An investigation into the present levels of contamination in children's toys and jewelry in different countries: a systematic review

Contamination by heavy metals and toxic elements in children's toys and jewelry is an ongoing challenge in different countries. These contaminants can enter the children's body via oral, dermal, and respiratory routes, leading to adverse health effects. This study aimed to investigate the present levels of contamination in children's toys and jewelry in 15 countries, including UK, Saudi Arabia, Cambodia, China, Kosovo, Nigeria, North American, Kazakhstan, UAE, Pakistan, Iraq, Israel, West Bank/Palestine, Czech Republic, and Turkey. In this review, the legislation and recommendation of the United States (U.S.), the Bureau of Indian Standards (BIS), Turkish Standards Institute (TSE), Canada, and the European Union (E.U.) on toxic elements in toys and jewelry are introduced. Plastic or metallic toys and children's jewelry still have the most severe toxic elements pollution and the existence of lead (Pb), nickel (Ni), cadmium (Cd), arsenic (As), mercury (Hg), chromium (Cr), copper (Cu), selenium (Se), barium (Ba), Zinc (Zn), cobalt (Co), manganese (Mn), bisphenol A, phthalates, parabens, azo dyes, and flame retardants has been regarded as an ongoing challenge in these articles. Finally, this review offers benchmarking of the concentrations of toxic elements in all types of children's toys and jewelry in different nations.

Modular Toolbox as Snap Jewelry for Biomimetic Synthesis of Multifunctional Amino Acid Surfactants Inspired by Melanin

Amino acid surfactants have gained significant importance in overcoming the limitations of conventional surfactants, notably, their low biocompatibility and biodegradability. However, the current amino acid surfactants lack multifunctional properties due to the nonreactivity of their aliphatic chains, necessitating the development of a new type of amino acid surfactant. A novel melanin-like amino acid surfactant and a biomimetic synthesis route were devised by mimicking the biosynthesis of melanin. Renewable natural polyphenol compounds with catechol moieties were utilized as building blocks for the hydrophobic group. In a proof-of-concept experiment, ethyl protocatechuate was oxidized to o-quinone and subsequently covalently linked to the amino group of lysine via Michael addition. The chemical structure was verified using liquid chromatography-tandem mass spectroscopy. The melanin-like amino acid surfactant exhibited excellent surface-active properties, with a critical micelle concentration of 1.59 mN m-1. Furthermore, it demonstrated remarkable emulsifying, foaming, solubilizing, dispersing, and wetting capabilities. Notably, it also possessed multifunctionality, including antibacterial activity, antioxidant activity, robustness, and mildness. These outstanding properties indicate significant potential for various applications. This strategy offers innovative insights and a versatile, modular toolbox for synthesizing multifunctional amino acid surfactants that mimic melanin. The approach allows for the easy interchange of o-quinone building blocks, which is akin to snap jewelry.

The toxicological assessment of hazardous elements (Pb, Cd and Hg) in low-cost jewelry for adults from Chinese E-commerce platforms: In situ analysis by portable X-ray fluorescence measurement

This article focusses on the environmental implications of low-cost jewelry for adults from Chinese e-commerce platforms ((n = 8) with heavy metal impurities (Pb, Cd and Hg) and their potential impact on human health and the environment. The study highlights the advantages of using portable X-ray fluorescence (pXRF) analysis for rapid, non-destructive, and in situ analysis of heavy metals in jewelry. The results reveal that all products (n = 106) contained heavy metals at varying levels, Hg being the most commonly detected heavy metal. The fact that 71% of the samples exceeded the EU limit for Pb and 51% exceeded the EU limit for Cd is alarming and highlights the need for stricter regulations and monitoring of the jewelry industry to mitigate the risks posed by heavy metals in the environment. The study emphasizes the importance of using pXRF analysis to identify heavy metals in jewelry and address the literature gap in environmental risk assessments of Pb, Cd, and Hg in low-cost jewelry for adults from China. In general, the findings call for urgent action to ensure the safety of consumers and prevent environmental pollution by strengthening regulations and monitoring the jewelry industry.

Environmental assessment in fine jewelry in the U.S.-Mexico's Paso del Norte region: A qualitative study via X-ray fluorescence spectroscopy

Heavy metal contamination in raw materials has spread widely in the United States. The high increased number of recalls in consumer products and the lack of stricter regulations in the raw materials to be used in the jewelry industry have raised concerns among consumers. Studies in low-cost jewelry have shown the presence and high content of heavy metals; this environmental problem led to a child's death after swallowing a charm containing elevated levels of lead (Pb). Exposure to heavy metals, through inhalation, mouth, and skin contact, causes adverse health effects in children and adults. Exposure to lead affects mainly the nervous system and brain development; exposure to cadmium (Cd) causes damage to liver, kidneys, and lungs, and potentially leads to cancer; exposure to nickel (Ni) causes severe dermatitis. Thus, the importance and impact of studies of this nature cannot be overstated. As heavy metal contamination has increased in the United States, this research fills an important knowledge gap between previous studies conducted on low-cost jewelry and fine jewelry. In this study, conducted in the Paso del Norte region, one hundred and forty-three pieces of fine jewelry were evaluated for the presence of heavy metals using X-ray fluorescence (XRF) spectroscopy. Our study showed that 61 samples (42.7 %) exhibited the presence of Ni in the metal alloy, prevailing in jewelry pieces with lower percentage of gold. Eighteen samples showed the presence of Pb in gemstones, 11 pieces of these samples (7.7 % total) had <33.3 % gold (≤10 K); however, none of the samples showed the presence of Pb in the metal alloy. Further research is needed to evaluate the bioaccessibility of Pb in these gemstones, which may pose a potential health hazard to children and adults in the US Paso del Norte region and throughout the world.

An analysis of the utilisation of medical identification jewellery among children and young adults with type 1 diabetes mellitus in Australia

AIMS

People with type 1 diabetes mellitus (T1DM) are at risk of life-threatening illness. Medical jewellery is recommended for emergencies, but its uptake is unknown. This study assessed the use of medical jewellery among people with T1DM aged 0-24 years in Australia.

METHODS

A cross sectional analysis of subscription data to the largest medical identification jewellery service in Australia was analysed by age, sex and geographic location using Australian population data from 2018.

RESULTS

There were 1599 people with T1DM aged 0-24 in the database, but only 1061 had an active subscription, corresponding to an active subscription rate of 13.28/100,000 population or ~5% of the estimated patient population. Half of the active subscribers were male (543/1061, 51/3%). The average age of active subscribers was 17; very few (n = 12, 1.1%) were aged less than 5; and the highest number (n = 141, 39%) was in the 20-24 age group. Active subscription rates varied significantly by geographic location. 88.4% of active subscribers had a diagnosis of T1DM or equivalent inscribed on their emblem, while engraved instructions for management in an emergency were only included in 1.8% of records (n = 19).

CONCLUSIONS

Medical jewellery subscription rates were lower than expected; increased with age; and varied significantly by state/territory. The use of medical identification jewellery may be limited by the lack of suitable engraved instructions for use in an emergency. Factors leading to low use should be addressed. Photo 1 Medical Jewellery with emblem.

The Effects of the Activity of Making Jewelry From Beads on the Anxiety Levels of Children With Cancer: A Randomised Controlled Study

Background: Children hospitalized for cancer treatment are known to experience high levels of anxiety. This study aimed to examine the effects of making jewelry from beads on the state and trait anxiety levels of children with cancer. Methods: This parallel group, randomized controlled trial was conducted on 62 children aged 7-18 who were being treated for cancer. The children were selected using the random sampling method. The jewelry-making sessions with the children in the intervention group were held twice a week for four weeks. Data were analysed using the chi-square test, the Student's t-test, the independent samples t-test and linear regression. Results: The state anxiety levels of the children in the intervention group decreased both in the first week and the fourth week after making jewelry. The difference in the average post-test scores between the two groups was found to be significant (p < .05). The fourth week average trait anxiety score of the children in the intervention group decreased (M  =  33.2) in comparison to the average score of the control group (M  =  36.5). The difference between the two groups was found to be significant (p < .001). Discussion: This study found that the activity of making jewelry from beads was effective in reducing the state and trait anxiety levels of children with cancer.

Contamination by hazardous elements in low-priced children's plastic toys bought on the local markets of Karachi, Pakistan

Children's plastic toys may contain toxic metals to which infants and young children can be orally exposed and may pose acute or chronic adverse health effects. This research aims to evaluate the total metal concentrations (TMCs) of Pb, Cd, Cr, Ni, Zn, Cu, and Mn in children's plastic toys bought in the local markets of Karachi, Pakistan, and compare TMCs to different toy safety regulatory limits. A total of 44 children's plastic toys sourced in the Karachi local markets were analyzed by an atomic absorption spectrophotometer for contamination of hazardous elements. Toy samples were divided into two groups: plastic toys (DCT) and plastic toys with paints or coatings (DPCT). For plastic toys, 83% (19) of samples had TMCs that exceeded European Union (EU) toy safety regulation limits for Pb, and 65% (15) of samples that exceeded for Cd. For plastic toys with paints or coating, 43% (9) of samples had TMCs that exceeded EU migration limits for Pb and 24% (5) for Cd. More than 20 samples exceeded the United States Consumer Product Safety Commission (US CPSC), Canadian, and Bureau of Indian Standards (BIS) toy safety regulation limits. In toy samples (n = 44), very high TMCs of Pb (64%), Cd (45%), Cr (5%), and Ni (2%) were observed. Zn, Cu, and Mn TMCs existed but were below the regulation limits. The contamination levels of Pb, Cd, Cr, and Ni and smaller extent of Zn, Cu, and Mn still pose health issues in children and may cause serious problems in their health.

Nickel release from metal items in contact with skin: a comparison of methods and practical implications for regulation in Europe

Contact allergy to Nickel is the most prevalent contact allergy in western societies. This has led to regulation for metallic items that come into prolonged and direct contact with the skin, such as buttons on clothing, belt buckles, jewelry and watches. In Europe, the legal provision is based on a test in which there is a limit to the amount of nickel that may be released from the item to an artificial sweat solution (EN 1811). This test is costly and has reproducibility issues. The resulting undertesting of items placed on the market, leads to many nickel releasing non-compliant articles being available in spite of the regulations that are in place. In this study, the performance of the standard release test is compared to the performance of a rapid nickel spot test based on dimethylglyoxime (DMG-test). The data suggest that using the rapid DMG-test for compliance testing is sufficiently equivalent to the current gold standard of EN 1811. Previously published comparisons between the DMG-test and EN 1811 did not consider the effect of accelerated wear and corrosion testing according to EN 12472. This study shows that by applying EN 12472, the number of deviating results between the DMG-test and EN 1811 decreases significantly. Regarding consumer protection, it is necessary for wear and corrosion resistance to be considered.

Use of medical identification jewellery in children and young adults with adrenal insufficiency in Australia

PURPOSE

Patients with adrenal insufficiency (AI) are at risk of life-threatening illness. Medical jewellery is recommended for emergencies, but its uptake is unknown. This study assessed the use of medical jewellery among Australian AI patients aged 25 years and under.

METHODS

Data on the age, sex, region, and diagnosis of subscribers to the largest medical jewellery provider in Australia were analysed. Subscription rates were calculated using 2017 Australian population data.

RESULTS

There were 666 patients aged 25 years and under in the database but only 358 (53.8%) had an active (up to date) subscription, corresponding to a subscription rate of 43.67/million or approximately 14.6% of the estimated patient population. The majority (n = 238, 66.5%) had primary AI; followed by secondary AI (n = 82, 22.9%); and the remaining patients (n = 38, 10.6%) could not be classified. Congenital adrenal hyperplasia (CAH) was the most frequent diagnosis (n = 153, 42.7%), corresponding to a subscription rate of 18.67/ million or 28.9% of the estimated number of patients with CAH. The mean age of subscribers was 15.9 (SD = 5.8) years. Only 18 (5%) patients were aged under 5 years. More females (n = 199, 55.9%) than males were active subscribers and subscription rates differed significantly by geographic area. Inactive (lapsed) subscriptions increased with age and were highest in the 20-25 year age group.

CONCLUSION

Subscription rates were lower than recommended; increased with age; and were more common in females. Older age was associated with higher levels of lapsed subscriptions. Factors leading to low use and discontinuation in young adults should be addressed.

Buyer beware: Inexpensive, high cadmium jewelry can pose severe health risks

The use of cadmium to produce inexpensive jewelry has recently been documented. Governments have adopted varying standards, with US states focused on either total cadmium content or extractable cadmium from children's jewelry, while the European Union has adopted a limit of 100 mg/kg cadmium for all jewelry. This study evaluated 80 items purchased at a discount jewelry store. The objective was to determine prevalence of cadmium in this jewelry, the amount of cadmium released by simulated mouthing or ingestion, and to confirm previous reports that damage to jewelry can increase cadmium release. Finally, a modified toxicity characteristic leaching procedure (TCLP) assessed the potential for jewelry to release cadmium after disposal. Thirty-two (40%) items showed detectable cadmium by X-ray fluorescence. Nine high‑cadmium pendants and rings with cadmium content ranging from 31.3 to 89.2% were subjected to extractions simulating mouthing or ingestion. Seven of nine items extracted in dilute saline to simulate mouthing released more than the US recommended maximum of 18 micrograms. Damaged jewelry released more cadmium for most items tested, with one ring yielding an average of 10,600 micrograms. Two pendants small enough to be swallowed were tested using dilute HCl to simulate ingestion. While one pendant did not release cadmium in excess of the US recommended maximum of 200 micrograms even when damaged, the other released an average of 63,100 micrograms after being damaged. Fourteen of fifteen samples of two high cadmium charms extracted using a modified TCLP extraction exceeded the 1.0 mg/L TCLP limit for cadmium, averaging 13.1 and 9.6 mg/L respectively for the two charms. These results demonstrate that high‑cadmium jewelry may pose a serious hazard if mouthed or ingested, and that regulatory standards that do not take into account the potential for increased release of cadmium resulting from damage to jewelry electroplating are inadequate.

Environmentally friendly process instead of cyanide leaching on recycling of gold and silver from jewellery scraps and wastes

Nowadays, the production and exploration of gold has an increased importance all over the world. Recycling is a significant source for the supply of gold and has a pronounced effect on its price. The flotation method, which is more economical and more environmentally friendly than cyanide leaching, has been investigated for recycling gold and silver from jewellery slag. A jewellery slag sample containing 28.3 ppm Au and 42.0 ppm Ag was obtained from a refinery in Turkey. Flotation concentrate assaying 614.6 ppm Au and 511 ppm Ag was achieved with recoveries of 89.0% and 83.2%, respectively. On the other hand, 87.8% Au and 81.5% Ag extractions were obtained by cyanide leaching tests. Based on these results, flotation is suggested, considering its environmental and economic benefits.

Potentially toxic elements in toys and children's jewelry: A critical review of recent advances in legislation and in scientific research

Contamination by potentially toxic elements (PTEs) in children's toys and jewelry is an ongoing problem where PTEs can become bioavailable especially via oral pathway (ingestion as a whole or of parts, and mouthing) and may cause adverse health effects for children. In the present review, legislation updates from the last decade in the United States (U.S.), Canada, and the European Union (E.U.) on PTEs in toys and jewelry are presented. Then, a literature review mostly covering the last decade on the total concentration, bioavailability, children's exposure, and bioaccessibility of PTEs in toys and jewelry is provided. The U.S. and Canadian legislations mainly focus on lead (Pb) and cadmium (Cd) total/soluble concentration limits to prevent exposure and have received several updates within the last decade, extending particularly the covered span of children's products. It seems that the introduction, subsequent enforcement, and update of regulations in developed countries have shifted the problem towards developing countries. In terms of categories, metallic toys and children's jewelry still have the most severe PTE contamination and the presence of Pb and Cd in these articles is an ongoing issue. Some studies suggest that color can be used as an indicator for the potential presence of PTEs (linked to chemicals such as lead chromate, cadmium sulfide) but the evidence is not always clear. Another concern is vintage/second-hand toys and jewelry as those items might have been produced before the legislation was present. As total and bioaccessible concentrations of PTEs in toys and jewelry do not always correlate, approaches considering bioaccessibility (e.g. of the E.U.) are more scientifically appropriate and help with better estimation of risk from exposure. Studies on toy and jewelry contamination using in vitro bioaccessibility techniques has become more common, however, there is still no in vitro test specifically designed and validated for toys and jewelry.

Contamination by eleven harmful elements in children's jewelry and toys from Central Asian market

Contamination by potentially toxic elements (PTEs) in children's toys and jewelry is an ongoing problem, and there is evidence in the literature that the issue is shifting towards developing countries and small markets. The present research aims (1) to characterize total concentrations of eleven PTEs (As, Ba, Cd, Co, Cr, Cu, Mn, Ni, Pb, Se, and Zn) in children's jewelry and toys purchased from the Central Asian market (n = 65), and (2) to investigate the relationship between the extent of contamination and sample categories/properties. The laboratory analyses showed that the majority of the samples had PTEs above the total and soluble limits for PTEs stated in the USA, Canadian, and the EU legislation. Particularly for metallic toys and jewelry (n = 46), the total concentrations in 45 samples exceeded the EU migration limits for one or more PTEs. In particular, Cu and Zn concentrations were extremely high (up to 100%) in many samples and highly toxic Cd and Pb were present in elevated quantities in several articles. Contamination was also present, albeit to a much lesser extent, in other toy categories: brittle/pliable toys for Co and Cr, plastic toys and jewelry for Pb, and other toys for Co. Although average values and visual observations suggested evidence, no statistically significant relationship between PTE concentrations and sample properties (color, price, and degree of appeal) could be found. The findings supported the evidence that the contamination issue in children's jewelry and toys by PTEs is an ongoing issue in developing countries. Very high total concentrations of PTEs particularly found in several metallic samples warrant further investigation of migratable concentrations. Thus, conducting bioaccessibility tests and a subsequent human health risk characterization is recommended. Overall, there is a potential risk for children in the case of exposure to PTEs from children's jewelry and toys sold on the Central Asian market. More effective enforcement of legislation for consumer goods in the region and raising public awareness regarding chemicals in children's products are recommended.

The use of medical identification jewellery in adults with adrenal insufficiency in Australia

OBJECTIVE

Hydrocortisone stress dosing during illness can prevent adrenal crises (AC) in patients with adrenal insufficiency (AI). When patients cannot communicate, medical identification jewellery may facilitate parenteral hydrocortisone provision but patient adoption rates are not known.

DESIGN

A cross-sectional analysis of Australian medical identification jewellery subscription data.

PATIENTS

Patients with AI aged 20 years and over with an active subscription to a large medical jewellery provider.

MEASUREMENTS

Subscription rates by AI subtype, geographic area, age and gender.

RESULTS

There were 1955 patients with AI and an active subscription in the database, corresponding to a subscription rate of 105.79/million or approximately one-third of the AI population. The subscription rate was substantially higher in primary AI (60.72/million) than secondary AI (23.16/million), corresponding to approximately 60.7% and 11.6% of the estimated population prevalence of each disorder, respectively. There was substantial variation in use by state/territory, with the highest subscribing state having a rate of over four times that of the lowest (P < 0.001). Women comprised 64.8% (n = 1266) of the group. Subscription also varied by age, being highest in the 60-69 year age group (165.15/million) and lowest in those aged 30-39 years (47.23/million) (P < 0.001). Few patients (4.8%, n = 94) mentioned, either in their record or on their jewellery, the need for urgent parenteral hydrocortisone in the event of severe illness.

CONCLUSIONS

Medical jewellery is a component of AC risk reduction. However, subscription appears to be underutilised in the Australian AI population, especially among patients with secondary AI. Urgent treatment recommendations should be inscribed on the jewellery.

Gold&silver recovery from jewelry waste with combination of physical and physicochemical methods

The recovery of precious metals can be successfully managed from waste which is considered to be secondary sources of raw material. Waste derived from jewelry activity falls in this category, and represents an essential component of precious metals. The most important metals in the jewelry sector are gold (Au) and silver (Ag). As a result of workmanship, the thin metals, jewel parts and metallic powders are generated and the dust produced from jewelry workshops is of great importance. This paper describes the concentration and recovery of Au and Ag from floor sweeping waste at jewelry workshops by physical (shaking table, multi gravity separator (MGS), Knelson and Falcon concentrators) and physicochemical methods (froth flotation). Experimental results demonstrated that the gravity beneficiation methods were effective for eliminating much of the waste matrix. A heavy fraction with 701 g/t Au and 6017 g/t Ag content was obtained from a feed assaying 183 g/t Au and 1835 g/t Ag by shaking table separator. For enhanced beneficiation, the middling's from tabling were subjected to centrifugal separator and Ag grade increased from 848 g/t to 7812 g/t. Au and Ag fractions discharged in tailings from gravity and centrifugal separations were successfully concentrated using froth flotation and led to a total recovery around 92% both for Au and Ag.

Cadmium pigments in consumer products and their health risks

Cadmium is a toxic heavy metal that has been increasingly regulated over the past few decades. The main exposure routes for the general public are the consumption of certain foods and the inhalation of cigarette smoke. However, additional exposure may occur through the current and historical use of the metal in consumer products. In this paper, the uses of Cd in consumer goods are reviewed, with the focus on brightly-coloured Cd sulphide and sulphoselenide pigments, and measurements of Cd in historical and contemporary products ascertained by XRF are reported. Cadmium is encountered across a wide range of contemporary plastic products, mainly because of the unregulated recycling of electronic waste and polyvinyl chloride. However, concentrations are generally low (<100 μg g^-1), conforming with current limits and posing minimal risk to consumers. Of greater concern is high concentrations of pigmented Cd (up to 2% by weight) in old products, and in particular children's toys that remain in circulation. Here, tests conducted suggest that Cd migration in some products exceeds the Toy Safety Directive limit of 17 μg g^-1 by an order of magnitude. The principal current use of Cd pigments is in ceramic products where the metal is encapsulated and overglazed. Leaching tests on new and secondhand items of hollowware indicate compliance with respect to the current Cd limit of 300 μg L^-1, but that non-compliance could occur for items of earthenware or damaged articles should a proposed limit of 5 μg L^-1 be introduced. The greatest consumer risk identified is the use of Cd pigments in the enamels of decorated drinking glasses. Thus, while décor is restricted to the exterior, any enamel within the lip area is subject to ready attack from acidic beverages because the pigments are neither encapsulated nor overglazed. Glass bottles decorated with Cd-based enamel do not appear to represent a direct health hazard but have the propensity to contaminate recycled glass products. It is recommended that decorated glassware is better regulated and that old, brightly-coloured toys are treated cautiously.

Do looks matter? The role of the Electronic Residency Application Service photograph in dermatology residency selection

BACKGROUND

There is a lack of research on the impact of the Electronic Residency Application Service (ERAS) photograph on the residency selection process.

OBJECTIVE

We sought to elucidate the role of the ERAS photograph in the dermatology residency selection outcome and to determine if photographs submitted by matched applicants differ from those of unmatched applicants.

METHODS

We analyzed ERAS photographs submitted by dermatology residency applicants based on photograph characteristics related to composition, attire, facial expression, hairstyle, and accessories.

RESULTS

Candidates who smiled, wore glasses, and wore jackets in their photographs were more likely to match. There was no difference in the rate of matching among applicants depending on whether their photograph was of professional quality or whether they wore formal attire in their pictures. Gender specific characteristics were not found to be influential in the match outcome for male applicants. Among female applicants, having hair to the shoulders or longer was associated with a positive match outcome.

CONCLUSION

Certain characteristics of the ERAS photographs were found to be associated with a more favorable match outcome. Further biases inferred from these photographs might be present in the dermatology selection process. We suggest blinding the selection committees to ERAS application photographs prior to granting residency interviews.

The environmental impact of informal and home productive arrangement in the jewelry and fashion jewelry chain on sanitary sewer system

The outsourcing informal home practices adopted in jewelry and fashion jewelry chain can cause toxic substance elimination in the effluents and raise a concern for its environmental impact. This study evaluates if this informal work alters the concentration of potentially toxic elements (PTEs: As, Cd, Cr total and Cr-VI, Cu, Hg, Ni, Pb, Sn, and Zn) in the sewage network. The sanitary sewage samples (n = 540) were collected in 15 manholes during two campaigns in three different areas of Limeira-SP, Brazil (industrial area, with informal work and without known industrial/informal activity). The sewage sludge (n = 12), raw (n = 12), and treated sewage (n = 12) were collected in two wastewater treatment plants (WWT: AS and TATU) operating with different treatment process. The PTE determination was performed by ICP-OES, direct mercury analysis, and UV-Vis spectroscopy. Cr-VI, Cu, Ni, and Zn were the only elements above the quantification limit. Four samples exceeded Cu or Zn values permitted to be discharged into sewage system; however, the concentration average was lower than that established by Brazilian legislation. A difference was found between values above and below the 75th percentile for campaign and total organic carbon values (p < 0.015). The AS-treated sewage presented low concentrations of Cu (p < 0.05), Zn (p = 0.02), and Ni (p = 0.01) compared to treated sewage from TATU. In the sludge samples, the Cu means exceeded the limits of the Brazilian legislation (1500 mg kg^-1) and the Zn results were very close to the limits (2800 mg kg^-1). The heterogeneity of the results can indicate the sporadic nature of the PTE's sanitary disposal. PTEs used in jewelry and fashion jewelry chain may precipitate on the sludge, where presented high concentrations of Cu and Zn which require controlled destination.

Regulation of chemicals in children's products: How U.S. and EU regulation impacts small markets

Toys and children's products may contain trace metals and organic compounds that are potentially harmful to the health and development of infants and young children. Intergovernmental organizations and individual countries regulate chemicals in consumer products, but a coordinated international approach is lacking. This paper examines the implications of chemical regulation in children's products in large markets for a smaller market, namely Israel. We compared chemical regulations in children's products in the U.S., EU and Israel, and conducted in-depth interviews with diverse stakeholders in the Israeli product standardization process. Israel adopted EU chemical standards for certain chemicals (e.g., trace metals, phthalates) but not others (e.g., bisphenol A, flame retardants, trace metals in children's jewelry). Israeli regulation of chemicals in consumer products relies on regulations in large markets such as the U.S. and EU, which therefore have impacts beyond their territories. However, Israel adopts only product-specific standards and has regulatory gaps due to the lack of an overarching regulatory approach that exists in the U.S. and the EU. Furthermore, Israeli policy is to adopt parallel standards from large markets in order to remove trade barriers, despite their different approaches to chemical regulation, an approach which prioritizes trade considerations over health considerations. We conclude with policy recommendations for Israel, which have relevance for other small markets.

Guideline Implementation: Hand Hygiene

Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Toxicity assessment of ash and dust from handmade gold jewelry manufacturing workshops in Bangladesh

Traditionally, handmade gold jewelry played a very important role in the cultural heritage of Bangladesh. Goldsmiths still are partially using ancient manufacturing process with coal fire, candle flame blowing, and nitric and sulfuric acid treatments. Such process leads to the contamination of workplace with the dust of toxic metals, acidic vapors, and particles of different natures. To evaluate contamination by particulate matter (PM), the passive particle collectors were installed in different manufacturing units for a period of 85 days at Tanti Bazar, Dhaka, Bangladesh. The laser diffraction analysis of the samples collected at the soldering units showed significant amounts of particulates, both PM10 and PM 2.5, and also nanoparticles in both nucleation and accumulation mode. SEM/EDS analysis revealed partially melted micro blebs that contain a very high concentration of Fe along with Cu. The toxic elements were detected with ICP analysis and include higher concentrations of cadmium (Cd), chromium (Cr), lead (Pb), and arsenic (As). It is notable that detection of arsenic contamination was unexpected since raw materials used for jewelry making should not have any arsenic.

Oral Jewelry and Piercing: Risks to Health

What appears to be a decorative fad, pursued by people of all ages, is, for the most part, an invasion of the body by poorly trained individuals. Simple-to-complex, the insertion of body jewelry is embarked upon on a whim with little concern for health, including the possibility of infection. Many of those who opt for piercings have outcomes that are unremarkable and relatively trouble free. Others, less fortunate, end up with irreversible scars, serious infections, torn anatomic structures and teeth that are fractured, disfigured or have drifted out of line.

Evaluation of a two rubber band technique for finger ring removal

INTRODUCTION

Rings are required to be removed from a finger in many clinical situations. Rings that are difficult to remove is a problem encountered frequently. Many techniques have been reported for this problem. This study looks at the effectiveness of a single technique for removing difficult rings from fingers.

METHODS

A two rubber band technique was used in this study of 69 difficult to remove rings. Success of the technique and time to removal were recorded.

RESULTS

Difficult rings were removed in 92.5% of cases, in a mean time of 10.7 seconds. No fingers or rings suffered damage during the study.

CONCLUSIONS

This two rubber band technique is a rapid, safe and effective method for removing rings that cannot be removed easily.

Risk of eye lens radiation exposure for members of the public

In 2011, the International Commission on Radiological Protection (ICRP) reviewed its recommendation concerning the equivalent dose limit for the eye lens, lowering it to 20 mSv in a year, for occupational exposure in planned exposure situations. The ICRP's statement does not contain any explicit recommendations regarding the organ dose limit for the eye lens for public exposure. For the moment, no change is proposed. But, to be coherent in the overall approach, the current equivalent limit for the public might be lowered. A similar yardstick than in the former recommendation may be used, that is to say a reduction of 10 times lower than that for occupational exposure. In this context, additional data on potential scenarios for public exposure of the eye lens are necessary. This paper, mainly based on a literature study, aims to provide, as far as possible, an exhaustive list of the situations in which members of the public can be exposed at the level of the eye lens. Once these situations have been defined, some calculations, made to assess the associated doses to the eye lens, are presented. This literature study did not reveal any current situations where members of the public would receive significant radiation doses to the eye lens. Indeed, the situations in which the dose to the eye lens might reach around 1 mSv per year for the public are extremely rare.

Pressure-induced isomorphic sclerodermoid graft-versus-host disease from brassiere underwire and tight-fitting watch

Sclerodermoid chronic graft-versus-host disease (scGVHD) is a rare form of cGVHD with an estimated prevalence of 3% to 11% in patients receiving allogeneic bone marrow transplants. scGVHD is believed to be an immune-mediated response characterized by aberrant T-cell function and dysregulation of tyrosine kinase cascades. Published literature on scGVHD is still limited and the mechanisms are yet to be fully understood. Thus, successful treatment of scGVHD remains largely unknown and many current options are hindered by potential side effects. This case provides an example of scGVHD localizing to areas of trauma and friction as a potential mechanism behind scGVHD and provides several case reports that document similar findings.

Objective classification of performance in the use of a piercing saw in jewellery making

Data from 15 jewellery students, in their 1st and 3rd years of training, were analysed to show how data collected from work settings can be used to objectively evaluate performance in the use of tools. Participants were asked to use a piercing saw to cut 5 lines in a piece of metal. Performance was categorised in terms of functional dynamics. Data from strain gauges and a tri-axial accelerometer (built into the handle of the saw) were recorded and thirteen metrics derived from these data. The key question for this paper is which metrics could be used to distinguish levels of ability. Principal Components Analysis identified five components: sawing action; grasp of handle; task completion time; lateral deviation of strokes; and quality of lines cut. Using representative metrics for these components, participants could be ranked in terms of performance (low, medium, high) and statistical analysis showed significant differences between participants on key metrics.

Rapidly Fatal Silicosis Among Jewellery Workers Attending a District Medical College of West Bengal, India

BACKGROUND

Silicosis is a slowly progressive chronic occupational lung disease, developed after a prolong period of exposure to high concentration of silica dust.

METHODS

In this longitudinal study, we enrolled old and new silicosis patients (n=19; 8 jewellery polishers, 11 from other occupations) seen at our Pulmonary Medicine Department from June 2009 to December 2012 to document the course of illness as per their occupational exposure.

RESULTS

Six of the eight jewellery polishing workers had developed silicosis within five years of exposure, while six of the 11 other workers with other occupational exposure had developed silicosis after exposure of 10 years or more. Mean duration of exposure was significantly less among jewellery polishing workers compared to other workers (3.4 +/- 1.7 versus 9.3 +/- 4.1; p=0.001). Mean duration of illness (months) (14.9 +/- 5.8 versus 28.5 +/- 16.5; p=0.040) were significantly less among the jewellery polishing workers compared to other workers. At the end of the study period, all eight jewellery polishing workers with silicosis had died while four of the 11 patients with other occupational exposure had died.

CONCLUSION

Silicosis among jewellery polishing workers was found to be more severe and progressive compared to silicosis due to other occupational exposures, in our study.

Display Modes of Personal Ornaments in the Upper Palaeolithic Sites of Istria, Croatia

In the attempt to understand culture and social behavior of prehistoric populations, findings of personal ornaments are of particular interest. Personal ornaments in their formal expressions (marine shells and snails, river snails, animal teeth, modified animal bones etc.) not only point to an universal idea of decoration and aesthetic sensibility, but may also reveal contact zones and communication paths. Perforated animal teeth, mostly deer canines, reveal us not only symbolic, but also some important sociocultural aspects of behavior of prehistoric populations. In order to test whether there are universals in display modes and materials used in this region, we will use the finds of personal ornaments from the Upper Paleolithic strata from five Istrian sites: Ljubićeva cave, Pupićina cave, Romualdova cave, Šandalja II, and Vešanska cave.

Toxic metals in children's toys and jewelry: coupling bioaccessibility with risk assessment

A total of 45 children's toys and jewelry were tested for total and bioaccessible metal concentrations. Total As, Cd, Sb, Cr, Ni, and Pb concentrations were 0.22-19, 0.01-139, 0.1-189, 0.06-846, 0.14-2894 and 0.08-860,000 mg kg(-1). Metallic products had the highest concentrations, with 3-7 out of 13 samples exceeding the European Union safety limit for Cd, Pb, Cr, or Ni. However, assessment based on hazard index >1 and bioaccessible metal showed different trends. Under saliva mobilization or gastric ingestion, 11 out of 45 samples showed HI >1 for As, Cd, Sb, Cr, or Ni. Pb with the highest total concentration showed HI <1 for all samples while Ni showed the most hazard with HI up to 113. Our data suggest the importance of using bioaccessibility to evaluate health hazard of metals in children's toys and jewelry, and besides Pb and Cd, As, Ni, Cr, and Sb in children's products also deserve attention.

Analysis and interpretation of a unique Arabic finger ring from the Viking Age town of Birka, Sweden

In this work we used non-destructive SEM imaging and EDS analysis to characterize the material composition of an Arabic finger ring, which was found in a 9(th) c. woman's grave at the Viking Age (A.D. 793-1066) trading center of Birka, Sweden. The ring is set with a violet stone inscribed with Arabic Kufic writing, here interpreted as reading "il-la-lah", i.e. "For/to Allah". The stone was previously thought to be an amethyst, but the current results show it to be coloured glass. The ring has been cast in a high-grade silver alloy (94.5/5.5 Ag/Cu) and retains the post-casting marks from the filing done to remove flash and mold lines. Thus, the ring has rarely been worn, and likely passed from the silversmith to the woman buried at Birka with few owners in between. The ring may therefore constitute material evidence for direct interactions between Viking Age Scandinavia and the Islamic world. Being the only ring with an Arabic inscription found at a Scandinavian archaeological site, it is a unique object among Swedish Viking Age material. The technical analysis presented here provides a better understanding of the properties and background of this intriguing piece of jewelry.

Multi-technique quantitative analysis and socioeconomic considerations of lead, cadmium, and arsenic in children's toys and toy jewelry

A wide spectrum and large number of children's toys and toy jewelry items were purchased from both bargain and retail vendors and analyzed for arsenic, cadmium, and lead metal content using multiple analytical techniques, including flame and furnace atomic absorption spectroscopy as well as X-ray fluorescence spectroscopy. Particularly dangerous for young children, metal concentrations in toys/toy jewelry were assessed for compliance with current Consumer Safety Product Commission (CPSC) regulations (F963-11). A conservative metric involving multiple analytical techniques was used to categorize compliance: one technique confirmation of metal in excess of CPSC limits indicated a "suspect" item while confirmation on two different techniques warranted a non-compliant designation. Sample matrix-based standard addition provided additional confirmation of non-compliant and suspect products. Results suggest that origin of purchase, rather than cost, is a significant factor in the risk assessment of these materials with 57% of toys/toy jewelry items from bargain stores non-compliant or suspect compared to only 15% from retail outlets and 13% if only low cost items from the retail stores are compared. While jewelry was found to be the most problematic product (73% of non-compliant/suspect samples), lead (45%) and arsenic (76%) were the most dominant toxins found in non-compliant/suspect samples. Using the greater Richmond area as a model, the discrepancy between bargain and retail children's products, along with growing numbers of bargain stores in low-income and urban areas, exemplifies an emerging socioeconomic public health issue.

An unusual foreign body impaction in the pharynx of a child - a case report and literature review

AIMS AND OBJECTIVES

Foreign body impaction in the upper aero-digestive tract is relatively common in Otorhino/aryngological practice. The aim is to present a case of an unusual impacted foreign body (ear ring), in the pharynx of a child,that was confirmed by plain radiographs.

CASE REPORT

An 8-month old male baby presented in emergency paediatric unit(EPU) of our hospital with a history of ingestion of an empty paracetamol satchel. Plain X-ray soft tissue of the neck however revealed a big metallic ear ring that impacted in the upper aerodigestive tract. It was removed successfully under general anaesthesia. The possible delay in diagnosis and various complications of pharyngeal foreign bodies were highlighted /reviewed.

CONCLUSION

In conclusion foreign body impaction is common in the paediatric age group. Effort should be made by the attending physician to inquire into details of event relating to ingestion of foreign body in order to arrive at early and timely diagnosis and treatment so as to prevent complications.

Children's exposure to harmful elements in toys and low-cost jewelry: characterizing risks and developing a comprehensive approach

Contamination problem in jewelry and toys and children's exposure possibility have been previously demonstrated. For this study, risk from oral exposure has been characterized for highly contaminated metallic toys and jewelry ((MJ), n=16) considering three scenarios. Total and bioaccessible concentrations of Cd, Cu, Ni, and Pb were high in selected MJ. First scenario (ingestion of parts or pieces) caused unacceptable risk for eight items for Cd, Ni, and/or Pb (hazard index (HI)>1, up to 75, 5.8, and 43, respectively). HI for ingestion of scraped-off material scenario was always <1. Finally, saliva mobilization scenario caused HI>1 in three samples (two for Cd, one for Ni). Risk characterization identified different potentially hazardous items compared to United States, Canadian, and European Union approaches. A comprehensive approach was also developed to deal with complexity and drawbacks caused by various toy/jewelry definitions, test methods, exposure scenarios, and elements considered in different regulatory approaches. It includes bioaccessible limits for eight priority elements (As, Cd, Cr, Cu, Hg, Ni, Pb, and Sb). Research is recommended on metals bioaccessibility determination in toys/jewelry, in vitro bioaccessibility test development, estimation of material ingestion rates and frequency, presence of hexavalent Cr and organic Sn, and assessment of prolonged exposure to MJ.

Identification of four differently injured victims of the Mangalore air crash disaster

On the 22nd of May 2010, a Boeing 737-800 aircraft crashed at the Mangalore International Airport killing all but 8 of the 166 people on board. One of the most important roles of the forensic investigation is to identify the victims of the crash. This task was made even more difficult because of the fact that most of the bodies were charred beyond recognition. Four bodies were transported to a mortuary to undergo a postmortem examination, whereas the rest of the victims were examined elsewhere. There is a wide range of methods to identify victims of mass disasters ranging from simple facial recognition to highly complex DNA comparisons. This paper highlights the experience and methods used to describe various types of injuries associated with a plane crash and the methods and techniques used to successfully identify the four victims of the crash. Implications for forensic nurses are discussed.

[Scarf pin: an intrabronchial foreign body who is not unusual]

OBJECTIVE

Inhalation of foreign bodies is rare in adults. Inhalation of scarf pin is a phenomenon more frequent in the female population in Morocco. The aim of our study was to describe the characteristics of this particular foreign body and illustrate the circumstances and consequences of its inhalation.

PATIENTS AND METHODS

Twenty-six young patients, all veiled, were hospitalized in the service of Respiratory Diseases University Hospital Ibn Rushd of Casablanca between January 2005 and July 2011 for inhaled scarf pin.

RESULTS

The mean age was 16 years. Inhalation was accidental in all cases, whereas patients initiated to wear the veil. The penetration syndrome was found in all cases. Clinical examination was normal in all patients. The chest X-ray showed the foreign body as a linear opacity, located right in 18 cases and left in eight cases. Flexible bronchoscopy was able to extract the pin in 21 cases. The pin was released spontaneously in three cases and two patients were operated on.

CONCLUSION

The scarf pin is a foreign body especially more common in women who wear the Islamic veil. Flexible bronchoscopy is an essential means of therapy, but the best preventive treatment is avoiding to put in the mouth sharp objects.

[Piercings--what the physician needs to know?]

Body piercing (BP) is defined as penetration of jewellery through the skin. Along with tattooing BPs are the most common body modifications. Complications related to piercing are numerous. They can be acute or chronic, infectious or non infectious and local or systemic complications. Acute infections constitute the most important complications and occur independently of the piercing site. Special attention should be brought on oral piercings, as they are frequent and responsible for numerous complications. A non-judgmental approach is recommended, when a pierced patient seeks medical help for a piercing complication or any other health issue.

Jewelry boxes contaminated by Aspergillus oryzae: an occupational health risk?

In 2009, 100,000 jewelry boxes, manufactured in China, were delivered to a jewelry manufacturer in Besançon, France. All the boxes were contaminated by mold. Because the workers refused to handle these jewelry boxes, the company contacted our laboratory to determine how to deal with the problem. Three choices were available: (1) decontaminate the boxes, (2) return the boxes to the Chinese manufacturer, or (3) destroy the entire shipment. Based on microscopic identification, the culture analysis was positive for A. oryzae. This could not be confirmed by molecular techniques because of the genetic proximity of A. oryzae and A. flavus. Because A. flavus can produce aflatoxins, we tested for them using mass spectrometry. Aflatoxins B1, B2, G1, G2, and M1 were not detected; however, given the specifics of this situation, we could not discard the possibility of the presence of other aflatoxins, such as P1, B3, GM2, and ethoxyaflatoxin B2. We concluded that the contamination by A. oryzae was probably due to food products. However, because of the possible presence of aflatoxins, occupational health risks could not be entirely ruled out. The decision was therefore taken to destroy all the jewelry boxes by incineration. To avoid a similar situation we propose: (1) to maintain conditions limiting mold contamination during production (not eating on the work site, efficient ventilation systems); (2) to desiccate the products before sending them; and (3) to closely control the levels of dampness during storage and transport.