\\n\\n
These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\\n\\n\\n\\n\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\n\n\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"9376",leadTitle:null,fullTitle:"Contemporary Developments and Perspectives in International Health Security - Volume 1",title:"Contemporary Developments and Perspectives in International Health Security",subtitle:"Volume 1",reviewType:"peer-reviewed",abstract:"International health security (IHS) is a broad and highly heterogeneous area. Within this general context, IHS encompasses subdomains that potentially influence (and more specifically endanger) the well-being and wellness of humans. The general umbrella of IHS includes, but is not limited to, natural disasters, emerging infectious diseases (EID) and pandemics, rapid urbanization, social determinants of health, population growth, systemic racism and discrimination, environmental matters, civilian violence and warfare, various forms of terrorism, misuse of antibiotics, and the misuse of social media. The need for this expanded definition of health security stems from the realization that topics such as EID; food, water, and pharmaceutical supply chain safety; medical and health information cybersecurity; and bioterrorism, although important within the overall realm of health security, are not only able to actively modulate the wellness and health of human populations, but also tend to do so in a synergistic fashion. This inaugural tome of a multi-volume collection, Contemporary Developments and Perspectives in International Health Security, introduces many of the topics directly relevant to modern IHS theory and practice. This first volume provides a solid foundation for future installments of this important and relevant book series.",isbn:"978-1-83880-130-4",printIsbn:"978-1-83880-129-8",pdfIsbn:"978-1-83962-928-0",doi:"10.5772/intechopen.84766",price:119,priceEur:129,priceUsd:155,slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-1",numberOfPages:238,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"b9a00b84cd04aae458fb1d6c65795601",bookSignature:"Stanislaw P. Stawicki, Michael S. Firstenberg, Sagar C. Galwankar, Ricardo Izurieta and Thomas Papadimos",publishedDate:"January 7th 2021",coverURL:"https://cdn.intechopen.com/books/images_new/9376.jpg",numberOfDownloads:6613,numberOfWosCitations:0,numberOfCrossrefCitations:7,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:10,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:17,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 25th 2019",dateEndSecondStepPublish:"August 27th 2019",dateEndThirdStepPublish:"October 26th 2019",dateEndFourthStepPublish:"January 14th 2020",dateEndFifthStepPublish:"March 14th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki",profilePictureURL:"https://mts.intechopen.com/storage/users/181694/images/system/181694.jpeg",biography:"Dr. Stanislaw P. Stawicki is a Professor of Surgery and chair of the Department of Research and Innovation, St. Luke\\'s University Health Network, Bethlehem, Pennsylvania. A specialist in general surgery, surgical critical care, and neurocritical care, he has co-authored more than 650 scholarly works, including more than 20 books. In addition to local, national, and international medical leadership roles, Dr. Stawicki is a member of numerous editorial boards. His areas of expertise are diverse and include health security, medical information security, blockchain technology, patient safety, academic leadership, mentorship and leadership development, traumatology, surgical critical care, and sonography.",institutionString:"St. Luke's University Health Network",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"33",totalChapterViews:"0",totalEditedBooks:"8",institution:{name:"St. Luke's University Health Network",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/64343/images/system/64343.png",biography:"Dr. Michael S. Firstenberg is a thoracic surgeon at the St. Elizabeth Medical Center (Ascension), Appleton, Wisconsin. He attended Case Western Reserve University Medical School, Cleveland, OH, received his general surgery training at University Hospitals in Cleveland, and completed thoracic surgery fellowships at The Ohio State University and the Cleveland Clinic. He is an active member of the Society of Thoracic Surgeons (STS), American Association of Thoracic Surgeons (AATS), American College of Cardiology (ACC), and American College of Academic International Medicine (ACAIM), for which he served as president in 2021–2022. He has authored more than 250 peer-reviewed manuscripts, abstracts, and book chapters and has edited several textbooks and lectured worldwide on topics ranging from medical leadership, COVID-19, endocarditis, and extra-corporeal membrane oxygenation (ECMO).",institutionString:"St. Elizabeth Medical Center",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"26",totalChapterViews:"0",totalEditedBooks:"13",institution:null},coeditorTwo:{id:"293168",title:"Dr.",name:"Sagar C.",middleName:null,surname:"Galwankar",slug:"sagar-c.-galwankar",fullName:"Sagar C. Galwankar",profilePictureURL:"https://mts.intechopen.com/storage/users/293168/images/system/293168.jpeg",biography:"Sagar C. Galwankar, MBBS, DNB, MPH, MBA, FAAEM, FAIM, graduated with an MBBS and MD from Pune University, India. He is residency trained and board-certified in internal medicine and emergency medicine in India and the United States, respectively. He holds prestigious fellowships from the Royal College of Physicians, UK, the American College of Academic International Medicine, and the Academic College of Emergency Experts, India. He additionally obtained an MPH and MBA in the United States. His academic career over the last two decades is studded with remarkable achievements resulting from innovative strategies that led to the creation of organizations, publication of landmark papers, and commendations with prestigious citations and honors for his works that have impacted the academic medicine community globally. He has played a defining role in founding and building internationally recognized, interdisciplinary indexed journals. He championed the establishment and growth of academic emergency medicine in India which is a benchmark in the history of developing emergency medicine in the world’s largest and most diverse democracy in the world. He is the CEO of the INDUSEM Health and Medicine Collaborative and heads the World Academic Council of Emergency Medicine (WACEM). Additionally, he serves as the Global Executive Director for the American College of Academic International Medicine (ACAIM). He is Founding Director for Research in Emergency Medicine at Florida State University (FSU) and serves as a core faculty for the FSU Emergency Medicine Residency Program at Sarasota Memorial Hospital, Florida.",institutionString:"Florida State University College of Medicine",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of South Florida",institutionURL:null,country:{name:"United States of America"}}},coeditorThree:{id:"336849",title:"Prof.",name:"Ricardo",middleName:null,surname:"Izurieta",slug:"ricardo-izurieta",fullName:"Ricardo Izurieta",profilePictureURL:"https://mts.intechopen.com/storage/users/293169/images/system/293169.png",biography:"Ricardo Izurieta, MD, DrPH, MPH, is Professor and Director of Global Communicable Diseases at College of Public Health and director of the Public Health Scholar Concentration at Morsani College of Medicine, University of South Florida, Tampa. Dr. Izurieta received his MD from the Central University of Ecuador and carried out his postdoctoral training in Public Health and Tropical Infectious Diseases at the University of Alabama at Birmingham, Emory University, Atlanta, and Universidad Cayetano Heredia, Peru. In 1991, he faced the cholera epidemic that spread through Latin American countries as National Director of the Cholera Control Program in the Ministry of Public Health of Ecuador. In 1997, he was appointed Chief of the Department of Epidemiology and Director of the Vaccine Center of the Armed Forces of Ecuador. During his studies, he has been a USAID Thomas Jefferson Fellow, a PAHO Research Fellow, an ORISE/CDC Fellow, a Gorgas Memorial Institute Fellow, and a FUNDACYT Fellow. In 2003, Dr. Izurieta was elected vice president of the Gorgas Memorial Institute of Tropical and Preventive Medicine and currently he is its Latin American Liaison. He has been a panel reviewer for the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), National Science Foundation (NSF), and Wellcome Trust. He also served on the American College of Academic International Medicine (ACAIM) Taskforce on International Health Security and as a consultant for the United Nations Global Water Pathogens Project as well as for the United Kingdom and the Brazilian Academies of Sciences.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of South Florida",institutionURL:null,country:{name:"United States of America"}}},coeditorFour:{id:"183706",title:"Dr.",name:"Thomas",middleName:null,surname:"Papadimos",slug:"thomas-papadimos",fullName:"Thomas Papadimos",profilePictureURL:"https://mts.intechopen.com/storage/users/183706/images/system/183706.jpg",biography:"Dr. Thomas J. Papadimos is Professor of Anesthesiology at The Ohio State University Wexner Medical Center (OSUWMC), Columbus, Ohio, USA. At OSUWMC he has served as the Critical Care Fellowship Director, Vice Chair for Academic Affairs, and is currently the Anesthesiology Clinical Research Fellowship Director. He has also been an associate dean at the University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA. Dr. Papadimos was awarded a Fulbright Scholar Award to teach and mentor at the 2nd Department of Anesthesiology in October–December 2021 at the University of Athens, Greece. He is a retired US Navy Medical Officer and has authored or co-authored more than 400 papers, book chapters, books, and abstracts.",institutionString:"The Ohio State University Wexner Medical Center",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"The Ohio State University Wexner Medical Center",institutionURL:null,country:{name:"United States of America"}}},coeditorFive:null,topics:[{id:"1131",title:"Global Health",slug:"global-health"}],chapters:[{id:"73916",title:"Introductory Chapter: International Health Security Expanded and Re-Defined",doi:"10.5772/intechopen.94394",slug:"introductory-chapter-international-health-security-expanded-and-re-defined",totalDownloads:475,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:null,signatures:"Stanislaw P. Stawicki, Thomas J. Papadimos, Sagar C. Galwankar, Ricardo Izurieta and Michael S. Firstenberg",downloadPdfUrl:"/chapter/pdf-download/73916",previewPdfUrl:"/chapter/pdf-preview/73916",authors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"},{id:"336849",title:"Prof.",name:"Ricardo",surname:"Izurieta",slug:"ricardo-izurieta",fullName:"Ricardo Izurieta"}],corrections:null},{id:"73042",title:"International Health Security: A Summative Assessment by ACAIM Consensus Group",doi:"10.5772/intechopen.93214",slug:"international-health-security-a-summative-assessment-by-acaim-consensus-group",totalDownloads:590,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:0,abstract:"International health security (IHS) encompasses any natural or anthropogenic occurrence that can threaten the safety of human health and well-being. The American College of Academic International Medicine IHS Consensus Group (ACAIM-CG) developed a summative assessment highlighting the main issues that can impact IHS including emerging infectious diseases; chronic health conditions; bioterrorism; planetary changes (volcanic eruptions, earthquakes, wildfires, and climate change); nuclear incidents; information and cyber health; industrialization; globalization; pharmaceutical production; and communication platforms (social media). These concerns can directly and indirectly impact IHS both in the long and short term. When considering IHS, we aim to emphasize the utility of applying a predefined framework to effectively approach health security threats. This framework comprises of prevention, detection, assessment, reporting, response, addressing needs, and the perpetual repetition of the above cycle (inclusive of appropriate mitigation measures). It is hoped that this collective work will provide a foundation for further research within the redefined, expanded scope of IHS.",signatures:"Nicole K. Le, Manish Garg, Ricardo Izurieta, Sona M. Garg, Thomas J. Papadimos, Bonnie Arquilla, Andrew C. Miller, Abbas M. Khan, Tamara Worlton, Michael S. Firstenberg, Sagar C. Galwankar, Sunil Raina, Harry L. Anderson III, Rebecca Jeanmonod, Donald Jeanmonod, Ijeoma Nnodim Opara, Kristiana Kaufmann, Juan A. Asensio and Stanislaw P. Stawicki",downloadPdfUrl:"/chapter/pdf-download/73042",previewPdfUrl:"/chapter/pdf-preview/73042",authors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"},{id:"64343",title:"Dr.",name:"Michael S.",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],corrections:null},{id:"72756",title:"The Impact of Systems of Care on International Health Security",doi:"10.5772/intechopen.93055",slug:"the-impact-of-systems-of-care-on-international-health-security",totalDownloads:383,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"International health security (IHS) prioritizes cross-border threats to nations such as epidemics, bioterrorism, and climate change. In the modern era, however, the leading causes of mortality are not infectious. Cardiovascular disease (CVD) is the leading cause of death worldwide. Over three-quarters of CVD deaths take place in low-income countries, illustrating a disparity in care. Traumatic injury also remains one of the leading causes of morbidity and mortality worldwide, placing a particularly heavy burden upon countries with limited resources. Cerebrovascular disease and acute stroke syndromes are major causes of mortality and disability worldwide. Programs leading to timely revascularization have proven to be the most powerful predictor of disease outcomes. The health of women and children is vital to creating a healthy world. The impact of neonatal resuscitation programs on mortality has been a major force in advancing international health security. Finally, the establishment of emergency medical services (EMS) systems has been shown to improve the health of communities in both high- and low-income nations. 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.",signatures:"Nicholas Reis and James Cipolla",downloadPdfUrl:"/chapter/pdf-download/72756",previewPdfUrl:"/chapter/pdf-preview/72756",authors:[{id:"187661",title:"Dr.",name:"James",surname:"Cipolla",slug:"james-cipolla",fullName:"James Cipolla"},{id:"318864",title:"Dr.",name:"Nicholas",surname:"Reis",slug:"nicholas-reis",fullName:"Nicholas Reis"}],corrections:null},{id:"71371",title:"Ransomware and Academic International Medicine",doi:"10.5772/intechopen.91762",slug:"ransomware-and-academic-international-medicine",totalDownloads:505,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Healthcare is among the leading industries targeted by cyber-criminals. Ransomware exploits vulnerabilities to hijack target information technology (IT) infrastructures for monetary gain. Due to the nature and value of information, access to medical information enables cyber-criminals to commit identity theft, medical fraud, and extortion, and illegally obtain controlled substances. The utility and versatility of medical information, extensive centralized storage of medical information, relatively weak IT security systems, and the expanding use of healthcare IT infrastructure all contribute to an increase in cyber-attacks on healthcare entities. Research suggests that an individual’s medical information is 20–50 times more valuable to cyber-criminals than personal financial information. As such, cyber-attacks targeting medical information are increasing 22% per year. This chapter explores the history of ransomware attacks in healthcare, ransomware types, ransom payment, healthcare vulnerabilities, implications for international health security, and means of institutional protection.",signatures:"Andrew C. Miller, Abbas M. Khan and Sophia Ziad",downloadPdfUrl:"/chapter/pdf-download/71371",previewPdfUrl:"/chapter/pdf-preview/71371",authors:[{id:"317540",title:"Dr.",name:"Andrew",surname:"Miller",slug:"andrew-miller",fullName:"Andrew Miller"},{id:"317805",title:"Dr.",name:"Abbas",surname:"Khan",slug:"abbas-khan",fullName:"Abbas Khan"}],corrections:null},{id:"72906",title:"The Evolving Interplay between Social Media and International Health Security: A Point of View",doi:"10.5772/intechopen.93215",slug:"the-evolving-interplay-between-social-media-and-international-health-security-a-point-of-view",totalDownloads:640,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Human communication and interaction had been rapidly evolving with the advent and continuing influence of social media (SM) thereby accelerating information exchange and increasing global connectivity. Despite clear advantages, this new technology can present unintended consequences including medical misinformation and “fake news.” Although International Health Security (IHS) stands to benefit tremendously from various SM platforms, high-level decision-makers and other stakeholders must also be aware of the dangers related to its intentional and unintentional misuse (and abuse). An overview of SM utility in fighting disease, disseminating life-saving information, and organizing people and teams in a constructive fashion is discussed herein. The potential negatives associated with SM misuse, including intentional and unintentional misinformation, as well as the ability to organize people in a disruptive fashion, will also be presented. Our treatise will additionally outline how deliberate misinformation may lead to harmful behaviors, public health panics, and orchestrated patterns of distrust. In terms of both its affirmative and destructive considerations, SM can be viewed as an asymmetric influencing force, with observed effects (whether beneficial or harmful) being disproportionately greater than the cost of the intervention.",signatures:"Keith Conti, Shania Desai, Stanislaw P. Stawicki and Thomas J. Papadimos",downloadPdfUrl:"/chapter/pdf-download/72906",previewPdfUrl:"/chapter/pdf-preview/72906",authors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"},{id:"312709",title:"Dr.",name:"Keith",surname:"Conti",slug:"keith-conti",fullName:"Keith Conti"},{id:"319928",title:"Dr.",name:"Shanaya",surname:"Desai",slug:"shanaya-desai",fullName:"Shanaya Desai"},{id:"319929",title:"Dr.",name:"Thomas",surname:"Papadimos",slug:"thomas-papadimos",fullName:"Thomas Papadimos"}],corrections:null},{id:"71050",title:"Health Security and the Refugee Crisis in Greece: The Refugee Perspective",doi:"10.5772/intechopen.91210",slug:"health-security-and-the-refugee-crisis-in-greece-the-refugee-perspective",totalDownloads:779,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The flight of refugees has been part of the human condition since the beginning of time. Recent events in the Middle East have caused a mass migration of refugees from Syria, Iraq, and Afghanistan. Their primary destination has been Europe, more specifically, the affluent, better industrialized countries of central and northern Europe. However, the European law currently requires that refugees must be processed at the first port of entry to Europe. In most cases, this involves the eastern Aegean Sea islands of Greece. Here the refugee camps have become overcrowded and underfunded, and have little medical care and security. The Greek government has limited resources and the response for support from the more affluent European countries has been underwhelming. Here we summarize the lack of health security from the refugee perspective of those that are awaiting entry to Europe and are encamped in Greece.",signatures:"Thomas Papadimos, Scott Pappada, Michael Lyaker, James Papadimos and Andrew Casabianca",downloadPdfUrl:"/chapter/pdf-download/71050",previewPdfUrl:"/chapter/pdf-preview/71050",authors:[{id:"183706",title:"Dr.",name:"Thomas",surname:"Papadimos",slug:"thomas-papadimos",fullName:"Thomas Papadimos"},{id:"317698",title:"Dr.",name:"Scott",surname:"Pappada",slug:"scott-pappada",fullName:"Scott Pappada"},{id:"317699",title:"Dr.",name:"Michael",surname:"Lyaker",slug:"michael-lyaker",fullName:"Michael Lyaker"},{id:"317700",title:"MSc.",name:"James",surname:"Papadimos",slug:"james-papadimos",fullName:"James Papadimos"},{id:"317701",title:"Dr.",name:"Andrew",surname:"Casabianca",slug:"andrew-casabianca",fullName:"Andrew Casabianca"}],corrections:null},{id:"71896",title:"A Moral Perspective on Refugee Healthcare",doi:"10.5772/intechopen.92110",slug:"a-moral-perspective-on-refugee-healthcare",totalDownloads:584,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"There is currently an increasing number of international refugees due to political warfare and natural calamities. Over the recent years, countries are shying away from assisting with the provision of healthcare to this vulnerable population either in their home country through humanitarian aid and services or in the host country by providing free healthcare coverage. World leaders and politicians have attempted to ignore the morality behind these decisions and have put forth a false narrative of scarcity and racism to appeal to the population of developed countries. As this question remains unsolved, we have attempted to look at the question from the perspective of our moral obligations as a species. We have discussed some of the popular moral theories that support providing healthcare services to global refugees and refuted theories that object to the same. We conclude with a brief look at the direction that countries could take without violating established moral code while attempting (without evidence) to prioritize the welfare of their citizens.",signatures:"Tanaya Sparkle and Debanshu Roy",downloadPdfUrl:"/chapter/pdf-download/71896",previewPdfUrl:"/chapter/pdf-preview/71896",authors:[{id:"316129",title:"Dr.",name:"Tanaya",surname:"Sparkle",slug:"tanaya-sparkle",fullName:"Tanaya Sparkle"},{id:"316130",title:"Dr.",name:"Debanshu",surname:"Roy",slug:"debanshu-roy",fullName:"Debanshu Roy"}],corrections:null},{id:"74355",title:"Strengthening International Health Security by Embedding the Role of Civil Society Organizations in National Health Systems: Lessons from the 2014–2016 West Africa Ebola Response",doi:"10.5772/intechopen.93333",slug:"strengthening-international-health-security-by-embedding-the-role-of-civil-society-organizations-in-",totalDownloads:330,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Following the recent global health crises, such as the 2014 Ebola and 2016 ZIKA outbreaks, the international health community’s ability to deal with such threats has been debated. Amid discussions of how international health security (IHS) and related national health systems should and could be strengthened, the potential of harnessing the role of civil society organizations (CSOs) for more effective responses has been frequently raised. Such participation is often based on the notion that CSOs by their grassroots presence can more effectively help to address health security and health systems challenges in affected populations and communities. Using the World Health Organization’s (WHO) health systems’ building blocks as an evaluative framework, this chapter examines CSOs’ roles and responsibilities during the 2014–2016 West Africa Ebola Outbreak and how they can be further empowered to perform these functions. The chapter draws conclusions about the opportunities and challenges CSOs represent for strengthening IHS and national health systems during public health emergencies in low- and middle-income countries (LMICs).",signatures:"Martin Hushie, Rita Suhuyini Salifu and Iddrisu Seidu",downloadPdfUrl:"/chapter/pdf-download/74355",previewPdfUrl:"/chapter/pdf-preview/74355",authors:[{id:"305768",title:"Dr.",name:"Martin",surname:"Hushie",slug:"martin-hushie",fullName:"Martin Hushie"},{id:"325474",title:"Ms.",name:"Rita",surname:"Salifu",slug:"rita-salifu",fullName:"Rita Salifu"},{id:"325674",title:"Mr.",name:"Iddrisu",surname:"Seidu",slug:"iddrisu-seidu",fullName:"Iddrisu Seidu"}],corrections:null},{id:"71548",title:"The Importance of Reduction in the Registry of Deaths to Ill-Defined Causes and Their Impact on Mortality Profile: The Brazilian Experience and Its Implications to International Health Security",doi:"10.5772/intechopen.91757",slug:"the-importance-of-reduction-in-the-registry-of-deaths-to-ill-defined-causes-and-their-impact-on-mort",totalDownloads:419,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter aims to describe the strategies implemented by the Ministry of Health since 2004 to reduce deaths classified as ill-defined causes (IDC) and the impacts on the mortality profile. Since 1979, deaths occurring and recorded across the country have been stored electronically on the Datasus website (www.datasus.gov.br), which is in the public domain. From this database, it appears that the proportion of deaths from IDC in the country decreased from 20.1% in 1979 to 5.5% in 2017. In small municipalities, less than 20,000 inhabitants, which have the worst data quality and worse socioeconomic status and with the greatest inequities in health, requiring greater investments, the reduction was smaller. The Ministry of Health implemented several actions that involved suspending the transfer of resources from the federal fund to the municipal fund for non-compliance with the rules for the collection, flow and periodicity of information on deaths, in addition to training and qualification of human resources to record and code the causes of death and to investigate deaths by IDC through verbal autopsy. These are initiatives that can be replicated in other contexts, except, perhaps, of a legal nature, as they fit into the legal system that presents specificities in each country.",signatures:"Davi Félix Martins Junior",downloadPdfUrl:"/chapter/pdf-download/71548",previewPdfUrl:"/chapter/pdf-preview/71548",authors:[{id:"305668",title:"Prof.",name:"Davi",surname:"F. Martins Junior",slug:"davi-f.-martins-junior",fullName:"Davi F. Martins Junior"}],corrections:null},{id:"73255",title:"The Relationship of Adulthood Chronic Disease and Adverse Childhood Experiences (ACEs): Implications Regarding Prevention and Promotion in International Health",doi:"10.5772/intechopen.93520",slug:"the-relationship-of-adulthood-chronic-disease-and-adverse-childhood-experiences-aces-implications-re",totalDownloads:500,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Several studies, including the innovative 1998 ACE Study by CDC-Kaiser Permanente, have assessed the association among adulthood chronic disease and the prevalence of maladaptive, health-harming behaviors including: excessive alcohol use, tobacco use, physical inactivity, psychiatric illness including suicidal ideation or attempts, promiscuous sexual behavior (>50 sex partners), history of STI/STD and severe obesity (obesity (BMI > 35 kg/m2)), subsequent to an individual’s exposure to adverse childhood experiences (ACEs). Individuals that have encountered numerous instances of ACEs are almost twice as likely to die before the age of 75, demonstrating a dose-dependent relationship between the instances of ACEs and an increased morbidity/mortality in regard to chronic disease. This excerpt examines the contribution of ACEs to chronic disease and the consequential maladaptive behavior to said adversity, the consequential physiologic and biomolecular changes explained by the Biological Embedding of Childhood Adversity Model in addition to the implications of recounted ACEs on international health security in regard to concepts like conflict, displacement and food insecurity. The apparent association among adulthood chronic disease and ACEs demand changes that promote preventative processes as a means to address the implications these interconnections have on international health.",signatures:"Jordan Holter, Christine Marchionni and Bankim Bhatt",downloadPdfUrl:"/chapter/pdf-download/73255",previewPdfUrl:"/chapter/pdf-preview/73255",authors:[{id:"202740",title:"Dr.",name:"Christine",surname:"Marchionni",slug:"christine-marchionni",fullName:"Christine Marchionni"},{id:"319351",title:"Dr.",name:"Bankim",surname:"Bhatt",slug:"bankim-bhatt",fullName:"Bankim Bhatt"},{id:"319352",title:"Dr.",name:"Jordan",surname:"Holter",slug:"jordan-holter",fullName:"Jordan Holter"}],corrections:null},{id:"72168",title:"Nurturing Responsible Future Generation of Scientists: Focus on Maintaining International Health Security Competency",doi:"10.5772/intechopen.90050",slug:"nurturing-responsible-future-generation-of-scientists-focus-on-maintaining-international-health-secu",totalDownloads:322,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Rapid progress of technologies does not only exclusively belong to developed countries nowadays but also spread out to developing countries including Indonesia. There are many Indonesian universities and emerging translational medicine centers that had declared themselves as research centers focusing on to bring science from bench to bedside. Since the outbreak of 2007 Avian Influenza, Indonesia had been starting to accumulate more knowledge and experiences related to biosafety and biosecurity. While Indonesian researchers were focusing on biorisk management of high pathogenic bioagents, students were also being exposed gradually to more sophisticated biological hazards through the utilization of synthetic biology and genetic modifications on their own researches. Nurturing the responsible future generation of scientist whom aware of the ethical, biosafety, biosecurity concerns cannot become more important, considering the possibility of dual use research results, which could bring either prosperity or chaos to the universe.",signatures:"Aroem Naroeni and Budiman Bela",downloadPdfUrl:"/chapter/pdf-download/72168",previewPdfUrl:"/chapter/pdf-preview/72168",authors:[{id:"304293",title:"Dr.",name:"Aroem",surname:"Naroeni",slug:"aroem-naroeni",fullName:"Aroem Naroeni"},{id:"308874",title:"Dr.",name:"Budiman",surname:"Bela",slug:"budiman-bela",fullName:"Budiman Bela"}],corrections:null},{id:"70424",title:"mHealth-Based Microfluidic Lab-on-a-Chip for International Health Security",doi:"10.5772/intechopen.90283",slug:"mhealth-based-microfluidic-lab-on-a-chip-for-international-health-security",totalDownloads:552,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"The increasing threats of emerging and reemerging infectious disease outbreaks demand research and development (R&D) of effective and fit-for-all-purpose tools and technologies for international public health security. Recent advances in biomedical engineering, mostly related to the convergence of communication and network technology in health, i.e., mobile health with microfluidic Lab-on-a-Chip technology can improve the international public health crises and employ in international public health security. Lab-on-a-Chip technology is now commonly found in most research centers, hospitals, and clinics where health care infrastructure is weak, and access to quality and timely medical care is challenging. Microfluidic devices—also known as Lab-on-a-Chip (LoC)—are an alternative for accessible, cost-effective, and early detection medical trials. The mHealth-based microfluidic LoC technology has been under rapid development, and they are becoming influential tools in a wide range of biomedical research and international public health applications. The perspective in this chapter demonstrates a potentially transformative opportunity for the deployment of mHealth with LoC with the fabrication protocols and their potential for strengthening and improving the international public health security. This attempt is not conclusive and exhaustive, and it is anticipated that such a discussion will enable the exchange of ideas between biomedical engineering, microfluidic LoC technology professionals, international public health, and health security experts.",signatures:"Mirza Abdul Aleem Baig",downloadPdfUrl:"/chapter/pdf-download/70424",previewPdfUrl:"/chapter/pdf-preview/70424",authors:[{id:"299318",title:"Mr.",name:"Mirza Abdul Aleem",surname:"Baig",slug:"mirza-abdul-aleem-baig",fullName:"Mirza Abdul Aleem Baig"}],corrections:null},{id:"73775",title:"Beyond Health and Safety at Work: Reflections on Biopolitics in Occupational Health as an Important Component of International Health Security",doi:"10.5772/intechopen.93749",slug:"beyond-health-and-safety-at-work-reflections-on-biopolitics-in-occupational-health-as-an-important-c",totalDownloads:535,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The general objective in this chapter is to reflect on health and safety at work based on biopolitics and biopower. The intention will be to clarify unequal processes in health and safety at work. In addition to occupational health, occupational health and safety actions aim to increase control over workers’ bodies, as well as reduce costs in the work process. The intention is still to establish a dialogue with the French philosopher Michel Foucault and with the Italian philosopher Giorgio Agamben, both discussing the consequences of biopolitics and biopower in industrial society modern. The proposed reflections go beyond the benefits of occupational health and safety at work, as they aim to understand the centrality of life in industrial organizations. It is important and necessary to minimize the negative effects of inequality in health and safety at work. 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\r\n\tIn the past few years, electrochemical sensing interfaces have become substantial, easy, and bonafide techniques to evaluate food quality, neurotransmitters, toxic chemicals, and various bioactive compounds. The present book aims to determine such compounds using various nanomaterials, nanocomposites, surfactants, organic materials, etc. as modifiers using various voltammetric methods like cyclic voltammetry, linear sweep voltammetry, differential pulse voltammetry, and square wave voltammetry (SWV). It also emphasizes the corrosion-resistant properties of various metals and alloys using voltammetric methods. The recent advancements in sensor innovations like miniaturization of electrochemical cells, use of multi-sensor arrangements, an extension of sensor application regarding temperature, pressure, and aggressive media at both experimental and theoretical aspects will also be included. Currently, the electrical and supercapacitor applications of nanomaterials are the focus of material scientists all over the world. The potential applications of hybrid nanostructures in the area of the supercapacitor, dielectric materials, superconductors, transistors, etc. will also be added in the book followed by the challenges in commercializing voltammetric sensors.
",isbn:"978-1-80356-447-0",printIsbn:"978-1-80356-446-3",pdfIsbn:"978-1-80356-448-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"fc53a7599a61ed04a0672a7bca81e9c2",bookSignature:"Dr. Rajendrachari Shashanka, Dr. Kiran Kenchappa Somashekharappa, Dr. Sharath Peramenahalli Chikkegouda and Dr. Shamanth Vasanth",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11910.jpg",keywords:"History of Voltammetry, Electrochemical Impedance Spectroscopy, Differential Pulse Voltammetry, Neurotransmitters, Redox, Corrosion, Oxidation, Differential Pulse Voltammetry, Cyclic Voltammetry, Superconductor, Dielectrics, Selectivity",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 1st 2022",dateEndSecondStepPublish:"May 3rd 2022",dateEndThirdStepPublish:"July 2nd 2022",dateEndFourthStepPublish:"September 20th 2022",dateEndFifthStepPublish:"November 19th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Rajendrachari has a strong interdisciplinary academic and research background (Electrochemical sensors, Nanomaterials, Corrosion, Powder metallurgy) and, his name was listed in the top 2% best scientists of the world for the year 2020 as reported by Stanford University, USA. Dr. Rajendrachari has won numerous awards and is currently serving as guest editor and editorial member of various International Journals.",coeditorOneBiosketch:"Dr. Kiran is currently doing research in photocatalysis, electrochemical sensors, nanomaterials and working as a faculty in the Dept. of Chemistry at Govt. First Grade College, Shivamogga, Karnataka, India. He has published six research articles and one book chapter in various International Journals.",coeditorTwoBiosketch:"Dr. Sharath P.C. has published 18 research articles and 4 book chapters in various International Journals. Dr. Sharath P.C. is currently doing research in metal forming, powder metallurgy, and electrochemical sensors. He has received several research awards in various conferences and currently has one research grant to his credit.",coeditorThreeBiosketch:"Dr. Vasanth has a very good Interdisciplinary academic and research background (Additive Manufacturing, Heat Treatment of Steels, Material Characterization), Electrochemical sensors. He has published 2 book chapters and 17 international research publications. His current research is Synthesis of High Strength and Corrosion Resistant Nanostructured Stainless Steels by Selective Laser Melting, which is financed by the Department of Science and Technology (DST) Government of India.",coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"246025",title:"Dr.",name:"Shashanka",middleName:null,surname:"Rajendrachari",slug:"shashanka-rajendrachari",fullName:"Shashanka Rajendrachari",profilePictureURL:"https://mts.intechopen.com/storage/users/246025/images/system/246025.jpg",biography:"Dr. Shashanka Rajendrachari is Assistant Professor at the Department of Metallurgical and Materials Engineering, Bartin University, Turkey. He obtained his Ph.D. from the Department of Metallurgical and Materials Engineering at NIT Rourkela, Odisha, India. Dr. Rajendrachari has a very good Interdisciplinary academic and research background (Electrochemical sensors, Nanomaterials, Corrosion, Powder metallurgy) and, his name was listed in the top 2% best scientists of the world for the year 2020 as reported by Stanford University, USA and published by Elsevier. He completed his M.Sc (Industrial Chemistry) and M.Tech (Nanoscience and Technology) from Kuvempu University, Shimoga, India. He has published 5 book chapters, 4 books, and 41 international research publications. Dr. Rajendrachari was awarded the Grand Powder Metallurgy student of the year-2015 award from the Powder Metallurgy Association of India at IIT Bombay. Recently, he was won the prestigious 'Young Scientist-2020” award at the 4th International Scientist Awards ceremony on Engineering, Science and Medicine held in Chennai, India. He was also awarded the 'Young Achiever of the Year-2020” award by DHS Foundation, New Delhi, India, and CAMPBELL University, North Carolina, USA at PERFICIO AWARDS-2020, New Delhi, India. Dr. Rajendrachari is currently serving as guest editor and editorial member of various International Journals.",institutionString:"Bartin University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Bartin University",institutionURL:null,country:{name:"Turkey"}}}],coeditorOne:{id:"454845",title:"Dr.",name:"Kiran",middleName:null,surname:"Kenchappa Somashekharappa",slug:"kiran-kenchappa-somashekharappa",fullName:"Kiran Kenchappa Somashekharappa",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003OmGjUQAV/Profile_Picture_1644917686826",biography:"Dr. Kiran Kenchappa Somashekharappa, currently working as a faculty in the Department of Chemistry, Government First Grade College, Bapuji Nagar, Shivamogga, Karnataka, India. He pursued Ph.D., from the Department of Applied Sciences (Nanotechnology) at Visvesvaraya Technological University, Center for PG studies-Bangalore Region, Muddenahalli, Chikkaballapura (D), India. He studied B.Sc., (Ic. C. P) from Sahyadri Science College, Shivamogga, and M.Sc., in Chemistry from Govt. Science College, Chitradurga, Kuvempu University, Karnataka, India. He has a good academic career and research knowledge such as Synthesis of Nanomaterials with different morphology, with different methods and their characterizations and application in the field of catalysis, photocatalysis, sensors, and so on. He worked as a Project Assistant for the project entitled “Synthesis, Characterization of Novel Titanate and Niobate Nanotubes/Nanorods and their Applications” sanctioned by Science and Engineering Research Board, Dept. of Science and Technology, Govt. of India, New Delhi. \nHe has published research work in many peer reviewed journals like American Chemical Society, Elsevier, Springer, etc., and also bagged the Best Paper Awards in International Conferences such as International Conference on Nano Engineering Science and Research Advances (NESARA-2019) and International Conference on NANOTECHNOLOGY-2019 “Opportunities and Challenges”. He has presented, participated in many International, National Conferences/Symposiums, and obtained Travel Grant to visit Aryabhatta Knowledge University, Patna, Bihar under Knowledge Exchange Program as a Visiting Scholar visited by Visvesvaraya Technological University. He is a member/ life member of some professional bodies such as Associate Member of Institute of Chemists India, Kolkata, Indian Science Congress Association (ISCA), Kolkata, Society for Materials Chemistry, BARC, Mumbai, Materials Research Society, Warrendale, USA, and American Chemical Society Community Member, Washington, USA.",institutionString:"Govt. First Grade College, Shivamogga",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:{id:"299842",title:"Dr.",name:"Sharath",middleName:null,surname:"Peramenahalli Chikkegouda",slug:"sharath-peramenahalli-chikkegouda",fullName:"Sharath Peramenahalli Chikkegouda",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002ktfgxQAA/Profile_Picture_1644917887295",biography:"Dr. Sharath P.C. is currently working as an Assistant Professor in the Dept. of Metallurgical and materials engineering, School of Mechanical Engineering, Jain University, Bengaluru, India. He obtained his Ph.D. in Metallurgical and Materials Engineering and M.Tech in Process Metallurgy from the National Institute of Technology Karnataka (NITK), Surathkal, India. He has published 18 research articles and 4 book chapters in various International Journals. Dr. Sharath P.C. is currently doing research in metal forming, powder metallurgy, and electrochemical sensors. He has received several research awards in various conferences and currently has one research grant to his credit.",institutionString:"Jain University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Jain University",institutionURL:null,country:{name:"India"}}},coeditorThree:{id:"257201",title:"Dr.",name:"Shamanth",middleName:null,surname:"Vasanth",slug:"shamanth-vasanth",fullName:"Shamanth Vasanth",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX3jQAG/Profile_Picture_1644917948582",biography:"Dr. Shamanth Vasanth is currently working as an Associate Professor at the School of Mechanical Engineering, REVA University, Bangalore, India. He obtained his Ph.D. from the Department of Metallurgical and Materials Engineering at NITK Surathkal, Karnataka, India. Dr. Vasanth has a very good Interdisciplinary academic and research background (Additive Manufacturing, Heat Treatment of Steels, Material Characterization), Electrochemical sensors. He completed his BE (Mechanical Engineering) and M.Tech (Manufacturing Science and Engineering) from Visvesvaraya Technological University, Belagavi, Karnataka, India. So far, he has published 2 book chapters and 17 international research publications. His current research is Synthesis of High Strength and Corrosion Resistant Nanostructured Stainless Steels by Selective Laser Melting, which is financed by the Department of Science and Technology (DST) Government of India.",institutionString:"REVA University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"REVA University",institutionURL:null,country:{name:"India"}}},coeditorFour:null,coeditorFive:null,topics:[{id:"8",title:"Chemistry",slug:"chemistry"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"455410",firstName:"Dajana",lastName:"Jusic",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/455410/images/20500_n.jpeg",email:"dajana.j@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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MK‐4 is a member of a sub‐family with eliciting the same cellular reactions, but with different effects. MK‐4 is deemed necessary for γ‐carboxylation of proteins, and activation of the vitamin K‐dependent proteins, i.e., Osteocalcin (bone‐Gla‐protein), matrix‐Gla proteins (MGPs), Periostin, as well as protein S. Without these activated proteins, the body is not able to regulate the process of calcium uptake and bone mineralization. To date, we know of 19 different vitamin K‐dependent proteins. The process also ensures the access of energy for a plethora of cellular reactions. The most common of the K vitamins is phylloquinine‐1 (K1). K1 is found in leafy green vegetables, olive oil, and soybean oil, while MK‐4 is found in small amounts in egg yolks, butter, and hard cheese. Fermented soybeans, known as natto, a special Japanese food, contain another subfamily member menaquinone‐7 (MK‐7). It is the richest dietary source of menaquinones (yielding about 1100 μg/100 g). In Western diets, MK‐7 in fermented cheeses amounts to only 62 μg/100 g, approximately. Very small amounts of MK‐4 are produced by intestinal bacteria. The adequate intake (AI) for vitamin K1 from 2001 in the United States and Canada was recommended to be 90 μg/day for women, 120 μg/day for men. These values are based on the need for hepatic vitamin K1 to ensure sufficient clotting factor synthesis. To date, we know that the early AI is not enough to meet the request for a complete carboxylation of all the extrahepatic vitamin K‐dependent proteins. When MK‐4 ingestion is insufficient, the serum concentration of uncarboxylated MGP (ucMGP) or uncarboxylated Osteocalcin (ucOC) is increased. This serves as the major sign of a deficient intake of K1 or a deficient hepatic transformation of vitamin K1 to MK‐4. High serum concentrations of MK‐1 and MK‐4 reflect only the recent intake of vitamin K, not the accumulation or steady state levels of a “chronic” intake. The bioavailability of K1 and MK‐4 is very short, i.e., about 1.5–3 h in contrast to 72 h for MK‐7. To date, K1, MK‐4, and MK‐7 are available as dietary supplements [1, 2].
\nOsteoporosis is, on a worldwide basis, the reason for many emerging, spontaneous fractures. On a global basis, osteoporosis causes more than 88.9 million fractures annually. The condition is estimated to affect 200 million women worldwide, i.e., approximately one‐tenth of women aged 60, one‐fifth of women aged 70, two‐fifths of women aged 80, and two‐thirds of women aged 90 years. Worldwide, one in three women over the age of 50, will experience osteoporotic fractures, as will one in five of men aged over 50 [3]. From Europe, the number of new fractures in 2010 was estimated at 3.5 million, comprising approximately 620,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures, and 1,800,000 of other fractures (types or sites). For women in the EU: approximately 50% of fractures related deaths, were due to hip fractures, 28% to clinical vertebral fractures, and 22% to other types of fractures. In men, the corresponding figures were 47, 39, and 14%, respectively [3]. From the USA Preventive Services Task Force (USPSTF) for 2013, it is therefore concluded that the current evidence is insufficient to assess the balance of the benefits and harm of combined vitamin D and calcium supplementation for the primary prevention of fractures In the treatment of pre‐ and postmenopausal women or in men, these indicate that new treatments of osteoporosis are wanted [3, 4].
\nIn 1984, Hart et al. [5] revealed that the serum concentrations of vitamin K1 were very low among patients with hip fractures, and hypothesized that poor vitamin K status is associated with increased rates of osteoporotic fractures. The period of 1991–1993 was regarded as the beginning of the era of vitamin K examinations, since patients‐based studies by Hodges et al. confirmed that low serum concentrations of vitamin K1 and K2 were associated with increased risk of spine and hip fracture. The same phenomena were also shown by Szulc et al. in a French study, yielding a positive association between ucOC and fracture risk [6–8]. Other countries, like the Netherlands, as shown by the group of Knaben et al. [9] and Finland, as shown by Luukinen et al. [10], clearly demonstrated that this association (ucOC versus fracture risk) point to the fact that vitamin K status is a predictor of bone health (fracture‐free percentage of a population group). The correlation between low intake of vitamin K and increased fracture rate was also revealed by prospective analysis within the Nurses’ Health Study cohort 1984. Here, the diet was assessed in 72,327 women, aged 38–63 years, with a food‐frequency baseline‐questionnaire. During the subsequent 10 years of follow‐up, 270 hip fractures resulting from low or moderate trauma were reported. Results: women in quintiles 2–5 of vitamin K intake had a significantly lower age‐adjusted relative risk (RR: 0.70; 95% CI: 0.53, 0.93) of hip fracture than women in the lowest quintile [11].
\nIn Japan, a high dose of menaquinone‐4 (MK‐4) of 45 mg/day (15 mg × 3/day) was used as therapeutic treatment for osteoporosis. The principle cause‐effect of vitamin K2 on osteoporosis is mainly the prevention of bone fractures due to its improvement of bone quality, and not the ensuing increasing bone mineral density. Due to variable contents of vitamin K in the diet, the Japanese Society of Osteoporosis included in 1995 vitamin K2 as Menatetrenone (MK‐4), together with vitamin D, in the first line treatment of osteoporosis [12].
\nOsteoporosis, in its primary form, is characterized by bone loss, and the age of females upon onset or development of menopause, however, the disease also affects a smaller cohort of men. Genetics is the single most important cause for both sexes, however, changes of lifestyle, exercise levels, smoking habits, and low body weight, are important contributors, which may trigger the onset of the disease. Secondary forms of osteoporosis‐related chronic diseases are rheumatoid arthritis, chronic lung disease, and anorexia. In addition, it is well known that the use of cortisone or prednisolone can reduce bone mineral density (BMD). Standard examination of bone mineral density (BMD) is the dual energy X‐ray absorptiometry (DEXA). BMD values is not the same for all women and men but different due to race. In the last decade, research have combined DEXA scan with more specific geometric hip and vertebra measurements as femoral neck width (FNW) and hip‐axis length (HAL) and vertebral fracture (VF) assessment (VFA).
\nHowever, it may be asserted to a certain extent, that proper bone 3D‐architecture may “make up” for a marginal reduction in BMD‐values in terms of predictive value of the BMD‐levels
The incidence of osteoporosis is lower in Japanese women, even though they are subjected to the same period with menopause as other women. However, in some regions, like in Tokyo, the intake of vitamin K as MK‐7 in the special fermented food of natto, soybeans together with other treatments result in higher BMD‐values and lower fracture rates than age‐matched woman in the United States and Europe [3].
\nOf other health outcome studies featuring patients with an without osteoporosis, a few warrant special attention: observational studies of subjects displaying a low long‐term vitamin K intake revealed a higher incidence of osteoarthritis in the hand and knee [13], dementia [14, 15]. From population‐based studies of atherosclerosis, Jie et al. revealed that, in atherosclerotic women, vitamin K status is associated with lower bone mass. All these findings support our hypothesis that vitamin K status affects the mineralization processes in both bone and atherosclerotic plaques in a healthy manner [16]. And, from the population‐based Rotterdam Study, the relation between low vitamin K status and development of coronary artery disease [17] is indisputable.
\nThe importance of vitamin D for bone health has been known since it was used in the treatment of rachitis in the 1930s. Vitamin D and calcium supplements have been recommended as a pillar in the treatment of osteoporosis over the last three decades. Vitamin D and calcium supplementation increases spinal BMD in healthy, postmenopausal women [18, 19], and vitamin D is crucial in the process of mobilizing the Ca2+ ions into the bone tissue [20]. Interestingly, vitamin D and calcium alone are not able to rebuild bone tissue and infrastructure that are being lost. The synergistic effect of vitamin D and retinoic acid on osteoblast production of osteocalcin was shown in 1993 [21], where Hara et al. demonstrated that MK‐4 was able to partly inhibit the bone resorption induced by inflammation, vitamin D loss and ensuing PTH induction, as seen in the calvariae and incubation medium in his mode
Osteocalcin is produced by osteoblasts during bone formation, and serves as the most abundant protein in bone after collagen. Furthermore, it is crucial for bone mineralization. Activated osteocalcin is located within hydroxyapatite crystals and binds calcium strongly to facilitate mineralization of the hydroxyapatite crystal grid [24]. Osteocalcin production is regulated by a plethora of factors including retinoic acid (RA), estrogens, glucocorticoids, as well as vitamin D [25–27]. In 1995, Douglas et al. showed the percentage of carboxylated osteocalcin (cOC), as calculated from total osteocalcin, was found to be less than 60% in osteoporotic postmenopausal women compared to 70–80% in young, healthy adults [28]. The osteocalcin production is increased by vitamin D but also increased by both MK‐4 and MK‐7 in a synergistic fashion. From 2007, as used by Knapen et al., osteocalcin has been employed as a marker for the deficiency of vitamin K in bone. Today, the specific osteocalcin molecules are total Osteocalcin (tOC), ucOsteocalcin (ucOC), and cOsteocalcin (cOC) [28, 44]. A secondary action of MK‐4 and MK‐7 is the ensuing increased collagen production by cells of the osteoblastic lineage. Collagen should make the structural fundament, on which calcium and other minerals are accumulated within the bone matrix. Increased deposition of collagen makes the bone more flexible and this is very important for the attainment of “higher” or better bone quality [24]. In 2001, Yamaguchi et al. unraveled the stimulatory effect of MK‐7 on osteoblastic bone formation
In relation to the loss of bone associated by deficient intake of vitamin K1, many observational studies have been conducted. However, few randomized studies have been able to reveal a significant positive rebuilding of bone mass and increased BMD. This chapter deals only with randomized clinical trials with a duration exceeding 1 year.
\nSchaafsma et al. from the Netherlands showed in a 1‐year long randomized study from 2000 [32] (featuring four groups with 400 IU vitamin D3; vitamin K1 supplementation 80 μg daily, vitamin K1 and D3, and placebo of Dutch postmenopausal women (with a patient total,
In the Bram et al. study from 2003, three groups were examined; group K1D: the effect of vitamin K1 (1 mg/day) and vitamin D (8 μg/day including standard mineral supplementation), group D (vitamin D and minerals) and group 3, placebo on bone loss retardation in a randomized, double‐blind, placebo‐controlled 3‐year intervention study. Of 181 healthy postmenopausal women between 50 and 60 years of age, 155 completed the observation period. The main outcomes of the study were significant changes in BMD‐values of the femoral neck and lumbar spine after 3 years. The group receiving the supplement with additional vitamin K1 showed a decline in the bone loss from the femoral neck. The difference in femoral neck bone mass between the K1D group and the placebo group was 1.7% (95% CI: 0.35–3.44). The difference between the K1D group and the D group was 1.3% (95% CI: 0.10–3.41). No significant differences were observed among the three groups with respect to changes in BMD at the site of the lumbar spine. It was therefore concluded that the minerals and vitamin D, coadministered with the vitamin K1 supplement, substantially contributed to a significant reduction in postmenopausal bone loss at the site of the femoral neck [33].
\nIn a systematic review and meta‐analysis of 700 patients, Cockayne et al. showed in 2006 that the MK‐4 intake in Japan yielded a powerful reduction in the incident of fractures. However, the authors would not recommend vitamin K supplementation until a new randomized clinical trial confirmed the results [34].
\nBoton‐Smith et al. performed a 2‐year, randomized, double‐blind, and placebo‐controlled study in 2007, scrutinizing the effect of dietary supplementation with either: (1) 200 μg vitamin K1 daily, (2) vitamin D 400 UI daily (3) and calcium 1000 mg daily, or (4) their combination on 244 healthy nonosteoporotic older women. Baseline and 6‐month measurements included DXA bone mineral scans of the hip and wrist, markers of bone turnover, and vitamin status. The results reported were the following: the combined vitamin K1 with vitamin D plus calcium treatment was associated with only a modest but significant increase in BMC at the ultradistal radius, however not at other sites in the hip or radius [35].
\nThe Booth et al.\'s study was published 1 year later, in 2008. The goal of the present investigation was to pinpoint the effect of a consecutive 3‐year administration of vitamin K1 on putative alterations in bone mineral density (BMD) of the femoral neck in elderly patients of both sexes, who presented upon inclusion with calcium and vitamin D repletion. In the present double‐blind, controlled survey, 452 individuals (both men and women, 60–80 years of age) were evenly distributed, in a randomized fashion, each to receive a multivitamin containing either 500 μg/day of vitamin K1 or placebo, in addition to a daily, 600 mg elemental calcium with vitamin D (400 IU) supplement. Analyses of the femoral neck, spine (L2–L4), and total‐body BMD, turnover of bone mass, and indigenous status of both vitamins K and D was checked every 6–12 months. Results were as follows: one could not find any distinction in BMD values localized to any pertinent body sites, when comparing the two patient groups. Furthermore, the population receiving the vitamin K1 supplement showed a markedly higher vitamin K1 level, as well as a substantially lower degree (percentage) of ucCO concentrations, when matched with the patients not ingesting K1. Neither of the additional biochemical variables measured differed between the patient treatment groups. Hence, the authors concluded that vitamin K1 supplementation, in a dose attainable in the diet, does not confer any additional benefit for bone health at the spine or hip when taken with recommended amounts of calcium and vitamin D [36].
\nThe emerging questions to ask were then: Was the dose of vitamin K1 supplement too low, or the follow up period too short to elicit an increase of BMD, or was it possible to use other sub‐family vitamin K members, such as menaquinone‐4 (MK‐4)? Or, could vitamin K supplementation potentially be harmful to the body?
\nCheung et al. from Canada addressed the last of these questions in their 2–4‐year study from 2008. In this trial, 440 postmenopausal women with osteopenia were randomized into a placebo‐controlled double‐blind trial, and it was conducted, mainly to determine whether daily high‐dose vitamin K1 supplementation safely reduces bone loss, bone turnover, and fractures. The conclusions coming out of the study were: 5 mg of daily vitamin K1 supplementation for 2–4 years does not protect against age‐related decline in BMD, but may protect against fractures and cancers in postmenopausal women with osteopenia. Overall fracture rate was reduced by 50% (9 versus 20,
Brinkley et al. from USA conducted a 1‐year study in 2009 and found that low vitamin K status is associated with low BMD and an increased fracture risk. From the bulk of reports available at that time, it seemed that the menaquinones (menatetrenone: MK‐4), might diminish the fracture risk incurred by the enrolled patients. Whether vitamin K is an important “by‐player” in maintaining skeletal health in females situated in the northern part of the US remains an unsolved issue. Furthermore, different entities of K vitamins (i.e., phylloquinone (K1) and MK‐4) may exert differing biological effects on the skeleton. The present study was designed to assess the efficacy of either vitamin K1 or MK‐4 exposure on biomarkers of skeletal health and bone mineral density (BMD) in postmenopausal nonosteoporotic, North American women. In the present, placebo‐controlled and double‐blind investigation, a total of 381 postmenopausal females were given either vitamin K1 (1 mg/day), MK‐4 (45 mg/day), or a placebo treatment. The whole observation period was 12 months. All enrolled patients/participants were given either Ca2+ or vitamin D3 supplementation. Bone‐specific BSALP (alkaline phosphatase) in blood samples, as well as the
In 1998, Orimo et al from Japan evaluated the effects of menatetrenone‐4 (MK‐4) on bone and calcium metabolism in osteoporosis patients in a 24‐week double‐blind placebo‐controlled study, where 80 osteoporotic patients were included. Treatment was MK‐4, 90 mg/day (
In 2000, Shiraki et al. conducted a 2‐year study in Japan, to assess whether MK‐4 effectively prevented the incidence of new fractures in osteoporotic patients. Two hundred forty‐one osteoporotic women were enrolled in a 24‐month, randomized, and open label study. The population constituted: a control group without treatment (
In 2000, Iwamoto et al. showed in 92 postmenopausal women, aged 55–81 years, completing a 2‐year randomized controlled trial in four groups receiving either menatetrenone (MK‐4, 45 mg/day), 1α‐hydroxyvitamin D3 (0.75 μg/day), a combination of MK‐4 and D3 (same dosage as above), or calcium lactate (2 g/day). The MK‐4 and vitamin D3 groups experienced significant enhancements of their BMD‐values (+0.91 and 0.38%), compared to the “Calcium group” (–0.79%), while the combined MK‐4 and D treatment, being synergistic, significantly increased lumbar BMD by 1.5 %,
Ushiroyama et al. completing a randomized 2‐year study in 2002, investigated the therapeutic effect of the combined use of menatetrenone MK‐4 and vitamin D3 on vertebral bone mineral density in 172 postmenopausal women with low bone mass and osteoporosis. Four groups, each with 43 subjects received the following; either (a) MK‐4, 45 mg/day, (b) standard vitamin D3 supplement, (c) combined MK‐4 and vitamin D3 therapy, and (d) control group receiving dietary therapy alone. BMD (bone mineral density) was assessed before initiation of therapy and subsequent to 6–24 months of treatment, respectively. Analyzed biological markers of osseous metabolism constituted: serum type 1 collagen carboxyterminal propeptide (P1CP), intact or total osteocalcin, as well as urinary pyridinoline. Tests for potential of blood coagulation was done analyzing “activated‐partial‐thromboplastin‐time” (APTT), as well as assessment of levels of antithrombin III (AT III), fibrinogen, and plasminogen, respectively. Conclusions summarized in the paper were combined therapy with MK‐4 and vitamin D3 given for 24 months significantly increased bone mineral density = BMD (4.92 ± 7.89%),
In 2007, Knapen et al. from the Netherlands presented the result of a 3‐year randomized clinical intervention study of 325 healthy postmenopausal non‐ osteoporotic women receiving MK‐4, 45 mg/day, or placebo. BMC and hip geometry were assessed by DXA, and bone strength indices were calculated from DXA‐BMD, femoral neck width (FNW) and hip axis length (HAL). Computations showed that MK‐4 significantly improved the hip bone strength, BMC and FNW, but in the placebo group, bone strength decreased significantly. However, MK‐4 did not affect the DXA‐BMD values. It was therefore speculated that the high vitamin K2 intake prevented the postmenopausal, nonosteoporotic bone loss. The importance of K vitamins for optimal bone health has been suggested on the basis of population‐based analyses, however, intervention trials performed with DXA‐BMD serving as measures of clinical endpoints have given contradicting conclusions. In contrast, BMC, compared with DXA‐BMD does not take into account the geometry (size, thickness) of bone, which is construed as an independent contributor to and “interpreter” of bone resilience and fracture risk [44].
\nJiang et al. conducted a 1‐year study in China in 2014. In this randomized, double‐blinded study, it was evaluated whether the efficacy of MK‐4 is inferior to α‐calcidol in Chinese postmenopausal women. Two hundred and thirty‐six women were randomized to two groups: Group MK‐4, receiving 45 mg/day or Group α‐calcidol, receiving 0.5 μg/day, respectively. Furthermore, all enrolled individuals ingested 500 mg/day of calcium. Assessment of bone mineral density (BMD) post‐treatment, onset or occurrence of new fractures, as well as serum OC and ucOC levels were matched with patient baseline values in both patient groups. The information obtained was as follows: 90.3% of the patients completed the investigation. Results showed that the BMD‐values in the MK‐4 group significantly increased from baseline by 1.2% at the lumbar spine, and 2.7% at the trochanter, respectively (
Bisphosphonates, combined with vitamin D and calcium are widely used around the world in the treatment of osteoporotic patients. Vitamin K apparently sustains the lumbar BMD, thus reducing the incidence of osteoporotic fractures it was natural to investigate and compare bisphosphonates and MK‐4.
\nIn 2001, Iwamoto et al. presented a 2‐year preliminary randomized study, comparing the effects of etidronate (E) and MK‐4 on forearm BMD‐values and fracture incidence. Seventy‐two osteoporotic women, all 5 years after menopause were enrolled. The E‐group received 200 mg/day, 14 days per 3 months;
In 2003, Iwamoto et al. examined 98 postmenopausal osteoporotic women in a randomized, controlled, 2 years study, comprising four groups: (1) MK‐4, 45 mg/day of vitamin K; (2) etidronate 200 mg/day for 14 days per 3 months; (3) etidronate and MK‐4 combined; and (4) calcium supplement. End points assessments were: Forearm (distal radius) BMD measured by DXA using DTX‐200 (Osteometer®), and incidence of vertebral fractures (level T4‐L4). Results reported are summarized as follows: the forearm BMD in the calcium group was reduced from baseline, sustained by MK‐4, increased significantly by etidronate, and increased even more in the MK‐4 and etidronate group. The incidence of vertebral fractures in the MK‐4 group was 8.0%, in the etidronate group 8.7%, in the MK‐4 and etidronate group 3.8%, and in the calcium group 20.8%, respectively. The compelling conclusion is combined treatment with MK‐4 and bisphosphonates showed significant different (
Ishida and Kawai published in 2004 a 2‐year long study, examining 396 postmenopausal women with osteoporosis, randomized to six equally sized groups: (1) hormone replacement therapy (conjugated estrogen 0.625 mg/day plus medroxyprogesterone 2.5 mg/day), (2) etidronate (2 weeks of treatment with 200 mg/day followed by a 10‐week medication‐free period), (3) ell calcitonin (20 IU/week), (4) α‐calcidol 1 μg/day, (5) MK‐4 45 mg/day, and (6) control group (i.e., no treatment). End point BMD, bone markers and incidence of vertebral fractures served as clinically relevant end point measures. The results (2‐year mean changes in BMD) were 2% for the hormone replacement therapy, −0.5% for the etidronate treatment, 1.6% for the calcitonin treatment, −3.6% for the α‐calcidol treatment, −1.9 for the MK‐4 treatment, and −3.3 for the controls, respectively. Seventeen (26%) of the 66 control patients developed new vertebral fractures. Compared with controls, the relative risk of incurring vertebral fractures was 0.35 (95% CI: 0.14–0.83) in the hormone replacement therapy, 0.40 (95% CI: 0.17–0.92) in the etidronate group, 0.41 (95% CI: 0.17–0.93) in the calcitonin group, 0.56 (95% CI: 0.26–1.12) in the α‐calcidol group, and 0.44 (95% CI: 0.20–0.99) in the MK‐4 group, respectively. Hence, the conclusion: a substantial and significant reduction in the incidence of vertebral fractures was achieved due to either: (a) hormone replacement therapy, (b) etidronate, or (c) calcitonin medication. Significant improvements in BMD were obtained by the patients enrolled in the hormone replacement therapy group and in the calcitonin group [49].
\nHirao et al. conducted a 1‐year study in Japan in 2008. He enrolled and examined 48 postmenopausal women, but only 44 were followed up after 1 year. This randomized controlled study consisted of the following groups A, monotherapy of alendronate (5 mg/day) and group AK, alendronate plus MK‐4 (5 mg/day an 45 mg/day, respectively). The take home message was clear: MK‐4 decreased undercarboxylated osteocalcin significantly more than alendronate, which is known not to influence the degree of carboxylated osteocalcin. In the AK group, the femoral neck BMD was significantly increased. The small number of patients enrolled, and the short observation time undermines any conclusion drawn from this study. Further investigations using this combination therapy were recommended [50].
\nJe et al. from Korea published in 2011, a study evaluating the effects of MK‐4 supplementation on bone mineral density and undercarboxylated osteocalcin (ucOC) in 78 postmenopausal Korean women 60‐years‐old plus. These women, not receiving any medical treatment, were randomized into two groups: (1) calcium and vitamin D,
In 2012, Fang et al. presented a meta‐analysis of randomized controlled trials published during the period of 1999−2009. The analysis examined the role of vitamin K on bone mineral density (BMD). The study revealed that vitamin MK‐4 supplementation was associated with increased BMD at the lumbar spine, however not necessarily at the femoral neck. This untoward heterogeneity may be the result, may reside within different participant groups, different regions of the skeleton, gender, and type of vitamin K1 and MK‐4 supplementation. Hence, further studies are deemed required to investigate and unravel the detailed effects of vitamin K2 sub“populations” or metabolites on BMD [52].
\nJapanese menopausal women have traditionally a lower fracture risk than women from the western world [3]. An association with the ingestion of natto (a processed food containing fermented beans) was evaluated by Katsuyama et al. [53] and Ikeda et al. [54] in the so‐called Japanese population‐based osteoporosis (JPOS) study. The dietary natto intake over 3 years was shown to significantly increase the changes of total hip BMD
The Norwegian study published by Emaus et al. in 2010. features a 1‐year randomized double‐blind placebo‐controlled study with 334 early menopausal, but otherwise healthy, women. The patient groups received either MK‐7 (360 μg/day) or placebo. The summary of the present trial disclosed the following: in the MK‐7 group, serum uncarboxylated Osteocalcin (uc‐OC) was significantly reduced (from 4.14 to 2.22 ng/ml, respectively). In contrast, carboxylated Osteocalcin (c‐OC) was significantly increased (from 13.5 to 19.1 ng/ml, respectively). However, there was no statistical difference in bone loss rate between the groups at the “total hip site,” nor at any other measurements sites. This was most probably due to the shorter follow‐up time, i.e., after only 1 year of MK‐7 exposure [55].
\nAfter solid organ transplantations, loss of bone mass often occurs and may cause substantial health problems. In a study (published in 2010) on such a patients group, Forli et al. from Norway looked at the effect of MK‐7 on bone mass, measured as BMD of the lumbar spine. Despite the fact that the impact of MK‐7 on the measured BMD was not conclusive, it was recommended that further studies over an extended period of time should be conducted. Here, we refer to the main findings in the study.
\nThis study was the first in organ transplantation, featuring the effect of MK‐7 on bone mass, 1 year after lung and heart transplantation. Postoperatively, 35 lung and 59 heart recipients were actively treated with MK‐7 in a prospective and longitudinal study, receiving MK‐7 supplement, 180 μg/day or placebo. The results reported were the following: 1 year after solid organ transplantation, the difference between MK‐7 and placebo for the lumbar spine (L2–L4) BMD was 0.028 (SE 0.014) g/cm2,
In a stepwise linear regression analysis, alterations in the L2‐L4 BMD, controlled for alleged confounding variables (which include the use of bisphosphonates), significant predictors turned out to be: (a) organ (if heart = 1, BMD = −0.065 g/cm2 ,
Knapen et al., the Netherlands, published in 2013 the results of their 3 year study on the effect of low‐dose MK‐7 supplementation on bone loss in 244 healthy postmenopausal women. The study was a double‐blind, randomized placebo controlled study, with two groups: (a) active low‐dose vitamin K2 (MK‐7, 180 μg/day), and placebo. Their main task was to investigate whether low‐dose MK‐7 supplements beneficially could affect bone health in general.
\nSecondary to an improved and favorable vitamin K status, MK‐7 ingestion from supplements should have the possibility to significantly reduced age‐related loss of bone mineral density and ensuing bone mechanical properties. Hence, low‐dose MK‐7 supplements should consequently result in preventing bone loss in postmenopausal women. In spite of contradictory data emanating from trials with vitamin K supplementation on the status of bone health, the European Food Safety Authorities (EFSA) has accepted the health claim on vitamin K\'s role in the maintenance of normal and healthy bone structure. In accordance with EFSA\'s opinion, it was clearly demonstrated that a 3‐year high‐dose of vitamin K1 and MK‐4 supplementation improved bone health after menopause.
\nBecause of the longer half‐life, bioavailability, and greater potency of the long‐chain MK‐7, they also measured the effect of low‐dose MK‐7 supplementation on bone health, as reflected by bone mineral density (BMD) of lumbar spine, total hip, and femoral neck. The assessment of vertebral fractures was performed using DXA. Furthermore, blood levels of ucOC and cOC were also analyzed, and the ucOC/cOC ratio functions as an indicator of vitamin K “health” status. All analyses were performed at baseline, and subsequent to 1, 2, and 3 years of supplementation, respectively. A carboxylation rate of >50% was achieved during the first year of treatment, and it was maintained throughout the study period.
\nThe main results obtained were as follows: MK‐7 ingestion significantly enhanced vitamin K status and decreased the age‐related reduction in bone mass, as well as both BMC and BMD at the level of lumbar spine and femoral neck. However, total hip BMC and BMD decline could not be “rescued.” Bone strength also seemed to be favorably affected by MK‐7 ingestion, significantly decreasing the loss of vertebral height of the lower thoracic region at the mid‐site of the vertebrae
The need of vitamin K for the activation of clotting factors is lower than for the activation of extrahepatic vitamin K‐dependent proteins. This is the plausible reason for deficient rebuilding of bone mass and increased calcification process in blood vessels. Long‐term use of anticoagulants, likes warfarin, may potentially lead to the loss of bone, and/or an increased incidence of osteopenia or osteoporosis with and without fractures. The crucial question then is: What time span for patients on warfarin medication will suffice for the detection of bone loss?
\nIn an observational study conducted in Japan by Namba et al. 2015, the biomarkers during warfarin use in a 1‐year follow‐up on 42 patients treated for atrial fibrillation were described. Twenty‐four patients received warfarin (WF group) and 18 patients received non‐warfarin treatment (Non‐WF group). Results revealed an increased significant difference in ucOC in WF the group 10.3 ± 0.8 ng/ml, versus non‐WF group 3.4 ± 0.9 ng/ml,
Twenty years ago, clinical observations and research demonstrated that women, taking warfarin during the first trimester of their pregnancy, gave birth to children with punctate calcifications in the axial skeleton, proximal femurs, and calcanei. The presumed reason has since long been that prenatal vitamin K deficiency, induced by warfarin, was the reason for these calcifications [59].
\nLarge clinical studies on bone mass have given different results, and in early observation studies, the evaluation of duration of warfarin use and other patients receiving treatment for osteoporosis was not included. However, two newer studies showed no further risk on bone mass of warfarin use in elderly patients: In the first one published by Woo et al. in 2008, in a large cohort of elderly community‐dwelling men, no association was observed between current warfarin use and bone mass, bone loss or fracture risk. Although warfarin use was based upon a single assessment, the findings suggest that current warfarin use in older men does not appear to have clinically important effects on the skeleton [5, 60].
\nThe second experience was summarized by Misra et al. in 2014, featuring long‐term treatment of incident atrial fibrillation without prior history of fractures. Long‐term warfarin use was defined in two ways: (1) warfarin use ≥1 year; (2) warfarin use ≥3 years. Event‐score on warfarin users and nonusers were created to evaluate the association between long‐term warfarin use and risk of hip, spine, and wrist fractures separately, as well as combined, using Cox‐proportional hazards regression models. Among more than 20,000 participants with incident atrial fibrillation, the hazard ratios (HR) for hip fracture with warfarin use ≥1 and ≥3 years, respectively, were 1.08 (95% CI 0.87, 1.35) and 1.13 (95% CI 0.84, 1.50).
\nThe conclusion of the present trial was as follows: long‐term warfarin use among elders (i.e., >65 years of age) with atrial fibrillation was not associated with any increased risk of osteoporotic fractures and therefore does not appear to necessitate additional surveillance or prophylaxis [61]. These observational studies have focused on clinical fractures as endpoints below follow‐up time at 5–10 years, but the thesis that warfarin‐induced clinical fractures was not confirmed. This may be due to the beneficial effect of MK‐7 on bone mass, which appears to stay unaffected by the impact of warfarin on vitamin K1, which again reinforces the notion that vitamin K2 status (measured as ucOC) per se is a good marker of bone homeostasis [58].
\nThe link between increased calcification of vessels and bone complications changes the definition of CKD‐MBD to better describe the complexity of the syndrome [62]. The link between osteoporosis and cardiovascular morbidity is well described in postmenopausal women with intact renal function [63]. In chronic hemodialysis patients, a lower bone volume is associated with higher coronary calcification scores measured by multislice computed tomography, reflecting a higher risk of cardiovascular events [64]. This association between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease was also described in 2008 by Toussaint et al. [65]. Furthermore, the mortality of hemodialysis patients was evaluated in 2003 by Taal et al. among 88 hemodialysis patients over a 3.5 years follow‐up period. Here, it appeared that mortality was associated with age, Ca‐P product, lack of transplantation and a low bone mineral density measured at the hip. The leading cause of death (42.5%) appeared to be related to cardiovascular events [66].
\nThe therapeutic options are few, since many women on renal replacement treatment did not accept reinstigation of hormone replacement therapy. However, the efficacy of hormone replacement was confirmed in a randomized trial in women on continuous dialysis, receiving hormone therapy (estradiol and cyclic norethisterone) for 1 year. At the end of the study, the active group showed an increase in bone mineral density at the lumbar spine. This difference between the active and control group (receiving cinacalcet) was significant at all measurement sites [67]. Active vitamin D analogs, calcimimetics administration and phosphate‐binders are widely used to suppress iPTH and thus bone specific alkaline phosphatase, as a marker of enhanced bone turnover.
\nKohlmeier et al. were the first to show an independent association between serum concentration of phylloquinone <1.2 nmol/l or less (poor vitamin K status) and an increased risk of bone fracture in patients with end‐stage renal disease [68]. This observation was confirmed by Fusaro et al. [69] in 2013, showing that hemodialysis patients treated by warfarin for longer than 1 year had an increased risk of vertebral fractures, compared with patients not on warfarin. McCabe et al. enrolling 172, stage 3–5 CKD patients without dialysis treatment, showed that intake of vitamin K was insufficient in more than 50–60% of individuals on a given diet, if measures of ucOC were conducted (>20% ucOC), and 97% if evaluation was done by the prothrombin induced by vitamin K absence‐II (PIVKA‐II) assessment (>2 nmol/l) [70, 71]. After establishment of dialysis as a therapeutic intervention, Cranenburg et al. showed in a study of 40 chronic hemodialysis patients from 2012 that the dietary intake of vitamin K1 and K2, in general, was insufficient. This was reflected by analyses of plasma levels of desphospho‐undercarboxylated (dp‐uc) MGP (matrix‐GLA protein), which was increased over the normal range by some 82.5% with elevated PIVKA‐II values 3.81.4–12.4 ng/ml, reference value <2 ng/ml. [72]. Elevated dp‐ucMGP levels suggest insufficient vitamin K2 levels on the vascular site, while high ucOC reflects insufficient vitamin K2 on bone or osseous sites.
\nA 6 weeks randomized controlled trial on hemodialysis patients evaluated the response of biomarkers of vitamin K status (dp‐ucMGP, PIVKA‐II and ucOC) to the ingestion of 45, 135, 360 μg/day of MK‐7. The study confirmed that most patients displayed a functional deficiency at baseline, and that MK‐7 supplementation decreased dp‐ucMGP and PIVKA‐II. However, only the highest doses brought about a significant decrease in ucOC [73].
\nIn osteoporosis, the main treatment aims at inhibiting osteoclastic bone resorption. The osteoclast and osteoblast are functionally tightly coupled, and the mechanism of this reciprocal link is now very well known. By the discovery of MK‐7, which is able to play a role in the prevention of bone loss from most sites of the skeleton, there is hope for efficient treatment. MK‐7 has been shown to stimulate osteoblastic bone formation, as well as suppressing osteoclastic bone resorption
New trials enrolling CKD and chronic dialysis patients treated with MK‐7 supplementation are presently being conducted to fully evaluate the effect of MK‐7 on atherosclerosis and bone mineral density.
\nIn the near future, the dose, bioavailability and potency of the vitamin K2 subfamily member menaquinone MK‐7, will most probably make it possible to improve on the bone building process, yielding enhanced bone strength and resilience in several bone‐losing patient categories, such as those suffering from osteoporosis of different etiologies, and patients presenting with low bone mass (osteopenia).
As a result of danger, the brain responds with anxiety and anxiety behavior. In an evolutionary understanding, an anxiety reaction is aimed to avoid given threat. In fact, anxiety states may lead to adaptive behaviors, as the lack of given anxiety reaction in the event of a threat, e.g. a pandemic, could have negative consequences [1, 2]. The anxiety state and its aftermath can result desirable in numerous ways. One of them is escape or avoidance of danger, which increases the distance between the organism and the harmful factor. The anxiety state may trigger aggression towards the source of danger to neutralize it, or submissive behavior, resulting in the possibility of survival in life-threatening situations. An important factor in generating an anxiety reaction is the distance to the threat, what can be distinguished into immediate threat, perception of danger from a distance, and the presence of risk without a specific threat. Neuroimaging studies have shown activation of more archaic brain structures (such as the paraviductal gray matter) due to immediate threat, while at a greater distance to the danger, there was enhanced activation of the ventral prefrontal cortex. The variety of anxiety states occurring in humans is mainly related to the dynamic development of the prefrontal cortex [3].
The current crisis places multifaceted burden on children. The socio-ecological impact of the pandemic, which is understood to be enormous, must be also considered. The pandemic has affected children at different levels – health, social, family and individual [4]. COVID-19 worldwide crisis causes stress, worry and helplessness among children and adolescents. A role of sensitivity to anxiety in children was emphasized. However, it is still unclear whether the sensitivity to anxiety precedes or is a consequence of fear. It may be also a two-way relationship [5].
A risk factor for anxiety disorders in children is anxiety sensitivity. A meta-analysis found that anxiety sensitivity was associated with a higher level of anxiety [6]. The research results indicated so far a significant increase in the frequency of anxiety symptoms in children and adolescents due to the pandemics. Developmental mental health problems are associated with several risk factors. They affect more often children with special educational needs, those in poor general condition, whose parents have problems with mental health or who grow up in dysfunctional families.
The impact of COVID-19 pandemic and lockdown on children and youth depends on several vulnerability factors such as the developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection/fear of infection [7, 8]. Children and adolescents may be more susceptible than other social groups to the psychosocial effects of pandemics, because they are in a critical period of development. Adolescence is a phase associated with increased risk for many psychiatric disorders, such as anxiety and depression [9]. Additionally, many of hormonal and neurobiological changes during adolescence correspond with heightened emotional reactivity and the ongoing process of incorporating coping strategies and stress regulation [10, 11]. Simultaneously, adolescence is marked by the increased importance of peer relationships and a greater reliance on peers for social support. The COVID-19 pandemic, especially for children and adolescents, will have a significant impact on their growth in terms of their whole life [12].
Resilience reflects processes and resources that restore equilibrium, offset challenges, and foster adaptation to harsh conditions. Research on individual adaptation to uncertain conditions during the pandemic requires longitudinal analyses, because factors connected with resilience will change dynamically over time.
As a result of COVID-19, children and adolescents have experienced unprecedented disruption of their daily lives. It is anticipated that this intermission may trigger mental illness, including anxiety. Many studies provided child and/or adolescent reports of anxiety during COVID-19 pandemic [13, 14, 15]. Chinese research found that 18.9% of children reported anxiety symptoms on the Screen for Child Anxiety Related Emotional Disorders [14]. Another study of prevalence of anxiety symptoms disclosed its frequency as 37.4% [15]. Parental reports according child and adolescents mental difficulties included anxiety symptoms as worry (28%), fear of death of a relative (22%) [16, 17].
The factors that generate anxiety include specific, characteristic personality traits of parents, especially their timidity. This applies to both parents, but more to the mother. Parents’ anxiety behavior is taken over by the child as a result of social learning through imitation, identification and replication of parental behaviors patterns. Among other factors triggering anxiety are also specific educational influences of parents and specific educational attitudes. The source of fear is the parental overprotective attitude, which can take two forms: over-indulgent care and domination-based care, or the attitude of excessive demands. A dysfunctional family has a negative impact on the development of all its members, especially children. The pandemic contributes to the exacerbation of dysfunctional family characteristics.
Anxiety is reduced by relationship with parents based on acceptance, love and care, when the child feels and knows that she/he is loved. Those children who have had too few of these situations acquire relatively permanent tendency to react with fear. Especially those, who had too little anxiety-relieving stimuli in early childhood. The emergence of anxiety is also related to temperamental traits. Children with anxiety traits are more likely to perceive the changes caused by a pandemic as a threat.
Social isolation is considered to be one of the most important psychological risk factors for the development of various diseases, including anxiety disorders. In single people, genes responsible for the production of inflammatory proteins were activated, while those related to fighting viral infection were inactive [18].
Studies in the UK, Europe, and Asia evidenced COVID-19 related anxiety and somatic symptoms in children. 20–50% children and adolescents were reported to experience worries about themselves, friends or family catching COVID-19, 8–10% children and young people had moderate to high somatic symptoms [13, 19, 20, 21]. Some research results indicated a significant increase in the level of anxiety (by 164%) in the self-assessment of health of children and young people during pandemic Covid-19 [22]. The researchers also reported that age, gender, knowledge about COVID-19, degree of worry about epidemiological infection, and confidence about overcoming the outbreak significantly influenced the children’s psychological status [23]. Studies also reported that girls showed higher anxiety levels during COVID-19 than male adolescents did. Some studies also reported that the anxiety levels among the adolescent population were significantly higher than those in children. In addition, adolescents in senior high school had the greatest anxiety symptoms [24]. Levita’s study showed that over 47% of girls and 60% of boys aged 13–18 had an anxiety increase above the cut-off point on the scale assessing the presence of anxiety [21]. Rates in European and Asian studies were lower, ranging between 10 and 30% [14, 15, 19]. Differences in anxiety have been established between European countries. Anxiety and depressive symptoms were more likely in children whose parents reported higher levels of stress [25]. Some studies showed that being female was a risk factor for higher rates of anxiety symptoms [15, 26], while other found that sex did not predict anxiety symptoms [14]. The financial strain predicted higher anxiety symptoms [17].
Perceived stress in parents and children was associated with negative coping strategies. Additionally, children’s stress levels were influenced by prior and current parental overreactivity. These results suggested that children in families with negative coping strategies and a history of parental overreactivity might be at risk for negative consequences of the lockdown [27]. Some families assumed that they are unable to cope with the multiple new challenges. They experienced a sense of chaos, inability to take decisions while focusing on negative information that aggravates panic. Other families looked for strategies to handle the difficulties. They moved on to mobilization stage and initiated all available coping resources.
Few studies have assessed protective factors. The awareness of COVID-19, together with pursuing interests, were protective against anxiety symptoms and helped in reducing child mental distress related to pandemic [15, 16]. Deterioration in mental state of minors caused by pandemics requires undertaking decisive protective measures- already now, during the ongoing limitations- as well as conducted in future long-term therapy. Worsening of children’s mental health status due to COVID-19 pandemics illuminates that age-specific coping strategies are crucial in response to distinct needs of young population.
Coping is substantial in considerations of how stressors affect children and adolescents as it emphasizes active role in the transactional process of dealing with stressful situations in a youngster’s life, but also brings reflections about one’s future development [28].
The understanding of coping in children and adolescents for many years relied on conceptualization of coping in adulthood defined by Lazarus and Folkman [29]. In this traditional approach coping is “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” ([29], p. 141). It is understood as conscious cognitive and behavioral activity, aimed at reducing the intensity or duration of unpleasant feelings, preventing the occurrence and development of emotions or limiting the negative effects on their well-being. In the theory of psychological stress coping strategies can be categorized into problem-focused and emotion-focused [30]. Problem-focused forms of coping comprise of “aggressive interpersonal efforts to alter the situation, as well as cool, rational, deliberate efforts to problem solve, and emotion-focused forms of coping include distancing, self-controlling, seeking social support, escape-avoidance, accepting responsibility, and positive reappraisal ([30], p. 572). Folkman et al. [31] show possible ways of influencing health by the coping process: coping with stress can influence neurochemical reactions (their frequency, intensity, duration); coping with stress may be associated with engaging in anti-health behaviors; some forms of coping, such as denial or avoidance, may lead to maladaptive coping behaviors.
Slightly different approach towards coping assume that coping strategies can be considered as engaged and disengaged [32]. While engaged coping involves active confronting with stressors and reassuring thoughts, disengagement coping implicates passive reaction pattern, palliative response and avoidance. Empirical results clearly show that the first group of strategies is positively associated with more sense of control and psychological well-being [32].
When considering child and adolescent coping, the approach should be complemented by the developmental framework. Unquestionable is fact that coping strategies used by children depend on the age [28, 33]. Out of many ways of coping that have been identified in studies children and adolescents appear to favor: support seeking within the family, problem-solving (and instrumental action), escape, and, when escape is not possible, distraction. Young children use predominantly behavioral strategies to distract themselves (eg. playing with something fun), while older children use cognitive strategies (eg. thinking about something pleasant). Behavioral strategies of coping are common among children but normatively decrease in middle childhood. Preschool children mostly engage in: seeking social support (primarily from caregivers), intervening directly in stressful situations, withdrawing, avoidance, or using behavioral activities to distract attention. Due to progress of cognitive development, school children occur to rely on more varied coping strategies as they adjust cognition in problem-solving and distraction tactics, but also turn to sources of support outside family. In adolescence independency in thinking, ability to monitor one’s behavior and manage emotions by using positive self-talk and cognitive reformulation improve repertoire of coping strategies [28]. Over time anger-related emotion regulation decrease and media use as a way of managing stress increase [33]. Generally, children coping capacities develop in problem-solving strategy from instrumental action to planful problem-solving, in support-seeking from reliance on adults to more self-reliance. In distraction tactic behavior action gives way to cognition (with more organization, flexibility, integration with other coping strategies and aim specifically at problem) [34].
Not only age matters in understanding ability to cope with stress among children, but also gender. As the findings show [35] girls aged 8–13 tend to use more often maladaptive coping patterns than boys. Among young females as emotional regulating strategies (minimization and distraction/recreation) and problem-focused tactics (positive self-instructions) were decreased, while rumination, resignation and aggression were increased. Girls were also characterized by increase in engaging in the problem-focused strategy (support seeking) [35, 36]. The results of other study [37] indicated that active distraction used by girls decreased over time, while passive distraction increased. The paper referred also to boys who presented increase in self-destructive and aggressive coping behaviors increased with age.
Developmentally orientated researchers suggest that process of dealing with stress by children should comprise of such factors as emotion regulation, family functioning, temperament (and deriving from it reactivity) and the role of social interactions [28]. Researchers agree that positive coping lead to better psychological well-being and mental health [38, 39, 40].
At this point, the literature on children’ coping strategies in the context of COVID-19 pandemic and its impact on children’ psychosocial well-being is still limited. The outcomes come mostly from observations, and research conducted in Europe and Asia.
Several studies have primarily examined coping strategies and factors associated according to age of children. Research conducted by Domínguez-Álvarez et al. [41] in a Spanish sample of children aged 3–12 during the acute phase of COVID-19 pandemic proved that children’s coping strategies differed between age groups and that stress management relied more on strategies reflecting engagement than disengagement. Parents of preschoolers, middle-aged children and early adolescents referred to child’s coping and possible observed changes on behavior related to the pre-pandemic functioning through specially developed scale. Comparing to older children, preschoolers appeared to use more strategies based on negative emotion regulation (such as yelling or getting angry). Children aged 7–9 were reported as using more engaged-oriented strategies such as problem solving, looking for understanding of such extraordinary circumstances and seeking instrumental social support. Early adolescents presented range of strategies of pandemic stress management and more complex ways of coping through positive emotion regulation (e.g., “trying to calm him/herself”), but also humor (“making jokes or trying to laugh about the current situation”) and wishful thinking (“wishing it never had happened”). Typically, engagement coping was positively correlated with psychosocial adjustment across all age groups. Disengagement-orientated coping was associated to some of the COVID-19-related stressors (i.e., close death, economic impact, and particularly fear of the future) and distinctively was related with negative outcomes (i.e., higher levels of behavioral and emotional difficulties) [41].
A study of Chinese adolescents aged 13–17 [42] revealed that general positive coping was protective factor for the occurrence of depressive, anxiety and stress. Additionally, positive coping was a protective factor for trauma-related distress in older adolescents. Negative coping occurred to be a risk factor for depression, anxiety, stress symptoms and trauma-related distress in a whole sample regardless of gender.
Available literature examining children and adolescents’ coping during COVID-19 pandemics focused also on the impact of adults from the environment of young people. Role of family and school in managing psychological distress among youngsters due to pandemics is being highlighted. Attention should be drawn to parents’ distress, parent–child relationships, the marital relationship in the family system, teachers’ distress, teacher–student relationships, and peer relationships within the school [43]. In one notable study [44] coping skills were investigated along with children’s adjustment. Results showed that maternal coping skills were protective factor with prediction for children’s positive emotions.
Accordingly to research findings, what helpful strategies in managing stress and anxiety can be provided by parents and specialists during the period of COVID-19 pandemics? Most studies report that attention should be paid to effective, sensitive, emotion-focused and empathetic communication concerning life-threatening illness as it assets children and other family members’ long-term psychological wellbeing [45].
Kang et al. [46] drew four main tactics for caregivers: Acknowledge, Discuss, Do, and Reflect. The first one refers to caregivers’ acknowledgement of the change and its possible consequences in order to ensure children that they can turn to their caregivers for support. Second strategy is based on supporting youngsters with accurate information from trustworthy sources tailored to their age and level of understanding aiming generally at better understanding of pandemics. Third tactic is associated with ensuring predictability in child’s environment, maintaining routines and – what seems to be crucial - equipping children with coping strategies (through expression of their feelings via writing and drawing, breathing exercises and progressive muscle relaxation, staying with touch with friends and schoolmates over social media platforms but with caregiver supervision). Finally, the fourth suggestion indicates caregivers’ affecting their psychological well-being [46].
Also De Young et al. [47] in their report described Australian parents’ efforts to support their children during early stages of COVID. They noticed that nearly 43% caregivers kept their child from seeing or hearing any information about COVID-19. 25% parents appeared to be a lot more cautious or overprotective with their child during the pandemic. Although many parents were found to relieve child of stress and anxiety through empathetic response to child’s emotion (94.3% of a research sample), maintenance or creating new routines (88.4%), staying in touch with family and friends (88.4%), managing emotion and thoughts by verbal communication (87.3%) and, finally, using practical coping strategies (78.5%). Positive parenting responses, including sticking to routines and showing empathy, correlated with more positive affect and emotion regulation in children and more positive parent–child relationships while taking care of daily habits was associated with less anxiety, depression and angry behaviors among youngsters.
As it was indicated, coping plays essential role for children and adolescents’ adjustment to stressors associated with COVID-19 pandemics such as uncertainty, social isolation, disruption in daily life routine, parents’ stress (such as working from home) [48].
When dealing with stress induced by the COVID-19 pandemic also resilience should be taken into account as it protects from future various psychiatric outcomes among young people.
In the last 20 years, there has been a growing interest in resilience theory. The first findings in this area were based on the long-term observation of people who suffered from schizophrenia. It was found that despite a difficult course of the disorder, some people’s abilities to cope are more adequate than the others [49]. These findings had an impact on broad research among children exposed to difficult developmental conditions [50]. As a result of amble evidence confirming negative consequences of trauma to mental development and mental health [51], there were attempts to find individual risk and protective factors which could differentiate the results of risk exposure [52]. Based on the findings, there were hopes for finding prevention and treatment methods to reduce psychopathology among those who experienced trauma [53]. Mental health’s researchers and practitioners are concerning not only with the effects of stressful or traumatic events but also the factors that determine the ability to restore physical equilibrium. Resilience is widely known as the ability to bounce back after facing up an extremely stressful situation or the ability to cope successfully with traumatic experiences. According to The American Psychological Association, resilience is defined as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress” [54]. It refers to individual processes and mechanisms. As far as such understanding of resilience is useful, it seems to be insufficient for understanding the complexity of the concept [49, 52, 53].
Considering resilience it is worth pointing out that nowadays it is not only referred to individual traits, abilities but also family and environmental factors. Despite being observed in one’s behavior, resilience is bound up with external issues. In the early 80ties, resilience was treated as characters strength and flexibility. This comprehension indicates resilience as the responsibility of the individual and omits the influence of family and social support which may be stigmatizing [55]. Being resilient is connected with a biological basis but it is also under the influence of the environment and can change during lifespan [52].
The major dimensions of resilience are risk and protective factors. Risk factors involve negative life experiences and nonadoptive traits. Protective factors involve individual traits, family and social support [1]. In the practical approach, there were found plenty of protective and risk factors which may be useful in planning proper psychological interventions. The major protective factors include individual traits: high self-esteem, sense of efficiency, sociability, intelligence, cheerful disposition, faith, talents, family factors: cohesion, compatibility, close relations between family members, good financial situation, external factors: safe neighborhood, having a mentor, belonging to a pro-social organization, attending an efficient school, features of society’s politics and culture - protection of the health and safety, care of the education system, prevention and protection against violence [56]. Risk factors are divided into specific and nonspecific. Nonspecific risk factors may lead to different disorders. Specific factors are strictly connected with a specific disorder. Commonly mentioned nonspecific factors include attention disorders, family conflicts, school failures, peer rejection, poverty, discrimination [55].
There are three major models of resilience: compensatory model, protective (or immunity) model and challenge model [55]. The compensatory model assumes that protective factors constrain the risk factors. The Protective (or immunity) model is based on the assumption that protective factors interact with risk factors and influence one’s behavior. Whereas the challenge model indicates that a medium level of risk factors make one more resistant to stress [57].
Resilience processes are activated in the face of adversity that cannot be controlled by the subject. As a result, resilience is considered in accidental cases such as war, disaster, illness [58].
COVID 19 pandemic creates an extraordinary, demanding situation worldwide. It is named as a global health crisis and one of the greatest challenge in the medical, economic and social areas of our times. Despite being a global demand, pandemic COVID 19 concerns individuals. People had to face up with adversities as uncertainty and unpredictability that may lead to an increased level of stress. According to the previously mentioned thesis that people can differ considerably in terms of coping with adversities and numerous factors may modify the ability to deal with difficulties, resilience is an issue of growing interest in the light of pandemic COVID 19. Researchers are trying to identify factors that can play a protective role for mental health in the current situation [4].
There are a plethora of findings concerning the mental health of medical workers [4]. During the pandemic period, they are found to be exposed to stress factors to the great extent. However, as was mentioned above, pandemic related problems apply to every each of us. In China, it was found that adolescences are more likely to manifest depressive symptoms than adults during pandemic COVID- 19 [15]. The situation of children and adolescents in terms of a pandemic should be taken into consideration to a great extent.
Children and adolescents during the pandemic period have had to face up: isolation, remote learning, social distancing, limited contacts with peers, loneliness [15]. Those difficulties seem to be crucial in the children’s and adolescences because they are strictly connected with their basic needs and they also impairs the unspecific protective resilience factors. They are also exposed to the stress of their parents which may also influence the child’s mental health and his or her abilities to cope with stress.
Major research areas concerning the pandemic period applied to specific risk and protective resilience factors among children, the role of parents mental health condition on child resilience, possible interventions that may enhance resilience will be analyzed.
To find the risk and protective factors that may promote resilience, there were examined Hong-Kong families. The study group consists of children aged 2–12. Researchers assumed that family demographics, child psychosocial wellbeing, habits, parent–child interactions and parental stress will be crucial for resilience in the pandemic period. The research was based on the online survey completed by the parents based on their child’s observations. The risk factors that were found involves special educational needs of the child, chronic disease of a child, mental illness of mothers, one-parent family and low economic status of the family. Moreover, sleep difficulties, insufficient exercises, excessive use of electronic devices were connected with worse functioning of a child and higher level of parents stress. It is worth pointing out that, as it was proved, not only the child’s difficulties strictly connected with pandemic are tremendous but also the family situation and mental health of a parent before the emergence of COVID 19 [59].
Similarly to the previous findings, Fegert, Vitiello, Plener, Clemens suggested that the role of environmental (including family) and intrinsic stress-related processes are vital to predict the functioning of a child in the pandemic situation [60].
Daks, Peltz and Rogge focused on the parents’ traits and abilities as a resilience risk and protective factor. They found out that psychological flexibility versus inflexibility of a parent is a part of resiliency and can affluence the current pandemic situation. The 742 parents completed the online survey which measured the level of psychological flexibility. It was proved that the more flexible the parent is the better family cohesion is achieved. The lower flexibility of a parent can lead to disagreement in the family. In general, pandemic related circumstances increase the level of stress and the possible discord in the families. It was proved that the families with greater cohesion and greater psychological flexibility can cope with pandemic stressor more successfully than the families with lower psychological flexibility and, as a result, more family discords. There was also proved that the parents attitudes towards flexibility and results of particular attitude affluence the child’s level of stress. The research proved once again the role of parents traits, emotions and behavior on how resilient a child will be [57].
There are also suggestions that the younger the child is the more important role of protective resilience factors connected with a parent is. A developing child’s brain is more likely to be disturbed by stress factors. Moreover, young children’s executive functions and self-regulating skills are not developed to a great extent which could be also protective for them. The parents’ cognitive flexibility, stress coping strategies, mental health, positive parenting and attachment, warmth and sensitivity can be protective for a child. As far as the self-regulation skills of a child are immature, a parent should take over the function of the child’s emotion regulation by effective communication and emotional support. Despite the factors connected with a parent ability, the role of sport and creative activities were also pointed out as factors that can support the child in enhancing his and her abilities to cope with stress, regulate emotions and strengthen resilience [61].
On the other hand, resilience understood as the child’s trait was found to play a protective role for intrusive rumination during pandemic COVID 19. There was found a connection between creativity and intrusive rumination. The more creative children seem to be, the more intrusive rumination can create. However, it was found that resilience is a moderator between creativity and intrusive rumination. Highly developed resilience contributes to cognitive flexibility, positive thinking and, as a result, better adaptation [62].
There are plenty of findings that proved the negative effects of the pandemic. In contrary, there are also suggestions that self-isolation, remote learning may have also positive consequences that we should take advantage of. Dvorsky, Breaux and Becker extracted a specific situation, in which pandemic connected circumstances can be helpful for a child or adolescents. Remote learning was found to be helpful for children with educational problems in its traditional way. Online lessons provide a child possibility to individualize the way of learning. For instance, children with attention and behavior disorders have an opportunity to engage in activities that help them to overcome difficulties more likely than in schools. Those who suffer peer victimization have an opportunity to focus on learning and enhance selected, positive relations. Some children are also supposed to discover hobbies or talents more often. Moreover, the necessity to stay at home may provide an opportunity to bond up with family members as there are more chances to spent time together [63].
According to the researcher, resilience can be enhanced by mindfulness training and cognitive-behavioral techniques [64]. What is more, it was found that such training can also influence emotional intelligence defined as the ability to identify, understand the reason and the consequence of emotions and cope adaptively with them, Based on this assumption, Yonon tried to find the impact of mindfulness training on resilience during the pandemic period among middle schools. The Connor-Davidson Resilience Scale and Emotional Intelligence Scale were used. 180 students were examined. They were divided into the experimental and the control group. The Experimental Group participated in 8-weeks long Mindfulness Training. It was found that students from the experimental group enhanced significantly resilience as well as emotional intelligence. Mindfulness training was found to help to accept the present situation, avoid judgment and, as a result, avoid negative emotions [65].
Some practical guides devoted to resilience can be also found. Bartlett and Viverte on Childs Trends published: “Ways to Promote Children’s Resilience to the COVID-19 Pandemic”. The authors pointed out protective factors, presented as tips for a parent. They pointed out that sensitive, responsive caregiving, especially in the light of pandemic is an issue of paramount importance. There was suggested that not only a parent can meet this need but also adults who are not living with a child (grandparents, teachers). There is an importance of the usage of internet and electric devices to keep the contact. What is more, meeting basic needs is necessary. It is crucial for parenting to look for and benefit from the community services when it is needed. The third protective factor that was analyzed is emotional support for a child. Authors propose to take care of reassurance children about the love and support of a parent. It is worth keeping daily routines and practise with child regulation skills. In the guide, there was also indicated that support for caregivers is as important as support for a child. The mental health of a parent can be protective for the mental health of a child. The last suggestion is devoted to maintenance social contacts as far as it is possible using the internet. There were also pointed out the importance of conducting regular visits by professionals, social workers within families with violence abuse and poverty problem [66].
A parallel example of the open guide on how to enhance resilience during a pandemic was prepared by the Centre on the Developing Child, Harvard University. In this approach, researchers focus on the necessity to keep a balance between the negative and the positive outcomes related to pandemic. On the one hand, we should reduce the sources of stress, on the other – adjust supportive issues. It was indicated that the level of stress could be reduced by the social programs and organization promoting meet basic needs (food, healthcare, internet access), help in receiving financial support, encourage self-care for adults. Supportive issues that were mentioned concerns responsive relationships. Such relationships are commonly known as the relationship between a caregiver and a child but in this case, there is also a focus on a responsive relationship between an adult and adult. Responsive relationships have the potential to meet the needs of a person and relief stress. There was highlight the role of adults family and friendship relationships but also the contact with professional family workers and a parent. What is more, according to this guide, core skills such as executive function and self-regulation should be strengthened. These skills can be enhanced by basic activities such as day planning, creating checklists and prioritizing needs [67].
Centre for Childhood Resilience had also prepared tips that should be taken into consideration to promote resilience within children and their families. They also pay special attention to the role of caregivers on children during the pandemic period. Firstly, there was a focus on a safe environment for a child. As a safe environment physical and emotional support is understood. There was an assumption that the environment of a child is safe when it is explicable. Moreover, according to the tips, parents should support the child in emotional regulation. It is worth pointing out that the role of self-care of a parent is mentioned again. Additionally, the role of building relationships and connectedness with parents, siblings and remote family is highlighted [68].
Taking everything into account, resilience seems to be a crucial issue in the light of pandemic COVID-19. It was found to be vital to find factors that may affect children coping strategies. However, as far as it was concerned, parental care is an issue of paramount importance. There should be taken into consideration the supportive role of a parent on a child in detail. Moreover, a parent should also take care of his or her mental health to be able to take proper care of a child [57, 59, 60, 61, 66, 67, 68]. Additional factors that can be improved to enhance children’s and adolescents resilience during the pandemic mentioned above include: keeping relationships, reflecting optimistic approach, keeping a daily routine, practising mindfulness training and performing physical activities [59, 62, 65].
The COVID-19 pandemics seem to highlight the need for shaping effective means of coping with stress and anxiety and develop innovative strategies to improve the psychological well-being in young individuals. As review of the literature shows, caregivers “try to do their best”. However, consequences of anxiety, stress and violence exposure may be leading problems to meet in psychological and psychiatric care after pandemics. Taking into account that the way children and their parents response to pandemic stressors plays fundamental role for their adjustment, there is need of combining both child and family variables in tailored-preventive interventions targeted at enhancing resilience of children and their parents, reducing negative coping strategies, practicing effective means of coping with stress in order to protect their mental health now and in the future.
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',metaTitle:"Publication Agreement - Chapters",metaDescription:"IN TECH aims to guarantee that original material is published while at the same time giving significant freedom to our authors. For that matter, we uphold a flexible copyright policy meaning that there is no transfer of copyright to the publisher and authors retain exclusive copyright to their work.\n\nWhen submitting a manuscript the Corresponding Author is required to accept the terms and conditions set forth in our Publication Agreement as follows:",metaKeywords:null,canonicalURL:"/page/publication-agreement-chapters",contentRaw:'[{"type":"htmlEditorComponent","content":"The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
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The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
\n\n1. DEFINITIONS
\n\nCorresponding Author: The Author of the Chapter who serves as a Signatory to this Agreement. The Corresponding Author acts on behalf of any other Co-Author.
\n\nCo-Author: All other Authors of the Chapter besides the Corresponding Author.
\n\nIntechOpen: IntechOpen Ltd., the Publisher of the Book.
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\n\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
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\n\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\n\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
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\n\nLast updated: 2020-11-27
\n\n\n\n
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Ovarian hormones induce the cellular and biochemical changes in the oviducts during the egg formation and oviposition. Estradiol regulates the folliculogenesis, accumulation of yolk in the follicles, ovulation, and development of oviducts. Estradiol also induces glandular development and expression of the genes responsible for egg white proteins. Progesterone induces the ovulation of yolk from the ovary, and development of oviductal glands. In addition, several genes are spatiotemporally expressed in the magnum for albumen synthesis and deposition around the yolk, in the isthmus for shell membranes synthesis, and in the uterus for eggshell biomineralization. This chapter highlights the involvement of hormones, genes/proteins, and their interaction for egg formation in the oviduct of laying hens.",book:{id:"8470",slug:"poultry-an-advanced-learning",title:"Poultry",fullTitle:"Poultry - An Advanced Learning"},signatures:"Birendra Mishra, Nirvay Sah and Sanjeev Wasti",authors:[{id:"274927",title:"Dr.",name:"Birendra",middleName:null,surname:"Mishra",slug:"birendra-mishra",fullName:"Birendra Mishra"},{id:"290539",title:"Dr.",name:"Nirvay",middleName:null,surname:"Sah",slug:"nirvay-sah",fullName:"Nirvay Sah"},{id:"290540",title:"Dr.",name:"Sanjeev",middleName:null,surname:"Wasti",slug:"sanjeev-wasti",fullName:"Sanjeev Wasti"}]},{id:"65864",doi:"10.5772/intechopen.83811",title:"Poultry Housing and Management",slug:"poultry-housing-and-management",totalDownloads:3177,totalCrossrefCites:5,totalDimensionsCites:11,abstract:"Majority of the people in the poorest regions of the tropics rely on poultry production as their major source of protein supply. However, poultry production is hindered by the harsh environmental conditions in this regions therefore, reducing the daily supply of protein. It is believed that understanding heat stress in birds by paying detail attention to the sources of heat generation in a poultry house can help manage the heat stress situation in this region. This text reviews the internal climatic conditions of the poultry houses, how the birds respond to them, and their implications for heat management in poultry production. Thus, it provides pertinent information for guidance on parameters for open poultry houses architectural design that ensures optimum climatic conditions that will alleviate heat stress problem in poultry production in hot and humid climate.",book:{id:"8470",slug:"poultry-an-advanced-learning",title:"Poultry",fullTitle:"Poultry - An Advanced Learning"},signatures:"Ayodeji Oloyo and Adedamola Ojerinde",authors:[{id:"273409",title:"Mr.",name:"Ayodeji",middleName:null,surname:"Oloyo",slug:"ayodeji-oloyo",fullName:"Ayodeji Oloyo"},{id:"274920",title:"MSc.",name:"Adedamola",middleName:null,surname:"Ojerinde",slug:"adedamola-ojerinde",fullName:"Adedamola Ojerinde"}]},{id:"62271",doi:"10.5772/intechopen.77966",title:"Selection Methods in Poultry Breeding: From Genetics to Genomics",slug:"selection-methods-in-poultry-breeding-from-genetics-to-genomics",totalDownloads:4467,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"Scientific and technological advancements have led to great expansion of poultry sector in last few decades. The development of genetically superior stocks capable of higher production, even under adverse climatic conditions, has transformed poultry from rural farming to full-fledged industry within 30–35 years. Increase in production volume and productivity per bird may largely be attributed to the combined crossbred and purebred selection (CCPS). The superior purebred lines were evaluated for their nicking ability by specialized cross-breeding program, and the best nicking male and female lines were used for developing four-way commercial crosses. With advancement in molecular techniques, the DNA marker technology emerged as a finer tool for assessing the genetic variability. Genome-wide scan using microsatellites led to identification of quantitative trait loci (QTL) for their use in marker-assisted selection (MAS). Subsequently, the single nucleotide polymorphisms (SNPs) were discovered as third generation of genetic markers. Recent “next-generation sequencing” technique led to the development of high-density SNP arrays as powerful tool for genetic analysis. Predicting genomic estimate of breeding value (GEBV) of individual using SNPs across the whole genome paved way to conceptualization of “genomic selection” which emerged as the most advanced technology to revolutionize the animal production.",book:{id:"6623",slug:"application-of-genetics-and-genomics-in-poultry-science",title:"Application of Genetics and Genomics in Poultry Science",fullTitle:"Application of Genetics and Genomics in Poultry Science"},signatures:"Vishesh Kumar Saxena and Gautham Kolluri",authors:[{id:"234356",title:"Dr.",name:"Gautham",middleName:null,surname:"Kolluri",slug:"gautham-kolluri",fullName:"Gautham Kolluri"},{id:"239339",title:"Dr.",name:"V.K",middleName:null,surname:"Saxena",slug:"v.k-saxena",fullName:"V.K Saxena"}]},{id:"52383",doi:"10.5772/65363",title:"Assessment of Maize (Zea mays) as Feed Resource for Poultry",slug:"assessment-of-maize-zea-mays-as-feed-resource-for-poultry",totalDownloads:4851,totalCrossrefCites:5,totalDimensionsCites:9,abstract:"Maize, also known as corn (Zea mays L), has been recognised worldwide as a major energy feed ingredient in the diets of poultry. Its major nutritional limitation has been the low protein content and poor protein quality, which necessitates the use of expensive high‐protein supplements or synthetic amino acids such as lysine in diets containing large proportion of maize. Therefore, extensive research has been conducted by maize breeders on the world maize germplasms collection with the aim of improving its nutritive value, particularly protein quality for monogastric animals. This chapter assesses the genetic upgrading of the nutritional quality of maize protein that culminated in the development of a new class of maize known as “Quality Protein Maize (QPM)”. Various studies on the nutritionally improved maize for poultry as well as future challenges confronting maize utilisation in poultry production are highlighted.",book:{id:"5315",slug:"poultry-science",title:"Poultry Science",fullTitle:"Poultry Science"},signatures:"Herbert K. Dei",authors:[{id:"28844",title:"Prof.",name:"Herbert Kwabla",middleName:"Kwabla",surname:"Dei",slug:"herbert-kwabla-dei",fullName:"Herbert Kwabla Dei"}]},{id:"52005",doi:"10.5772/64860",title:"The Effect of Age on Growth Performance and Carcass Quality Parameters in Different Poultry Species",slug:"the-effect-of-age-on-growth-performance-and-carcass-quality-parameters-in-different-poultry-species",totalDownloads:2505,totalCrossrefCites:3,totalDimensionsCites:8,abstract:"In recent years, a steady increase in global poultry meat production has been witnessed, accompanied by an increase in a major portion of a poultry carcass, referred to as the inedible portion. In poultry, edible components include meat, skin with subcutaneous fat and giblets (gizzard, liver, and heart) and sometimes also abdominal fat in waterfowl. Age, together with species and environmental conditions, is one of the key factors affecting body growth rate. In four poultry species, chickens, turkeys, Pekin ducks, and geese, an increase in body weight is accompanied by an increase in edible weight and a decrease in inedible weight in the carcass, and more significant age-related changes occur in turkeys and broiler chickens than in ducks and geese. The highest increase in the content of edible components expressed as a percentage of total body weight is noted in turkeys (20% in males, 25% in females), followed by broiler chickens (19.4%), ducks (17.1%), and geese (only 8.2%). Gallinaceous birds have also a higher content of muscle tissue and a lower content of skin (including subcutaneous fat) and bones than waterfowl.",book:{id:"5315",slug:"poultry-science",title:"Poultry Science",fullTitle:"Poultry Science"},signatures:"Daria Murawska",authors:[{id:"147435",title:"Dr.",name:"Daria",middleName:null,surname:"Murawska",slug:"daria-murawska",fullName:"Daria Murawska"}]}],mostDownloadedChaptersLast30Days:[{id:"52383",title:"Assessment of Maize (Zea mays) as Feed Resource for Poultry",slug:"assessment-of-maize-zea-mays-as-feed-resource-for-poultry",totalDownloads:4851,totalCrossrefCites:5,totalDimensionsCites:9,abstract:"Maize, also known as corn (Zea mays L), has been recognised worldwide as a major energy feed ingredient in the diets of poultry. Its major nutritional limitation has been the low protein content and poor protein quality, which necessitates the use of expensive high‐protein supplements or synthetic amino acids such as lysine in diets containing large proportion of maize. Therefore, extensive research has been conducted by maize breeders on the world maize germplasms collection with the aim of improving its nutritive value, particularly protein quality for monogastric animals. This chapter assesses the genetic upgrading of the nutritional quality of maize protein that culminated in the development of a new class of maize known as “Quality Protein Maize (QPM)”. Various studies on the nutritionally improved maize for poultry as well as future challenges confronting maize utilisation in poultry production are highlighted.",book:{id:"5315",slug:"poultry-science",title:"Poultry Science",fullTitle:"Poultry Science"},signatures:"Herbert K. 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Mainly, type FAdV-4 is responsible for hydropericardium hepatitis syndrome (HP), type FAdV-1 for gizzard erosion and ulceration (GEU), and types FAdV-2, 8a, 8b, and 11 seem to be responsible for inclusion body hepatitis (IBH). Defining the spreading of the avian adenovirus strains in different types of fowl profile production, recognising their property and determining their types and molecular characterisation are very important from the epidemiological point of view and are considered as excellent basis for vaccine development and gene therapy implementation. This chapter provides a comprehensive review of FAdVs, including their epidemiology, pathogenesis, diagnostic, detection, and molecular characterisation. This comprehensive review is needed to better understand the latest progress in study of the viruses and prospects regarding disease control and implementation of gene therapy.",book:{id:"6623",slug:"application-of-genetics-and-genomics-in-poultry-science",title:"Application of Genetics and Genomics in Poultry Science",fullTitle:"Application of Genetics and Genomics in Poultry Science"},signatures:"Jowita Samanta Niczyporuk",authors:[{id:"212649",title:"Dr.",name:"Jowita Samanta",middleName:null,surname:"Niczyporuk",slug:"jowita-samanta-niczyporuk",fullName:"Jowita Samanta Niczyporuk"}]},{id:"65864",title:"Poultry Housing and Management",slug:"poultry-housing-and-management",totalDownloads:3177,totalCrossrefCites:5,totalDimensionsCites:11,abstract:"Majority of the people in the poorest regions of the tropics rely on poultry production as their major source of protein supply. However, poultry production is hindered by the harsh environmental conditions in this regions therefore, reducing the daily supply of protein. It is believed that understanding heat stress in birds by paying detail attention to the sources of heat generation in a poultry house can help manage the heat stress situation in this region. This text reviews the internal climatic conditions of the poultry houses, how the birds respond to them, and their implications for heat management in poultry production. 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Even though it varies by species and sex, some common effects are reduced feed intake, weight gain, feed efficiency, growth performance, immunity and hatchability along with increased mortality, organ damages (mainly kidney and liver), carcinogenicity, teratogenicity and decreased egg production. Besides their adverse health effects and the decrease in production rate, concerns over their importance in public health is still under debate. Decontamination approaches to reduce mycotoxins in feed are technologically diverse and based on chemical, biological and physical strategies. Chemical remediation strategies involve the conversion of mycotoxins via chemical reactions. Biological strategies involve various substances such as plant ingredients, enzymes and microorganisms. Physical processes include sorting, milling, dehulling, cleaning, heating, irradiation or combinational approaches. 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Meanwhile, due to this increasing demand in industry resulting strict measures in disease control and environmental factors, these products may involve some chemical and natural compounds with hazardous properties at detectable or even very low concentrations. Among these compounds, residues are of concern, including veterinary drugs, environmental pollutants (such as dioxins, pesticides, and phthalates), natural contaminants (mycotoxins, etc), and/or phytosanitary substances accidentally contaminating poultry product during production or marketing stages. In order to keep the consumers safe from the harmful/undesirable effects due to these compounds, such as genotoxic, immunotoxic, carcinogenic, teratogenic, or endocrine disrupting effects, new strategies and concepts for poultry food security have been emerged and developed globally. 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He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. 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He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. from Integral University, Lucknow, India, with his work titled ‘Development and evaluation of silymarin nanoformulation for hepatic carcinoma’. Currently, he is an Assistant Professor of Pharmaceutics, at the Faculty of Pharmacy, Integral University. He has been teaching PharmD, BPharm, and MPharm students and conducting research in the novel drug delivery domain. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than twenty-four original journal articles, two edited books, four book chapters, and several scientific articles to his credit. He is a member of the American Association for Cancer Research, the International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. He has also been appointed to review many scientific manuscripts by established journals such as the British Medical Journal (BMJ). He has presented his research works at numerous local and international conferences such as the European Association for Cardiothoracic Surgery (EACTS) and the European Society of Cardiovascular Surgery (ESCVS), to name a few. He has also won many awards for his research presentations at meetings and conferences like the prestigious International Invention, Innovation & Technology Exhibition (ITEX); Design, Research and Innovation Exhibition, the National Conference on Medical Sciences and the Annual Scientific Meetings of the Malaysian Association for Thoracic and Cardiovascular Surgery. He was awarded the Darjah Setia Pangkuan Negeri (DSPN) by the Governor of Penang in July, 2015.",institutionString:null,institution:{name:"Monash University Malaysia",country:{name:"Malaysia"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}}]}},subseries:{item:{id:"2",type:"subseries",title:"Prosthodontics and Implant Dentistry",keywords:"Osseointegration, Hard tissue, Peri-implant soft tissue, Restorative materials, Prosthesis design, Prosthesis, Patient satisfaction, Rehabilitation",scope:"