Algae have been consumed for millennia in several parts of the world as food, food supplements, and additives, due to their unique organoleptic properties and nutritional and health benefits. Algae are sustainable sources of proteins, minerals, and fiber, with well-balanced essential amino acids, pigments, and fatty acids, among other relevant metabolites for human nutrition. This review covers the historical consumption of algae in Europe, developments in the current European market, challenges when introducing new species to the market, bottlenecks in production technology, consumer acceptance, and legislation. The current algae species that are consumed and commercialized in Europe were investigated, according to their status under the European Union (EU) Novel Food legislation, along with the market perspectives in terms of the current research and development initiatives, while evaluating the interest and potential in the European market. The regular consumption of more than 150 algae species was identified, of which only 20% are approved under the EU Novel Food legislation, which demonstrates that the current legislation is not broad enough and requires an urgent update. Finally, the potential of the European algae market growth was indicated by the analysis of the trends in research, technological advances, and market initiatives to promote algae commercialization and consumption. However, concerns regarding the environmental impact of the current food production systems, together with health and animal welfare issues, have driven the need to develop healthier and more sustainable food sources .Algae—microalgae (including cyanobacteria) and seaweed —have been used as food since medieval times, with a consolidated market in Asia and a growing market in Europe, being driven by a rising awareness in consumers regarding sustainable and healthy foods ,3,4,5. ISpirulina, 36% seaweed, and 10% microalgae. The remaining 8% produce both Spirulina and microalgae [In 2009, the European Algae Biomass Association (EABA) was founded to promote the algae industry by establishing synergies between academia, industry, and decision-makers in the field . After tcroalgae ,12,13.Algae can be consumed as food or as ingredients in prepared foods, in a fresh, fermented, dried, or frozen format, either whole or milled into differently sized flakes, granules, or powders ,15. Algaω-3 PUFA, such as docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids, are also earning market relevance, replacing the traditional intake of these compounds via fish consumption [β-carotene, lycopene, and astaxanthin are mainly used as dietary supplements, food fortifiers, and beverage natural colorants, as the new generation of consumers chooses natural over synthetic products  [Moreover, algae are a sustainable source of natural high-value bioactive compounds, with the potential to manufacture new products for human nutrition. Lipids, in the form of polyunsaturated fatty acids (PUFA), ω-3 and ω-6 PUFA, and phytosterols are major compounds in algae that can be applied in several contexts, due to their beneficial properties for the cardiovascular system, anti-cholesterol activity, and others ,36,37,38sumption . Proteinsumption ,45,46,47sumption ,52,53,54sumption ,58,59,60oncerns) ,63,64,65Each category of algae-based products is regulated by separate legislation. For food and food supplements, novel food regulation (EU 2017/2470) is covered in the Novel Food Catalog, a list of authorized novel foods that are safe for human consumption .This review paper addresses the applications of algae  as a food in Europe, with an overview of the consumption habits, market, and legislation. Approved and consumed algae species are listed and the challenges of incorporating them into the European market are evaluated, together with the analysis of research and development initiatives.Algae have been included historically in the human diet worldwide. According to archaeological findings in Monte Verde (Chile), people were collecting seaweeds for food and medicine 14,000 years ago . SeaweedPalmaria palmata  was traditionally eaten raw, toasted with hot irons, cooked in a thick oatmeal broth, served boiled, tossed in butter, or fried as crisped seaweed “bacon” for sandwiches; later, it was used for chewing tobacco, as well as ingested for deworming and to cure “women’s longing” [Porphyra sp. (Atlantic Nori or Purple Laver), baked into different dishes, such as the popular Welsh laverbread (“bara lawr”) from Wales, or fried as an ingredient in omelets or pies , in the Azores Islands  [Ulva lactuca (sea lettuce) and Chondracanthus teedei  were traditionally eaten fresh by fishermen and beachgoers, with a squeeze of lemon and salt, in coastal regions such as Catania (Sicily) [In Europe, seaweeds are likely to have been harvested for human consumption for centuries, although they are a vastly underexploited resource when compared with consumption in Asia ,72. Archlonging” ,90,91,92longing” ,86,87,91ortugal) ,85,93,94(Sicily) ,96,97. T(Sicily) .Ascophyllum nodosum, known as Rockweed, in Norway; Laminaria digitata, or Oarweed, in France and Ireland; Laminaria hyperborea, or Tangle, in Britain, Ireland, and Norway); harvested Irish Moss in coastal areas  and black carrageenan or “Danish Agar”  for carrageenan and furcellaran extraction [Porphyra sp.), Wakame (Undaria pinnatifida), Kombu (Laminaria sp.), Agar, Arame (Eisenia bicyclis) and Hijiki (Hizikia fusiforme), which are still largely imported from Asia to this day [Chondrus sp. and Mastocarpus sp.), in mainland Portugal, Spain, and France , the Azorean Islands (Pterocladiella capillacea) and Italy (Gracilariopsis longissima (or Gracilaria verrucosa) [Gelidium corneum and Pterocladiella capillacea peaked in 1980, with Portugal leading as the world’s fifth-largest agar producer and European macroalgae contributing to 34% of the world’s alginate supply [In Western countries, seaweeds have been mainly associated with industrial applications focused on the extraction of phycocolloids for the food industry ,98. In ttraction ,86,88,99this day ,101,102.this day ,101. By this day ,60. The rrucosa) ,109,110.rrucosa) ,112. Fure supply ,110,113.Nostoc species are traditional foods in China , Mongolia, and South America  [Arthrospira  was historically harvested by the Aztecs living near Lake Texcoco, as recorded in the 14th century as an ingredient for a dry cake called “Tecuitlatl” [For microalgae, the oldest documented use as food was 1500 years ago in China ,114. Nosushuru”) ,116,117.uitlatl” . In Afriuitlatl” ,119,120.uitlatl” . The comuitlatl” . Recentluitlatl” ,123,124.Microalgae have only recently been consumed in Europe. From the historical perspective, it is important to highlight that although microalgae were under active research for many decades, especially for the human diet, the product of this research has failed to materialize commercially in the EU space, at least until the publication of Regulation (EC) No. 258/97 of the European Parliament and of the Council of 27 January 1997, concerning novel foods and novel food ingredients ,22,125. The historical role of microalgae ,149,150 The European algae industry, with the production of around 500 t algae dry weight per year, remains a niche market, mainly directed to food and food-related applications and concentrated on the production of large quantities of biomass using a limited number of species ,12. Many−1 year−1, which may be compared to the consumption of salad in Europe (3 kg per capita−1 year−1) [Despite the promising figures, the high cost of production, the complexity of European regulations concerning cultivation licenses, and the synchronization of guidelines for organic certification between countries limit the algae market in Europe ,161,162. year−1) ,164. Int year−1) . European algae producers face heavy competition from Asian producers, mainly due to higher production costs and product prices, which may be discouraging for the producers. However, Asian producers are frequently criticized for the environmental impact caused by their aquaculture systems in eutrophic waters. As this is viewed negatively by an ever more eco-conscious market, European production might excel in the global market of retailers and consumers who demand higher-quality, sustainable algae-based products .The estimated value of the European algae products market is expected to grow by around 43% between 2016 and 2023 , forecasIn Europe, microalgae are commonly produced in photobioreactors in closed and controlled conditions. Germany, France, and Spain host the largest number of producers; however, it is in Portugal that we can find the oldest and the largest microalgae production companies in the EU, Necton and Allmicroalgae, respectively.Chlorella sp. being the most popular. Nevertheless, a wide range of algae has the potential to also be considered for this purpose [β-carotene, astaxanthin, fucoxanthin, or lutein can be obtained from microalgae, such as Dunaliella salina, Haematococcus pluvialis, Chlorella vulgaris, Microchloropsis gaditana , Auxenochlorella protothecoides, Phaeodactylum tricornutum, Tisochrysis lutea and Spirulina sp. [P. tricornutum, Chlorella sorokiniana or Nannochloropsis oceanica [H. pluvialis, and retinol or β-carotene obtained from D. salina [One of the key microalgae applications is in the nutraceutical market, in terms of dietary supplementation, where they are seen as valuable natural sources of macro- and micronutrients of great commercial potential ,173. In lina sp. ,178. Furoceanica . In seve. salina ,184,185.Chlorella and Spirulina [Nannochloropsis gaditana and Nannochloropsis oculata, while others, such as Chlorella sorokiniana and Auxenochlorella protothecoides, were being sold without any authorization until recently, when they were approved [Euglena gracilis, Spirulina, and Chlorella, among others, mostly for use in traditional food products such as pasta, ready-to-eat bars, dairy and fermented products, candies, and pâtés [Microalgae can be found either as an ingredient in food products or as a whole-cell powder that can be used freely in cooking recipes, smoothies, drinks, or simple snacks ,188,189.pirulina . In a 20pirulina . It is aapproved ,192,193.nd pâtés ,188,189.The European seaweed industry is still in its early development and has been almost exclusively based on wild stock harvesting, unlike the extensive farming that takes place in Asia . HoweverAscophyllum nodosum, Alaria esculenta, Laminaria hyperborea, L. digitata, Saccharina latissima and Undaria pinnatifida [The value of European seaweed is roughly estimated as EUR 500–600 million per annum , but it is highly dependent on species, whether wild-harvested or farmed, and the targeted market. Leading markets for seaweed are as plant biostimulants for agriculture and the phycocolloid industry, which is focused on the extraction of single products, such as alginic acid, laminaran, and colorants. Europe is the top food and pharma-grade alginate producer worldwide, with a minor share of global carrageenan and agar production ,99,163. natifida ,197.A. esculenta, S. latissima, Porphyra sp., P. palmata, and Ulva sp. [The European seaweed market is developing at a fast pace, with an annual growth rate of 7–10% and a wholesale value of around EUR 24 million, focusing only on Ulva sp. ,199,200;Ulva sp. . The proUlva sp. ,22,202. Ulva sp. . Pyropia sp. . Europe has a nominal supply of Atlantic Nori, producing only 1% of what is consumed. On the other hand, 90% of the P. palmata consumed in Europe is regionally wild-harvested in France. In this case, Europe is becoming more proactively competitive, relying on imports to satisfy 10% of the European consumer demand [In 2016, the EU imports of seaweed products were almost twice the size of its exports , making the EU the world’s second-largest importer in terms of volume, valued at EUR 506 million . Marketsr demand .Another use of seaweed in food production is its application in packaging biomaterials, such as for edible pouches or pods to replace drinking bottles .Despite the historical consumption of algae as a food and their associated nutritional and health benefits, there are still bottlenecks blocking its progress from the current niche markets to larger ones. The main reasons are production constraints, high costs, environmental concerns, health and safety, legality, and consumers’ perception of the product .The growth of algae can be affected not only by abiotic factors  but also by biological factors  and operational factors  ,209,210.In order to move to a larger-scale operation, an increase in qualified human resources, mechanization, and automation in the operations  is required. The scaling-up of photobioreactors from the laboratory to an industrial scale, for example, is pricey not only due to the high material costs but also because of high operational costs, especially if the algae are being cultivated in a different climate from their original habitat. The temperature and light control in this case significantly increases the energy costs of the operation .The appearance of biological contaminants during algae cultivation is also a constraint that can compromise cultures and lead to enormous economic losses. Like most other farming activities, algae cultivation suffers from contamination by parasites, epiphytes, epizootics, competitors, grazers, and predators ,217,218.In the case of microalgae, another constraint arises: due to their microscopic size, the sensitivity of the cell walls for most species, and their low culture concentrations , the downstream process is costly and difficult . There aP. palmata) and Atlantic Nori (Porphyra sp.). Successful production and domestication are, in many ways, dependent on the manipulation of different life stages and on monitoring the factors that trigger reproductive events, such as sporulation, which may result in large biomass losses [Additional challenges in seaweed production emerge, for instance, the complexity of their life cycles and domestication constraints for some of the most highly demanded species, such as Dulse  [Algae’s potential for human nutrition is strongly related to their biochemical composition and bioactive properties, which are known to vary widely among the different classes and even among strains. Some highlights include isolated polysaccharides, , proteins (phycobiliproteins), polyphenols , carotenoids  and ic acid) . Over thic acid) ,222. OveToxicological factors also need to be considered, as algae can produce or accumulate several contaminants that impact the consumer’s health. In early studies, human experiments with microalgae were scarce, and they were limited to certain countries, like Japan, the US, and Russia . It was Chlorella sp., sold as a food supplement, was found to be contaminated with anatoxin [Aphanizomenon sp., which naturally occurs in the Upper Klamath Lake, Oregon, USA, can also produce these toxins [Desmarestia sp. (Coarse Acid Kelp) is a genus that concentrates sulfuric acid in cell vacuoles and should be avoided since its consumption causes gastrointestinal problems [Coolia monotis, which produces cooliatoxin (a neurotoxin) and was detected in drifting seaweed in New Zealand [Natural toxins, such as cyanotoxins, are produced by cyanobacteria and are a common chemical contaminant in large-scale cultures . Cyanotoanatoxin , a compoanatoxin . The cyae toxins ; despitee toxins ,229. Altproblems . Another Zealand ,232.Chlorella sp., and some cyanobacteria were reported to produce a compound responsible for dermatitis and inflammations of the human respiratory system, but this is when the microalgae were in their natural form and not after being processed as a food [Algae-related food allergies are uncommon and are poorly documented, with only one clinic case documented, which was associated with Nori . Microals a food .Allergens in algae are usually associated with the environment in which they grow. Seaweeds are typically cultivated and are harvested in the open ocean or estuary environments, which are inhabited by crustaceans such as gammarids (amphipods), shrimp, and crabs (Decapoda). Commercial edible crustaceans are frequently involved in immunoglobulin E (IgE)-mediated food allergies . In a stAlthough heavy metals are not usually found in algae at values surpassing the legal limits, frequent and excessive algae consumption could pose risks that are associated with the bioaccumulation of these compounds. Heavy metal accumulation depends largely on species, as well as on environmental conditions like light, temperature, pH, salinity, or nitrogen levels ,238. ThiHizikia fusiforme, may have high levels of total and inorganic arsenic [Fucus vesiculosus, F. serratus, F. spiralis, F. evanescens, S. latissima, U. lactuca, and Cladophora sp.), there were low-level concerns regarding the presence of mercury, cadmium, and lead [In microalgae, the toxic heavy metals, arsenic, nickel, and lead, were found at very different concentrations among 10 commercial products, although at levels below the safety limits, according to the European Food Safety Authority (EFSA) . In seaw arsenic ,243. In and lead . In anotand lead . Health and lead ,245. Iodine is another common concern as it can occur in seaweed at high concentrations. Although it is essential to humans and its deficiency is a major public health challenge, excessive intake can have harmful effects, for instance, thyroid dysfunctions, goiter, and hyperthyroidism ,246,247.Mitigation strategies can be employed to minimize the risk of contamination from algae products. Water quality control is one way to avoid these problems, by minimizing the components that are adsorbed in algae . Hence, The specificity and complexity of algae contaminants are sometimes not taken into account by the current food legislation. For instance, the quantification of arsenic could be differentiated as organic and inorganic, as health risks are much lower when consuming the organic form . If thesThe processing and manipulation of the algae, such as their handling and packaging, can also be a hotspot for cross-contamination with viruses, bacteria, fungi, protozoa, organic molecules, such as prions, natural toxins, and persistent organic pollutants . The proLaminaria sp. [Biomass manipulation after harvesting could prevent the degradation of the product while ensuring a low level of contaminants. A conventional example of this manipulation is washing and boiling seaweed, as this can reduce its arsenic and iodine contents, achieving decreases of around 22% in inorganic arsenic and an almost complete reduction of iodine in aria sp. ,253,254.In the case of microalgae, boiling can have both beneficial and harmful effects. For example, boiling decreases the concentration of microcystin by 97% after 5 min , but incChlorella sp. was defined as having a strong vegetable-like flavor and aroma that would taste like powdered green tea; in the case of some dried seaweeds, they have an intense green color that could be considered limiting or off-putting when mixed in foods [Scenedesmus-based food, where the color was not well-received by testers. In France, tests on the nutritional value and customer acceptability of Spirulina-based foods concluded that algae were not very enjoyable to eat, due to their strong taste, smell, and even color [Another important factor to be highlighted regarding the introduction of algae to the market is their organoleptic characteristics, in terms of their color, odor, texture, and flavor . In termin foods ,133,136.en color . French en color .umami” makes algae stand out gastronomically [kombu) [umami”, for instance, a green-tea aroma and flavor in kelp species [The unique flavor of “omically ,267,269. [kombu) ,267. In  species .The processing methods, as well as the storage conditions, could influence the flavor . NeverthFinally, and in a transversal way, a general lack of awareness and accessibility regarding algae is evidenced ,271,272.On the other hand, environmental concerns are quite different among countries; for instance, while Spanish consumers consider microalgae as being environmentally friendly, the French have contrastingly double perceptions, and the Belgians do not see this as an incentive to motivate consumption ,275,277.Over the last two decades, changes in the consumers’ mindset have been happening; now, the end consumers are more informed and receptive to sustainable behaviors. This aligns with both the new and improved support policies for research projects and programs, leading to the continuous expressive growth of algae applications in the European market ,272,279.Italian consumers have a high level of willingness to eat seaweed, according to studies, given the familiarity with seaweed gastronomy in both national and Asian traditional dishes . In NordSome specific legislation and food standards entities regulate how algae can be used as food for human consumption worldwide. Usually, algae and algae-based products are regulated individually, as in the EU. The categories applied to algae are in foods including food supplements and food additives, feed and feed additives, nutraceuticals, cosmetics, packaging materials, fertilizers, biostimulants, and biofuels.In the USA, the safety of food items, including algae products, is under the regulation of the Food and Drug Administration (FDA), which grants the status of being generally recognized as safe (GRAS) to any substance that is considered to be safe for human consumption ,282. GRASimilar approaches in the regulations of novel foods are also found in Australia and New Zealand, where the Food Standards in Australia and New Zealand (FSANZ) are the entity responsible for regulating the use of new ingredients. According to FSANZ, the novel food and novel food ingredients are considered all non-traditional food and/or its derivatives requiring an assessment of the public health under the Novel Foods in the Food Standards Code. A novel food cannot be sold as food or used as a food ingredient unless expressly permitted by the Code in Standard 1.5.1 ,287.Laminaria, Gracilaria, Porphyra, Undaria, and Eucheuma have been accepted as a traditional food instead of a novel food by the Chinese for many years. Moreover, algae products could also be approved as “Food for Special Medical Purposes”, with a 5-year validation certificate being issued by the Center for Food Evaluation in the State Administration for the Market Regulation of China. When compared with the EU, both have established a similar system to regulate novel foods, within some common perspectives. The growth of novel food regulation in China is justified by the development of the food industries and the long-lasting food culture ,289,290.Algae, as food products in the EU, are subject to the General Food Law Regulation (EU) No. 178/2002 which is implemented in all member countries. Furthermore, the entry of novel algae species into the EU market is regulated by the Novel Food Regulation (EU), No. 2015/2283. The application procedure for authorizing the placing on the market within the EU of novel food and for updating the Union List may be found in the Official Journal of the EU (L327/1).Consumption history affects the regulatory status, meaning that the entry of novel algae species that have not been used as food in the EU before 15 May 1997 need prior authorization, to ensure their safety for human consumption. Additionally, a notification system is available to offer an easier route to the EU market for some species that have not been used in Europe but that are considered traditional foods in developing countries. This “traditional food” status is given if a history of safe food use for at least 25 years can be proven. This new Regulation facilitates the introduction of new and innovative foods to the EU market, provided that specifications, such as labeling and usage conditions, are respected, thus guaranteeing food safety for European consumers.The rules enforced on algae products are regulated by Directive 2002/46/EC, which aims to protect consumers against the potential health risks associated with toxicity or misinformation. The SANCO/2006/E4/018 report assessed the use of substances, other than vitamins and minerals, with a nutritional or physiological effect in food supplements, which includes amino acids, enzymes, pre- and probiotics, essential fatty acids, botanicals , botanical extracts, and other bioactive substances. In addition, the EU delivered several reports (SEC (2008) 2976 and SEC (2008) 2977) stating that specific rules being made applicable to substances other than vitamins and minerals for use in FS are not justified. Food additives, such as preservatives, colorants, or sweeteners, which are normally used during food preparation are regulated by (EC) 1333/2008 and (EU) 231/2012 legislations. The safety of these products and the authorization assessment are carried out by the Scientific Committee on Food (SCF) and the EFSA. The concept of functional food, derived from Japan and the USA, goes beyond the nutritional and health benefits of traditional nutritional effects and differs from food supplements and nutraceuticals. Although this market is gaining extensive popularity in the last few years, the EU still lacks a regulatory framework for functional food, hindering economic competitiveness in this sector.Legislation inadequacies remain regarding the use of algae as a raw material for food. Therefore, the European Committee for Standardization (CEN) developed a technical committee for algae and algae products, including cyanobacteria and Thraustochytrids (CEN/TC 454) in 2017, which focuses on standardizing the specification, classification, terminology, algae processing, and determination methods for algae biomass, extracts or purified compounds. It is noteworthy that as these guidelines are updated, the legislation is changed accordingly.Because of limited European regulation, some EU countries are implementing their specific regulations regarding the use of algae as a food source. Non-approved algae species are being commercialized for food purposes in several European countries. For example, in 1990, France was the first European country to establish a specific regulation concerning the use of seaweed for human consumption as a non-traditional food substance, authorizing the consumption of algae for food other than what is considered to be a novel food, according to the EU ,156. TheEvidence for the consumption of more than 150 edible species of algae was identified in Europe, of which 14% are considered microalgae and cyanobacteria and 86% are considered seaweed . InteresResearch and development to mature the production process (from cultivation to packaging) have been encouraged to introduce new algae species to the market .−1, which are planned to decrease to EUR 0.5 kg−1 in the best-case scenario within the next decade [Microalgae biotechnology R&D dates back to the 19th century; since then, technologies have evolved, leading to the continuous improvement of production systems . Today, t decade . i.To increase the risk-benefit seaweed analyses, with added knowledge on the speciation of iodine/chemical form, and bioavailability;ii.To standardize and define the chemical compound classes, activities, traceability, methods, and species identification;iii.To further investigate the domestication of new species, the effects of preservation methods and treatments on biomass, and to define the best storage procedures and best practices for the evaluation of product shelf-life; andiv.To implement sensory evaluation panels .Seaweed wild harvesting is a well-established industry, and the cultivation process has been promoted . SpecifiScientists successfully brought a green fingerprint to algae as an alternative, sustainable feedstock for food and other applications , which led to an increase in the funding rate for algae-related projects within the European Union over the last few decades a.The eco-friendly image of algae industries is currently moving this sector toward larger markets, bringing with it the creation of new, skilled jobs, study programs, and economic value. Most EU projects use the green fingerprint and sustainability aspects of algae products or processes to promote a more sustainable way of living. The driving arguments for food-related algae projects and products are usually related to green consumerism. Indeed, algae technologies pose advantages compared to traditional approaches for a given application. For example, algae can be a source of food in areas where no arable lands or potable water is available and, thus, do not necessarily compete with agriculture. In addition, unsustainable fish- and soy-based lipids or proteins in food and feeds are replaceable by algae products, reducing overfishing and deforestation. This approach reduces the eutrophication and contamination of the environment and allows the recirculation of limited and valuable resources  . Despite this green image, algae industries generally receive low recognition among society and decision-makers. During the Seventh Framework Program (FP7), 2007–2013, only ~0.5% of the EUR 44 billion of total funding was spent on algae-related projects, which was the highest percentage so far. Notably, approximately ten times more money was invested in agriculture research. Nonetheless, algae biotechnology is earning its position in the research world in Europe.n = 23) were coordinated by Spanish companies and institutions, accounting for 19% of the projects, followed by those in France (n = 19), the United Kingdom (n = 13), Germany (n = 11), and Portugal . By choosing species that are able to produce NPs, the downstream process of algae cultivation—especially microalgae—becomes easier and cheaper. This happens because metallic NPs have the capability to clump together, allowing a faster, cleaner, and easier separation of the algae from the culture media (2). Biological sensors made from nanoparticles are also being developed to identify the presence of hostile microorganisms. The incorporation of this technology into the cultivation of algae—especially microalgae—would enable a possible way of controlling the contamination of algal cultures, since this could become an accurate and fast technique by which to signal the presence of contaminants and even kill them, due to their bioactive properties .Metallic NPs have also been reported to have anti-bacterial and anti-fungal properties, especially silver and gold NP, AgNP, and AuNP, respectively . By inclWith the increase in the research for food products, an increase in the market for algae products is expected to make space for new products and brands. Algae-based products for the foods, cosmetics, and nutraceuticals markets can benefit compared to existing products, if the manufacturing companies advertise their positive properties, including the richness of their essential nutrients or the product’s green fingerprint. A “green” product will drive consumers to spend more money, even if it is of lower quality or performance than a regular product ; interesThe design of algae foods is essential for market integration because algae are usually not part of Western cuisine and may have a distasteful or fishy taste and smell. Novel algae food designs are supported by EU projects. Commonly, these projects aim to position small- and medium-sized enterprises (SMEs) in the algae health food market and usually include strategies for promoting and establishing algae products in these markets. Indeed, the evolving green consumerism market serves as a stepping-stone for many companies toward the full market integration of algae foods, which is key for the movement from the development bench to the market and away from the dependency on public funding. Once established, algae products will probably spread quickly among communities via peer-to-peer influence and social norms.With legislation amendment and investment in the research and development of production systems and algae products, the algae market has the potential to grow in Europe . The ideThis review has highlighted the historical consumption of microalgae and seaweed species diversity, and their applications as foodstuffs, food supplements, and food additives in Europe. Concerns regarding establishing algae products in the market, such as production constraints , health impacts , and consumers’ perceptions (acceptance and knowledge) have been addressed, as well as the legislation process followed to submit algae to the EU Novel Food Catalog. The current legislation is not broad enough for the algae sector, with specific regulations within each country and several species being produced, consumed, and commercialized beyond the approved catalog. Therefore, an update of the authorized species list is urgently required. It is evident that the algae market has strong motivations and huge potential, due to algae’s nutritional and health benefits, the likelihood of sustainable production, and especially, the need to address the rise in food demand by the growing population. The development of new projects and products has been encouraged, especially regarding microalgae cultivation technology, as seaweed products are becoming more established in the global market.


Asian/Pacific Island Nursing Journal (APINJ). Created to fill the gap between nursing science and behavioral/social sciences, APINJ offers a forum for empirical, theoretical, and methodological issues related to Asian American and Pacific Islander ethnic and cultural values and beliefs as well as the biological and physiological phenomena that can affect nursing care. APINJ serves as a voice for nursing and other health care providers for research, education, and practice. APINJ is included in PubMed, PubMed Central, the Directory of Open Access Journals, and Scopus. As an open access journal, APINJ follows a continuous publication model, and articles are published as soon as they have been peer-reviewed and copyedited.As the editor-in-chief, I am happy to announce the launch of a new member of JMIR Publications’ open access family of journals, the Nursing in Asia and the Pacific Islands comprises a rapidly growing group of professionals, and the region represents the fastest growing minority group in the United States. According to the 2020 United States census , there aAs the official journal of the Asian American / Pacific Islander Nurses Association, APINJ supports researchers, educators, and practitioners in addressing these critical information deficits by providing a quality, peer-reviewed, international forum for the exchange of knowledge in relation to Asian and Pacific Islander health and nursing care. APINJ features research papers; empirical, theoretical, and clinical articles; editorials; abstracts of recent dissertations; and conference summaries that relate to Asian American and Pacific Islander health and nursing written by those in the nursing and social sciences disciplines, such as clinical and developmental psychology, sociology, anthropology, social work, public health, education, genetics, pharmacology, infectious disease, oncology, cardiovascular disease, pulmonary function and disease, dermatology, wound healing, immunology, anesthesiology, endocrinology, gastroenterology, hematology, neonatology, nephrology, pathology, physiology, nutrition, pain management, sleep disturbances, dental health, and mental health.Building on the JMIR foundation, the scope of APINJ includes, but is not limited to, methods, interventions, instrumentation, and educational techniques; theoretical foundations that increase the understanding of underlying mechanisms for changes in health and illness; biopsychosocial, spiritual, and ecological impacts on practice, education, and research; and policy issues as a result of rigorous research outcomes.Journal of Medical Internet Research.APINJ offers authors a rapid and thorough peer-review, professional copyediting, and professional production of PDF, XHTML, and XML proofs. This journal adheres to the same quality standards as our flagship journal, the


Preterm delivery  complicates 5–13% of deliveries worldwide ,3,4,5. PIn most countries, PTD rates are increasing, and an annual estimation of 15 million babies, which equates to 11.1% of live births, are born prematurely worldwide .Spontaneous preterm parturition is a result of the pathological activation of one or more of the processes leading to delivery. The etiology of spontaneous preterm labor, which accounts for 70–83% of PTDs, is mostly unknown ,10, and Prevention strategies have been suggested and practiced to lower the risk of PTD; however, their effectiveness is questioned, especially among women considered to be at low risk for PTD ,14,15. TRisk factors for PTD are obstetrical, socio-economical, behavioral, environmental, and genetic, and include young or old maternal age, infertility treatments, and smoking ,17. For One of the early detectable PTD risk factors is cervical shortening or insufficiency , defined as an inability of the cervix to remain closed during pregnancy . HoweverSince PTD events are likely to re-occur in the same mother and within the family , factorsFetal development occurs throughout the entire pregnancy until full term; therefore, when PTD occurs, the newborn is not physiologically and metabolically mature, leading to immediate and long-term complications ,3,4,5. TLowering the rate of this major, relatively prevalent pregnancy complication has been declared by the WHO as “an urgent priority for reaching Millennium Development Goal 4, calling for the reduction of child deaths” . AlthougWe would like to give special thanks to the colleagues who took part in this project for their valuable contributions.


In the published article, there was an error in the affiliation. Instead of “School of Biological and Chemical Engineering, Ningbo Tech University, Ningbo, China”, it should be “School of Biological and Chemical Engineering, NingboTech University, Ningbo, China”.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Anticholinergic syndrome (AS) is a complication that can appear due to different drugs with antimuscarinic effects, such as antihistamines, alkaloids, antipsychotics, tricyclic antidepressives or anesthetics, and it is characterized by urinary retention, dry mouth and skin, mydriasis, low-grade fever, and confusion or coma.To describe a clinical case of AS admitted to our hospital.We present a case report of a patient with schizophrenia who presented an anticholinergic syndrome. We also searched for previous studies of AS using a pubmed query.A 53-year-old male was admitted for a psychotic decompensation to another hospital in Barcelona. The usual treatment at home was amisulpride 1200mg/d, olanzapine 30mg/d and lormetazepam, and haloperidol 6mg/d and clotiapine 40mg/d were added to treat the decompensation. Then, the patient started to present mydriasis, mucocutaneous dryness, low-grade fever, slight hypertension and tachycardia, repeated retentions of urine, confusion, unintelligible speech and agitation, so he was referred to our hospital. Once he was admitted, haloperidol was withdrawn and support measures  were applied. After a few days, most of the mentioned alterations were stabilized, but the psychotic symptoms, such as thought and behavioural disorganization, persisted and required electroconvulsive therapy, with subsequent improvement.AS is a relatively frequent side effect of psychiatric medication, which diagnosis is clinical, so, we must be capable to identify it and initiate early treatment to prevent possible complications. The first step, as reflected in the case described, is to stop the causative drugs, and apply support measures. Additionally, physostigmine can be used, as it is an effective antidote.No significant relationships.


In the published article, there was an error in affiliation 1. Instead of “Department of Clinical Medicine, Shantou University Medical College, Shantou, China,” it should be “Shantou University Medical College, Shantou, China.”In the published article, there was also an error in affiliation 2. Instead of “Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,” it should be “Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.”In the published article, there was also an error in affiliation 3. Instead of “Division of Critical Care Medicine, Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,” it should be “Division of Geriatrics Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.”The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Over the past decade, the number of organ transplants performed worldwide has significantly increased for patients with advanced organ failure ,2,3,4,5.In this Special Issue, “Progress and Recent Advances in Solid Organ Transplantation”, researchers from different disciplines with different expertise and resources highlighted the novelty of their recent investigations in the field of organ transplantation, including issues related to donors, allografts, and patient survival ,18,19,20Immunosuppression management is essential for patient and graft survival in transplant recipients ,23,24, aBetter understanding of subgroups of transplant recipients, such as older transplant recipients and Black transplant recipients, can help the transplant community to identify individualized strategies to improve outcomes among these vulnerable populations ,14,28. IIn summary, the findings published in this Special Issue provide novelty and additional knowledge and may help the transplant community to ultimately improve the management and outcomes of patients with solid organ transplantation.


In this study, experiments were done according to the current standard methods, EPA from hemodialysis instruments. Finally, using SPSS18 software and descriptive statistics, the relationship between results at the removal of toxic, microbial, and chemical pollutants in different months and hospitals was investigated. this study showed that the average concentration of chemical characteristics during the warm season at Razi, Imam, and Golestan educational hospitals for pH, Turbidity, PO4, Cl, Mg, So4, Ca, NO2, and EC were ; ; ; ; ; , ; , and , respectively during 2018. Also, during 2019, results showed that the average levels of amounts for pH, Turbidity, PO4, Cl, Mg, So4, Ca, NO2, and EC in Razi, Imam, and Golestan educational hospitals were , , , , , , , , and , respectively. According to the results, hemodialysis instruments in Razi and Imam have a 90% efficiency in removing heterotrophic bacteria counts (HPC). Based on these findings, educational hospital hemodialysis equipment effluent in Ahvaz, Iran was mitted to Iran environmental standards for use in hemodialysis machines. The result showed that the removal percentage level of microbial and chemical pollutants by the hemodialysis process is comparatively suitable. It should be mentioned that in the proper operation and reconstruction, hemodialysis systems can have an increased rate of removal of microbial and chemical pollutants.Dialysis water is vital because of various harmful contaminants for patients. The aim of this study was to assess the efficiency of hemodialysis instruments in the removal of microbial and chemical pollutant in educational hospitals affiliated to Ahvaz Jundishapur University of medical sciences, Iran during 2018–2019. This cross-sectional descriptive research studied the microbial and chemical water quality of hemodialysis instruments in Razi, Sina, and Golestan hospitals in Ahwaz, Iran. 72 samples of microbial parameters and 24 samples of chemical parameters were collected from water used in hemodialysis instruments, including microbial characteristics  and chemical characteristics (pH, turbidity, PO Levels of microbial and chemical pollutants in water used in hemodialysis machines have become a global problem today for patents . EnterinWater quality is important for preparation of dialysis solution due to its direct relationship with blood of patients with renal failure . HospitaThe used dialysis liquid is considered as the largest volume of water used in medicine . Water uBased on several reported studies, the main chemical agents' effects on process dialysis in hemodialysis machines include trace elements ; ionic compounds ; chemical additives to water  and physiology elements  –18. The The use of normal tap water always carries the possibility of transferring potentially toxic substances from the dialysis fluid to the patient's blood, therefore the quality of the water used to prepare the dialysis solution is very important. Because of the logical connection between water quality and the health of patients Dialysis, physicochemical and microbial quality compliance water used to prepare dialysis fluid with standards international seem necessary .Pathogenic microorganisms, disinfectants, pharmaceuticals, toxic, radioactive elements, chemicals, and microbial pollutants in water resources can all have a significant impact on human and animal health , 24. TheThe distribution network, state hospital sanitation, number of beds for dialysis, cultural situation, climatic conditions are the main agents affecting the quality and quantity of medical center water used in hemodialysis instruments , 19. EvaSurface waters are the primary source of water in Iran's southwestern region and the Khuzestan Plain . Due to the abundant resources of surface water and fertile soil, this region is one of the most strategic agricultural poles of Iran, which has a large share in the production of agricultural products . In AhvaThe high potential of Ahvaz for development  and the need to equip and construct new medical centers and hospitals, increases the importance of this research. As a result, the primary goal of this study was to determine the efficacy of hemodialysis instruments in removing toxic, microbial, and chemical pollutants in the educational hospital Ahvaz Jundishapur University of Medical Sciences in southwest Iran from 2018 to 2019.4, Na, Ca, Mg, and HPC values were determined according to the standard methods . It borders Iraq on the west and the Persian Gulf on the south  38). Ah. Ah38).  methods –45.4, Cl, Mg, So4, Ca, NO2, and EC) in educational hospital affiliated to Ahvaz Jundishapur University of medical sciences (located in south-western Iran) during 2018–2019 by using hemodialysis devices system which includes 2 years including 2018–2019.In this study, we used to assess the potential haemodialysis devices on removing the microbial characteristics  and chemical characteristics , residual chlorine, sodium (flame photo meter), magnesium, calcium (titration), and sulfate (spectrophotometry method) on the efficiency of removal  in sterile glass containers with a sanding head to volume 250 mL from the water inlet to hemodialysis machines. Samples of input hemodialysis devices were collected from Razi, Imam, and Golestan hospitals' dialysis departments and transferred to a laboratory for further analysis. Temperature and pH parameters were measured  removal –48. ElecThe levels of microbial and chemical pollutants in hemodialysis instruments were collected from the three hospitals in Ahvaz city  during 2018–2019. The coded data was entered into the SPSS software. Data analyses were performed, using SPSS-18. The data were analyzed using descriptive statistics and the mean standard deviation of the mean (SD).4, Cl, Mg, So4, Ca, NO2, and EC characteristics of the hospital hemodialysis machines , , , , , , , , and , respectively. 4, Cl, Mg, So4, Ca, NO2, and EC were , , , , , , , , and , respectively.4, Cl, Mg, So4, Ca, NO2, and EC were , , , , , , , , and , respectively , , , , , , , , and , respectively during 2018 , , , , , , , , and , respectively , , , , , , , , and , respectively during cold season , , , , , , , , and , respectively during the warm season in Razi, Imam, and Golestan hospitals during 2018 , , , , , , , , and , respectively  and dialysate with particular toxicity in hemodialysis patients are raw water and municipal water, municipal water, dialysis facility, municipal water, raw water, and dialysis facility, respectively –54.According to different studies, the principal toxicities of chemical contaminants including copper, sulfate, chloramine, aluminum, fluoride, and nitrate are anemia , anemia , cardiovascular disease, and anemia, respectively –55.3, SO4, and Na shown by them . The result of their study showed that the residual chlorine and PH of water were less than the standard amount . In a siSome differences in the efficiency of hemodialysis instruments in the removal of microbial and chemical pollutants can be attributed to the quality of water supplied to water sources (surface and groundwater), the quality of water transmission and distribution network in different regions, geographical and climatic conditions in different regions of Iran or other countries, and the use of modern and up-to-date hemodialysis instruments.Different result of studies in the field of performance hemodialysis Instruments in dialysis ward at hospital and compared with our findings showed in An increasing amount of chemical and microbial pollutants can contaminate the burden of organic, microbial, chemical, and toxic pollution in the environment of the Karun river and underground sources that are fed from the Karun basin. It should be noted that the reduction of surface and groundwater quality in the region can have a direct effect on water quality in the provision of hemodialysis instruments and kidney patients referred to the dialysis wards of hospitals in Ahvaz.Any discharge of effluents and pollutants into the water supply sources of citizens and patients can greatly increase the level of dangerous and toxic pollutants that threaten the health of patients.This study investigated the performance of efficiency for hemodialysis instrument treatment in the removal of a level of microbial and chemical pollutants. Based on the results of the analysis, microbial and chemical pollutant removal during the study, had a significant direct effect on the river purification with hemodialysis instrument efficiency. Toxic, microbial, and chemical pollutants in the hemodialysis process can be very threatening to the patents. According to the results of this study, the mean value of microbial pollutants  was lower than the AAMI standard value. Also, the average level of chemical pollutants  was higher than the AAMI standard value. The results of this study showed that pollutants discharged into the Ahvaz Karun river are the main cause of chemical and microbial pollutants in water in this region. The results of this study showed that the health of dialysis patients, the general health of the community, and the environment are directly affected by the essential elements of bioavailability of water. Appropriate microbial and chemical water quality used in dialysis machines can be referred to the use of appropriate devices, periodic monitoring and supervision of medical engineering and environmental health experts, proper management of these devices, and the importance of managers to provide optimal services to kidney patients in the dialysis ward. The most important trends that health policymakers and experts should pay attention are updating dialysis machines with new technology, using new membrane filters with higher efficiency and using primary sources of higher quality water among. Further studies are required to assess the efficiency of hemodialysis instruments in the removal of the level of another pollutant that threatens the patents' health.The original contributions presented in the study are included in the article/HAS, ATJ, GS, ZS, AT, FK, and MJM were principal investigators of the study, drafted the manuscript, and performed the statistical analysis. HAS, ATJ, GS, and MJM were advisors of the study. All authors contributed to the design and data analysis, assisted in the preparation of the final version of the manuscript, read, and approved the final version of the manuscript.This work was funded by the grant: (ETRC-9907) from Ahvaz Jundishapur University of Medical Sciences. This study was originally approved by the Ahvaz Jundishapur University of Medical Sciences with code IR.AJUMS.REC.1399.512.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Current data suggest that SARS-CoV-2 reinfections are rare. Uncertainties remain, however, on the duration of the natural immunity, its protection against Omicron variant, and on the impact of vaccination to reduce reinfection rates. In this retrospective cohort analysis of the entire population of an Italian region, we followed 1,293,941 subjects from the beginning of the pandemic to the current scenario of Omicron predominance (up to mid-February 2022). After an average of 277 days, we recorded 729 reinfections among 119,266 previously infected subjects , eight COVID-19-related hospitalizations , and two deaths. Importantly, the incidence of reinfection did not vary substantially over time: after 18–22 months from the primary infection, the reinfection rate was still 6.7‰, suggesting that protection conferred by natural immunity may last beyond 12 months. The risk of reinfection was significantly higher among females, unvaccinated subjects, and during the Omicron wave. After the first documented case in August 2020 in Hong Kong , a numbeWe included all residents in the Abruzzo Region, Italy with ≥1 positive nasopharyngeal swab detected through RT-PCR by the regional-accredited laboratories, from the start of the pandemic  up to January 4, 2022. On February 18, 2022 , we extracted all data of the official vaccination , COVID-19 (“Surveillance COVID-19 Platform”), demographic , hospital , and co-pay exemption  datasets of the National Healthcare System, merging individual information through encrypted fiscal code  was used for all analyses.The proportion of reinfections was computed in the total sample, and by demographic and clinical characteristics, time after primary infection , and predominant circulating variant . Cox proportional hazard analysis was then used to compute the relative hazards of reinfection, after adjusting for age, gender, vaccine status , severe COVID-19 after the first infection, and comorbidities, all included From the start of the pandemic, a total of 251,047 infections were detected among the 1,293,941 residents in the Abruzzo Region. After the exclusions of the subjects with a follow-up <45 days, or lacking negative intermediate swabs, a total of 119,266 subjects with primary infection were included in the analysis. The average time after the primary infection was 277 days ; 3,001 subjects had a follow-up longer than 18 months .Overall, the incidence of reinfection was 6.1‰ (n = 729). Eight subjects were hospitalized due to COVID-19 , and two died .n = 613; 11.4 per day) than during the 317 days of the pre-Omicron period . In contrast, the incidence of reinfection did not vary substantially by baseline comorbidities and over time: after 18 or more months from the primary infection (up to 22 months), the reinfection rate was still 6.7‰. The multivariable analysis  confirmed univariate results . The Ethics Committee waived the requirement of written informed consent for participation.MF, GS, CAM, and LM: concept and design. GS, GDM, RC, and LM: acquisition, analysis, or interpretation of data. MF, CAM, and LM: drafting of the manuscript. GS, GDM, AC, and LM: critical revision of the manuscript for important intellectual content. MF and LM: statistical analysis. GS, GDM, RC, and AC: administrative, technical, or material support. AC and LM: supervision. LM: had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Background: Equity, equality, diversity, and inclusion are terms covered in the academic literature focusing on sports, kinesiology, physical education, and physical activity, including in conjunction with marginalized groups. Universities in many countries use various EDI policy frameworks and work under the EDI headers “equality, diversity and inclusion”, “equity, diversity and inclusion”, “diversity, equity and inclusion”, and similar phrases  to rectify problems students, non-academic staff, and academic staff from marginalized groups, such as women, Indigenous peoples, visible/racialized minorities, disabled people, and Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and Two-Spirit (LGBTQ2S+) experience. Which EDI data, if any, are generated influences EDI efforts in universities  of all programs. Method: Our study used a scoping review approach and employed SCOPUS and the 70 databases of EBSCO-Host, which includes SportDiscus, as sources aimed to analyze the extent (and how) the academic literature focusing on sports, kinesiology, physical education, and physical activity engages with EDI. Results: We found only 18 relevant sources and a low to no coverage of marginalized groups linked to EDI, namely racialized minorities (12), women (6), LGBTQ2S+ (5), disabled people (2), and Indigenous peoples (0). Conclusions: Our findings suggest a gap in the academic inquiry and huge opportunities. Many different EDI-related phrases, such as “equity, diversity and inclusion”, “diversity, equity and inclusion”, and others ,20,21,22Many different EDI-related phrases have been generated in recent years, such as equity, diversity, and inclusion ; equalitWork performed under these EDI frameworks and EDI phrases are envisioned to lead to systemic positive change for students, academic staff, and non-academic staff in universities as a workplace, in general, but also in the research and education reality . Althoug“Dimensions: equity, diversity and inclusion Canada invites you to take part in a post-secondary transformation to increase equity, diversity and inclusion (EDI) and help drive deeper cultural change within the research ecosystem” . “The DiHowever, many problems have been identified, in relation to EDI implementations .Studies focusing on sports engage with equity and equality, in the context of the EDI groups of gender ,40,41,42Studies focusing on kinesiology engage with equity and equality, in the context of the EDI groups of gender ,84,85,86Studies focusing on physical education engage with equity and equality, in the context of the EDI groups of gender ,100, racStudies focusing on physical activity discuss equity and equality, in the context of the EDI groups of gender , race 1,124,125,UN Convention on the Rights of Persons with Disabilities flags access to recreation, leisure, and sport in their daily life, including schools [The  schools , as a pr schools ,141,142. schools , differe schools , and ben schools . Nationa schools  (p. 291) schools . These p schools , and it  schools . Many pr schools . Problem schools  (p. 71), schools . Accordi schools  (p. 91). schools , non-dis schools , diversi schools , more ha schools  (p. 225) schools  (p. 225)Disabled activists and academics coined the term ableism in the United States and Britain during the 1960s and 1970s to flag the cultural reality of ability-based expectations, judgments, norms, and conflicts. Many worked, and work is ongoing on the disabling and enabling use of ability expectations and ableism ,175,176,Ableism is also used to call out ability-based discriminations against disabled people within the kinesiology, sport, physical education, and physical education literature ,193,194,As to physical education, instructional ableism and microaggressions is flagged as a problem , and it Regarding sports, it is argued that ableism impacts social practice within sports, and ableism in sports has to be addressed ,195. It Many studies cover individual EDI terms that make up the various EDI phrases in the context of sports, kinesiology, physical education, and physical activity. However, to our knowledge, no study has, so far, analyzed whether the academic literature also engages with the existing EDI phrases and frameworks. That is important to know because EDI phrases and frameworks are linked to specific policy endeavors in the workplace, such as universities. How these policies are implemented impacts the research and education activities of and day-to-day operations in the fields of sports, kinesiology, physical education, and physical activity. Our study aims to fill the gap and investigate to what extent (and how) the academic literature focusing on sports, kinesiology, physical education, and physical activity engages with existing EDI phrases and frameworks. Given that specific marginalized groups are the focus of the activities performed under the EDI phrases and frameworks, our study also investigated which marginalized groups are mentioned.Scoping studies are useful in identifying the research that exists on a subject ,199. OurOur study employed a modified version of a scoping review outlined by Arksey and O’Malley , as perfWe searched, on 22–26 May 2021 , the 70 databases accessible through EBSCO-Host, which includes CINAHL, SportDiscus, and Scopus (which incorporates the full Medline database collection) for English language data with no time restrictions, accessing journals that cover relevant content to our research questions. We searched for scholarly peer-reviewed journal articles in EBSCO-Host, and we searched for reviews, peer-reviewed articles, conference papers, and editorials in Scopus. We performed the following search strategies .To answer the research questions, we first obtained hit counts for our search term combinations , employiAs to trustworthiness measures ,208,209,The search strategies generated 26 abstracts, of which 18 were deemed to have relevant content. The full texts of the 18 relevant abstracts were downloaded and thematically analyzed . (a)The first one being academic/educational setting, but not university, which was classified as anything that is related to academics  setting; for example, research conferences that are open to all fields of studies and careers, K to 12 education, and other academic organizations.(b)Non-academic settings, which primarily looked at sport facilities and organizations, recreational facilities and organizations, and general physical activity.(c)University setting, consisting of discussions around different university institutions and, specifically, different areas of the faculty of kinesiology.We present the themes in the downloaded full text articles in three sections:We separated the findings further by the following four areas: physical education, sport, physical activity, and kinesiology.Furthermore, we separate the findings into the four common themes we found: (a) EDI recommendation/EDI needs, (b) EDI curriculum and teacher/educator/mentor role in EDI, (c) EDI literacy/EDI narrative, and, lastly, (d) EDI study results.Finally, we separated the results according to which EDI group they looked at. If a source did not specifically discuss equity deserving groups, it was labelled as “no group”.In each of the results sections, we first provide the frequency counts for the presence of themes we found. We only list where there was at least one hit for the theme. The themes that had 0 results are not listed in the tables.-0 results on physical education, in terms of EDI study results;-0 results on sport, in terms of EDI curriculum and educators and mentor’s role in EDI;-0 results on physical activity, in terms of EDI recommendations/EDI needs;-0 results on physical activity, in terms of EDI curriculum and educators and mentor’s role in EDI;-0 results on physical activity, in terms of EDI literacy/EDI narrative;-0 results on physical activity, in terms of EDI study result;-0 results on kinesiology, in terms of ALL the EDI-related themes.Within the academic/educational setting theme, the following themes returned no results and, as such, are neither listed in There were twelve findings, in a total of five sources, that discussed EDI recommendations/EDI needs, in the context of physical education in an academic setting. Out of the twelve findings, one of them discussed persons with disabilities, three of them discussed ethnic groups, and eight of them did not cover any specific EDI group.The Recreational Sports Journal, and found that EDI was not discussed in a meaningful way during the time period of their study; it is very important to address this void and publish more papers that cover EDI topics [The EDI recommendation related to persons with disability(s) in physical education settings was that regular contact with non-disabled children in physical education classes aids in the inclusion of those with disabilities in society . The EDII topics . It was I topics .There were nine findings, in a total of three sources, that discussed EDI curricula and the teachers/educator/mentor role in EDI, in the context of physical education in an academic setting. Out of the nine findings, one of them discussed ethnic groups and the other eight covered no specific EDI group. In terms of ethnic groups, it was discussed that taking the initiative to build EDI curricula brings the opportunity to include more culturally responsive and cultural enrichment pedagogy . The folJournal of Sport Rehabilitation for their commitment to diversity, equity, and inclusion [There were three findings, out of a total of one source, that discussed EDI recommendation/EDI needs, in the context of sports in an academic setting. Out of those three findings, none of them covered a specific EDI group. The source was a statement that was put out by the nclusion . In the nclusion . They stnclusion . They funclusion .The following source discusses reflections that occurred at EDI conferences . This soRecreational Sports Journal [Recreational Sports Journal articles that were analyzed, 18% addressed at least one equity diversity and/or inclusion issues [There were seven findings, out of a total of two sources, that discussed EDI study results, in the context of sports in an academic setting. One of the sources covered all EDI groups, whereas the other source did not cover any EDI groups. The first source was a content analysis of equity, diversity, and inclusion in the  Journal , perform Journal . In this Journal . It is i Journal . This con issues . Furthern issues . The secn issues . In thisn issues . It was n issues .-0 results on physical education, in terms of all the EDI-related themes;-0 results on sports, in terms of EDI curriculum and educator/mentor’s role in EDI;-0 results on sports, in terms of EDI literacy/EDI narrative;-0 results on physical activity, in terms of EDI curriculum and educators/mentor’s role in EDI;-0 results on physical activity, in terms of EDI literacy/EDI narrative;-0 results on physical activity, in terms of EDI study results;-0 results on kinesiology, in terms of ALL the EDI-related themes.Within the non-academic setting theme, the following returned no results and, as such, are neither listed in There was one finding, through one source, that discussed EDI recommendations/EDI needs in the context of physical activity in a non-academic setting. This EDI recommendation/EDI need did not cover any specific EDI group. It was discussed that there is an “urgent need” to address EDI within intramural and recreational sports . This reThere were five findings, in a total of four sources, that discussed EDI recommendations/EDI needs in the context of sport in a non-academic setting. Out of those five findings, one discussed women and ethnic groups, one discussed ethnic groups, and two discussed no EDI groups. The EDI recommendation and need to promote racial EDI within black women’s football in Brazil were highlighted . This reThere were eight findings, out of a total of three sources, that presented EDI study results in the context of support in a non-academic setting. Out of the eight findings, four discussed LGBTQIA+ topics, two discussed women, one discussed ethnic groups, and one discussed both women and ethnic groups. One EDI study result discussing LGBTQIA+ was that athletes have a fear of disclosing their sexuality or sexual orientation, in fear of discrimination from the sports industry . Because-0 results on physical education, in terms of ALL the EDI-related themes;-0 results on sports, in terms of EDI curriculum and educator/mentor’s role in EDI;-0 results on sports, in terms of EDI literacy/EDI narrative;-0 results on sports, in terms of EDI study result;-0 results on physical activity, in terms of ALL the EDI-related themes;-0 results on kinesiology, in terms of EDI curriculum and Educators/mentors role;-0 results on kinesiology, in terms of EDI/EDI narrative.Within the university setting theme, the following returned no results and, as such, are neither listed in There were four findings, in a total of two sources, that discussed EDI recommendation/EDI needs in the context of sport in a university setting. Out of those four findings, none of them discussed a specific EDI group. One of the findings presented the recommendation that, for the future of college recreational sports programs, those programs have a responsibility to address the needs of the changing demographic interests, as well as the diverse students on campus . This soThe recommendation in this one source addressed that the kinesiology program design can use student narratives and experiences to make the shift from neutral documents and pedagogy to ones that expose and work towards dismantling Eurocentricity within the field of study .The objective of this study was to ascertain to what extent (and how) the academic literature focusing on sports, kinesiology, physical education, and physical activity engages with the various EDI phrases and frameworks, as well as which of the marginalized groups covered under EDI are mentioned in the literature covered.We found only 18 relevant hits with all our search strategies, whereby the EDI frameworks were not at all found. Only ‘sport*’ generated any hits related to EDI phrases; the other three fields did not. The majority of our findings were based on the presence of all the individual EDI terms, but not as phrases; within these sources, the term “sport*” was the most linked to EDI, with much less physical activity or physical education and even less kinesiology. On top, we found a very low to no coverage of marginalized groups normally linked to EDI, namely racialized minorities (12), women (6), LGBTQ2S+ (5), disabled people (2), and Indigenous peoples (0), within the already low coverage of EDI.Altogether, our findings suggest a huge gap in the academic inquiry and huge opportunities for research on EDI within sports, physical education, physical activity, and kinesiology by themselves, but also in collaborations with many other fields and groups, such as disability studies and other identity group studies, social justice studies, education, media studies, global south focused studies, sustainability studies, socially disadvantaged groups, practitioners, and policy makers. Given that ableism is employed in the academic literature covering sports, physical education, physical activity, and kinesiology, we especially see opportunities for sports, physical education, physical activity, and kinesiology academic efforts to use the ableism lens to enrich the EDI discourses. For the remainder of the section, we discuss the problems of our findings, using as lenses: (a) the academic literature related to physical education, sport, physical activity, and kinesiology, individually covering the terms equity, equality, inclusion, and diversity; (b) the premise of the EDI frameworks and phrases, in general, as well as in the context of disabled people; and (c) ableism experienced by disabled people, but also beyond.Efforts performed under the EDI frameworks and EDI policy terms are envisioned to lead to systemic positive change for students, academic staff, and non-academic staff in universities, as a workplace, in general, but also in the research and education reality in universities ,34,35,36Given this sweeping mandate for positive systemic and cultural changes EDI actions are to engender, much more should have been found in our searches that link sports, physical education, physical activity, and kinesiology to EDI policy frameworks and phrases with particular emphasis on the EDI targeted groups. However, our findings are not surprising, as the EDI frameworks and phrases are rarely visible in other contexts either, such as disabled people, in general . HoweverIn sports, physical education, physical activity, and kinesiology, the individual terms of equity, equality, diversity, and inclusion are discussed, in the context of the EDI groups of gender, race, LGBTQ2S+ ,125,126,Ableism is a term coined by disabled activists and academics to flag the cultural reality of ability-based expectations, judgments, norms, and conflicts ,175,176.The cultural reality of ableism is intersectional ,180,181.The search was limited to two academic databases and English language literature. As such, the findings are not to be generalized to the whole academic literature, non-academic literature, or non-English literature. These findings, however, allow conclusions to be made, within the parameters of the searches.The low hits we obtained in our scoping review suggests a gap in academic inquiry around EDI and sports, physical education, physical activity, and kinesiology. Many research projects could evaluate the existing EDI frameworks and EDI phrases, through the lens of sports, physical education, physical activity, and kinesiology. One could answer the following research questions: What do the EDI phrases mean for sports, physical education, physical activity, and kinesiology? Which phrases are the most suitable for sports, physical education, physical activity, and kinesiology? Do words have to be added to the phrases? Why has the academic literature in sports, physical education, physical activity, and kinesiology not engaged with the phrases and frameworks yet? What are the societal consequences of sports, physical education, physical activity, and kinesiology not generating academic data and engaging with the EDI frameworks and phrases? Answers to these questions can be obtained conceptually for sports, physical education, physical activity, and kinesiology, with surveys and interviews covering EDI-deserving groups on the level of students, academic staff, and non-academic staff. This research can engage with workplace climate, education, and research realities. For example, in a 2019 Statistics Canada survey, it is stated that 35% of disabled university professors, instructors, teachers, or researchers “experienced unfair treatment or discrimination in the past 12 months”, and 47% saw themselves “subjected to at least one type of harassment in the past 12 months” . Within


Dear Editor,Dracocephalum kotschyi and Trachyspermum ammi’ by Zarei-Yazdeli et al. (T. ammi seed extract (TASE) inhibited some pathogenic microorganisms such as Pseudomonas aeruginosa, Shigella dysenteriae, Escherichia coli and Staphylococcus aureus. The paper stated that seed extract from this plant can be considered as a phytochemical preservative in the food industry in the future. However, whilst there are some studies about TASE, it seems to me that the studies relating to the extraction process, biological effects and chemical components of this material are still insufficient.I read with interest the manuscript titled ‘Evaluation of antibacterial synergism of methanolic extract of i et al. , in whicT. ammi is commonly known as ajwain or ajowan. All parts of this plant can be used in medicine, especially the seeds, which contains carbohydrates, fibre, tannins, glycosides, protein, fat, saponins, flavones and minerals while the essential oil (EO) of the seeds possesses a large amount of precious components, including γ-terpinene, p-cymene and thymol. This material has many medical applications, such as antifungal, antioxidant, antimicrobial, antinociceptive, cytotoxic, hypolipidemic, antihypertensive, antispasmodic, broncho-dilating actions, antilithiasis, diuretic, abortifacient, antitussive, nematicidal, anthelmintic and antifilarial  ratios are different in all studies, ranging from 1/10 to 3/10 (g/mL)   , 3, 6, w species , althoug species , 9. ThisThere are no official standards and published reports on the specific chemical compounds (non-volatile compounds) that exist in TASE. In my opinion, non-volatile compounds such as phenolic acids, saponins, alkaloids or flavonoids are also extremely important for the bioactivity of the extract. We can completely determine these compounds by high-performance liquid chromatography (HPLC); however, this method is quite complex and costly and needs many different standard substances to screen and identify the chemical components. Therefore, in my opinion, finding new or precious compounds in TASE by HPLC is very interesting and necessary, as this will help us to clarify the roles of the bioactive compounds.In general, the bioactivity of TASE strongly depends on the extraction conditions and chemical components. I believe that we still have the space to study some issues related to this material and that the scientific results obtained will be very valuable as they will enhance our knowledge, which can be widely applied in the pharmaceutical and medical fields.


Chimeric antigen receptor (CAR) T cell therapy has transformed the care of patients with relapsed/refractory large B cell lymphoma and is associated with unique toxicities, in particular cytokine release syndrome (CRS) and neurotoxicity/immune effector cell‐associated encephalopathy syndrome (ICANS) , 2, 3. TA 28‐year old woman with refractory primary mediastinal B cell lymphoma was referred for standard of care (SOC) CAR T cell therapy after receiving R‐CHOP  chemotherapy, radiation, and GDP  salvage chemotherapy. Due to tumor burden with extensive abdominal involvement, she received bridging therapy with pembrolizumab, dexamethasone, and radiation to the right kidney  for presumed transverse myelitis but returned on D+33 with worsening ascending numbness, bilateral leg weakness, and urinary retention Figure . On examOver the next 4 months, the patient regained some motor strength in the lower limbs  and reported improvement in sensory symptoms . Follow‐up imaging of the spine on D+208 showed significant improvement in cord signal change from T1 ‐ T6 with resolution of enhancement  disruption which may facilitate the influx of cytokines, recruitment of monocytes, and activation of macrophages, but elevated levels of the excitatory N‐methyl‐D‐aspartate receptor agonists glutamate and quinolinic acid have also been described , 9, 17.Risk factors associated with the development of neurotoxicity include patient‐related factors such as younger age, higher tumor burden, and a history of early and/or high‐grade CRS, as well as product‐related characteristics such as CAR design and choice of lymphodepletion regimen , 5, 6. OOne limitation of this case report is that in the SOC setting CAR T cells are not routinely quantified or phenotyped, and, therefore, we could not determine if there were any CAR T cell characteristics that differed in this case, and neither was it possible to determine the presence of CAR T cells in the CSF. The patients who developed leukoencephalopathy in the case report from ZUMA‐1, for example, were found to have a massive expansion of peripheral CAR T cells and prominent features of BBB disruption .Interestingly, it is also unclear whether any of the treatments pursued  changed the disease course or whether time alone leads to disease improvement in such cases. Rituximab was not administered as CD19 CAR T cell therapy strongly depletes B cells, and additional B cell depletion was considered unlikely to be of benefit.As a relatively new technology, rare and unexpected side effects may occur in patients receiving CAR T cell therapy. Reporting and collection of such cases will help to increase awareness of rare presentations and advance the expertise in managing these challenging cases.SS, SM, JAS, KR, NF, DW: No disclosures. RF: Research funding from Novartis and Kite. MLD: Research funding from Celgene, Novartis, Kite, and Atara; other financial support from Novartis, Precision Biosciences, Celyad, Bellicum, and GlaxoSmithKline; stock options from Precision Biosciences, Adaptive Biotechnologies, and Anixa Biosciences. FLL: Scientific advisory role with Kite, a Gilead Company, Novartis, Celgene/Bristol‐Myers Squibb, GammaDelta Therapeutics, Wugen, Amgen, Calibr, and Allogene; consultant with grant options for Cellular Biomedicine Group, Inc.; research support from Kite, a Gilead Company. MDJ: Consultancy/advisory role for Kite/Gilead, Novartis, Takeda, and BMS. JGK: Consultant or advisory role for Abbvie, BMS, Gilead, Karyopharm, Merck, Roche, Seattle Genetics; honoraria from Amgen, Antengene, Astra Zeneca, BMS, Gilead, Incyte, Janssen, Karyopharm, Merck, Novartis, Pfizer, Roche, Seattle Genetics, TG Therapeutics; research funding from Canadian Cancer Society, Leukemia and Lymphoma Society Canada, Princess Margaret Cancer Foundation, Janssen, Roche, Astra Zeneca; other remuneration from Karyopharm (DSMB).KR and RF performed cytokine and data analyses and reviewed the manuscript; JAS, MLD, NF, and FLL critically reviewed and edited the manuscript; SS, MDJ, DW, and JGK analyzed data and wrote and edited the manuscript.


Data science, information theory, probability theory, statistical learning, statistical signal processing, and other related disciplines greatly benefit from non-negative measures of dissimilarity between pairs of probability measures. These are known as divergence measures, and exploring their mathematical foundations and diverse applications is of significant interest , and itvergence ,13. The i-Silvey , Csiszári-Silvey ,16,17, ai-Silvey , is a usf-divergences. The latter implies, in particular, that the Jensen–Shannon divergence satisfies data-processing inequalities. The first paper in this Special Issue [Relative entropy is a well-known asymmetric and unbounded divergence measure , whereasal Issue , authoreal Issue  further Many of Shannon’s information measures appear naturally in the context of horse gambling, when the gambler’s utility function is the expected log-wealth. The second paper , coauthof-divergences. The third paper [f-divergences. Applications that are studied in [The relative entropy  and the rd paper , by Nishudied in  include The interesting interplay between inequalities and information theory has a rich history, with notable examples that include the relationship between the Brunn–Minkowski inequality and the entropy power inequality, transportation-cost inequalities and their tight connections to information theory, logarithmic Sobolev inequalities and the entropy method, inequalities for matrices obtained from the nonnegativity of relative entropy, connections between information inequalities and finite groups, combinatorics, and other fields of mathematics . These properties lead to f-divergence inequalities, and to information-theoretic applications  strongly convex divergence dominates the square of the total variation, which extends the classical bound provided by the chi-squared divergence. Its analysis also yields improvements of Bayes risk f-divergence inequalities, consequently achieving a sharpening of Pinsker’s inequality.Basic properties of an e, e.g., ,35,36,37e, e.g., ,40,41,42e, e.g., , authoref-divergences, which contains most of the classical inferential tools, and which is indexed by a single scalar parameter. This class belongs to the family of f-divergences, and is usually referred to as the power divergence class, which has been considered by Cressie and Read [Divergences between probability measures are often used in statistics and data science in order to perform inference under models of various types. The corresponding methods extend the likelihood paradigm, and suggest inference in settings of minimum distance or minimum divergence, while allowing some tradeoff between efficiency and robustness. The sixth paper , authoreand Read ,45. The and Read  states tThe seventh paper by Verdú  is a reslarly to  (the seclarly to , it is wlarly to . In the larly to , the thistudy in . Furtherstudy in  closes tstraints ,49, by mf-divergence measures are considered. The optimal design of the linear transformation of the data onto a lower-dimensional subspace is characterized for zero-mean Gaussian models, and numerical algorithms are employed to find the design for general Gaussian models with non-zero means.In statistical inference, the information-theoretic performance limits can often be expressed in terms of a statistical divergence measure between the underlying statistical models (see, e.g.,  and refeIt is our hope that the reader will find interest in the eight original contributions of this Special Issue, and that these works will stimulate further research in the study of the mathematical foundations and applications of divergence measures.


N-nitroso compounds (NOCs) are a class of chemical carcinogens found in various environmental sources such as food, drinking water, cigarette smoke, the work environment, and the indoor air population. We conducted a systematic review and meta-analysis to investigate the links between nitrate, nitrite, and NOCs in food and water and the risk of gastrointestinal (GI) cancers, including esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), and pancreatic cancer (PC). A systematic search of the literature in Scopus, PubMed, Google Scholar, Web of Science, ScienceDirect, and Embase was performed for studies on the association between NOCs in drinking water and food sources and GI cancers. Forest plots of relative risk (RR) were constructed for all the cancer sites and the intake sources. The random-effects model was used to assess the heterogeneity between studies. Forty articles were included after removing duplicate and irrelevant articles. The meta-analysis indicated that the intake of high dose vs. low dose of these compounds was significantly associated with the overall GI cancer risk and nitrite , and N-nitrosodimethylamine (NDMA) . We found that dietary nitrite intake increased GC , and EC . Additionally, dietary NDMA intake increased the risk of CRC . This meta-analysis provides some evidence that the intake of dietary and water nitrate, nitrite, and NOCs may be associated with GI cancers. In particular, dietary nitrite is linked to GC and EC risks and dietary NDMA intake is associated with CRC. In 2020, cancer accounted for nearly 10 million deaths and nearly one in six deaths worldwide. Gastrointestinal (GI) cancers, with an estimation of approximately 5 million new cases and 3.5 million deaths worldwide, accounted for half of the cancer burden in 2020 [H pylori infection, high body mass index, low physical activity, and dietary factors [In addition to non-modifiable risk factors such as the demographic characteristics, family history, and genetic predisposition, some preventable risk factors are well established for GI cancer, including tobacco smoking, alcohol consumption,  factors ,4,5,6.The N-nitroso compounds (NOCs) are a broad class of chemical carcinogens that exist in various environmental sources such as food, drinking water, cigarette smoke, the work environment, and the indoor air population, although intrinsic sources are also available for crucial needs of our bodies ,10,11,12Several experimental and epidemiological studies have shown that nitrate, nitrite and NDMA can affect human health , includiThe online database searches were performed in January 2022. Searches were undertaken for English-language peer-reviewed publications on the association of nitrate, nitrite, and NOCs and the risk of GI cancers between 1990 to the present. The databases included Scopus, PubMed, Google Scholar, Web of Science, ScienceDirect, and Embase. The search strategy was designed using MeSH terms like “Gastrointestinal Cancers”, “Digestive System Cancers”, “Organic Chemicals”, “Nitroso Compounds”, “Nitrate”, “Nitrite”,”NDMA”, and “Epidemiologic Studies”. Based on our searches on the databases, a total of 12,750 articles were retrieved, including 4539 articles for GC, 2204 for EC, 6673 for CRC, and 2243 for PC. A total of 40 studies were included after the title, abstract, full-text evaluations, and quality assessment ,60,61,62The study screening and quality assessment were conducted by three researchers , and in the event of any discrepancies, a referee (EM) intervened. The data extraction file contained the demographic characteristics of the article such as the author’s name, the year of publication, the title, the type of study, the country, as well as the design characteristics, including the sample size, the sampling method, the source of the population, the type of controls, the type of cancer, the source of nitrate, nitrite, and the NOCs , and the method of data collection . Finally, the effect size measures, including the relative risks (RRs) for the cohort studies and the odds ratios (ORs) for the case-control studies and their 95% CI were abstracted.Quality assessment of the included articles (case-control or cohort studies) was accomplished using the Newcastle-Ottawa Scale (NOS) . For cas2 statistic  [2 > 60%), was estimated using a random-effects model [p-value of heterogeneity was assessed using a sub meta-analysis. Moreover, publication bias was examined by creating a funnel plot and a regression asymmetry test [The relationships between nitrite, nitrate, or NMDA intake and the risk of GI cancers were examined based on the effect size measurements and the corresponding 95% CIs of each study. Because of the rare disease assumption, the ORs are assumed to approximate the RRs . Heteroggeneity) . The poots model . All anatry test ,69.A total of 40 independent studies were included in the meta-analysis, including 27 case-control studies ,57,60,61The meta-analysis was repeated for each cancer site based on the nitrate, nitrite, NDMA and the source intake.2 = 80.2%, P-heterogeneity = 0.025), the food intake of nitrate , and the food intake of nitrite  . There were no statistically significant excess risks from the food sources of nitrate, NDMA, or the water sources of nitrate intake. We observed significant heterogeneity for studies of the food sources of NDMA (I= 0.004) . There w= 0.004) .2 = 92.2%, P-heterogeneity = 0.000). Additionally, there were significant heterogeneities for studies of the food intake of NDMA , the food intake of nitrate , and the water intake of nitrate   (I= 0.000) . We foun= 0.000) .2 = 73.4%, P-heterogeneity = 0.002), the food nitrite intake , and the water intake of nitrate  . No statistically significant heterogeneity across studies was observed for CRC in relation to NDMA intake, but heterogeneity was statistically significant for studies of the food nitrate intake (I= 0.000) . Stratif= 0.000) .2 = 80.7%, P-heterogeneity = 0.000), and nitrite   . No sign= 0.000) .We found limited high-quality research on nitrate, nitrite, NOCs, and cancer risk, most likely due to the difficulty of quantifying these compounds from different sources worldwide. Despite this limitation, the literature suggests that dietary and water sources may be risk factors for GI cancers, in particular, nitrate intake from water sources and diet for CRC, nitrite intake from diet for GC, and NDMA intake for CRC and EC ,56,59,70Nitrate and nitrite as precursors of the NOCs  are suspected of playing a key role in cancer carcinogenesis through the induction of DNA-damaging metabolites, like aldehydes and alkyldiazonium ions, which could cause cancerous lesions in cells ,16,58,70H pylori infection in the GC studies [There was heterogeneity in the study designs and the methodologies, which may explain the differences in the results of the published studies. The high heterogeneity observed in our meta-analyses may be due to the variety of confounders used in the models as well as the differences between the study settings, the population characteristics, the compound ranges, and the estimation methods. Except for age and gender, other confounders were less consistently controlled for, particularly dietary factors and specific risk factors, such as  studies .The number of reviews for EC was limited. A meta-analysis study by Lie et al.  in 2016 H.pylori infection may increase the NOCs product level and increase the risk of GC [In 2016, Lie and others found an inverse association between dietary nitrate consumption and GC, and a borderline association between dietary nitrite consumption and GC . In 2015sk of GC .Previous studies on association between the NOCs and CRC are inconsistent. In 2016, one systematic review reported that dietary nitrite/nitrate intake was not significantly linked with CRC , howeverNone of the previous reviews reported a significant relationship between dietary or water intake of nitrate, nitrite, and NDMA and the risk of PC ,19. Our The geographical distribution of the studies plays an important role in achieving reliable results. A majority of the studies included in our review were conducted in Europe (30%) and North America (48%), and we found no reliable studies from low- and middle-income countries (LMICs). As a result, our findings cannot be generalized to LMICs, where the amounts of nitrate, nitrite, and NOCs may vary based on the dietary patterns, the cooking methods, the water sources, the effect of seasonal rainfall on water compounds, and the fertilizer compounds . Also, mIn conclusion, our meta-analysis shows modest evidence on the association between dietary and water nitrate, nitrite, and NOCs intake and certain types of GI cancer risk. The dietary intake of nitrite is associated with GS and EC and the dietary NDMA intake is associated with CRC. In future studies, the influence of different compound types on cancer should be explored by considering the source intake, and gender differences, particularly in less studied geographical regions.