Health outcomes and provider choice under full practice authority for certified nurse-midwives

Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008-2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.

Tobacco products and electronic cigarettes' legislation violations - observational study in 31 European countries, 2005-2022

BACKGROUND

European Union (EU) law regulates the manufacture, presentation, and sale of tobacco and related products in all member states. This study examined whether legislation non-compliant tobacco products and electronic cigarettes were available for sale in the European market.

METHODS

We queried the EU Rapid Information System for dangerous non-food products, covering 28 current and former EU member states and 3 associated countries, also known as Rapex, for non-compliant tobacco and related products reported between 2005 and 2022.

FINDINGS

During the operation of the Rapex system, 183 violations were reported (six on tobacco, three on traditional cigarettes, and 174 on e-cigarettes). Insufficient product safety information was found in 86% of the reports on e-cigarettes and 74% of the refills. Violations regarding the volume of the liquid container were observed in 26% of the e-cigarette reports and 20% of the refill reports. Approximately 15% of the reported e-cigarettes and 17% of refill liquids exceeded permissible nicotine levels. More serious standard violations were recorded for refills than for e-cigarettes. Approximately one-third of Rapex system countries submitted no notifications.

INTERPRETATION

E-cigarettes were the most frequently reported items in the European market of tobacco and non-tobacco nicotine products. The most common concerns were inadequate product safety information, incorrect liquid container volume, and excessive nicotine concentration. Identifying the most recognized legal infringements did not require laboratory tests and was based only on packaging and the manufacturer's declaration analysis. Further studies are necessary to corroborate whether products available in countries where no violations have been reported meet EU safety standards.

Quantitative risk assessment of allergens leaching from menstrual hygiene products

Allergic contact dermatitis (ACD) often associated with the topical use of perfumed products, remains one of the most common chronic skin disorders in Western countries. Since labelling of scented menstrual hygiene products (MHPs) is not mandatory, women might be unknowingly exposed to allergens. Given that vaginal mucosae lack the vital barrier function of the skin, skin allergens can easily penetrate and become systemically available and hence women may experience adverse effects in the anogenital region. The aim of this study was therefore to investigate whether women using scented MHPs are at risk of sensitization and hence developing ACD. Hereto, a Quantitative Risk Assessment (QRA) is performed on four well-known skin sensitizing chemicals (α-isomethyl ionone, benzyl salicylate, hexyl cinnamaldehyde and heliotropine) that were previously found leaching from five different scented MHPs including tampons and sanitary pads. The amounts of heliotropine, leached by one of the investigated tampons, exceeded acceptable exposure levels determined with the QRA and could induce sensitization. In addition, although no sensitization is expected for the other three compounds, an allergenic reaction might be provoked in women who are already sensitized. Labelling of allergens on scented MHPs would therefore help consumers to prevent adverse effects linked to ACD.

The revised European Directive 2020/2184 on the quality of water intended for human consumption. A step forward in risk assessment, consumer safety and informative communication

Water is an indispensable element for humankind and indeed all living beings; as such it is essential that it be supplied in adherence with safety and security criteria so as to fulfill its primordial role in community development. Therefore, the European Union has issued a new Directive on drinking water, updating the previous one (98/83/EC). The main new features of the updated Directive issued on January 12, 2021 include: • The adoption of a risk-based approach, in accordance with the principles of the Water Safety Plan, along the entire supply chain including the domestic system from the meter to the tap; • The updating of some quality standards, mainly related to the introduction of new parameters and the modification of parameter values for some in a more restrictive sense and for others in more permissive terms; • The identification of possible emerging pollutants present in supply sources (catchment areas); • The demand for effective and transparent communication to citizens on the quality of the water supplied, necessary to foster consumer confidence in the mains water supply. The Directive is the first European legislation adopted following a European Citizens' Initiative (ECI), a European Union participatory democracy tool launched through the "Right2Water" initiative aiming to positively affect the environment. Indeed, the increased consumer confidence in tap water resulting from the desired improvement in communication to citizens should lead to a gradual reduction in the use of plastic water bottles. In addition, the Directive confirms what WHO has been reporting for some time through its Water Safety Plans. It is not limited to monitoring activities but also reproposes and promotes a generalised safety approach based on risk identification and management along the entire drinking water supply chain (from the catchment area to extraction, treatment, storage including distribution). The revised Directive will become the reference standard for the quality of water intended for human consumption in EU countries, and its entry into force will make it possible to minimise the harmful impacts of pollution on human health.

Quality of indoor air environment and hygienic practices are potential vehicles for bacterial contamination in University cafeteria: case study from Haramaya University, Ethiopia

The aim of this study was to investigate the microbial quality of indoor air environment and hygienic practices of food handlers in Haramaya University cafeteria, Ethiopia. A total of 36 air samples were collected from the cafeteria using passive air sampling technique. Furthermore, 42 swab samples were taken from the hands and clothes of food handlers for microbial analysis. The results showed that air quality in the cafeteria is below satisfactory. Total coliform counts from all the swab samples were also above the acceptable microbial target value. Significantly higher microbial load was recorded in food handlers involved in serving food than these deployed in baking and sauce making roles. This study generally showed the importance of indoor air quality, and hands and clothes of food handlers as potential sources of bacterial contamination in the University's cafeteria. Therefore, improved housing condition, regular training, and close supervision are recommended.

A liquid chromatographic method for determination of acetamiprid and buprofezin residues and their dissipation kinetics in paddy matrices and soil

The present study was conducted to investigate the residue status of two insecticides (acetamiprid and buprofezin) and their dissipation kinetics in three matrices viz. paddy grain, straw, and soil. The extraction procedure for residues of these two insecticides was executed using acetonitrile solvent. The analytical method was validated, which showed good linearity with the limit of quantification (LOQ) value of 0.01 and 0.02 mg kg^-1 for acetamiprid and buprofezin, respectively. The recovery range was 79.67-98.33 % concerning all the matrices in both the insecticides. Acetamiprid (20% SP) and Buprofezin (25% SC) were applied separately in the paddy field in two doses: single dose (recommended dose) and double dose along with untreated control throughout the experiment. Residue analysis of these two insecticides in paddy (grain and straw) and soil was accomplished employing high-performance liquid chromatography (HPLC) with ultraviolet (UV) detector and confirmed by ultra-performance liquid chromatography (UPLC) coupled with mass spectrometry (UPLC-MS/MS). The dissipation data showed that acetamiprid exhibited higher dissipation in comparison with buprofezin. However, their persistence was found slightly higher in soil. The dissipation dynamics in the rice and soil were discussed with biological half-lives of both the insecticides. Consumer risk assessment study was also made considering its fate to the consumers.

Toxic boost: Acute, reversible neurotoxicity after ingestion of methylcyclopentadienyl manganese tricarbonyl (MMT) mistaken for an energy drink

Methylcyclopentadienyl manganese tricarbonyl (MMT) is an organometallic compound used as a gasoline additive for its antiknock properties. Human ingestion of MMT has not previously been reported. We present the case of a 54-year-old man who developed seizures and altered mental status after drinking 12 oz. of MMT-containing NOS Octane Booster Racing Formula. Due to label similarities, he mistook this for the NOS High Performance energy drink. The patient was intubated due to persistent seizures despite benzodiazepine treatment and admitted to the intensive care unit. He had two further seizures while intubated, but he was successfully extubated on the 4th day post-ingestion. He was confused and ataxic following extubation, but one day later his symptoms resolved and he was discharged without further incident. This case highlights the importance of responsible labeling of consumables. It is important for clinicians and poison centers to report any such instances to the United States Food and Drug Administration.

Heavy metal contents of selected commercially available oil-based house paints intended for residential use in Ethiopia

Environmental pollution by paint-based heavy metals have been continued to be a great concern. Thus, this study was aimed at investigating the levels of selected heavy metals (Ni, Cd, Cr, Zn, and Pb) in oil-based paint samples being manufactured and sold in Ethiopia. An optimized acid digestion procedure using conc. HNO₃, conc. HClO₄, and 30% H₂O₂ mixture by volume ratio of 3:4:1 mL, respectively, for 2 h at 200 °C were used for paint samples digestion, and the contents of heavy metals were assayed by flame atomic absorption spectroscopy. The 13 out of 14 (92.9%) analyzed paint samples had contained Pb > 90 mg/kg with the highest content of 51,200 mg/kg (dry weight) in the orange colored paint. Likewise, the levels of Cr, Ni, and Zn obtained were ranged from 43.75 to 50.00, 60.02 to 128.81, and 323.69 to 1102.16 mg/kg (dry weight), respectively, while Cd was not detected in all the paint samples. Generally, the mean contents of heavy metals in the investigated paint samples have followed the order: Pb > > Cr > Zn > Ni, demonstrating the occurrence of higher lead metal content. The elevated levels of heavy metals detected in the oil-based paint samples could be attributed to the continued usage of these metals in different form during paint manufacture. On the bases of the findings, a strict monitoring and evaluation of paints being produced in Ethiopia has been recommended so that the manufacturers comply with the national (policy issue) and/or international regulations on the levels of toxic metals in paints to ensure consumers safety.

Skin sensitisation testing in practice: Applying a stacking meta model to cosmetic ingredients

Recently, several non-animal approaches contributing to the identification of skin sensitisation hazard have been introduced. Their validation and acceptance has largely been directed towards regulatory classification. Considering the driving force for replacement of in vivo tests centred on cosmetics, it is reasonable to ask how well the new approaches perform in this respect. In the present study, 219 substances, largely cosmetic raw materials (including dyes, preservatives and fragrances), have been evaluated in our Defined Approach integrating a stacking meta model (version 5), incorporating the individual outcomes of 3 in vitro validated methods (Direct Peptide Reactivity Assay, Keratinosens™, U-SENS™), 2 in silico tools (TIMES SS, TOXTREE) and physicochemical parameters (volatility, pH). Stacking meta model outcomes were compared with existing local lymph node assay (LLNA) data. Non-sensitisers comprised 68/219; 86 were weak/moderate and 65 were stronger sensitisers. The model version revision demonstrate the gain to discriminate sensitizers to non-sensitiser when the in silico TIMES model is incorporated as input parameter. The 85% to 91% accuracy for the cosmetics categories, indicates the stacking meta model offers value for the next generation risk assessment framework. These results pinpoint the power of the stacking meta model relying on a confidence based on the probability given in any individual prediction.

Mechanism-specific and whole-organism ecotoxicity of mono-rhamnolipids

Biosurfactants like rhamnolipids are promising alternatives to chemical surfactants in a range of applications. A wider use requires an analysis of their environmental fate and their ecotoxicological potential. In the present study mono-rhamnolipids produced by a recombinant Pseudomonas putida strain were analyzed using the Green Toxicology concept for acute and mechanism-specific toxicity in an ecotoxicological test battery. Acute toxicity tests with the invertebrate Daphnia magna and with zebrafish embryos (Danio rerio) were performed. In addition, microbial and fungicidal effectiveness was investigated. Mutagenicity of the sample was tested by means of the Ames fluctuation assay. A selected mono-rhamnolipid was used for model simulations regarding mutagenicity and estrogenic activity. Our results indicate that mono-rhamnolipids cause acute toxicity to daphnids and zebrafish embryos comparable to or even lower than chemical surfactants. Rhamnolipids showed very low toxicity to the germination of Aspergillus niger spores and the growth of Candida albicans. No frameshift mutation or base substitutions were observed using the Ames fluctuation assay with the two tester strains TA98 and TA100. This result was confirmed by model simulations. Likewise it was computed that rhamnolipids have no estrogenic potential. In conclusion, mono-rhamnolipids are an environmental friendly alternative to chemical surfactants as the ecotoxicological potential is low.