an extent similar to the free-living peers by anti-methanogenic inhibitors [4]. Also, methanogens can be inhibited indirectly through inhibiting rumen ciliate protozoa. Based on fluorescence
Methane formation pathways comprise of three main steps; transfer of methyl group to coenzyme M (CoM-SH), reduction of methyl-coenzyme M with coenzyme B (CoB-SH), and reusing heterodisulfide CoM-S-S-CoB [4, 31]. Thus, obstruction of any of these steps may manipulate CH4 production. A wealth of literature on rumen CH4 manipulation strategies in ruminants have been published recently, but relatively very few have emphasized the suitable mitigation strategies at the farm level [32]. Each method has some potential advantages and limitations. The principal interest for animal producers is income, as they usually do not take CH4 mitigation strategies or climate changes into account. Thus, any strategy to mitigate greenhouse gasses emission would only be of practical interest if achievements on the efficiency of animal production can be obtained. This can be obtained through rumen CH4 modifiers that enhance the production of SCFAs and/or reduce proteases. The following part addresses some of these microbial modifiers.
Ionophores are polyether antibiotics that act as inhibitors to hydrogen-producing bacteria. They are widely used as successful growth promoters in the livestock industry due to their ability to modulate rumen fermentation toward propionate production, thereby decreasing CH4 production. Since propionate and CH4 are terminal acceptors for metabolic H2, any increase in propionate production may accompany reduced CH4. In addition, ionophores positively affect ruminal fermentation through inhibition of deamination compared to proteolysis, inhibition of hydrolysis of triglycerides, and biohydrogenation of unsaturated fatty acids, while enhancing the trans-octadecenoic isomers (cited from [33]).
From the literature, monensin and lasalocid are the most well-known ionophore-type antimicrobials used as rumen modifiers. Mainly, they inhibit Gram-positive bacteria; however, they can also inhibit some Gram-negative bacteria. Ionophores decrease CH4 production by inhibiting H2 producing bacteria by penetrating the bacterial cell wall membrane. They act as H+/Na+ and H+/K+ antiporters, dissipating ion gradients required for the synthesis of ATP, transport of nutrients, and other essential cellular activities in bacteria, resulting in retardation of cell growth and cell death [4, 34]. Monensin can decrease total methanogens number in cattle, and also alter the community composition of methanogen species, for example, monensin decreased the population of
Unfortunately, ionophores present a temporary impact on ruminal manipulation effects due to the adaptation of the microorganisms of these inhibitors. Ionophores are now restricted due to the possible resistance of pathogenic microorganisms to antibiotics [33]. Recently, the global scenario has shifted the interest toward plant natural feed additives with potential abilities to modulate CH4 emission [35, 36]. Moreover, the type of the dietary feeds affects the efficiency of ionophores with the better effect of ionophores observed in high starch diets [33]. Thus, this approach seems to be less effective for the small livestock holders in most developing countries since the forages are the main ingredient in the diets.
Numerous plant secondary compounds (PSC), including tannins, flavonoids, saponins, essential oils (EOs), organosulfur compounds, have been recognized as having the potential to modulate ruminal microbial fermentation [37, 38, 39]. Plant secondary compounds are natural phytochemicals with the potential ability to manipulate rumen fermentation without causing microbial resistance or residual noxious effects on animal products [3]. Unlike ionophores, the different active components found in plant extracts may manipulate ruminal microbiota through more potent mechanisms of action (e.g., antimicrobial and antioxidant), which may avoid the risk of losing activity over time [40].
Tannins are polyphenolic compounds with different molecular weights ranging from 500 to 5000 Da [41]. Tannins are classified into two major groups, that is, condensed (CT) and hydrolyzable tannins (HT). CT are proanthocyanidins consisting of oligomers or polymers of flavan-3-ol subunits. They act through binding with dietary proteins and carbohydrates by making strong complexes at ruminal pH [41, 42, 43]. Therefore, they are the most plant secondary metabolites studied in terms of rumen modulation pathways.
The literature reported quite various effects of CT supplementations regarding CH4 mitigation [38]. Some studies suggest a direct effect of CT on methanogens by binding with the proteinaceous adhesin or parts of the cell envelope, which impairs the establishment of methanogens-protozoa complex and decreases interspecies H2 transfer, and inhibits growth [44]. Other studies suggest an indirect effect of CT through the anti-protozoal effect. However, the effects of CT on rumen protozoal activity are varied in the literature, probably because some of the CTs have a direct effect on rumen methanogenic archaea, which are not associated with the protozoa. Tannins also can indirectly inhibit CH4 per unit of the animal product through tannin–protein or organic matter complexes under ruminal conditions, while protein from these complexes is released post ruminally, making it available for gastric digestion at abomasum and small intestine conditions, leading to enhancing the animal productivity [43]. Another theory is that tannins can act as H2 sink reducing the availability of H2 for CO2 reduction to CH4, implying that 1.2 mol CH4 is produced per mol of catechin [44].
Tree foliages are good feed resources for the small ruminants, which are rich in protein and perform catalytic functions in improving ruminal fermentation, especially in low-quality forage-based diets in developing countries [45]. The nutritionists have paid great attention to the tanniferous legumes and tree foliages as alternative cheap feed resources (especially in drought conditions and arid and semi-arid regions) and to achieve CH4 mitigation goals in the developing countries [46]. Many plants were investigated in the literature; however, the results are highly variable among studies. Soltan et al. [43] studied various tanniniferous browsers and found that some plants (i.e.,
Saponins are a group of plant secondary metabolites with high molecular weight glycosides in which a sugar is linked to a hydrophobic aglycone. It can be generally classified as steroidal and triterpenoid [48, 49]. The effects of saponins on rumen fermentation modulation have been reviewed extensively [49]. The main biological effect of saponins is on the cell membranes of bacteria and protozoa. Saponins are highly toxic to protozoa compared with bacteria because saponins can form complexes with sterols present in the protozoal membrane surface, disrupting the membrane function [49]. Thus, it can indirectly affect the methanogenic archaea through their symbiotic relationship with rumen protozoa [38]. However, some literature assumed that the effects of saponins on rumen protozoa could be transient due to the ability of ruminal bacteria to degrade saponins into sapogenins. The sapogenin compound cannot affect protozoa [50].
Essential oils (EO) are volatile aromatic complexes obtained from different plant volatile fractions by steam distillation. They can be obtained from various plant parts including leaf, stem, fruit, root, seed, flower, bark, and petal. EO contains numerous bioactive substances; the most important ones are terpenoids (monoterpenoids and sesquiterpenoids) and phenylpropanoids. Due to the lipophilic properties of these components, EO act against various rumen bacteria through interacting with the cell membrane [3].
Several EO compounds, either in pure form or in mixtures, had antioxidant and anti-bacterial properties; therefore, they can modulate the ruminal fermentation pathways [51]. The EO, unlike ionophores, does not alter the ruminal microbial activities through a specific mode of action. Therefore, EO may have more potent mechanisms of action that may not likely lose their effectiveness over time. Soltan et al. [40] suggested two mechanisms in explaining how combination of phenylpropanes and terpene hydrocarbons components in EO mixtures work together to enhance additive antimicrobial activity—1) phenolic compounds may increase cell membrane permeability through the action of hydroxyl group, thus facilitating the transport of terpene hydrocarbons into the microbial cells, which then combine with proteins and enzymes inside the cells; 2) phenolic compounds could increase the size, number or duration of the existence of the pores created by the binding of terpene hydrocarbons with proteins in cell membranes.
The effects of EO on rumen fermentation are variable depending on concentrations, types, diet and adaptation period, but most EO are found to have anti-methanogenic properties [35, 52]. Patra and Yu [52] studied various EO with different chemical structures (clove, eucalyptus, origanum, peppermint, and garlic oil)
Propolis is a mixture of resinous substances collected from buds of deciduous trees and crevices in the bark of coniferous and deciduous trees and secretions by honeybees [53, 54]. The bees use propolis to fill cracks, cover hive walls and embalm invading intruder insects or small animals [55, 56]. The literature reported that the chemical composition of propolis is highly variable by bee collection site since geographical location plays an important role [54]. The most bioactive components are belonging to groups of isoflavones, flavonoids, and fatty acids that have been reported to be biologically active [53]. Recently, bee propolis has been recognized as a natural alternative feed additive to antibiotics in ruminant diets [54]. Compared to ionophores (e.g., monensin), different propolis sources can reduce CH4 production while improving the organic matter digestibility and total SCFAs
Fats are usually used as energy sources for dairy cattle. The addition of fats is a promising approach for modulating rumen microbial communities and the fermentation process. Fats are known to inhibit microbial activity; however, supplementing fats up to 6% of dry matter has shown no adverse effects on total nutrient digestibility and total SCFAs [59]. A meta-analysis study suggests that methane emissions can be declined by 0.66 g/kg DM intake with each percentage increase in dietary fats, within dietary fat concentrations of 1.24–11.4% [59]. Fats containing high levels of C12:0, C18:3, and polyunsaturated fatty acids up to 6% of the dietary diet may be considered for CH4 mitigation without compromising the productivity in dairy cattle [59].
Plant oil supplements can modulate CH4 directly by inhibiting rumen protozoa and methanogens while enhancing biohydrogenation of polyunsaturated fatty acids (PUFA) to act as ruminal hydrogen sink for hydrogen produced by rumen microorganisms and reducing fiber degradation with less H2 production in the rumen [60]. The literature showed variable effects of plant oils on CH4 emission and rumen fermentation; this might be related to the oil type (free oil or whole seed), diet composition (forage to-concentrate ratio), and fatty acid type (short-chain or PUFA) present in diets [59]. Generally, consideration of vegetable oils supplementation to lower CH4 emission may depend upon the cost and expected outcome effect on animal productivity.
Chitosan is a natural polycationic polymer, nontoxic, biocompatible, biodegradable; thus, it is safe for human as well as animal consumption [61]. It is a linear polysaccharide composed of two repeated units—D-glucosamine and N-acetyl-D-glucosamine linked by β-(1–4)-linkages [61]. It can be found in the structural exoskeleton of insects, crustaceans, mollusks, cell walls of fungi, and certain algae, but it is mainly obtained from marine crustaceans [62]. It is characterized by anti-inflammatory, antitumor, antioxidative, anticholesterolemic, hemostatic, and analgesic effects. Moreover, it has a high antimicrobial affinity against a wide range of bacteria, fungi, and protozoa; therefore, it has been recently tested as a rumen fermentation modulator and considered as a promising natural agent with CH4 mitigating effects [61]. The antimicrobial mechanism of chitosan can include interactions at the cell surface and outer membranes through electrostatic forces, the replacement of Ca+2 and Mg+2 ions, the destabilization of the cell membrane, and leakage of intracellular substances, and cell death. The antimicrobial properties of chitosan can also include chelating capacity for various metal ions and the inhibition of mRNA and protein synthesis [61].
It seems chitosan activity depends on the diet type as well as the ruminal pH. The literature reports suggest that the maximum effect of chitosan is noted when grain (starch) is incorporated in the ration at low pH values, shifting the fermentation pattern to a more propionate production pathway, which could be explained by the higher sensitivity of Gram-positive bacteria than Gram-negative bacteria against chitosan [61, 63]. This type of change in ruminal fermentation by chitosan results in reductions in CH4 production. Moreover, supplementation of chitosan alters the rumen bacterial communities related to fatty acids biohydrogenation, that is,
Numerous chemical additives were used to modulate the rumen microbial activity for optimizing animal productivity, namely, defaunating agents, and anti-methanogenic agents to reduce CH4 emission. Patra et al. [4] reported the most promising anti-methanogenic agents that effectively lower CH4 without adverse effects on rumen degradability or producing SCFAs and each of which works through different modes of action when added together to additively decrease CH4 production. These include halogenated sulfonated compounds (e.g., 2-bromoethanesulfonate, 2-chloroethanesulfonate, and 3-bromopropanesulfonate), 3-nitrooxypropanol (3NOP), nitrate, and ethyl-3NOP are used to inhibit methyl-CoM reductase activity, the final limiting step to complete the methanogenesis pathways. Halogenated aliphatic compounds with 1 or 2 carbons can impair the corrinoid enzymes function and inhibit cobamide-dependent methyl group transfer in methanogenesis or may serve as terminal electron (e−) acceptors. Some agents, namely, lovastatin and mevastatin were found to inhibit 3-hydroxy-3-methylglutaryl coenzyme, which is essential in the mevalonate pathway to form isoprenoid alcohols of methanogen cell membranes [4]. The addition of nitrate has two benefits—it can inhibit methanogenesis and acts as a nonprotein nitrogen source, which could be useful in low-quality base diets [65].
Diets containing high amounts of rapidly fermenting soluble carbohydrate result in pH drop due to excessive production of lactate or VFA or a combination of both, which may be of subacute ruminal acidosis (pH between 5.0 to 5.5) or acute acidosis (<5.0) type with acute or chronic in duration [66]. The consequences of acidosis range widely along with death and more importantly lower productivity, especially in subacute ruminal acidosis [66, 67]. Decreasing the ruminal pH leads to inhibition of rumen cellulolytic bacteria. Therefore, maintaining ruminal pH at the average level (5.8–7.2) is an essential factor to balance the rumen microorganisms between acid producers and consumers. In this context, buffering reagents and alkalizer (e.g., sodium bicarbonate, magnesium oxide, and calcium magnesium carbonate), direct-fed microbials, and malate supplementation may increase pH in the rumen and production when ruminants are fed with high-grain based diets [66, 68]. Malate supplementation can stimulate Selenomonas ruminantium that converts lactate to VFA [69]. Marden et al. [70] reported that the inclusion of 150 g of sodium bicarbonate increased total ruminal VFA concentration by 11.7% compared to the control diet fed to lactating cows. The addition of sodium bicarbonate, magnesium oxide, and calcium magnesium carbonate reduced the duration of time ruminal pH persisted below 5.8 in lactating dairy cows fed a high-starch (342 g/kg DM) containing diet and increased milk and fat yield, and milk fat concentration, but reduced milk
Microbial protein in the rumen (RMP) accounts for between 50 and 90% of the protein entering into the duodenum and supplies the majority of the amino acids required for growth and milk protein synthesis [72]. Therefore, increasing RMP synthesis is important for improving animal productivity. Moreover, increasing the RMPS is an effective strategy to decrease protein (i.e., nitrogen) excretion in livestock since the dietary protein unless utilized properly by ruminal microorganisms is degraded to ammonia in the rumen, and ammonia is absorbed from the rumen, metabolized to urea in the liver, and excreted in urine causing environmental nitrogen pollution [10, 73].
There are many factors affecting RMP synthesis including dry matter intake, type of the ration fed (forage to concentrate ratio), the flow rate of digesta in the rumen, the sources, and synchronization of nitrogen and energy sources [74]. Among these, the amount of energy supplied to rumen microbes was found to be the main factor affecting the amount of nitrogen incorporated into RMP. Phosphorylation at the substrate level and electron transport level are two significant mechanisms of energy generation within microbial cells [75]. Based on 10 reconstructed pathways associated with the energy metabolism in the ruminal microbiome, Lu et al. [75] found that the energy-rich diet increased the total abundance of substrate-level phosphorylation enzymes in the glucose fermentation and F-type ATPase of the electron transporter chain more than the protein-rich diet. Therefore, they concluded that energy intake induces higher RMP yield more than protein intake. In this context, any factor affecting the available amount of soluble carbohydrates to rumen microbes will affect the efficiencies of RMP synthesis. Therefore, most of the previously mentioned rumen modifiers (e.g., plant secondary metabolites, dietary oil) may affect the RMP synthesis; however, most of the studies have ignored the determination of RMP.
Maximizing RMP synthesis seems to be the most effective approach for the small livestock holders in most developing countries since microbial protein sometimes becomes the only protein source for the animals fed on poor quality forage diets with low or without concentrate supplementations. Balancing the diets of these animals by supplementing of leaves of legumes, urea-molasses multinutrient blocks, urea in the form of slow ammonia release, and other nonprotein nitrogen resources found to be favorable for RMP synthesis [8, 10, 29, 73]. It has been recognized that feeding high true proteins (the most expensive ingredients in the ruminant diet) can be utilized by ruminal bacteria in about the same way as the ammonia from nonprotein nitrogen (e.g., urea). The optimum concentrations of ammonia in the rumen for maximal RMP synthesis are about 50–60 mg/L and 27–133 mg/L from the
Reduction in CH4 production can enhance the RMP synthesis. Soltan et al. [10, 29] observed that inclusion of
From an economic view, dietary protein concentrates increase production costs, especially for developing countries. Furthermore, the microbial population in the rumen has a high proteolytic capacity to degrade the dietary protein. Therefore, nutritionists are interested in formulating diets with ruminal undegradable protein sources. The protein degradation in rumen depends mainly on three processes—proteolysis, peptidolysis, and deamination. Many protein-degrading bacteria are naturally found under ruminal conditions, that is,
Several inhibitors of ruminal microbial protein degradation and ammonia production were reported in the literature. Condensed tannins, slow-release urea products, encapsulated nitrate, clays (e.g., bentonite and zeolite that acts through cation exchange capacity), and biochar were found to reduce the rapid increase in ammonia production and maintained the ruminal pH. Urea pool in the rumen is contributed from urea in the diet and recycling of urea through saliva and ruminal wall. The urease enzyme produced by the ruminal microbiota rapidly degrades urea to ammonia causing ammonia toxicity and inefficient urea utilization when used in excessive amounts [73]. Inhibitors of urease may reduce the risk of ammonia toxicity and efficient utilization of urea and other nonprotein nitrogen compounds [77].
Ruminant-derived foods (milk and meat) contain a high amount of saturated fatty acids, which are associated with human health concerns. Therefore, improving the functional value of ruminants’ products by increasing the content of beneficial fatty acids (FAs) and decreasing detrimental ones, specifically, decreasing the content of saturated FAs and increasing n-3 FAs and conjugated linoleic acids (e.g., cis-9, trans-11 C18:2, also called rumenic acid) have been great interests among the researchers [78]. Manipulating ruminal biohydrogenation of polyunsaturated fatty acids (PUFAs) has been the target to increase meat and milk content of rumenic acid and vaccenic acid, as both compounds are major intermediates in the biohydrogenation. To elevate rumenic acid content in products, inhibiting the last step of biohydrogenation needs to be attempted without affecting lipolysis and isomerization and reduction of linoleic acid and linolenic acid to rumenic acid and vaccenic acid. Alternatively, to elevate PUFAs in meat and milk, in particular n-3FAs, inhibition of early steps of biohydogenation should be targeted. Secondary compounds such as tannins, saponins, or essential oils rich in terpenes present in plants and forages or supplementation of vegetable oil can improve some aspects of meat and milk quality including n-3 FAs, conjugated linoleic acids, antioxidant properties [73, 79, 80, 81].
The ruminal fermentation end products are typically the outputs of several interactive reactions among the rumen microbial populations. Manipulations of rumen microbial fermentation toward enhancing fiber digestibility, SCFAs production, and outflow of microbial biomass, while reducing ammonia and CH4 emission are the most probable ways to improve animal productivity. Numerous rumen fermentation modifiers have been studied during the last few decades; however, their positive effects are sometimes associated with undesirable effects or highly significant costs (e.g., ionophore antibiotics, anti-methanogenic chemical feed additives, or essential oils). Moreover, most of these modifiers exhibited inconsistent efficacy in the literature mainly because of the variability in animal age, breed, diet formulation, physiological status, rumen microbial resistance, and adaptation. Despite the long history of studies on the rumen modifiers, most of the measurements are determined through the treatment period but knowledge is still limited on animal responses in later life or impacts on human health and growth. However, there is unanimous agreement that an ample array of drought-tolerant plants containing effective bioactive compounds, DFM, fibrolytic enzymes, and nonprotein nitrogen sources would cost-effectively modify the ruminal fermentation. Therefore, a combination of two or more of these rumen modifiers with complementary modes of action may be a promising approach to optimize the productivity of ruminants in developing countries.
The authors declare no conflict of interest.
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Review of Hydrogen-Natural Gas Blend Fuels in Internal Combustion Engines",slug:"a-review-of-use-of-hcng-fuels-in-internal-combustion-engines",totalDownloads:5955,totalCrossrefCites:8,totalDimensionsCites:15,abstract:null,book:{id:"1893",slug:"fossil-fuel-and-the-environment",title:"Fossil Fuel and the Environment",fullTitle:"Fossil Fuel and the Environment"},signatures:"Antonio Mariani, Biagio Morrone and Andrea Unich",authors:[{id:"108787",title:"Dr.",name:"Antonio",middleName:null,surname:"Mariani",slug:"antonio-mariani",fullName:"Antonio Mariani"}]},{id:"32329",doi:"10.5772/38176",title:"Fuel-N Conversion to NO, N2O and N2 During Coal Combustion",slug:"fuel-n-conversion-to-no-n2o-and-n2-during-coal-combustion",totalDownloads:5748,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"1893",slug:"fossil-fuel-and-the-environment",title:"Fossil Fuel and the Environment",fullTitle:"Fossil Fuel and the Environment"},signatures:"Stanisław Gil",authors:[{id:"115876",title:"Dr.",name:"Stanisław",middleName:null,surname:"Gil",slug:"stanislaw-gil",fullName:"Stanisław Gil"}]},{id:"65221",doi:"10.5772/intechopen.83681",title:"Integrating Citizen Science and GIS for Wildlife Habitat Assessment",slug:"integrating-citizen-science-and-gis-for-wildlife-habitat-assessment",totalDownloads:1215,totalCrossrefCites:4,totalDimensionsCites:6,abstract:"With the rapid advancement and popularity of geospatial technologies such as location-aware smartphones, mobile maps, etc., average citizens nowadays can easily contribute georeferenced wildlife data (e.g., wildlife sightings). Due to the wide spread of human settlements and lengthy living histories of citizens in their local areas, citizen-contributed wildlife data could cover large geographic areas over long time spans. Citizen science thus provides great opportunities for collecting wildlife data of extensive spatiotemporal coverage for wildlife habitat assessment. However, citizen-contributed wildlife data may be subject to data quality issues, for example, imprecise spatial position and biased spatial coverage. These issues need to be accounted for when using citizen-contributed data for wildlife habitat assessment. Geovisualization and geospatial analysis capabilities provisioned by geographic information systems (GISs) can be adopted to tackle such data quality issues. This chapter offers an overview of citizen science as a means of collecting wildlife data, the roles of GIS to tackle the data quality issues, and the integration of citizen science and GIS for wildlife habitat assessment. A case study of habitat assessment for the black-and-white snub-nosed monkey (Rhinopithecus bieti) using R. bieti sightings elicited from local villagers in Yunnan, China, is presented as a demonstration.",book:{id:"8846",slug:"wildlife-population-monitoring",title:"Wildlife Population Monitoring",fullTitle:"Wildlife Population Monitoring"},signatures:"Guiming Zhang",authors:null},{id:"65529",doi:"10.5772/intechopen.84290",title:"Infectious Disease Monitoring of European Bison (Bison bonasus)",slug:"infectious-disease-monitoring-of-european-bison-em-bison-bonasus-em-",totalDownloads:898,totalCrossrefCites:4,totalDimensionsCites:6,abstract:"In 2019, the 90th anniversary of the restitution of European bison (wisent) will be celebrated. Therefore, the chapter discusses the past, present, and future health threats of the Bison bonasus species that was on the edge of world extinction at the beginning of the twentieth century and was restituted with great efforts from many researchers, breeders, forestry workers, and caretakers. Due to the dramatic genetic “bottleneck” that depleted the gene pool, increasing the inbred of today’s European bison, the breeding may face problems of decreased fertility, deficiency in growth, and increased susceptibility to diseases. While the increasing numbers of European bison may be enjoyed by breeders, the suitable habitat for the largest herbivore in Europe shrinks with increasing human population density, forestry, and agricultural activity. Additional threats include inappropriate management based on animal farming rather than sylvatic ecosystems, need for supplementary winter feeding, and establishment of breeding of related species such as American bison (Bison bison) in Europe. The control of European bison exposure to pathogens through passive and active surveillance is a key component of the species conservation. Hereby, the current knowledge on the epidemiology of the most significant infectious diseases in European bison is presented.",book:{id:"8846",slug:"wildlife-population-monitoring",title:"Wildlife Population Monitoring",fullTitle:"Wildlife Population Monitoring"},signatures:"Magdalena Larska and Michał K. Krzysiak",authors:null}],mostDownloadedChaptersLast30Days:[{id:"66955",title:"TSE Monitoring in Wildlife Epidemiology, Transmission, Diagnosis, Genetics and Control",slug:"tse-monitoring-in-wildlife-epidemiology-transmission-diagnosis-genetics-and-control",totalDownloads:1271,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Among the transmissible spongiform encephalopathies (TSEs), chronic wasting disease (CWD) in cervids is now the rising concern within Europe. CWD will be outlined in this chapter gathering its epidemiology, transmission, diagnosis, genetics, and control. Prion diseases are fatal neurodegenerative diseases characterized by the accumulation of an abnormal isoform of the prion protein (PrPc), usually designated by PrPsc or prion. CWD is a prion disease of natural transmission affecting cervids detected mainly in North America. The first European case was detected in Norway, in 2016, in a wild reindeer; until April 2018, a total of 23 cases were described. The definite diagnosis is postmortem, performed in target areas of the brain and lymph nodes. Samples are first screened using a rapid test and, if positive, confirmed by immunohistochemistry and Western immunoblotting. It is not possible to establish a culling plan based on the genotype, once affected animals appear with all genotypes. However, some polymorphisms seem to result in longer incubation periods or confer a reduced risk. The control is not easy in captive cervids and even more in the wildlife; some recommendations have been proposed in order to understand the danger and impact of CWD on animal and public health.",book:{id:"8846",slug:"wildlife-population-monitoring",title:"Wildlife Population Monitoring",fullTitle:"Wildlife Population Monitoring"},signatures:"Carla Neves Machado, Leonor Orge, Isabel Pires, Adelina Gama, Alexandra Esteves, Ana Paula Mendonça, Ana Matos, Anabela Alves, Carla Lima, Estela Bastos, Fernanda Seixas, Filipe Silva, João Carlos Silva, Luis Figueira, Madalena Vieira-Pinto, Maria De Lurdes Pinto, Nuno Gonçalves-Anjo, Paula Tavares, Paulo Carvalho, Roberto Sargo and Maria Dos Anjos Pires",authors:null},{id:"76137",title:"Germplasm Conservation",slug:"germplasm-conservation",totalDownloads:552,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"With the increase in risk of extinction of various plants, the trend has been shifted to employment of many biotechnological techniques for preservation of genetic resources of plant and is the area of research which needs to be revolutionized after a specific time period because it allows the production and selection of crop varieties with desirable characteristics during breeding process such as improved fuel, food and health facilities. Having an immense research in conservation of non-threatened species, there is a small collection of knowledge available for conservation of endangered ones. This chapter aims to highlight the various techniques in germplasm conservation of endangered or the species which are at extent of extinction and also the future directions in this field. In developing countries where most of agriculture depends upon food crops, the maintenance of genetic variation is of immense importance. On farm conservation provides the best example of preservation and evolution based on genetic variability which can occur ex-situ and in- situ environment in farms or gene bank. So, it presents the best option for conservation or maintenance of ecosystem and biodiversity which ensures survival of endangered species via germplasm. The most point to consider is that germplasm or genes have to be conserved instead of genotype. In situ conservation involves preservation of plant crops in the field condition in ecosystem where plant is adopted to grow in order to maintain self –sustaining process in natural ecosystem. Similarly ex-situ involve the collections of seed banks of genes collected from plant under natural conditions to produce desirable varieties or from tissue culture in laboratory also referred as in-vitro methodology. In –vitro techniques include cryopreservation which include freezing at much lower temperature than that of freezing point i.e. -196 °C in liquid nitrogen for preserving species which are near to extent of endangerment. Cold storage and storing at lower temperature provides best opportunity for protection against damage caused by rapid freezing. Germplasm exchange has become now a usual practice ensuring exchange of varieties between cultivated and wild types as for example in potatoes specie etc. DNA as well as gene or seed banks provide molecular sources for conservation at biotechnological level. The techniques of introgression and incorporation are basic approaches for germplasm conservation. So there is need to revolutionize and practice germplasm conservation for fulfilling future needs being aimed at conserving endangered or threatened species from conservation hotspots.",book:{id:"9694",slug:"endangered-plants",title:"Endangered Plants",fullTitle:"Endangered Plants"},signatures:"Sameer Quazi, Tanya Golani and Arnaud Martino Capuzzo",authors:[{id:"331856",title:"Mr.",name:"Sameer",middleName:null,surname:"Quazi",slug:"sameer-quazi",fullName:"Sameer Quazi"},{id:"342338",title:"Ms.",name:"Tanya",middleName:null,surname:"Golani",slug:"tanya-golani",fullName:"Tanya Golani"},{id:"346414",title:"Dr.",name:"Arnaud Martino",middleName:null,surname:"Capuzzo",slug:"arnaud-martino-capuzzo",fullName:"Arnaud Martino Capuzzo"}]},{id:"66812",title:"An Assessment of the Human-Wildlife Conflict across Africa",slug:"an-assessment-of-the-human-wildlife-conflict-across-africa",totalDownloads:1419,totalCrossrefCites:0,totalDimensionsCites:4,abstract:"The coexistence between humans and mammals across Africa has led to Human Wildlife Conflict (HWC) due to the competition for limited natural resources. Over the past two decades, I have focused my research on conservation issues that either resulted from or induce human-wildlife conflict. Conflicts are intensified in regions where dense human populations live in close proximity to nature, and where livestock holdings and crop fields form a significant part of rural livelihoods. As a result, both people and wildlife suffer tangible consequences; therefore, creating the need for stakeholder’s involvement and their willingness to adopt conservation-based behaviors, as key ingredients for feasible and effective conservation counter measures. This chapter provides a comprehensive review of the wide array of drivers and conservation implications of HWC incidences throughout Africa. An in-depth analysis is essential to understanding the problem and support future conservation prospects. Examples explore key case studies ranging from decreasing numbers of the charismatic forest dwelling elephant (Loxodonta cyclotis) in the DRC, to increasing numbers of waterbuck (Kobus ellipsiprymnus) in Mozambique, and varying numbers of lion populations bordering Kruger National Park in South Africa. Concluding with conflict resolution strategies employed across Africa and recommendations for the effective conservation of the world’s most endangered mammals.",book:{id:"8846",slug:"wildlife-population-monitoring",title:"Wildlife Population Monitoring",fullTitle:"Wildlife Population Monitoring"},signatures:"Benjamin-Fink Nicole",authors:null},{id:"67071",title:"Cheetahs Race for Survival: Ecology and Conservation",slug:"cheetahs-race-for-survival-ecology-and-conservation",totalDownloads:1135,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Cheetahs reach speeds of up to 113 km/h accelerating from zero to 96 km/h in 3s. Revered for 5000 years throughout Asia, Europe and Africa has contributed to the species decline. Today’s wild cheetah population is estimated at 7100 adult and adolescents, a 90% reduction from a century ago, and a range reduction of 9%. Over 80% live outside protected areas where human-wildlife conflict occurs. Female cheetahs live solitarily with their cubs; male cubs form lifelong coalitions. Living in low densities cheetahs’ home ranges cover over 1500 km2, requiring large landscapes with prey. Although cheetahs’ lack genetic diversity from a historic population bottleneck, their greatest conservation problems are humans. Habitat loss and declining preybase leads to conflict with livestock farmers. Additionally, illegal wildlife trafficking of cubs is affecting small populations in the Horn of Africa. Solving the cheetah conservation crisis is critical and involves addressing a complex web of social, environmental and economic issues, and depends on a holistic approach balancing the needs of humans and cheetahs sharing land. 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