Search Results (112)

Coastal ecosystems, located at the interface of terrestrial and marine environments, provide significant ecological functions and resource value. Coastal salt pans, as critical coastal resources with significant implications for coastal ecosystem health and resource management, have attracted extensive research attention. However, current studies on the extraction of spatiotemporal patterns of coastal salt pans remain relatively limited and superficial. This study takes coastal salt pans in Laizhou Bay as a case study, proposing a hierarchical classification method—Salt Pan Feature-Enhanced Fusion Image Random Forest (SPFEFI-RF)—based on multi-index synergy guidance and deep-shallow feature fusion, achieving high-precision extraction of coastal salt pans. First, a Modified Water Index (MWI) and Salt Pan Crystallization Index (SCI) were constructed from image spectral features, specifically targeting the extraction of evaporation ponds. Concurrently, a salt pan sample dataset was developed for the DeepLabv3+ (DL) method to extract deep semantic features and perform multi-scale feature fusion. Subsequently, a three-channel fusion strategy—R(MWI)-G(SCI)-B(DL)—was employed to produce the Salt Pan Feature-Enhanced Fusion Image (SPFEFI), enhancing distinctions between salt pans and background land cover. Finally, the Random Forest (RF) classifier using shallow spectral features was applied to extract salt pan information, further optimized by spatial domain denoising techniques. Results indicate that the SPFEFI-RF approach effectively extracts coastal salt pan features, achieving an overall accuracy of 92.29% and a spatial consistency of 85.14% with ground-truth data. The SPFEFI-RF method provides advanced technical support for high-precision extraction of global coastal salt pan spatiotemporal characteristics, optimizing coastal zone management decisions and promoting the sustainable development of coastal ecosystems and resources. Full article

Histotripsy is a novel, non-invasive ultrasound-based ablative therapy that destroys tissue through focused cavitation. As solid tumors continue to be a major global health burden, there is interest in image-guided ablation techniques that reduce collateral damage and promote immune activation. This narrative review aims to synthesize current advancements, clinical applications, limitations, and future directions of histotripsy in both oncologic and non-oncologic contexts. A comprehensive literature search was conducted from database inception to July 2025. Search terms included combinations of subject headings and keywords such as “histotripsy,” “mechanical ablation,” “ultrasound,” and “solid tumors.” Boolean operators and truncation were used to increase sensitivity. Peer-reviewed studies were included, encompassing preclinical, clinical, and review articles. Reference lists of relevant articles were examined to identify additional sources. Histotripsy has shown strong potential in the treatment of tumors involving the liver, pancreas, kidney, brain, and cardiovascular system. It offers real-time imaging guidance, sharp lesion boundaries, and minimal damage to surrounding structures. Early clinical trials have demonstrated encouraging safety and efficacy, particularly in liver and kidney tumors. Its ability to preserve critical anatomy and stimulate innate and adaptive immune responses through the release of cellular debris and cytokines offers advantages over thermal ablation. Limitations include acoustic aberration, motion-related targeting challenges, and the need for further long-term clinical data. Histotripsy represents a promising advancement in noninvasive tumor ablation. Continued clinical investigation and technological refinement are necessary to validate its therapeutic value and define its role within comprehensive cancer care. Full article

This study provides a comprehensive evaluation of naturally occurring radionuclides—radium-226 (²²⁶Ra), thorium-232 (²³²Th), and potassium-40 (⁴⁰K)—in groundwater systems across the Nile Valley regions of Upper Egypt, based on the analysis of 85 groundwater wells. Measured mean activity concentrations were 0.74 ± 0.3 Bq/L for ²²⁶Ra, 0.24 ± 0.1 Bq/L for ²³²Th, and 13 ± 4 Bq/L for ⁴⁰K, with ²²⁶Ra displaying low correlations with salinity indicators including chloride (Cl⁻), sodium (Na⁺), electrical conductivity (EC), and total dissolved solids (TDS). Notably, approximately 30% of sampled wells exceeded the World Health Organization (WHO) guidance level of 1 Bq/L for ²²⁶Ra, primarily in central and eastern zones influenced by elevated salinity and evaporite dissolution processes. Geospatial mapping combined with multivariate statistical analysis identified four principal components accounting for over 85% of total data variability, demonstrating that depth-dependent processes, including prolonged water–rock interaction and redox evolution, are the primary controls on ²²⁶Ra mobilization, with salinity-driven ion exchange as a secondary factor. Minor anthropogenic influences, potentially linked to agricultural activities in shallow aquifers, were also detected. Radiological risk assessment confirmed that calculated annual effective doses remain well within international safety limits (<1 mSv/year), although infants and children demonstrated relatively higher exposure levels due to increased water intake per unit body weight. Lifetime cancer risk estimates via ingestion pathways yielded values below 1 × 10⁻⁴, aligning with global health organization benchmarks and reinforcing the general safety of groundwater use in the region. The study highlights potential risks posed by saline groundwater to ancient monuments and archaeological sites, as the cycles of salt forming and breaking down might speed up damage to buildings made of limestone and sandstone. These findings establish a robust scientific foundation for future groundwater quality management and cultural heritage conservation efforts in the Nile Valley region of southern Egypt. Full article

Background and Objectives: Cone Beam Computed Tomography (CBCT) offers high-resolution, three-dimensional imaging for detecting apical periodontitis (AP) and evaluating the technical quality of endodontic treatments. This study aimed to investigate the diagnostic value of CBCT in identifying endodontic failures and periapical lesions and to explore the clinical patterns associated with these findings in a Romanian patient cohort. Materials and Methods: A retrospective study was conducted on 258 patients (with 876 root canal-treated teeth), all of whom underwent CBCT imaging between October 2024 and April 2025 at a private radiology center in Craiova, Romania. Of the 876 treated teeth, 409 were diagnosed with apical periodontitis. Patients were present for endodontic treatment at the Endodontics Clinic of the Faculty of Dentistry, University of Medicine and Pharmacy of Craiova. With the patients’ consent, 3D radiological examinations were recommended for better case planning and accurate diagnosis. The periapical status and technical parameters of root canal fillings were assessed using the CBCT-PAI index and evaluated by three calibrated observers. Associations with demographic, clinical, and behavioral factors were statistically analyzed. Results: Apical periodontitis was detected in 46.69% of the teeth examined during the study period, with CBCT-PAI score 3 being the most prevalent. Poor root canal obturation quality (underfilling, overfilling, and voids) was significantly associated with periapical pathology. Chronic lesions were more common than acute ones, especially in older patients. The number of teeth with endodontic treatments and no AP, as well as the number of teeth with AP, was significantly lower for patients with acute AP, indicating the more severe impact of chronic AP on the patients’ oral health status. CBCT allowed the precise localization of missed canals and assessment of lesion severity. Conclusions: Within the limits of a retrospective, referral-based cohort, CBCT aided the detection of periapical pathology in root canal-treated teeth (46.69%). These findings do not represent population-based rates but support the selective use of CBCT, in line with current ESE guidance, for complex cases or when conventional imaging is inconclusive. Full article

Informed consent is a fundamental component of both the right to health and self-determination. Its violation, which occurs when the acquisition process is absent or flawed, can also lead to legal proceedings for isolated harm, regardless of the simultaneous existence of those related to biological and psychological harm. Across Europe, this remains a legal and ethical cornerstone, increasingly important in the context of cross-border care and culturally diverse healthcare settings. Many countries have enacted specific laws to ensure patients receive adequate information, while courts continue to refine its interpretation—often highlighting the inadequacy of informed consent in daily clinical practice. In Italy, in particular, recent rulings underscore the need for clear, comprehensive, and properly documented consent formats for health treatments. This review synthesizes rulings, regulations, and the scientific literature to offer practical guidance for improving informed consent practices in Italy, valuing the role of forensic experts in the integration in healthcare settings of the different interests at stake. The aim is to support both legal compliance and the delivery of high-quality, patient-centred care. Courts and legislation in Italy demand clear and tailored informative disclosure for health treatments, with indications of the treatment and outcomes, to be in written form. Yet, foreseeable risks, more common complications, and alternative treatment options are often poorly communicated in practice—frequently forming the basis of claims for compensation. Integrating team-based consultations and multimedia tools can significantly enhance patient understanding and secure the informed consent process. Those key points are summarized in a brief table, ideally suggesting the minimal requirements for an informed consent form. Investing in standardizing informed consent protocols, and also fostering the sharing of best practices with forensic medicine experts, are crucial steps in ensuring shared decision-making in healthcare and trying to reduce legal disputes. Full article

Conventional health risk assessments do not adequately reflect short-term exposure characteristics following chemical accidents. We aimed to evaluate the efficacy of existing assessment methods and propose a more suitable risk assessment approach for short-term exposure to hazardous chemicals. We analyzed foundational studies used to derive reference concentration (RfC), reference dose (RfD), and minimal risk level (MRL) values and applied these health guidance values (HGVs) to a hypothetical chemical accident scenario. An analysis of the studies underlying each HGV revealed that, except for the RfC for formaldehyde and the RfD for toluene, all values were derived under research conditions comparable to their respective exposure durations. Given the differing toxicity mechanisms between acute and chronic exposures, MRLs that were aligned with the corresponding exposure durations supported more appropriate risk management decisions. The health risk assessment results showed that RfC/RfD-based hazard quotients (HQs) were consistently higher than MRL-based HQs across all age groups and both substances, indicating that RfC/RfD values tend to yield more conservative risk estimates. For formaldehyde, the use of RfC instead of MRL resulted in an additional 208 tiles (2.08 km²) being classified as areas of potential concern (HQ > 1) relative to the MRL-based evaluation. These findings highlighted that the selection of HGVs can significantly influence the spatial extent of areas of potential concern, potentially altering health risk determinations for large population groups. This study provides a scientific basis for improving exposure and risk assessment frameworks under short-term exposure conditions. It also serves as valuable foundational data for developing effective and rational risk management strategies during actual chemical accidents. To the best of our knowledge, this is the first study to apply MRLs to a short-term chemical accident scenario and directly compare them with traditional reference values. Full article

Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article

Background/Objective: The use of artificial intelligence to assist in medical applications is an emerging area of investigation and discussion. The researchers studied whether there was a difference between homeopathy guidance provided by artificial intelligence (AI) (automated) and live professional practitioners (live) for acute illnesses. Additionally, the study explored the practical challenges associated with validating AI tools used for homeopathy and sought to generate insights on the potential value and limitations of these tools in the management of acute health complaints. Method: Randomly selected cases at a homeopathy teaching clinic (n = 100) were entered into a commercially available homeopathic remedy finder to investigate the consistency between automated and live recommendations. Client symptoms, medical disclaimers, remedies, and posology were compared. The findings of this study show that the purpose-built homeopathic remedy finder is not a one-to-one replacement for a live practitioner. Result: In the 100 cases compared, the automated online remedy finder provided between 1 and 20 prioritized remedy recommendations for each complaint, leaving the user to make the final remedy decision based on how well their characteristic symptoms were covered by each potential remedy. The live practitioner-recommended remedy was included somewhere among the auto-mated results in 59% of the cases, appeared in the top three results in 37% of the cases, and was a top remedy match in 17% of the cases. There was no guidance for managing remedy responses found in live clinical settings. Conclusion: This study also highlights the challenge and importance of validating AI remedy recommendations against real cases. The automated remedy finder used covered 74 acute complaints. The live cases from the teaching clinic included 22 of the 74 complaints. Full article

Art therapy serves as a crucial intervention modality for children with autism spectrum disorder (ASD), demonstrating unique value in emotional expression, sensory integration, and social communication. However, current practice presents critical challenges, including the disconnect between design expertise and clinical needs, unclear mechanisms of environmental factors’ impact on therapeutic outcomes, and insufficient evidence-based support for technology integration. Purpose: This study aimed to construct an evidence-based theoretical framework for art therapy environment design for children with autism, clarifying the relationship between environmental design elements and therapeutic effectiveness. Methodology: Based on the Web of Science database, this study employed a dual-track approach comprising bibliometric analysis and micro-qualitative content analysis to systematically examine the knowledge structure and developmental trends. Research hotspots were identified through keyword co-occurrence network analysis using CiteSpace, while 24 representative design cases were analyzed to gain insights into design concepts, emerging technologies, and implementation principles. Key Findings: Through keyword network visualization analysis, this study identified ten primary research clusters that were systematically categorized into four core design elements: sensory feedback design, behavioral guidance design, emotional resonance design, and therapeutic support design. A responsive therapeutic environment conceptual framework was proposed, encompassing four interconnected components based on the ABC model from positive psychology: emotional, sensory, environmental, and behavioral dimensions. Evidence-based design principles were established emphasizing child-centeredness, the promotion of multisensory expression, the achievement of dynamic feedback, and appropriate technology integration. Research Contribution: This research establishes theoretical connections between environmental design elements and art therapy effectiveness, providing a systematic design guidance framework for interdisciplinary teams, including environmental designers, clinical practitioners, technology developers, and healthcare administrators. The framework positions technology as a therapeutic mediator rather than a driver, ensuring technological integration supports rather than interferes with children’s natural creative impulses. This contributes to creating more effective environmental spaces for art therapy activities for children with autism while aligning with SDG3 goals for promoting mental health and reducing inequalities in therapeutic access. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article

Background/Objectives: Dental cavity preparation is a critical procedure in restorative dentistry that involves the removal of decayed tissue while preserving a healthy tooth structure. Excessive stress during tooth preparation leads to enamel cracking, dentin damage, and long term compressive pulp health. This study employed finite element analysis (FEA) to investigate the stress distribution in dental structures during cavity preparation using round diamond burs of varying diameters and depths of cut (DOC). Methods: A three-dimensional human maxillary first molar was generated from computed tomography (CT) scan data using 3D Slicer, Fusion 360, and ANSYS Space Claim 2024 R-2. Finite element analysis (FEA) was conducted using ANSYS Workbench 2024. Round diamond burs with diameters of 1, 2, and 3 mm were modeled. Cutting simulations were performed for DOC of 1 mm and 2 mm. The burs were treated as rigid bodies, whereas the dental structures were modeled as deformable bodies using the Cowper–Symonds model. Results: The simulations revealed that larger bur diameters and deeper cuts led to higher stress magnitudes, particularly in the enamel and dentin. The maximum von Mises stress was reached at 136.98 MPa, and dentin 140.33 MPa. Smaller burs (≤2 mm) and lower depths of cut (≤1 mm) produced lower stress values and were optimal for minimizing dental structural damage. Pulpal stress remained low but showed an increasing trend with increased DOC and bur size. Conclusions: This study provides clinically relevant guidance for reducing mechanical damage during cavity preparation by recommending the use of smaller burs and controlled cutting depths. The originality of this study lies in its integration of CT-based anatomy with dynamic FEA modeling, enabling a realistic simulation of tool–tissue interaction in dentistry. These insights can inform bur selection, cutting protocols, and future experimental validations. Full article

Relatively little data exist regarding the presence of unregulated contaminants in drinking waters. We sampled source and finished drinking water from 98 community water supply systems throughout Minnesota (U.S.). Facilities were grouped into four networks based on water source and influences from anthropogenic activities. Measured contaminants were dependent on network and included some combination of pesticides, pharmaceuticals, per- and poly-fluoroalkyl substances (PFAS), benzotriazoles, hormones, wastewater indicators, and illicit drugs. Overall, the number of contaminants detected in samples ranged from 0 to 35 and concentrations ranged from 0.38 ng/L (progesterone) to 47,500 ng/L (bromoform). Fewer contaminants and lower concentrations were detected in finished water samples, compared to source waters. Significantly (p < 0.05) more PFAS and pesticides and higher sample total concentrations were observed in wells designated as vulnerable to contamination. To estimate potential human-health risk from exposure in drinking water, concentrations were compared against bioactivity information from the U.S. Environmental Protection Agency’s ToxCast database and state-based guidance values, when available. Although comparisons could be made for relatively few contaminants, concentrations in finished waters were at least an order of magnitude lower than screening thresholds. Results from this study were used to inform enhancement of the Minnesota Department of Health’s drinking water protection program. Full article

Adequate and diverse diets are essential for children’s physical and cognitive development, yet food insecurity and malnutrition continue to threaten this fundamental right, which remains a pressing concern in many resource-poor settings. This study investigated food and nutrition security in Early Childhood Development (ECD) centres in Makhanda, South Africa, through a community-based participatory research approach. Using a mixed-methods approach combining questionnaire interviews, focus group discussions, direct observations, and community asset mapping across eight ECD centres enrolling 307 children aged 0–5 years, the study engaged ECD facilitators and analysed dietary practices across these centres. Results indicated that financial constraints severely affect the quality and diversity of food provided at the centres, thus undermining the ability to provide nutritionally adequate meals. The average amount spent on food per child per month at the centres was R90 ± R25 (South African Rand). Although three meals were generally offered daily, cost-driven dietary substitutions with cheaper, less diverse alternatives, often at the expense of nutritional value, were common. Despite guidance from Department of Health dieticians, financial limitations contributed to suboptimal feeding practices, with diets dominated by grains and starchy foods, with limited access to and rare consumption of protein-rich foods, dairy, and vitamin A-rich fruits and vegetables. ECD facilitators noted insufficient parental contributions and low engagement in supporting centre operations and child nutrition provision, indicating a gap in awareness and limited nutrition knowledge regarding optimal infant and young child feeding (IYCF) practices. The findings emphasise the need for sustainable, multi-level and community-led interventions, including food gardening, creating ECD centre food banks, parental nutrition education programmes, and enhanced financial literacy among ECD facilitators. Strengthening local food systems and establishing collaborative partnerships with communities and policymakers are essential to improve the nutritional environment in ECD settings. Similarly, enhanced government support mechanisms and policy-level reforms are critical to ensure that children in resource-poor areas receive adequate nutrition. Future research should focus on scalable, locally anchored models for sustainable child nutrition interventions that are contextually grounded, community-driven, and should strengthen the resilience of ECD centres in South Africa. Full article

The toxicity of metals such as lead (Pb) and cadmium (Cd) makes heavy metal contamination in food products a major health concern. The aim of this study is to measure the levels of Pb and Cd in yogurt samples that were collected from 11 distinct Lebanese locations and determine their compliance with the legal limits set by the European Commission (0.02 mg/kg for Pb and 0.005 mg/kg for Cd). A total of 165 yogurt samples were examined using atomic absorption spectrophotometry (AAS). Interestingly, the findings showed that 10.9% of samples had Pb concentrations over the allowable limit; the highest amounts were observed in Baalbeck-Hermel (0.118 mg/kg), North Area (0.125 mg/kg), and South Lebanon (0.115 mg/kg). In addition, the highest detected concentrations of Cd were found in North Area (0.094 mg/kg), Baalbeck-Hermel (0.076 mg/kg), and Akkar (0.042 mg/kg), with 14.5% of samples above the limit. The results show regional differences in contamination, which are probably caused by industrial emissions, agricultural activities, and environmental pollution. To better understand the potential health implications, the estimated daily intake (EDI) of Pb and Cd through yogurt consumption was calculated and compared to international health-based guidance values. Although the EDI values suggest a low risk from yogurt alone, the findings highlight the importance of cumulative exposure and emphasize the necessity of regular monitoring and stricter implementation of food safety laws to decrease exposure to heavy metals through dairy intake. Full article