{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:44:39Z","timestamp":1791222279229,"version":"4.1.0"},"reference-count":229,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Heavy metals including mercury (Hg), lead (Pb), cadmium (Cd), and arsenic (As) remain significant global toxins due to their environmental persistence, widespread anthropogenic release, and serious biological effects. This review consolidates current understanding of their natural and industrial sources, environmental cycling, human exposure routes, and population-level vulnerabilities. It covers their toxicokinetics and toxicodynamics, emphasizing species-specific absorption, distribution, and injury mechanisms, including oxidative stress, thiol binding, mitochondrial dysfunction, endocrine disruption, and cancer risk. Clinical signs range from subtle neurocognitive impairment and kidney damage to severe acute poisoning. The review evaluates evidence-based approaches to risk assessment and biomonitoring, such as blood, urine, hair, and speciation tests, noting issues, including unvalidated provoked testing. Treatment focuses on removing exposure, providing nutritional support, and offering supportive care, with chelation therapy reserved for specific cases. It explains the chemistry, pharmacology, and roles of chelating agents\u2014ALA, DMSA, DMPS, Cys, GSH, and physiologic thiols, comparing their effectiveness, limitations, and costs for various metals. Emerging therapies, precision toxicology, and public health strategies are discussed within a prevention-focused context. Unlike prior reviews focused primarily on toxic mechanisms or isolated clinical management, this review integrates mechanistic toxicology, biomarker interpretation and speciation, evidence-based clinical care, and ethical, cost-conscious decision-making within a single translational framework. This narrative review synthesizes foundational and contemporary literature published through 2025, with particular emphasis on studies published since 2000 that inform toxicokinetics, biomarker interpretation, diagnostics, clinical management, and prevention.<\/jats:p>","DOI":"10.3390\/ijms27083513","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T15:47:02Z","timestamp":1776181622000},"page":"3513","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Heavy Metal Toxicity in Clinical and Environmental Health: Sources, Mechanisms, Diagnostics, and Evidence-Based Management of Mercury, Lead, Cadmium, and Arsenic"],"prefix":"10.3390","volume":"27","author":[{"given":"Dib","family":"Chakif","sequence":"first","affiliation":[{"name":"Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2096-0618","authenticated-orcid":false,"given":"Julien","family":"Furrer","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020). Ten Chemicals of Major Health Concern, WHO. Available online: https:\/\/www.who.int\/news-room\/photo-story\/detail\/10-chemicals-of-public-health-concern."},{"key":"ref_2","unstructured":"Agency for Toxic Substances and Disease Registry (2025, December 25). Substance Priority List, Available online: https:\/\/www.atsdr.cdc.gov\/."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kabata-Pendias, A., and Mukherjee, A.B. (2007). Trace Elements from Soil to Human, Springer.","DOI":"10.1007\/978-3-540-32714-1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/0016-7037(95)00038-2","article-title":"The composition of the continental crust","volume":"59","year":"1995","journal-title":"Geochim. Cosmochim. Acta"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1029\/95RG00262","article-title":"The geochemical evolution of the continental crust","volume":"33","author":"Taylor","year":"1995","journal-title":"Rev. Geophys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1038\/338047a0","article-title":"A global assessment of natural sources of atmospheric trace metals","volume":"338","author":"Nriagu","year":"1989","journal-title":"Nature"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.15347\/wjs\/2018.007","article-title":"Lead: Properties, history, and applications","volume":"1","author":"Boldyrev","year":"2018","journal-title":"Wiki J. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5487\/TR.2016.32.1.065","article-title":"Cadmium Exposure and Potential Health Risk from Foods in Contaminated Area, Thailand","volume":"32","author":"Chunhabundit","year":"2016","journal-title":"Toxicol. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1006\/taap.1996.0244","article-title":"A Physiologically Based Pharmacokinetic Model for Arsenic Exposure","volume":"140","author":"Mann","year":"1996","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s10661-019-7528-7","article-title":"The relative impact of toxic heavy metals (THMs) (arsenic (As), cadmium (Cd), chromium (Cr)(VI), mercury (Hg), and lead (Pb)) on the total environment: An overview","volume":"191","author":"Rahman","year":"2019","journal-title":"Environ. Monit. Assess."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Balali-Mood, M., Naseri, K., Tahergorabi, Z., Khazdair, M.R., and Sadeghi, M. (2021). Toxic Mechanisms of Five Heavy Metals: Mercury, Lead, Chromium, Cadmium, and Arsenic. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.643972"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"115185","DOI":"10.1016\/j.ecoenv.2023.115185","article-title":"The potential of microorganisms as biomonitoring and bioremediation tools for mercury-contaminated soils","volume":"262","author":"Meyer","year":"2023","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Adriano, D.C. (2001). Trace Elements in Terrestrial Environments, Springer.","DOI":"10.1007\/978-0-387-21510-5"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Alloway, B.J. (2013). Heavy Metals in Soils: Trace Metals and Metalloids in Soils and Their Bioavailability, Springer. Environmental Pollution.","DOI":"10.1007\/978-94-007-4470-7"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5951","DOI":"10.5194\/acp-10-5951-2010","article-title":"Global mercury emissions to the atmosphere from anthropogenic and natural sources","volume":"10","author":"Pirrone","year":"2010","journal-title":"Atmos. Chem. Phys."},{"key":"ref_16","first-page":"63","article-title":"Speciation of Cadmium in the Environment","volume":"Volume 11","author":"Sigel","year":"2013","journal-title":"Cadmium: From Toxicity to Essentiality"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"304524","DOI":"10.1155\/2014\/304524","article-title":"Arsenic contamination of groundwater: A review of sources, prevalence, health risks, and strategies for mitigation","volume":"2014","author":"Shankar","year":"2014","journal-title":"Sci. World J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4048","DOI":"10.1016\/j.atmosenv.2006.03.041","article-title":"Global anthropogenic mercury emission inventory for 2000","volume":"40","author":"Pacyna","year":"2006","journal-title":"Atmos. Environ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2983","DOI":"10.1021\/es802474j","article-title":"Projections of Global Mercury Emissions in 2050","volume":"43","author":"Streets","year":"2009","journal-title":"Environ. Sci. Technol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1146\/annurev.environ.051308.084314","article-title":"Global Biogeochemical Cycling of Mercury: A Review","volume":"34","author":"Selin","year":"2009","journal-title":"Annu. Rev. Environ. Resour."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1579\/0044-7447(2007)36[19:ASOPAU]2.0.CO;2","article-title":"A Synthesis of Progress and Uncertainties in Attributing the Sources of Mercury in Deposition","volume":"36","author":"Lindberg","year":"2007","journal-title":"AMBIO J. Hum. Environ."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/S1352-2310(97)00293-8","article-title":"Atmospheric mercury\u2014An overview","volume":"32","author":"Schroeder","year":"1998","journal-title":"Atmos. Environ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.apgeochem.2010.11.012","article-title":"Mercury biogeochemical cycling in mercury contaminated environments","volume":"26","author":"Feng","year":"2011","journal-title":"Appl. Geochem."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3760","DOI":"10.1021\/cr500667e","article-title":"Mercury Physicochemical and Biogeochemical Transformation in the Atmosphere and at Atmospheric Interfaces: A Review and Future Directions","volume":"115","author":"Ariya","year":"2015","journal-title":"Chem. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1002\/2014GB004939","article-title":"Six centuries of changing oceanic mercury","volume":"28","author":"Zhang","year":"2014","journal-title":"Glob. Biogeochem. Cycles"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1289\/ehp.908975","article-title":"Environmental lead toxicity: Nutrition as a component of intervention","volume":"89","author":"Mahaffey","year":"1990","journal-title":"Environ. Health Perspect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1146\/annurev.med.55.091902.103653","article-title":"Lead Poisoning","volume":"55","author":"Needleman","year":"2004","journal-title":"Annu. Rev. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/0048-9697(87)90074-X","article-title":"Cadmium and lead contents of cigarettes produced in various areas of the world1","volume":"66","author":"Watanabe","year":"1987","journal-title":"Sci. Total Environ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1111\/j.1365-2389.2009.01142.x","article-title":"Partitioning of metals (Cd, Co, Cu, Ni, Pb, Zn) in soils: Concepts, methodologies, prediction and applications\u2014A review","volume":"60","author":"Degryse","year":"2009","journal-title":"Eur. J. Soil Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.hydromet.2008.04.012","article-title":"Leaching of waste battery paste components. Part 1: Lead citrate synthesis from PbO and PbO2","volume":"95","author":"Sonmez","year":"2009","journal-title":"Hydrometallurgy"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1093\/phr\/115.6.521","article-title":"Cognitive Deficits Associated with Blood Lead Concentrations <10 microg\/dL in US Children and Adolescents","volume":"115","author":"Lanphear","year":"2000","journal-title":"Public Health Rep."},{"key":"ref_32","first-page":"217","article-title":"Soil is an important pathway of human lead exposure","volume":"106","author":"Mielke","year":"1998","journal-title":"Environ. Health Perspect."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S0048-9697(02)00029-3","article-title":"Phasing out cadmium and lead\u2014Emissions and sediment loads in an urban area","volume":"292","author":"Jonsson","year":"2002","journal-title":"Sci. Total Environ."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1038\/333134a0","article-title":"Quantitative assessment of worldwide contamination of air, water and soils by trace metals","volume":"333","author":"Nriagu","year":"1988","journal-title":"Nature"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1289\/ehp.1002452","article-title":"Developmental Neurotoxicants in E-Waste: An Emerging Health Concern","volume":"119","author":"Chen","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/em.21896","article-title":"Genetic variation in arsenic (+3 oxidation state) methyltransferase (AS3MT), arsenic metabolism and risk of basal cell carcinoma in a E uropean population","volume":"56","author":"Vahter","year":"2015","journal-title":"Environ. Mol. Mutagen."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/(SICI)1520-670X(2000)13:1<141::AID-JTRA15>3.0.CO;2-A","article-title":"Essentiality and toxicity of trace elements: Principles and methods for assessment of risk from human exposure to essential trace elements","volume":"13","author":"Nordberg","year":"2000","journal-title":"J. Trace Elem. Exp. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s10653-015-9701-4","article-title":"Human exposure to methylmercury from crayfish (Procambarus clarkii) in China","volume":"38","author":"Peng","year":"2016","journal-title":"Environ. Geochem. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s10534-013-9700-9","article-title":"New science challenges old notion that mercury dental amalgam is safe","volume":"27","author":"Homme","year":"2014","journal-title":"BioMetals"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.neuro.2016.04.010","article-title":"Neurotoxic impact of mercury on the central nervous system evaluated by neuropsychological tests and on the autonomic nervous system evaluated by dynamic pupillometry","volume":"59","author":"Milioni","year":"2017","journal-title":"NeuroToxicology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1289\/ehp.1003012","article-title":"Evaluation of the Cardiovascular Effects of Methylmercury Exposures: Current Evidence Supports Development of a Dose\u2013Response Function for Regulatory Benefits Analysis","volume":"119","author":"Roman","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_42","first-page":"186","article-title":"Mercury Exposure and Children\u2019s Health","volume":"40","author":"McCarty","year":"2010","journal-title":"Curr. Probl. Pediatr. Adolesc. Health Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1289\/ehp.11241","article-title":"Lead Exposures in U.S. Children, 2008: Implications for Prevention","volume":"116","author":"Levin","year":"2008","journal-title":"Environ. Health Perspect."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"PREDIMED Study Investigators, Downer, M.K., Mart\u00ednez-Gonz\u00e1lez, M.A., Gea, A., Stampfer, M., Warnberg, J., Ruiz-Canela, M., Salas-Salvad\u00f3, J., Corella, D., and Ros, E. (2017). Mercury exposure and risk of cardiovascular disease: A nested case-control study in the PREDIMED (PREvention with MEDiterranean Diet) study. BMC Cardiovasc. Disord., 17.","DOI":"10.1186\/s12872-016-0435-8"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/MOP.0b013e3282f4f97b","article-title":"Very low lead exposures and children\u2019s neurodevelopment","volume":"20","author":"Bellinger","year":"2008","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1289\/ehp.9785","article-title":"Lead Exposure and Cardiovascular Disease\u2014A Systematic Review","volume":"115","author":"Guallar","year":"2007","journal-title":"Environ. Health Perspect."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.taap.2013.06.013","article-title":"Chronic cadmium exposure in vitro induces cancer cell characteristics in human lung cells","volume":"273","author":"Person","year":"2013","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/bmb\/ldg032","article-title":"Hazards of heavy metal contamination","volume":"68","year":"2003","journal-title":"Br. Med. Bull."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.yrtph.2012.07.008","article-title":"Cadmium exposure and tobacco consumption: Biomarkers and risk assessment","volume":"64","author":"Marano","year":"2012","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"ref_50","unstructured":"(2025, December 25). Agency for Toxic Substances and Disease Registry. U.S. Department of Health and Human Services, Available online: https:\/\/www.atsdr.cdc.gov\/toxprofiles\/tp5.pdf."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1038\/s41370-023-00556-8","article-title":"Association between environmental cadmium exposure and increased mortality in the U.S. National Health and Nutrition Examination Survey (1999\u20132018)","volume":"33","author":"Moon","year":"2023","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1289\/ehp.6751","article-title":"Adverse Health Effects of Chronic Exposure to Low-Level Cadmium in Foodstuffs and Cigarette Smoke","volume":"112","author":"Satarug","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/BF02784556","article-title":"Urinary cadmium levels during pregnancy and postpartum: A longitudinal study","volume":"53","author":"Hernandez","year":"1996","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1136\/oem.59.6.394","article-title":"Effects of maternal exposure to cadmium on pregnancy outcome and breast milk","volume":"59","author":"Nishijo","year":"2002","journal-title":"Occup. Environ. Med."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Zhao, L., Ru, Y., Liu, M., Tang, J., Zheng, J., Wu, B., Gu, Y., and Shi, H. (2017). Reproductive effects of cadmium on sperm function and early embryonic development in vitro. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0186727"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1203\/00006450-197801000-00008","article-title":"Absorption and Retention of Lead by Infants","volume":"12","author":"Ziegler","year":"1978","journal-title":"Pediatr. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1289\/ehp.011091079","article-title":"Iron deficiency associated with higher blood lead in children living in contaminated environments","volume":"109","author":"Bradman","year":"2001","journal-title":"Environ. Health Perspect."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0048-9697(02)00355-8","article-title":"Mobilization of lead from human bone tissue during pregnancy and lactation\u2014A summary of long-term research","volume":"303","author":"Gulson","year":"2003","journal-title":"Sci. Total Environ."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1076\/chin.9.1.35.14496","article-title":"Low-Level Lead Exposure, Executive Functioning, and Learning in Early Childhood","volume":"9","author":"Canfield","year":"2003","journal-title":"Child Neuropsychol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/1476-069X-4-20","article-title":"Inter-individual variations of human mercury exposure biomarkers: A cross-sectional assessment","volume":"4","author":"Berglund","year":"2005","journal-title":"Environ. Health"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Satarug, S., Ruangyuttikarn, W., Nishijo, M., and Ruiz, P. (2018). Urinary Cadmium Threshold to Prevent Kidney Disease Development. Toxics, 6.","DOI":"10.3390\/toxics6020026"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1093\/aje\/kww097","article-title":"Estimation of Inorganic Arsenic Exposure in Populations with Frequent Seafood Intake: Evidence from MESA and NHANES","volume":"184","author":"Jones","year":"2016","journal-title":"Am. J. Epidemiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/0891-5849(95)00017-R","article-title":"Alpha-lipoic acid as a biological antioxidant","volume":"19","author":"Packer","year":"1995","journal-title":"Free Radic. Biol. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1289\/ehp.98106267","article-title":"N-Acetylcysteine as an Antidote in Methylmercury Poisoning","volume":"106","author":"Ballatori","year":"1998","journal-title":"Environ. Health Perspect."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.jtemb.2014.10.001","article-title":"Chelation in metal intoxication\u2014Principles and paradigms","volume":"31","author":"Aaseth","year":"2015","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.yapd.2014.04.004","article-title":"Lead poisoning in children","volume":"61","author":"Dapul","year":"2014","journal-title":"Adv. Pediatr."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1146\/annurev.bi.52.070183.003431","article-title":"GLUTATHIONE","volume":"52","author":"Meister","year":"1983","journal-title":"Annu. Rev. Biochem."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.9734\/BJMMR\/2014\/6875","article-title":"Comparison of Chelating Agents DMPS, DMSA and EDTA for the Diagnosis and Treatment of Chronic Metal Exposure","volume":"4","year":"2014","journal-title":"Br. J. Med. Med. Res."},{"key":"ref_69","first-page":"872","article-title":"Enhancement of glucose disposal in patients with type 2 diabetes by alpha-lipoic acid","volume":"45","author":"Jacob","year":"1995","journal-title":"Arzneimittelforschung"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., and Palmer, R. (2016). Unithiol (DMPS). Critical Care Toxicology, Springer International Publishing.","DOI":"10.1007\/978-3-319-20790-2"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Gerhardsson, L., and Aaseth, J. (2016). Guidance for Clinical Treatment of Metal Poisonings\u2014Use and Misuse of Chelating Agents. Chelation Therapy in the Treatment of Metal Intoxication, Elsevier.","DOI":"10.1016\/B978-0-12-803072-1.00007-9"},{"key":"ref_72","unstructured":"(2024, October 15). Antidote Chart. Available online: https:\/\/calpoison.org\/antidotes."},{"key":"ref_73","unstructured":"Illinois Poison Center (2024, September 10). IPC Poison Antidote Stocking Chart. Available online: https:\/\/www.illinoispoisoncenter.org\/getmedia\/f7c14fba-03bf-44b8-b589-32f6f552f6c7\/ipc-antidote-stocking-list-2022_final-edit.pdf."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jinorgbio.2019.03.019","article-title":"Insights on alpha lipoic and dihydrolipoic acids as promising scavengers of oxidative stress and possible chelators in mercury toxicology","volume":"195","author":"Aaseth","year":"2019","journal-title":"J. Inorg. Biochem."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3345","DOI":"10.1007\/s00210-024-03576-9","article-title":"Alpha-lipoic acid, as an effective agent against toxic elements: A review","volume":"398","author":"Vafaee","year":"2025","journal-title":"Naunyn-Schmiedeberg\u2019s Arch. Pharmacol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1001\/jama.1986.03380220093029","article-title":"The Therapeutic Use of 2,3-Dimercaptopropane-1-Sulfonate in Two Cases of Inorganic Mercury Poisoning","volume":"256","author":"Campbell","year":"1986","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e05962","DOI":"10.1016\/j.heliyon.2021.e05962","article-title":"Synthesis, structural characterization, computational studies and stability evaluations of metal ions and ZnONPs complexes with dimercaptosuccinic acid","volume":"7","author":"Keattanong","year":"2021","journal-title":"Heliyon"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1021\/tx950096o","article-title":"Comparison of rac- and meso-2,3-Dimercaptosuccinic Acids for Chelation of Mercury and Cadmium Using Chemical Speciation Models","volume":"9","author":"Fang","year":"1996","journal-title":"Chem. Res. Toxicol."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Bj\u00f8rklund, G., Crisponi, G., Nurchi, V.M., Cappai, R., Buha Djordjevic, A., and Aaseth, J. (2019). A Review on Coordination Properties of Thiol-Containing Chelating Agents Towards Mercury, Cadmium, and Lead. Molecules, 24.","DOI":"10.3390\/molecules24183247"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jtemb.2016.03.013","article-title":"A review of pitfalls and progress in chelation treatment of metal poisonings","volume":"38","author":"Andersen","year":"2016","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1093\/jn\/134.3.489","article-title":"Glutathione Metabolism and Its Implications for Health","volume":"134","author":"Wu","year":"2004","journal-title":"J. Nutr."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.mam.2008.05.005","article-title":"Regulation of glutathione synthesis","volume":"30","author":"Lu","year":"2009","journal-title":"Mol. Asp. Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1081\/CLT-100100945","article-title":"Safety and Efficacy of Meso-2,3-Dimercaptosuccinic Acid (DMSA) in Children with Elevated Blood Lead Concentrations","volume":"38","author":"Chisolm","year":"2000","journal-title":"J. Toxicol. Clin. Toxicol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/BF01689511","article-title":"Effect of liposome encapsulated meso-2,3-dimercaptosuccinic acid (DMSA) on biochemical and trace metal alterations in cadmium exposed rats","volume":"47","author":"Behari","year":"1991","journal-title":"Bull. Environ. Contam. Toxicol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"505","DOI":"10.3109\/15563659209017938","article-title":"Human Studies with the Chelating Agents, DMPS and DMSA","volume":"30","author":"Maiorino","year":"1992","journal-title":"J. Toxicol. Clin. Toxicol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"841","DOI":"10.3109\/15563650903321064","article-title":"A comparison of sodium calcium edetate (edetate calcium disodium) and succimer (DMSA) in the treatment of inorganic lead poisoning","volume":"47","author":"Bradberry","year":"2009","journal-title":"Clin. Toxicol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/24734306.2020.1870077","article-title":"Rethinking treatment of mercury poisoning: The roles of selenium, acetylcysteine, and thiol chelators in the treatment of mercury poisoning: A narrative review","volume":"5","author":"Spiller","year":"2021","journal-title":"Toxicol. Commun."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"513","DOI":"10.2174\/1389557519666191119144100","article-title":"Medicinal Thiols: Current Status and New Perspectives","volume":"20","author":"Pfaff","year":"2020","journal-title":"Mini-Rev. Med. Chem."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"4605","DOI":"10.1021\/la5002336","article-title":"Metal Ion Coordination, Conditional Stability Constants, and Solution Behavior of Chelating Surfactant Metal Complexes","volume":"30","author":"Svanedal","year":"2014","journal-title":"Langmuir"},{"key":"ref_90","unstructured":"Reedijk, J. (2013). Comprehensive Inorganic Chemistry II: From Elements to Applications, Elsevier. [2nd ed.]."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.taap.2011.05.001","article-title":"Oxidative stress in MeHg-induced neurotoxicity","volume":"256","author":"Farina","year":"2011","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1006\/taap.2001.9157","article-title":"Recent Advances in Arsenic Carcinogenesis: Modes of Action, Animal Model Systems, and Methylated Arsenic Metabolites","volume":"172","author":"Kitchin","year":"2001","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"4921","DOI":"10.1021\/cr900134a","article-title":"Application of Metal Coordination Chemistry To Explore and Manipulate Cell Biology","volume":"109","author":"Haas","year":"2009","journal-title":"Chem. Rev."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1289\/ehp.02110s5887","article-title":"Molecular mechanisms of in vivo metal chelation: Implications for clinical treatment of metal intoxications","volume":"110","author":"Andersen","year":"2002","journal-title":"Environ. Health Perspect."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1177\/096032718300200214","article-title":"Recent Advance in the Therapy of Metal Poisonings with Chelating Agents","volume":"2","author":"Aaseth","year":"1983","journal-title":"Hum. Toxicol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"3533","DOI":"10.1021\/ja00905a001","article-title":"Hard and Soft Acids and Bases","volume":"85","author":"Pearson","year":"1963","journal-title":"J. Am. Chem. Soc."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/S0016-0032(38)91691-6","article-title":"Acids and bases","volume":"226","author":"Lewis","year":"1938","journal-title":"J. Frankl. Inst."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Nordberg, G.F., Fowler, B.A., and Nordberg, M. (2015). Handbook on the Toxicology of Metals, Elsevier.","DOI":"10.1016\/B978-0-444-59453-2.00001-9"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1080\/10408440600845619","article-title":"The Toxicology of Mercury and Its Chemical Compounds","volume":"36","author":"Clarkson","year":"2006","journal-title":"Crit. Rev. Toxicol."},{"key":"ref_100","unstructured":"Isaacson, R.L., and Jensen, K.F. (1992). Methylmercury Neurotoxicity and Its Uptake Across the Blood\u2014Brain Barrier. The Vulnerable Brain and Environmental Risks, Springer."},{"key":"ref_101","first-page":"191","article-title":"Nutrition and lead: Strategies for public health","volume":"103","author":"Mahaffey","year":"1995","journal-title":"Environ. Health Perspect."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0013-9351(88)80023-9","article-title":"Lead and osteoporosis: Mobilization of lead from bone in postmenopausal women","volume":"47","author":"Silbergeld","year":"1988","journal-title":"Environ. Res."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.taap.2009.03.015","article-title":"Historical perspectives on cadmium toxicology","volume":"238","author":"Nordberg","year":"2009","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0300-483X(02)00285-8","article-title":"Mechanisms of arsenic biotransformation","volume":"181\u2013182","author":"Vahter","year":"2002","journal-title":"Toxicology"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"152800","DOI":"10.1016\/j.tox.2021.152800","article-title":"Arsenic methylation\u2014Lessons from three decades of research","volume":"457","author":"Thomas","year":"2021","journal-title":"Toxicology"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2174\/1568026013394831","article-title":"Toxic Metals and Oxidative Stress Part I: Mechanisms Involved in Me-tal induced Oxidative Damage","volume":"1","year":"2001","journal-title":"Curr. Top. Med. Chem."},{"key":"ref_107","first-page":"2","article-title":"Lead toxicity, a review of the literature. Part 1: Exposure, evaluation, and treatment","volume":"11","author":"Patrick","year":"2006","journal-title":"Altern. Med. Rev. J. Clin. Ther."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.taap.2009.04.020","article-title":"Current status of cadmium as an environmental health problem","volume":"238","year":"2009","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jtemb.2014.07.023","article-title":"Trace elements as paradigms of developmental neurotoxicants: Lead, methylmercury and arsenic","volume":"31","author":"Grandjean","year":"2015","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"e42696","DOI":"10.1016\/j.heliyon.2025.e42696","article-title":"Recent advances in the clinical management of intoxication by five heavy metals: Mercury, lead, chromium, cadmium and arsenic","volume":"11","author":"Etemad","year":"2025","journal-title":"Heliyon"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2486\/indhealth.38.153","article-title":"Occupational and Environmental Toxicology of Mercury and Its Compounds","volume":"38","author":"Satoh","year":"2000","journal-title":"Ind. Health"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.envint.2016.03.029","article-title":"Prenatal methylmercury exposure and language delay at three years of age in the Norwegian Mother and Child Cohort Study","volume":"92\u201393","author":"Vejrup","year":"2016","journal-title":"Environ. Int."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/aje\/kws369","article-title":"Use of Arsenic-Induced Palmoplantar Hyperkeratosis and Skin Cancers to Predict Risk of Subsequent Internal Malignancy","volume":"177","author":"Hsu","year":"2013","journal-title":"Am. J. Epidemiol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1289\/ehp.1307110","article-title":"Non-renal effects and the risk assessment of environmental cadmium exposure","volume":"122","author":"Barregard","year":"2014","journal-title":"Environ. Health Perspect."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1191\/0960327104ht459cr","article-title":"Arsenic trioxide poisoning: A description of two acute overdoses","volume":"23","author":"Isbister","year":"2004","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/S0022-3476(97)70285-3","article-title":"Comparison of dimercaptosuccinic acid and calcium disodium ethylenediaminetetraacetic acid versus dimercaptopropanol and ethylenediaminetetraacetic acid in children with lead poisoning","volume":"130","author":"Besunder","year":"1997","journal-title":"J. Pediatr."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3904\/kjim.1998.13.2.127","article-title":"Mercury inhalation poisoning and acute lung injury","volume":"13","author":"Lim","year":"1998","journal-title":"Korean J. Intern. Med."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2340\/00015555-1201","article-title":"Bluish Pigmentation of the Gingiva in a Homeless Patient: A Quiz","volume":"92","author":"Kluger","year":"2012","journal-title":"Acta Derm. Venereol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"460508","DOI":"10.1155\/2012\/460508","article-title":"Mercury Toxicity and Treatment: A Review of the Literature","volume":"2012","author":"Bernhoft","year":"2012","journal-title":"J. Environ. Public Health"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"344","DOI":"10.3961\/jpmph.2012.45.6.344","article-title":"Human Exposure and Health Effects of Inorganic and Elemental Mercury","volume":"45","author":"Park","year":"2012","journal-title":"J. Prev. Med. Pub. Health"},{"key":"ref_121","first-page":"100094","article-title":"Bioaccumulation of lead (Pb) and its effects on human: A review","volume":"7","author":"Collin","year":"2022","journal-title":"J. Hazard. Mater. Adv."},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Helmich, F., and Lock, G. (2018). Burton\u2019s Line from Chronic Lead Intoxication. N. Engl. J. Med., 379.","DOI":"10.1056\/NEJMicm1801693"},{"key":"ref_123","first-page":"135","article-title":"Cadmium toxicity and treatment: An update","volume":"8","author":"Kazemi","year":"2017","journal-title":"Casp. J. Intern. Med."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"ski2.231","DOI":"10.1002\/ski2.231","article-title":"Cutaneous Manifestations and Treatment of Arsenic Toxicity: A Systematic Review","volume":"3","author":"Tang","year":"2023","journal-title":"Skin Health Dis."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1080\/15563650.2020.1853146","article-title":"Lead poisoning due to incense burning: An outbreak in a family","volume":"59","author":"Hung","year":"2021","journal-title":"Clin. Toxicol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5334\/aogh.3420","article-title":"Adult Lead Poisoning Caused by Contaminated Opium: A Two-Year Longitudinal Follow-Up Study","volume":"87","author":"Hosseini","year":"2021","journal-title":"Ann. Glob. Health"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jemermed.2022.06.004","article-title":"Arsenic Toxicity From the Ingestion of Terracotta Pottery","volume":"63","author":"Chiu","year":"2022","journal-title":"J. Emerg. Med."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.radcr.2022.10.099","article-title":"Mercury poisoning from artisanal gold mining equipment","volume":"18","author":"Waack","year":"2023","journal-title":"Radiol. Case Rep."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s11419-022-00653-7","article-title":"Suicidal intoxication with mercury chloride","volume":"41","author":"Majdanik","year":"2023","journal-title":"Forensic Toxicol."},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Kamal, I.J., Cerbini, T., Clouser, A., Hernandez, A., and Calello, D.P. (2024). Lead encephalopathy presenting as status epilepticus: A case report. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-04871-3"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1265\/ehpm.24-00063","article-title":"A suspected case of \u201citai-itai disease\u201d in a cadmium-polluted area in Akita prefecture, Japan","volume":"29","author":"Sasaki","year":"2024","journal-title":"Environ. Health Prev. Med."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1212\/01.wnl.0000336370.51010.a1","article-title":"Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of laboratory and genetic testing (an evidence-based review): Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation","volume":"72","author":"England","year":"2009","journal-title":"Neurology"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1001\/jama.2019.14745","article-title":"Chronic Kidney Disease Diagnosis and Management: A Review","volume":"322","author":"Chen","year":"2019","journal-title":"JAMA"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.4065\/78.10.1274","article-title":"Anemia in Adults: A Contemporary Approach to Diagnosis","volume":"78","author":"Tefferi","year":"2003","journal-title":"Mayo Clin. Proc."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40557-015-0086-8","article-title":"Evaluation of mercury exposure level, clinical diagnosis and treatment for mercury intoxication","volume":"28","author":"Ye","year":"2016","journal-title":"Ann. Occup. Environ. Med."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1289\/ehp.9784","article-title":"Recommendations for Medical Management of Adult Lead Exposure","volume":"115","author":"Kosnett","year":"2007","journal-title":"Environ. Health Perspect."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1016\/S0140-6736(05)66670-6","article-title":"Acute arsenic poisoning","volume":"365","year":"2005","journal-title":"The Lancet"},{"key":"ref_138","first-page":"68","article-title":"Assessing urinary flow rate, creatinine, osmolality and other hydration adjustment methods for urinary biomonitoring using NHANES arsenic, iodine, lead and cadmium data","volume":"15","author":"Middleton","year":"2016","journal-title":"Environ. Health Glob. Access Sci. Source"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1097\/PHH.0000000000000879","article-title":"Screening for Elevated Blood Lead Levels: False-Positive Rates of Tests on Capillary Samples, Minnesota, 2011\u20132017","volume":"25","author":"Wang","year":"2019","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"112394","DOI":"10.1016\/j.envres.2021.112394","article-title":"Selecting the best non-invasive matrix to measure mercury exposure in human biomonitoring surveys","volume":"204","author":"Arrebola","year":"2022","journal-title":"Environ. Res."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.envres.2003.10.003","article-title":"The effects of environmental cadmium exposure on kidney function: The possible influence of age","volume":"95","author":"Jakubowski","year":"2004","journal-title":"Environ. Res."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s40557-015-0085-9","article-title":"Evaluation and management of lead exposure","volume":"27","author":"Kim","year":"2015","journal-title":"Ann. Occup. Environ. Med."},{"key":"ref_143","doi-asserted-by":"crossref","unstructured":"Ruggieri, F., Majorani, C., Domanico, F., and Alimonti, A. (2017). Mercury in Children: Current State on Exposure through Human Biomonitoring Studies. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14050519"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0378-4274(02)00087-5","article-title":"Urinary arsenic speciation in subjects with or without restriction from seafood dietary intake","volume":"133","author":"Hsueh","year":"2002","journal-title":"Toxicol. Lett."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1158\/1055-9965.EPI-15-0718","article-title":"Determinants and Consequences of Arsenic Metabolism Efficiency among 4,794 Individuals: Demographics, Lifestyle, Genetics, and Toxicity","volume":"25","author":"Jansen","year":"2016","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_146","first-page":"107","article-title":"The use of K X-ray fluorescence for measuring lead burden in epidemiological studies: High and low lead burdens and measurement uncertainty","volume":"94","author":"Hu","year":"1991","journal-title":"Environ. Health Perspect."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.fct.2015.03.025","article-title":"Toxicological importance of human biomonitoring of metallic and metalloid elements in different biological samples","volume":"80","author":"Gil","year":"2015","journal-title":"Food Chem. Toxicol."},{"key":"ref_148","doi-asserted-by":"crossref","unstructured":"American College of Medical Toxicology (2010). American College of Medical Toxicology Position Statement on Post-Chelator Challenge Urinary Metal Testing. J. Med. Toxicol., 6, 74\u201375.","DOI":"10.1007\/s13181-010-0039-0"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1309\/LMYKGU05BEPE7IAW","article-title":"Testing for Toxic Elements: A Focus on Arsenic, Cadmium, Lead, and Mercury","volume":"42","author":"Keil","year":"2011","journal-title":"Lab. Med."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1080\/20961790.2016.1271098","article-title":"Guidelines for Collection of Biological Samples for Clinical and Forensic Toxicological Analysis","volume":"1","author":"Vieira","year":"2016","journal-title":"Forensic Sci. Res."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s13181-014-0381-8","article-title":"Analytical Considerations in the Clinical Laboratory Assessment of Metals","volume":"10","author":"Wang","year":"2014","journal-title":"J. Med. Toxicol."},{"key":"ref_152","doi-asserted-by":"crossref","unstructured":"Lam, J.H., Pickles, K., Stanaway, F.F., and Bell, K.J.L. (2020). Why clinicians overtest: Development of a thematic framework. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-05844-9"},{"key":"ref_153","doi-asserted-by":"crossref","unstructured":"Council on Environmental Health, Lanphear, B.P., Lowry, J.A., Ahdoot, S., Baum, C.R., Bernstein, A.S., Bole, A., Brumberg, H.L., Campbell, C.C., and Lanphear, B.P. (2016). Prevention of Childhood Lead Toxicity. Pediatrics, 138, e20161493. Erratum in Pediatrics\u00a02017, 140, e20171490. https:\/\/doi.org\/10.1542\/peds.2017-1490.","DOI":"10.1542\/peds.2016-1493"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.envres.2010.10.009","article-title":"Seafood intake and urine concentrations of total arsenic, dimethylarsinate and arsenobetaine in the US population","volume":"111","author":"Francesconi","year":"2011","journal-title":"Environ. Res."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.3390\/ijerph7072745","article-title":"Chelation in metal intoxication","volume":"7","author":"Flora","year":"2010","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.envres.2004.01.007","article-title":"Evaluation of cleaning methods applied in home environments after renovation and remodeling activities","volume":"96","author":"Yiin","year":"2004","journal-title":"Environ. Res."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.envres.2014.01.004","article-title":"Iron deficiency increases blood lead levels in boys and pre-menarche girls surveyed in KNHANES 2010\u20132011","volume":"130","author":"Sim","year":"2014","journal-title":"Environ. Res."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1289\/ehp.11868","article-title":"Effect of calcium supplementation on blood lead levels in pregnancy: A randomized placebo-controlled trial","volume":"117","author":"Ettinger","year":"2009","journal-title":"Environ. Health Perspect."},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1093\/toxsci\/kfj201","article-title":"Marginal Zinc Deficiency Exacerbates Bone Lead Accumulation and High Dietary Zinc Attenuates Lead Accumulation at the Expense of Bone Density in Growing Rats","volume":"92","author":"Jamieson","year":"2006","journal-title":"Toxicol. Sci."},{"key":"ref_160","first-page":"78","article-title":"Cooking rice in excess water reduces both arsenic and enriched vitamins in the cooked grain","volume":"33","author":"Gray","year":"2016","journal-title":"Food Addit. Contam. Part A"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.ijheh.2011.03.004","article-title":"Smoking status and urine cadmium above levels associated with subclinical renal effects in U.S. adults without chronic kidney disease","volume":"214","author":"Mortensen","year":"2011","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1542\/peds.2004-1957","article-title":"Acute Arsenic Poisoning in Two Siblings","volume":"116","author":"Lai","year":"2005","journal-title":"Pediatrics"},{"key":"ref_163","unstructured":"Shannon, M.W., Borron, S.W., and Burns, M.J. (2007). Emergency Management of Poisoning. Haddad and Winchester\u2019s Clinical Management of Poisoning and Drug Overdose, Elsevier."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s13181-013-0348-1","article-title":"Role of Chelation During Pregnancy in the Lead Poisoned Patient","volume":"9","author":"Brown","year":"2013","journal-title":"J. Med. Toxicol."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.1093\/jn\/136.9.2378","article-title":"Iron and\/or Zinc Supplementation Did Not Reduce Blood Lead Concentrations in Children in a Randomized, Placebo-Controlled Trial","volume":"136","author":"Rosado","year":"2006","journal-title":"J. Nutr."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"129301","DOI":"10.1016\/j.bbagen.2019.02.003","article-title":"Variation in the biological half-life of methylmercury in humans: Methods, measurements and meaning","volume":"1863","author":"Rand","year":"2019","journal-title":"Biochim. Biophys. Acta BBA\u2014Gen. Subj."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1177\/1403494816689310","article-title":"Public health benefits of hair-mercury analysis and dietary advice in lowering methylmercury exposure in pregnant women","volume":"45","author":"Kirk","year":"2017","journal-title":"Scand. J. Public Health"},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s13181-013-0341-8","article-title":"Role of chelation in the treatment of lead poisoning: Discussion of the Treatment of Lead-Exposed Children Trial (TLC)","volume":"9","author":"McKay","year":"2013","journal-title":"J. Med. Toxicol."},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1056\/NEJM200105103441902","article-title":"The Effect of Chelation Therapy with Succimer on Neuropsychological Development in Children Exposed to Lead","volume":"344","author":"Rogan","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s13181-013-0344-5","article-title":"The role of chelation in the treatment of arsenic and mercury poisoning","volume":"9","author":"Kosnett","year":"2013","journal-title":"J. Med. Toxicol."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/0272989X9501500104","article-title":"Management of Childhood Lead Poisoning: Clinical Impact and Cost-Effectiveness","volume":"15","author":"Glotzer","year":"1995","journal-title":"Med. Decis. Mak."},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1289\/ehp.1206424","article-title":"Economic Costs of Childhood Lead Exposure in Low- and Middle-Income Countries","volume":"121","author":"Attina","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1289\/ehp.0800408","article-title":"Childhood Lead Poisoning: Conservative Estimates of the Social and Economic Benefits of Lead Hazard Control","volume":"117","author":"Gould","year":"2009","journal-title":"Environ. Health Perspect."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1476-069X-10-44","article-title":"Childhood lead exposure in France: Benefit estimation and partial cost-benefit analysis of lead hazard control","volume":"10","author":"Pichery","year":"2011","journal-title":"Environ. Health"},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/2017GH000109","article-title":"Cost Effectiveness of Environmental Lead Risk Mitigation in Low- and Middle-Income Countries","volume":"2","author":"Ericson","year":"2018","journal-title":"GeoHealth"},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.envres.2006.04.007","article-title":"Evaluation of HUD-funded lead hazard control treatments at 6 years post-intervention","volume":"102","author":"Wilson","year":"2006","journal-title":"Environ. Res."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1177\/0009922818821871","article-title":"Evaluation of an Electronic Dosing Calculator to Reduce Pediatric Medication Errors","volume":"58","author":"Murray","year":"2019","journal-title":"Clin. Pediatr."},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.annemergmed.2009.01.023","article-title":"Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care","volume":"54","author":"Dart","year":"2009","journal-title":"Ann. Emerg. Med."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s13181-013-0349-0","article-title":"Editorial: Use and Misuse of Metal Chelation Therapy","volume":"9","author":"McKay","year":"2013","journal-title":"J. Med. Toxicol."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"e386","DOI":"10.1200\/OP.20.00118","article-title":"Electronic Patient Reporting of Adverse Events and Quality of Life: A Prospective Feasibility Study in General Oncology","volume":"17","author":"Kennedy","year":"2021","journal-title":"JCO Oncol. Pract."},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1146\/annurev-publhealth-031914-122747","article-title":"Uses of Electronic Health Records for Public Health Surveillance to Advance Public Health","volume":"36","author":"Birkhead","year":"2015","journal-title":"Annu. Rev. Public Health"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1111\/j.1553-2712.2007.tb02372.x","article-title":"Implementation of Clinical Decision Rules in the Emergency Department","volume":"14","author":"Stiell","year":"2007","journal-title":"Acad. Emerg. Med."},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1038\/s41746-025-02141-9","article-title":"Mixed methods evaluation of a clinical decision support system to reduce variation in healthcare","volume":"8","author":"Pak","year":"2025","journal-title":"Npj Digit. Med."},{"key":"ref_184","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/j.1524-4733.2010.00725.x","article-title":"A Review of Quantitative Risk\u2013Benefit Methodologies for Assessing Drug Safety and Efficacy\u2014Report of the ISPOR Risk\u2013Benefit Management Working Group","volume":"13","author":"Guo","year":"2010","journal-title":"Value Health"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1097\/PHH.0000000000000868","article-title":"CDC\u2019s Lead Poisoning Prevention Program: A Long-standing Responsibility and Commitment to Protect Children From Lead Exposure","volume":"25","author":"Ettinger","year":"2019","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1289\/ehp.7688","article-title":"Low-Level Environmental Lead Exposure and Children\u2019s Intellectual Function: An International Pooled Analysis","volume":"113","author":"Lanphear","year":"2005","journal-title":"Environ. Health Perspect."},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1177\/096032719000900403","article-title":"Evaluation of the Efficacy of Dimercapto Chelating Agents for the Treatment of Systemic Organic Arsenic Poisoning in Rabbits","volume":"9","author":"Inns","year":"1990","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"394652","DOI":"10.1155\/2013\/394652","article-title":"Cadmium Toxicity and Treatment","volume":"2013","author":"Bernhoft","year":"2013","journal-title":"Sci. World J."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"4540","DOI":"10.1021\/cr400460s","article-title":"Metallodrugs in Medicinal Inorganic Chemistry","volume":"114","author":"Mjos","year":"2014","journal-title":"Chem. Rev."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.bbadis.2005.06.006","article-title":"Nanoparticle and other metal chelation therapeutics in Alzheimer disease","volume":"1741","author":"Liu","year":"2005","journal-title":"Biochim. Biophys. Acta BBA\u2014Mol. Basis Dis."},{"key":"ref_191","doi-asserted-by":"crossref","first-page":"5114","DOI":"10.1021\/es0705238","article-title":"Removal of Heavy Metals from Aqueous Systems with Thiol Functionalized Superparamagnetic Nanoparticles","volume":"41","author":"Yantasee","year":"2007","journal-title":"Environ. Sci. Technol."},{"key":"ref_192","doi-asserted-by":"crossref","unstructured":"Yu, X., Liu, C., Guo, Y., and Deng, T. (2019). Speciation Analysis of Trace Arsenic, Mercury, Selenium and Antimony in Environmental and Biological Samples Based on Hyphenated Techniques. Molecules, 24.","DOI":"10.3390\/molecules24050926"},{"key":"ref_193","doi-asserted-by":"crossref","first-page":"7663","DOI":"10.1021\/acsnano.8b01249","article-title":"Micelle-Forming Dexamethasone Prodrug Attenuates Nephritis in Lupus-Prone Mice without Apparent Glucocorticoid Side Effects","volume":"12","author":"Jia","year":"2018","journal-title":"ACS Nano"},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"2102451","DOI":"10.1002\/advs.202102451","article-title":"Thiolated Nanoparticles for Biomedical Applications: Mimicking the Workhorses of Our Body","volume":"9","author":"Hock","year":"2022","journal-title":"Adv. Sci."},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"847","DOI":"10.2174\/138920111795470886","article-title":"Metal Release from and Sequestration by Metallothioneins Monitored by Electrochemistry and SPR","volume":"12","author":"Liu","year":"2011","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1021\/acsenvironau.1c00022","article-title":"Demethylation\u2014The Other Side of the Mercury Methylation Coin: A Critical Review","volume":"2","author":"Barkay","year":"2022","journal-title":"ACS Environ. Au"},{"key":"ref_197","doi-asserted-by":"crossref","first-page":"wraf215","DOI":"10.1093\/ismejo\/wraf215","article-title":"Deciphering the universal role of gut microbiota in pollutant transformation","volume":"19","author":"Hou","year":"2025","journal-title":"ISME J."},{"key":"ref_198","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1007\/s00204-023-03548-7","article-title":"Assessing the role of the gut microbiome in methylmercury demethylation and elimination in humans and gnotobiotic mice","volume":"97","author":"Coe","year":"2023","journal-title":"Arch. Toxicol."},{"key":"ref_199","doi-asserted-by":"crossref","first-page":"5454","DOI":"10.1021\/acs.est.9b00392","article-title":"Metabolomics of Children and Adolescents Exposed to Industrial Carcinogenic Pollutants","volume":"53","author":"Chen","year":"2019","journal-title":"Environ. Sci. Technol."},{"key":"ref_200","doi-asserted-by":"crossref","unstructured":"Hsiao, C.-Y., Gresham, C., and Marshall, M.R. (2019). Treatment of lead and arsenic poisoning in anuric patients\u2014A case report and narrative review of the literature. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1561-1"},{"key":"ref_201","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3109\/08860228109076031","article-title":"Results of Hemodialysis & Hemoperfusion in the Treatment of Acute Arsenic Ingestion","volume":"5","author":"Smith","year":"1981","journal-title":"Clin. Exp. Dial. Apher."},{"key":"ref_202","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s11671-024-03981-2","article-title":"Nanomaterial-based optical colorimetric sensors for rapid monitoring of inorganic arsenic species: A review","volume":"19","author":"Gebremedhin","year":"2024","journal-title":"Discov. Nano"},{"key":"ref_203","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/s41545-021-00128-z","article-title":"A critical review of point-of-use drinking water treatment in the United States","volume":"4","author":"Wu","year":"2021","journal-title":"npj Clean Water"},{"key":"ref_204","doi-asserted-by":"crossref","unstructured":"Tinggi, U., and Perkins, A.V. (2022). Selenium Status: Its Interactions with Dietary Mercury Exposure and Implications in Human Health. Nutrients, 14.","DOI":"10.3390\/nu14245308"},{"key":"ref_205","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/0147-6513(91)90074-Y","article-title":"Mercury and selenium interaction: A review","volume":"21","author":"Furness","year":"1991","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_206","doi-asserted-by":"crossref","first-page":"115668","DOI":"10.1016\/j.envpol.2020.115668","article-title":"Selective removal of arsenic in water: A critical review","volume":"268","author":"Weerasundara","year":"2021","journal-title":"Environ. Pollut."},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.scitotenv.2016.12.113","article-title":"Human exposure to organic arsenic species from seafood","volume":"580","author":"Taylor","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_208","doi-asserted-by":"crossref","first-page":"112592","DOI":"10.1016\/j.envres.2021.112592","article-title":"Long-term monitoring of mercury in young German adults: Time trend analyses from the German Environmental Specimen Bank, 1995\u20132018","volume":"207","author":"Lermen","year":"2022","journal-title":"Environ. Res."},{"key":"ref_209","doi-asserted-by":"crossref","unstructured":"Satarug, S., Vesey, D.A., and Buha \u0110or\u0111evi\u0107, A. (2025). Use of Urinary \u03b22-Microglobulin in the Assessment of the Health Risk from Environmental Cadmium Exposure. Appl. Sci., 15.","DOI":"10.20944\/preprints202509.2442.v1"},{"key":"ref_210","doi-asserted-by":"crossref","unstructured":"(2006). Deaths Associated with Hypocalcemia From Chelation Therapy\u2014Texas, Pennsylvania, and Oregon, 2003\u20132005. JAMA, 295, 2131.","DOI":"10.1001\/jama.295.18.2131"},{"key":"ref_211","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3109\/08860229909085087","article-title":"Usefulness of Biomarkers of Exposure to Inorganic Mercury, Lead, or Cadmium in Controlling Occupational and Environmental Risks of Nephrotoxicity","volume":"21","author":"Roels","year":"1999","journal-title":"Ren. Fail."},{"key":"ref_212","doi-asserted-by":"crossref","unstructured":"Pamphlett, R., Doble, P.A., and Bishop, D.P. (2021). The Prevalence of Inorganic Mercury in Human Kidneys Suggests a Role for Toxic Metals in Essential Hypertension. Toxics, 9.","DOI":"10.3390\/toxics9030067"},{"key":"ref_213","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1007\/s00204-020-02847-7","article-title":"Heavy metal chelation tests: The misleading and hazardous promise","volume":"94","author":"Hoet","year":"2020","journal-title":"Arch. Toxicol."},{"key":"ref_214","doi-asserted-by":"crossref","first-page":"S115","DOI":"10.2105\/AJPH.2010.300058","article-title":"Environmental Health Disparities in Housing","volume":"101","author":"Jacobs","year":"2011","journal-title":"Am. J. Public Health"},{"key":"ref_215","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1001\/jamainternmed.2018.3573","article-title":"Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments","volume":"178","author":"Korenstein","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"ref_216","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.envint.2014.09.015","article-title":"Communicating with the public about environmental health risks: A community-engaged approach to dialogue about metal speciation and toxicity","volume":"74","author":"Friedman","year":"2015","journal-title":"Environ. Int."},{"key":"ref_217","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1108\/MHRJ-01-2018-0001","article-title":"Multidisciplinary team functioning and decision making within forensic mental health","volume":"23","author":"Haines","year":"2018","journal-title":"Ment. Health Rev."},{"key":"ref_218","doi-asserted-by":"crossref","unstructured":"Taberna, M., Gil Moncayo, F., Jan\u00e9-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., Peralvez Torres, E., and Mes\u00eda, R. (2020). The Multidisciplinary Team (MDT) Approach and Quality of Care. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.00085"},{"key":"ref_219","first-page":"562","article-title":"Checking it twice: An evaluation of checklists for detecting medication errors at the bedside using a chemotherapy model","volume":"19","author":"White","year":"2010","journal-title":"Qual. Saf. Health Care"},{"key":"ref_220","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1093\/jamia\/ocy112","article-title":"Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: A systematic review","volume":"25","author":"Powers","year":"2018","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_221","doi-asserted-by":"crossref","first-page":"e037641","DOI":"10.1136\/bmjopen-2020-037641","article-title":"Using patient feedback to drive quality improvement in hospitals: A qualitative study","volume":"10","author":"Berger","year":"2020","journal-title":"BMJ Open"},{"key":"ref_222","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s40572-023-00402-x","article-title":"A State-of-the-Science Review on Metal Biomarkers","volume":"10","author":"Sobel","year":"2023","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_223","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1038\/clpt.2010.132","article-title":"Chelation for Heavy Metals (Arsenic, Lead, and Mercury): Protective or Perilous?","volume":"88","author":"Kosnett","year":"2010","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_224","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s13181-013-0350-7","article-title":"Recommendations for provoked challenge urine testing","volume":"9","author":"Ruha","year":"2013","journal-title":"J. Med. Toxicol."},{"key":"ref_225","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.2105\/AJPH.2011.300121","article-title":"Disproportionate exposures in environmental justice and other populations: The importance of outliers","volume":"101","author":"Gochfeld","year":"2011","journal-title":"Am. J. Public Health"},{"key":"ref_226","doi-asserted-by":"crossref","first-page":"S238","DOI":"10.2105\/AJPH.2011.300119","article-title":"Moving Environmental Justice Indoors: Understanding Structural Influences on Residential Exposure Patterns in Low-Income Communities","volume":"101","author":"Adamkiewicz","year":"2011","journal-title":"Am. J. Public Health"},{"key":"ref_227","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1007\/s11096-017-0545-0","article-title":"Implementation of an IT-guided checklist to improve the quality of medication history records at hospital admission","volume":"39","author":"Huber","year":"2017","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_228","doi-asserted-by":"crossref","unstructured":"Enticott, J., Johnson, A., and Teede, H. (2021). Learning health systems using data to drive healthcare improvement and impact: A systematic review. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06215-8"},{"key":"ref_229","doi-asserted-by":"crossref","first-page":"e17026","DOI":"10.2196\/17026","article-title":"An Analysis of the Learning Health System in Its First Decade in Practice: Scoping Review","volume":"22","author":"Platt","year":"2020","journal-title":"J. Med. Internet Res."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/8\/3513\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T04:12:51Z","timestamp":1777263171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/8\/3513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":229,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijms27083513"],"URL":"https:\/\/doi.org\/10.3390\/ijms27083513","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]}}}