Defining Optimal Cobalamin Status for Neonates and Infants.

BACKGROUND: An optimal cobalamin status is necessary for normal neurodevelopment. OBJECTIVE: To give a description of the epidemiology, pathophysiology and diagnostic challenges related to cobalamin insufficiency in neonates and infants in order to prevent its occurence. RESULTS: Inadequate cobalamin status is prevalent among neonates and young infants, due to a high prevalence of maternal cobalamin deficiency, exclusive breastfeeding for extended periods and late introduction of animal food. Cobalamin insufficiency is associated with delayed neurodevelopment and subtle clinical symptoms like feeding difficulties, regurgitations and constipation in young infants. Early diagnosis and treatment of impaired cobalamin status is important to prevent neurologic damage. CONCLUSION: Clinical suspicion of cobalamin insufficiency in infants should infer immediate biochemical testing and a plasma total homocysteine > 5.0 µmol/L indicate cobalamin insufficiency in need of intramuscular treatment with hydroxycobalamin, followed by introduction of animal food after 4 months of age.

Plain language titleVitamin B12 Is Important for Normal Development in Young ChildrenPlain language summaryVitamin B12, also called cobalamin, is found only in animal-sourced food. As low-meat, vegetarian, and vegan diets are increasingly popular in Western countries, vitamin B12 deficiency has become common, also in pregnant women and babies. Vitamin B12 status is essential for normal development and adequate levels of this vitamin is particularly important during pregnancy and the first years of life. In pregnancy, vitamin B12 is transferred from the mother to the fetus, so the baby has a store of this vitamin at birth. However, if the mother has vitamin B12 deficiency or the baby is born premature or with a low birth weight, the vitamin store may be insufficient and the baby may develop vitamin B12 deficiency. Maternal vitamin B12 status is important as long as the baby is exclusively breastfed. Breast milk contains vitamin B12, but the concentration decreases after 4 to 6 weeks and may be too low to support the baby until animal-sourced foods are introduced. The vitamin B12 content in formula milk is higher than in breast milk, and vitamin B12 deficiency is more common in exclusively breastfed babies. Vitamin B12 deficiency is associated with diffuse symptoms in small babies and may be difficult to detect, and the diagnosis have a mean delay of 4 months in this age-group. Typical symptoms are regurgitations or spitting up, constipation, problems with feeding and swallowing, and delayed psychomotor development. Suspicion of vitamin B12 insufficiency in babies should prompt immediate biochemical testing. Plasma total homocysteine is a metabolic marker of vitamin B12 status and can be measured in a blood sample from the baby. A level >5.0 µmol/L indicates probable vitamin B12 insufficiency and the baby should receive vitamin B12 supplementation, followed by introduction of animal-sourced foods at 3 to 4 months of age.

Establishing harmonised screening limits and detection times in greyhound racing - A considered approach.

An outline of the approach taken by international greyhound regulators to establish internationally harmonised screening limits and detection times in greyhound racing, which included a program of administration studies and an extensive and recognised risk assessment process, to ensure delivery of an effective anti-doping and medication control program.

[Status of occupational exposure limits of air toxic substances in the GESTIS Substances Database].

Objective: In order to understand the current situation of air toxic substances without occupational exposure limits (OELs) in the workplace in the Germany GESTIS Substance Database, and to provide an effective reference for formulating OELs of corresponding toxic substances and improving health standards. Methods: From March 2022 to May 2023, based on the standard of GBZ 2.1-2019 Occupational Exposure Limits for Hazardous Agents in the Workplace-Part 1: Chemical Hazardous Agents, air toxic substances without OELs in the standard of GBZ/T 300.1-2017 Determination of Toxic Substances in Workplace Air-Part 1: General Principles were screened out, then corresponding OELs in other countrie/regions were queried through the Germany GESTIS Substance Database. Results: Among the 333 kinds (classes) of air toxic substances in 160 parts of GBZ/T 300.1-2017 standard, 48 kinds (classes) of air toxic substances were screened out and had not yet been formulated OELs in GBZ 2.1-2019 standard. By querying the Germany GESTIS Substance Database, it was found that among the 48 kinds (classes) of air toxic substances, 35 kinds (classes) of air toxic substances had both 8-hour occupational exposure limit and short-term occupational exposure limit, 4 kinds (classes) of air toxic substances had 8-hour occupational exposure limit but no short-term occupational exposure limit, 9 kinds (classes) of air toxic substances hadn't been retrieved any OELs. In addition, standard test methods of 7 kinds of air toxic substances hadn't been published in the present, including trimethylchlorosilane, trimethylbenzenes, cumene, chloroethane, chloropropane, dibromoethane and acetophenone. Conclusion: In the process of formulating or revising the standards of GBZ 2.1-2019 and GBZ/T 300, the latest published OELs in the Germany GESTIS Substance Database could be used as a reference basis.

Assessment of heavy metal contamination in leafy vegetables: implications for public health and regulatory measures.

Heavy metal contamination in leafy vegetables poses significant health risks, highlighting the urgent need for stringent monitoring and intervention measures to ensure food safety and mitigate potential adverse effects on public health. This study investigates the levels of heavy metals, including cadmium (Cd), chromium (Cr), nickel (Ni), lead (Pb), zinc (Zn), and copper (Cu), in locally grown and commercially available leafy vegetables, comparing them to the safety limits established by WHO/FAO. The results revealed that levels of Cd, Cr, Ni, and Pb in the vegetables exceeded WHO/FAO limits, while Zn and Cu remained within permissible bounds. Marketed vegetables exhibited higher metal concentrations than those from nearby farms. For Cu (0.114-0.289 mg/kg) and Zn (0.005-0.574 mg/kg), the daily intake of metals (DIM) was below the dietary intake (DI) and upper limit (UL). Cd's DIM (0.031-0.062 mg/kg) remained below the UL but exceeded the DI. Marketed kale and mint surpassed both DI and UL limits for Ni, while local produce only exceeded the DI. All vegetables had DIM below the DI, except for mint and kale. For Pb, every vegetable exceeded DI limits, with market samples contributing significantly. Cr's DIM ranged from 0.028 to 1.335 mg/kg, for which no set maximum daily intake exists. The health risk index (HRI) values for Zn, Cd, Cu, Ni, and Pb suggested potential health risks associated with leafy greens, while Cr's HRI was below 1. The study underscores the need for stringent monitoring and intervention measures to mitigate the health risks posed by heavy metal contamination in leafy vegetables. These findings suggest that consuming these leafy greens may put consumers at considerable risk for health problems related to Cd, Cu, Ni, Pb, and Zn exposure.

Genoarchitectural Definition of the Adult Mouse Mesocortical Ring: A Contribution to Cortical Ring Theory.

Data mining was performed at the databases of the Allen Institute for Brain Science (RRID:SCR_017001) searching for genes expressed selectively throughout the adult mouse mesocortex (transitional cortex ring predicted within the concentric ring theory of mammalian cortical structure, in contrast with central isocortex [ICx] and peripheral allocortex). We aimed to explore a shared molecular profile selective of all or most mesocortex areas. This approach checks and corroborates the precision of other previous definitory criteria, such as poor myelination and high kainate receptor level. Another aim was to examine which cortical areas properly belong to mesocortex. A total of 34 positive adult selective marker genes of mesocortex were identified, jointly with 12 negative selective markers, making a total of 46 markers. All of them identify the same set of cortical areas surrounding the molecularly different ICx as well as excluding adjacent allocortex. Four representative mesocortex markers-Crym, Lypd1, Cdh13, and Smoc2-are amply illustrated, jointly with complementary material including myelin basic protein, to check myelination, and Rorb, to check layer 4 presence. The retrosplenial (ReSp) area, long held to be mesocortical, does not share any of the 46 markers of mesocortex and instead expresses Nr4a2 and Tshz2, selective parahippocampal allocortex markers. Moreover, it is not hypomyelinic and lacks a Rorb-positive layer 4, aspects generally present in mesocortex. Exclusion of the ReSp area from the mesocortex ring reveals the latter to be closed at this locus instead by two adjacent areas previously thought to be associative visual ICx (reidentified here molecularly as postsplenial and parasplenial mesocortex areas). The concepts of ICx, mesocortex, and parahippocampal allocortex are thus subtly modified by substantial molecular evidence.

Comparison of Sub-Ppm Instrument Response Suggests Higher Detection Limits Could Be Used to Quantify Methane Emissions from Oil and Gas Infrastructure.

Quantifying and controlling fugitive methane emissions from oil and gas facilities remains essential for addressing climate goals, but the costs associated with monitoring millions of production sites remain prohibitively expensive. Current thinking, supported by measurement and simple dispersion modelling, assumes single-digit parts-per-million instrumentation is required. To investigate instrument response, the inlets of three trace-methane (sub-ppm) analyzers were collocated on a facility designed to release gas of known composition at known flow rates between 0.4 and 5.2 kg CH4 h-1 from simulated oil and gas infrastructure. Methane mixing ratios were measured by each instrument at 1 Hertz resolution over nine hours. While mixing ratios reported by a cavity ring-down spectrometer (CRDS)-based instrument were on average 10.0 ppm (range 1.8 to 83 ppm), a mid-infrared laser absorption spectroscopy (MIRA)-based instrument reported short-lived mixing ratios far larger than expected (range 1.8 to 779 ppm) with a similar nine-hour average to the CRDS (10.1 ppm). We suggest the peaks detected by the MIRA are likely caused by a micrometeorological phenomenon, where vortex shedding has resulted in heterogeneous methane plumes which only the MIRA can observe. Further analysis suggests an instrument like the MIRA (an optical-cavity-based instrument with cavity size ≤10 cm3 measuring at ≥2 Hz with air flow rates in the order of ≤0.3 slpm at distances of ≤20 m from the source) but with a higher detection limit (25 ppm) could detect enough of the high-concentration events to generate representative 20 min-average methane mixing ratios. Even though development of a lower-cost, high-precision, high-accuracy instrument with a 25 ppm detection threshold remains a significant problem, this has implications for the use of instrumentation with higher detection thresholds, resulting in the reduction in cost to measure methane emissions and providing a mechanism for the widespread deployment of effective leak detection and repair programs for all oil and gas infrastructure.

Temporal and Spatial Variation of Toxic Metal Concentrations in Cultivated Soil in Jiaxing, Zhejiang Province, China: Characteristics and Mechanisms.

The toxic metal (As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) pollution in 250 agricultural soil samples representing the urban area of Jiaxing was studied to investigate the temporal and spatial variations. Compared to the early 1990s, the pollution level has increased. Industry and urbanization were the main factors causing toxic metal pollution on temporal variation, especially the use of feed containing toxic metals. The soil types and crop cultivation methods are the main factors causing toxic metal pollution on spatial variation. Although the single-factor pollution indices of all the toxic metals were within the safe limits, as per the National Soil Environmental Quality Standard (risk screening value), if the background values of soil elements in Jiaxing City are used as the standard, the pollution index of all the elements surveyed exceeds 1.0, reaching a level of mild pollution. The soil samples investigated were heavily contaminated with toxic metal compounds, and their levels increased over time. This situation poses potential ecological and health risks.

The origins of unpredictability in life outcome prediction tasks.

Why are some life outcomes difficult to predict? We investigated this question through in-depth qualitative interviews with 40 families sampled from a multidecade longitudinal study. Our sampling and interviewing process was informed by the earlier efforts of hundreds of researchers to predict life outcomes for participants in this study. The qualitative evidence we uncovered in these interviews combined with a mathematical decomposition of prediction error led us to create a conceptual framework. Our specific evidence and our more general framework suggest that unpredictability should be expected in many life outcome prediction tasks, even in the presence of complex algorithms and large datasets. Our work provides a foundation for future empirical and theoretical work on unpredictability in human lives.

Is adaptation associated with long-term persistence beyond a geographic range limit?

Adaptation to new habitats might facilitate species' range shifts in response to climate change. In 2005, we transplanted experimental populations of coastal dune plant Camissoniopsis cheiranthifolia into four sites within and one site beyond its poleward range limit. Beyond-range transplants had high fitness and often delayed reproduction. To test for adaptation associated with experimental range expansion, we transplanted descendants from beyond and within-range populations after 10 generations in situ into two sites within the range, one at the range edge, and two sites beyond the range. We expected to detect adaptation to beyond-range conditions due to substantial genetic variation within experimental populations and environmental variation among sites. However, individuals from beyond-range experimental populations were not fitter than those from within the range when planted at either beyond-range site, indicating no adaptation to the beyond-range site or beyond-range environments in general. Beyond-range descendants also did not suffer lower fitness within the range. Although reproduction was again delayed beyond the range, late reproduction was not favored more strongly beyond than within the range, and beyond-range descendants did not delay reproduction more than within-range descendants. Persistence in beyond-range environments may not require adaptation, which could allow a rapid response to climate change.

Factors limiting the potential range expansion of lodgepole pine in Interior Alaska.

Understanding the factors influencing species range limits is increasingly crucial in anticipating migrations due to human-caused climate change. In the boreal biome, ongoing climate change and the associated increases in the rate, size, and severity of disturbances may alter the distributions of boreal tree species. Notably, Interior Alaska lacks native pine, a biogeographical anomaly that carries implications for ecosystem structure and function. The current range of lodgepole pine (Pinus contorta var. latifolia) in the adjacent Yukon Territory may expand into Interior Alaska, particularly with human assistance. Evaluating the potential for pine expansion in Alaska requires testing constraints on range limits such as dispersal limitations, environmental tolerance limits, and positive or negative biotic interactions. In this study, we used field experiments with pine seeds and transplanted seedlings, complemented by model simulations, to assess the abiotic and biotic factors influencing lodgepole pine seedling establishment and growth after fire in Interior Alaska. We found that pine could successfully recruit, survive, grow, and reproduce across our broadly distributed network of experimental sites. Our results show that both mammalian herbivory and competition from native tree species are unlikely to constrain pine growth and that environmental conditions commonly found in Interior Alaska fall well within the tolerance limits for pine. If dispersal constraints are released, lodgepole pine could have a geographically expansive range in Alaska, and once established, its growth is sufficient to support pine-dominated stands. Given the impacts of lodgepole pine on ecosystem processes such as increases in timber production, carbon sequestration, landscape flammability, and reduced forage quality, natural or human-assisted migration of this species is likely to substantially alter responses of Alaskan forest ecosystems to climate change.

Towards tailored guidelines for microbial air quality in the food industry.

Airborne microorganisms in food processing environments pose a potential risk for food product contamination. Yet, the absence of established standards or guidelines setting quantitative limits on airborne microorganisms underscores a critical gap in current regulatory frameworks. This review seeks to explore the feasibility of establishing quantitative limits for airborne microorganisms in food processing facilities, aiming to provide evidence-based guidance to enhance food safety practices in the industry. The review begins by addressing the complexities of microbial air quality in the food industry through a general literature search covering sources of airborne microorganisms, factors affecting particle deposition, air sampling methods and preventive measures. Subsequently, it employs a structured approach to assess the significance of air quality and its impact on product quality. Utilizing the PRISMA method, relevant scientific literature from May 2002 to May 2022 was examined, resulting in 26 articles meeting inclusion criteria from a pool of 11,737 original research papers. Additionally, the review investigates existing probability models for assessing airborne contamination to enhance air quality risk assessment in food safety management systems. The literature reveals a lack of substantial evidence supporting a direct correlation between airborne microorganisms and food contamination. The absence of standardized air sampling methodologies in previous studies hinders the comparability and reliability of research findings. Additionally, the literature fails to establish a conclusive relationship between influencing factors such as total particle counts, temperature, relative humidity and airborne contamination. Contradictory probability models for quantifying airborne contamination, and the absence of tailored preventive measures, hinder effective control and undermine microbial contamination control in diverse food processing contexts. In conclusion, the development of numeric guidelines for airborne contamination necessitates a tailored approach, considering factors such as product characteristics and production context. By integrating risk assessment models into this process, a more thorough comprehension of contamination risks can be achieved, providing tailored guidance based on the identified risk levels for each product. Ongoing collaborative efforts are essential to develop evidence-based guidelines that effectively mitigate risks without incurring unnecessary costs.

Acclimation to warmer temperatures can protect host populations from both further heat stress and the potential invasion of pathogens.

Thermal acclimation can provide an essential buffer against heat stress for host populations, while acting simultaneously on various life-history traits that determine population growth. In turn, the ability of a pathogen to invade a host population is intimately linked to these changes via the supply of new susceptible hosts, as well as the impact of warming on its immediate infection dynamics. Acclimation therefore has consequences for hosts and pathogens that extend beyond simply coping with heat stress-governing both population growth trajectories and, as a result, an inherent propensity for a disease outbreak to occur. The impact of thermal acclimation on heat tolerances, however, is rarely considered simultaneously with metrics of both host and pathogen population growth, and ultimately fitness. Using the host Daphnia magna and its bacterial pathogen, we investigated how thermal acclimation impacts host and pathogen performance at both the individual and population scales. We first tested the effect of maternal and direct thermal acclimation on the life-history traits of infected and uninfected individuals, such as heat tolerance, fecundity, and lifespan, as well as pathogen infection success and spore production. We then predicted the effects of each acclimation treatment on rates of host and pathogen population increase by deriving a host's intrinsic growth rate (rm) and a pathogen's basic reproductive number (R0). We found that direct acclimation to warming enhanced a host's heat tolerance and rate of population growth, despite a decline in life-history traits such as lifetime fecundity and lifespan. In contrast, pathogen performance was consistently worse under warming, with within-host pathogen success, and ultimately the potential for disease spread, severely hampered at higher temperatures. Our results suggest that hosts could benefit more from warming than their pathogens, but only by linking multiple individual traits to population processes can the full impact of higher temperatures on host and pathogen population dynamics be realised.

A comprehensive review of dose limits, triage systems and measurement tools for consequence management of nuclear and radiological emergencies.

During a radiological or nuclear emergency, occupational workers, members of the public, and emergency responders may be exposed to radionuclides, whether external or internal, through inhalation, ingestion, or wounds. In the case of internalized radiation exposure, prompt assessment of contamination is necessary to inform subsequent medical interventions. This review assembles the constituent considerations for managing nuclear and radiological incidents, focused on a parallel analysis of the evolution of radiation dose limits - notably in the emergency preparedness and response realm - alongside a discussion of triage systems and in vivo radionuclide detection tools. The review maps the development of international and national standards and regulations concerning radiation dose limits, illuminating how past incidents and accumulated knowledge have informed present emergency preparedness and response practices, specifically for internalized radiation. Additionally, the objectives and levels of radiation triage systems are explored in-depth, along with a global survey of practices and protocols. Finally, this review also focuses on in vivo detection systems and their capacities for radionuclide identification, prioritizing internalized gamma-emitting isotopes due to their broader relevance. Collectively, this study comprehensively addresses the intricacies of triage management following radiation emergencies, emphasizing the imperative for enhanced standardization and continued research in this critical domain.

Bioaccumulated trace element toxicity in commercially harvested bronze whaler sharks (Carcharhinus brachyurus) of South Africa.

Shark meat consumption may pose a significant risk to human health as high levels of toxic pollutants bioaccumulate in muscular tissue. Commercial harvest of Carcharhinus brachyurus meat in South Africa is estimated at 100-300 filleted tons per annum. Muscle tissue samples from 41 sharks were collected from the southern and eastern coastlines of South Africa in 2022 and analysed for 10 trace elements and 8 polychlorinated biphenyl congeners. All trace elements were found to be lower than the regulatory maximum limits for human consumption in most samples irrespective of shark length, sex, and sampling region. However, the estimated daily intake for Mercury and Arsenic exceeded the oral reference dose set by international agencies. The meat from this shark may be consumed due to its low toxic potential for human health, however long-term exposure to C. brachyurus meat should be avoided as it could pose detrimental health risks to consumers.

Simultaneous microwave digestion for total arsenic and inorganic arsenic in local shrimp and prawn commodities of Brunei Darussalam for regulatory and safety monitoring.

The data gap in food safety regulations have created misinformation leading to the rejection of commodities for trade. The evidence presented is the local regulation of arsenic in sea produce which is based on total arsenic, tAs, instead of toxic inorganic arsenic, iAs. Furthermore, tAs data in animal origin seafood has been widely proven to be dominated by the non-toxic Arsenobetaine, AsB. Therefore, if arsenic regulatory limit was set based only on tAs without reference to iAs data, seafood products might be wrongfully rejected for trade because of non-compliance to tAs limit. We provided analysis of tAs and iAs of 14 local prawn and shrimp commodities from three shrimp/prawn sector namely aquaculture (n = 3), capture (n = 5) and processed (n = 6) using effective extraction, as well as, a fit-for-purpose analytical method for iAs. A HVG-AAS method was developed and validated for iAs with LoQ of 1.6 ppb, analytical range of 0-6 ppb, repeatability RSDr of 0.5-3.1 %, coefficient of determination R2 of 0.9975, and percentage recovery of 90.9 %, while an existing method using ICP-MS was used to verify the tAs. Based on the AOAC Official Method 999.10 2005 with minor adjustments, seafood samples were digested with concentrated nitric acid and hydrogen peroxide under pressure in a closed vessel heated by a microwave digester. An additional step for iAs determination was necessary to ensure compatibility in HVG-AAS analysis. Further subdivision of the aquaculture and capture samples was done by dividing them into 3 fractions, namely head, flesh and peel. Comparison of tAs in all the three fractions indicated that for aquaculture sector, the highest tAs were found in the flesh (2nd highest in % weight) whereas for the capture sector, the highest amount of tAs correlated with the highest % weight of the fraction. On regulatory aspects, speciation analysis on the iAs indicated samples with quantifiable iAs value were in-compliance despite tAs were initially found to be higher than the national limits. Risk assessment of iAs indicated there were no risk for human daily intake based on the BDML0.5 value of 3.0 µg/kg b.w per day for an average 70 kg man. All findings concluded the need for doing arsenic speciation analysis of iAs along with tAs for routine monitoring of prawn/shrimp samples and to revise the local limits from tAs to iAs particularly for seafood commodities.

Flexibility in thermal requirements: a comparative analysis of the wide-spread lizard genus Sceloporus.

Adaptation or acclimation of thermal requirements to environmental conditions can reduce thermoregulation costs and increase fitness, especially in ectotherms, which rely heavily on environmental temperatures for thermoregulation. Insight into how thermal niches have shaped thermal requirements across evolutionary history may help predict the survival of species during climate change. The lizard genus Sceloporus has a widespread distribution and inhabits an ample variety of habitats. We evaluated the effects of geographical gradients (i.e. elevation and latitude) and local environmental temperatures on thermal requirements (i.e. preferred body temperature, active body temperature in the field, and critical thermal limits) of Sceloporus species using published and field-collected data and performing phylogenetic comparative analyses. To contrast macro- and micro-evolutional patterns, we also performed intra-specific analyses when sufficient reports existed for a species. We found that preferred body temperature increased with elevation, whereas body temperature in the field decreased with elevation and increased with local environmental temperatures. Critical thermal limits were not related to the geographic gradient or environmental temperatures. The apparent lack of relation of thermal requirements to geographic gradient may increase vulnerability to extinction due to climate change. However, local and temporal variations in thermal landscape determine thermoregulation opportunities and may not be well represented by geographic gradient and mean environmental temperatures. Results showed that Sceloporus lizards are excellent thermoregulators, have wide thermal tolerance ranges, and the preferred temperature was labile. Our results suggest that Sceloporus lizards can adjust to different thermal landscapes, highlighting opportunities for continuous survival in changing thermal environments.

Visual Attention in Crisis.

Research on visual attention has uncovered significant anomalies, and some traditional methods may have inadvertently probed peripheral vision rather than attention. Vision science needs to rethink visual attention from the ground up. To facilitate this, for a year I banned the word "attention" in my lab. This constraint promoted a more precise discussion of attention-related phenomena, capacity limits, and mechanisms. The insights gained lead me to challenge attributing to "attention" those phenomena that can be better explained by perceptual processes, are predictable by an ideal observer model, or that otherwise may not require an additional mechanism. I enumerate a set of critical phenomena in need of explanation. Finally, I propose a unifying theory in which all perception results from performing a task, and tasks face a limit on complexity.

Evaluating the protective capacity of soil heavy metals regulation limits on human health: A critical analysis concerning risk assessment - Importance of localization.

Heavy metal pollution of agricultural soil is a major global concern, prompting the establishment of maximum allowable limits (MALs) to ensure food safety and protect human health. This study collected and compared MALs for six heavy metals (As, Cd, Hg, Pb, Zn, and Cu) in agricultural soils from representative countries and organizations (EU and WHO/FAO). The research evaluated the critical health risks and efficacy of these MALs under the hypothetical scenario of metals concentrations reaching the maximum allowable level. Safe thresholds for heavy metals were then derived based on maximum acceptable health risk levels. The comparative analysis revealed significant variations in the specific limit values and terms of MALs across countries and organizations, even for the same metal. This suggests that there is no consensus among countries and organizations regarding the level of metal-related health risks. Furthermore, the risk analysis of metal concentrations reaching the maximum level accentuated heightened risks associated with As, suggesting that the current risk of soil As exposure was underestimated, particularly for children. However, soil Cu, Cd, and Zn limits generally resulted in low health risks, implying that the current limits may overestimate their hazard. Overall, the results highlight that the current MALs for soil heavy metals may not fully safeguard human health. There is a critical need to optimize current soil MALs based on localized risks and the actual impact of these metals on human health. It is suggested to appropriately lower the limits of metals (such as As) whose impact on health risks is underestimated, and cautiously increase the limits of metals (such as Cu, Cd, and Zn) that currently pose minor health risks. This approach aims to reduce both over and insufficient protection problems of soil heavy metal MALs, emphasizing the importance of considering the locality in setting these limits.

A weighty issue.

Interventions for management of obesity continue to expand. This Views and Reviews article discusses the impact of obesity on in vitro fertilization outcomes and practices and reviews emerging tools for weight management, specifically glucagon-like peptide-1 agents.

[Treatment of proximal humeral fractures in childhood and adolescence : Consensus report of the pediatric traumatology section of the German Society for Trauma Surgery]. / Die Behandlung der proximalen Humerusfraktur im Kindes- und im Jugendalter : Konsensusbericht der Sektion Kindertraumatologie der DGU.

BACKGROUND: Proximal humeral fractures are a relatively common injury in childhood and adolescence, accounting for 0.45-2% of all fractures [2, 18]. Treatment is usually conservative but is still the subject of a scientific debate [9, 12]. In addition to the S1-LL, there are different recommendations for the diagnostics and treatment of these fractures in the literature. METHODOLOGY: As part of the 10th scientific meeting of the SKT of the DGU, the existing recommendations and the relevant or current literature were critically discussed by a panel of experts and a consensus was formulated. An algorithm for the diagnostics, therapy and treatment was integrated into this. RESULTS: The measurement of axial deviation and tilt is not interobserver and intraobserver reliable [3]. The age limit for when complete correction is possible was set at an age of 10 years, as the correction potential changes around this age. For diagnostic purposes, well-centered X­ray images in 2 planes (true AP and Y­images without thoracic parts) is defined as the standard. At the age of less than 10 years, any malposition can be treated conservatively with Gilchrist bandaging for 2-3 weeks. Surgery can only be indicated in individual cases, e.g., in the event of severe pain or the need for rapid weight bearing. An ad latus displacement of more than half the shaft width should not be tolerated over the age of 10 years. Due to the variance in the measurement results, it is not possible to recommend surgical treatment depending on the extent of the ad axim dislocation. As a guideline, the greater the dislocation and the closer the child is to growth joint closure, the more likely surgical treatment is indicated. The development should be taken into account. The gold standard is retrograde, radial and unilateral ESIN osteosynthesis using two intramedullary nails. Osteosynthesis does not require immobilization. A follow-up X­ray is planned for unstable fractures without osteosynthesis after 1 week, otherwise optional for documentation of consolidation after 4-6 weeks, e.g., if sports clearance is to be granted and before metal removal (12 weeks). CONCLUSION: Recommendations for surgical indications based on the extent of tilt are not reproducible and seem difficult in view of the current literature [3, 9, 12]. A pragmatic approach is recommended. The prognosis of the fracture appears to be so good, taking the algorithm into account, that restitutio ad integrum can be expected in most cases.