Safe Use Of Products Research Articles

Evaluating Occupational Workforce and Practices in New York Metropolitan Nail Salons.

This study investigated workforce characteristics, work practices, protective measures, and health symptoms among nail salon workers in New York and New Jersey following the implementation of local exhaust ventilation (LEV) regulations in New York. An online survey conducted from 2022 to 2023 targeted registered nail salons and manicurists in both states (N = 146). The majority of respondents were Asian, primarily Korean (52.1%) and Chinese (26%). In New York, 79% of salons had a mechanical ventilation system, including LEV, while in New Jersey, where no ventilation regulation exists, only 52% of nail salons had mechanical ventilation systems. A substantial proportion of manicurists reported health-related concerns (40.5%) and symptoms related to chemical exposure (67.6%). The study emphasizes the need for continuous and improved illness prevention strategies, including the use of safer products, comprehensive health and safety training, and effective ventilation practices, to better protect nail salon workers.

Developing Flexible Risk Management Systems for Resilience in a Post-pandemic World: Can Lessons from a Makerspace Case Study Support Pacific Island Communities?

Pacific Island communities are facing disruptions to supply chains from natural disasters and a changing global environment, which have become more acute following the COVID-19 pandemic. Further, it has been demonstrated how flexible systems can enhance resilience in low-resource environments, such as adapting to changing consumer needs and minimizing supply chain disruptions. This paper considers how the development of a flexible system for conducting a risk assessment on a product that was developed and manufactured in a Makerspace environment would have application in Pacific Island communities to improve resilience. Using a participative action research (PAR) approach, a traditional product risk assessment is refined through iterative PAR cycles to reconceptualize it into a structured simplified risk process. The resulting product development risk assessment process (PDRAP) demonstrates that it is possible to adapt a detailed systematic risk assessment process, such as hazard and operability analysis (HAZOP), to be more suitable and effective for low-resource situations requiring flexible solutions. The improved process provides greater system flexibility to empower people to develop products which may improve their resilience in an ever changing and complex world. The PDRAP process can improve product design and adaptability which assists safeguarding supply chains from system wide disruptions. With the emergence of Makerspaces in developing countries for supply chain recovery from natural disasters and a changing national strategy, the PDRAP provides communities with a low-resource approach for risk assessment to ensure the safe use of products fabricated using emerging low-volume, rapid prototyping, and manufacturing technology.

Cannabis Social Clubs in Contemporary Legalization Reforms: Talking Consumption Sites and Social Justice

There is ongoing debate about what policy approaches to cannabis use might best address health and social related harm. Profit-driven, adult-use cannabis markets have been introduced in the United States and Canada, where legalization reform has had mixed effects to date in terms of public health and has made limited progress in achieving social justice aims. Meanwhile, several jurisdictions have seen an organic evolution of alternative cannabis-supply regimes. Cannabis social clubs (CSCs), the focus of this commentary, are nonprofit cooperatives that supply cannabis to consumers with the goal of harm reduction. The peer and participatory aspects of CSCs may have positive effects on health-related outcomes of cannabis use, such as through encouraging the use of safer products and responsible use practices. The nonprofit objectives of CSCs may diminish the risk for increasing cannabis consumption in wider society. CSCs have recently made an important transition from grassroots organizations in Spain and elsewhere. In particular, they have become key players in top-down cannabis legalization reform in Uruguay and, most recently, Malta. The history of CSCs in reducing harm from cannabis use is an important advantage, but there might be concerns around the grassroots origins, low taxation opportunities, and capacity to sustain social objectives. Also, the CSC model might not seem unique, as contemporary cannabis entrepreneurs have absorbed some features of their community-based predecessors. CSCs can play an important role in future cannabis legalization reform due to their unique strengths as cannabis-consumption sites and can be effective in advancing social justice by giving people affected by cannabis prohibition agency and direct access to resources.

Use of poultry manure as an alternative to inorganic fertilizer: A review of potential human and environmental health risks

Poultry manure has excellent potential to reduce overdependence on inorganic fertilizers for crop production among resource-constrained farming communities. However, its use on a large scale could possess short- and long-term risks. These risks fall into three main categories, namely human and other livestock, crop health, and environmental. This review research presented the potential value of chicken manure in soil health and food security stability. The review also presented the critical risks, such as pathogen transmission, heavy metal accumulation, and nutrient runoff, that are likely to hinder the large-scale use of poultry manure. Finally, this research has intensively presented scientifically proven strategies that could be adapted and adopted to help mitigate the current risks. Active government involvement through formulating and enacting appropriate policies and laws provides the first step in risk mitigation. Other practices, such as manure treatment and the adoption of better agronomic practices, are essential and have proved to be critical for the safe use of poultry manure. Poultry manure has excellent potential to reduce overdependence on inorganic fertilizers. To do this effectively, appropriate policies and laws should be enacted to encourage the use of safe products in the poultry sector, proper manure collection, and treatment and use. Farmers should choose and apply manure within the best agronomic principles.

Cleaning Products Commonly Used in Oklahoma Family Child Care Homes: Implications for Respiratory Risk and Children's Health.

Little is known about the cleaning products used by early care and education programs that contribute to childhood asthma, particularly in Oklahoma where rates of uncontrolled asthma are higher than national rates (60.0% vs. 50.3%, respectively). We conducted a cross-sectional study of cleaning products used by Oklahoma-licensed family child care homes (FCCHs) (n = 50) to characterize and identify potential respiratory-health risks associated with chemical contents. Overall, 386 chemicals were abstracted from the 132 reported products. Of these, 100 unique chemicals were identified. Four percent (4.2%) of providers used a product with a sensitizer that may cause allergy or asthma symptoms if inhaled and 35.4% used a product with an irritant that may cause irritation to the respiratory tract. Most (62.5%) reported using a product with a chemical that had a C=C double bond in its molecular structure that may make it highly reactive with other substances in the air and produce secondary air pollutants and 83.3% reported using a sodium hypochlorite containing product. Twenty-three percent reported products that contain carcinogens. Policy, educational, and technical assistance interventions are needed to promote the use of safer products and reduce respiratory and other health risks posed by chemicals in Oklahoma FCCHs.

A Study on the Risk Recognition and PROTECTION of Semi-Permanent Makeup in Female Students

Purpose: Since ancient times, the culture of putting on wounds or paints on the body like a tattoo has been carried on until now. In modern times, the interest, popularity, and market potential of semi-permanent makeup are increasing because it gives confidence and convenience as if wearing makeup. However, continuous research on safety is necessary because the risk factors for semi-permanent makeup are perceived in various aspects such as design, safety of ingredients, belief, worry, pain, and sanitary environment. Method: The researcher used the questionnaire method to construct questionnaire items with reference to previous studies. The questionnaire was constructed using a 5-point Likert scale and checklist. The questionnaire consisted of questions about demographic variables, the status of semi-permanent makeup, and risk perception factors. The subjects of this study were set as middle and high school girls and female university students from all over the country. The results were derived using frequency analysis. Results: The risk perception factors of semi-permanent makeup were design, eyebrow color, skin trouble, pain, and product and tool safety. However, there was an opinion(48.6%) that semi-permanent makeup should be performed by a beautician who is good at designing rather than a medical person. 46.4% answered that semi-permanent makeup is a type of makeup. However, as to the reasons for thinking that semi-permanent makeup should be regulated by the medical law, the highest responses were because it is more hygienic and the risk of infection is lower if it is done in a hospital and the difference in trustworthiness was the highest, and anesthetic cream was ranked next. Conclusion: According to the results of the study on risk perception and protection for semi-permanent makeup, it is recommended that a beautician with design and technology perform the procedure, but in terms of hygiene, infection, trust, and use of anesthetic cream, it should be regulated by the Medical Act. It is presumed to think that Therefore, as in the case of other countries, beauticians are allowed to perform semi-permanent makeup, but thorough education and management on semi-permanent makeup procedures, hygiene management, and safe use of products and tools are required.

Abstract P5-09-02: Symptom profile of breast cancer patients seeking medical cannabis in Pennsylvania’s new medical marijuana program

Abstract Background: Little is known about the role of medical cannabis in the care of breast cancer patients. Cancer is 1 of 17 medical conditions in the 2018 launch of Pennsylvania’s Medical Marijuana Program (PA MMP), requiring physician qualification followed by an evaluation by an HCP (usually a pharmacist) at a medical marijuana dispensary. To help reduce this knowledge gap, we analyzed the symptoms for which breast cancer patients sought medical cannabis. Methods: One breast oncologist at Lankenau Medical Center, a community academic hospital, performed all patient certifications after taking the following steps: history and physical examination; review of all medications, including the Prescription Monitoring Program database, for drug-drug-interactions; and informed consent. The dispensary and cannabis products utilized were chosen by the patient. EMR and PA MMD records of all patients certified in the first 10 months of the PA MMP were analyzed. There was no access to the dispensaries’ database. Results: Of the 54 cancer patients certified, 31 had breast cancer: 22 had non-metastatic disease and 9 had metastatic disease. Median age was 64 (range, 26 - 86). Of the 22 women with non-metastatic disease, 16 (73%) sought cannabis for pain, of whom 4/16 (25%) had chemotherapy-induced peripheral neuropathy (CIPN), 3/16 (19%) had exacerbation of pre-existing muscle/joint pain from hormonal therapy. 11/22 (50%) had insomnia and 10/22 (45%) had anxiety—of whom 8 had both. 1 of 22 had nausea. 3 recreational users wanted to shift to medical grade products. The 9 patients with metastatic breast cancer sought medical cannabis for: cancer pain (8/9, 89%), anxiety (8/9, 89%); insomnia (3/9, 33%), anorexia (3/9, 33%), and nausea (3/9, 33%). Patients had an average of 3 symptoms. About half of patients with pain expressed a fear of opioid use and wanted to avoid, stop, or reduce its use. All patients sought a medical solution for symptom relief; only 2 also admitted a desire to get high. The qualifying physician mainly recommended a CBD-dominant sublingual preparation. Topical products applied to focal areas of pain were also commonly suggested. Except for immediate relief of acute pain, smoking and vaping were strongly discouraged to avoid lung toxicity, especially during radiation and chemotherapy. As the PA MMP physician-facing patient-certification database does not interface with the dispensaries’ database, the product type, dose, source, and method of delivery purchased by each patient are unknown. Conclusion: Women with non-metastatic and metastatic breast cancer sought medical cannabis for symptomatic management of pain (73-89%, resp), anxiety (45-89%, resp), insomnia (50-33%, resp), nausea (4% and 33%, resp), and anorexia (0 and 33%). Patients reported an average of 3 symptoms. Pain was rarely experienced alone. Insomnia and anxiety were frequently combined. Other benefits of medical cannabis included the use of safer products (eg with less fungus and pesticides than recreational sources) and a shift to safer methods of delivery (eg. sublingual preparations vs. smoking or vaping). Fear of opioids motivated patients to avoid, reduce or stop opioids. For optimal continuity of care, the physician and dispensary databases must be integrated. Citation Format: Julianne Hibbs, Marisa Weiss, Zonera Ali, Aarti Shevade, Adam Leitenberger, Melissa Bowman-Jenkins, Paul Gilman. Symptom profile of breast cancer patients seeking medical cannabis in Pennsylvania’s new medical marijuana program [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-09-02.

Barriers to the safe use of chemical household products: A comparison across European countries

Chemical household products, such as cleaning and washing products or pest control and garden chemicals, are frequently involved in poisonings in private households. Consumer research has identified a number of barriers that impede the safe use of these products, ranging from unfamiliarity, to misconceptions and a lack of risk perception, to behavioural or situational barriers. This study aimed at investigating these barriers for consumers in eight European countries. Participants from eight European countries were recruited and asked to fill out an online questionnaire on their familiarity with hazard pictograms, perceptions and self-reported behaviour (Total: N = 5631, Austria: N = 731, Switzerland: N = 698, Germany: N = 711, France: N = 708, Italy: N = 695, Poland: N = 693, Sweden: N = 682, UK: N = 713). Across all countries, the lowest consumer familiarity was found for the meaning of the pictogram for “health hazard” (65% indicated having never seen it before). Small-sized differences between the eight countries were observed regarding people’s familiarity, perceptions and self-reported behaviour. The results suggest that people apply hazard-related as well as product- and marketing-related strategies to judge the dangerousness of a chemical household product. These findings suggest a number of starting points for risk regulation and communication regarding hazardous household chemical products. Further, the results suggest that positive outcome expectancies and rules of thumb for judging the risks of a chemical household product are particularly relevant for people’s self-reported safe use of chemical household products.

Health Risk Assessment on Hazardous Ingredients in Household Deodorizing Products.

The inhalation of a water aerosol from a humidifier containing disinfectants has led to serious lung injuries in Korea. To promote the safe use of products, the Korean government enacted regulations on the chemicals in various consumer products that could have adverse health effects. Given the concern over the potential health risks associated with the hazardous ingredients in deodorizing consumer products, 17 ingredients were analyzed and assessed according to their health risk on 3 groups by the application type in 47 deodorizing products. The risk assessment study followed a stepwise procedure (e.g., collecting toxicological information, hazard identification/exposure assessment, and screening and detailed assessment for inhalation and dermal routes). The worst-case scenario and maximum concentration determined by the product purpose and application type were used as the screening assessment. In a detailed assessment, the 75th exposure factor values were used to estimate the assumed reasonable exposure to ingredients. The exposed concentrations of seven ingredients were calculated. Due to limitation of toxicity information, butylated hydroxyl toluene for a consumer’s exposure via the dermal route only was conducted for a detailed assessment. This study showed that the assessed ingredients have no health risks at their maximum concentrations in deodorizing products. This approach can be used to establish guidelines for ingredients that may pose inhalation and dermal hazards.

Sequencing and Analysis of Strobilanthes cusia (Nees) Kuntze Chloroplast Genome Revealed the Rare Simultaneous Contraction and Expansion of the Inverted Repeat Region in Angiosperm.

Ban-Lan-Gen, the root tissues derived from several morphologically indistinguishable plant species, have been used widely in traditional Chinese medicines for numerous years. The identification of reliable markers to distinguish various source plant species is critical for the effective and safe use of products containing Ban-Lan-Gen. Here, we analyzed and characterized the complete chloroplast (cp) genome sequence of Strobilanthes cusia (Nees) Kuntze to identify high-resolution markers for the species determination of Southern Ban-Lan-Gen. Total DNA was extracted and subjected to next-generation sequencing. The cp genome was then assembled, and the gaps were filled using PCR amplification and Sanger sequencing. Genome annotation was conducted using CpGAVAS web server. The genome was 144,133 bp in length, presenting a typical quadripartite structure of large (LSC; 91,666 bp) and small (SSC; 17,328 bp) single-copy regions separated by a pair of inverted repeats (IRs; 17,811 bp). The genome encodes 113 unique genes, including 79 protein-coding, 30 transfer RNA, and 4 ribosomal RNA genes. A total of 20 tandem, 2 forward, and 6 palindromic repeats were detected in the genome. A phylogenetic analysis based on 65 protein-coding genes showed that S. cusia was closely related to Andrographis paniculata and Ruellia breedlovei, which belong to the same family, Acanthaceae. One interesting feature is that the IR regions apparently undergo simultaneous contraction and expansion, resulting in the presence of single copies of rps19, rpl2, rpl23, and ycf2 in the LSC region and the duplication of psbA and trnH genes in the IRs. This study provides the first complete cp genome in the genus Strobilanthes, containing critical information for the classification of various Strobilanthes species in the future. This study also provides the foundation for precisely determining the plant sources of Ban-Lan-Gen.

CMIT / MIT used in hair styling products Study on safety review and improvement of management system

Although the domestic cosmetics industry is growing rapidly, there are consumer cases that have suffered from the use of hair styling products containing CMIT/MIT recently due to insufficient management of harmful substances in cosmetics. In addition, exposure to harmful substances has spread as a result of the damage caused by the public health has emerged as a risk factor, increased consumption of cosmetics and consumers’ use of safe products. Therefore, this study compares and analyzes the regulations of CMIT/MIT in order to reduce the exposure of cosmetics to the public, and suggests cases of CMIT/MIT violation in cosmetics. First, lack of awareness of harmful factors and lack of identification of damage cases for CMIT/MIT added. Second, hair products have a wide average surface area of exposed skin, absorbed into the body through scalp, etc., and affect long-term hair retention. Therefore, the hazard component management for related products should be more thoroughly performed. Third, the safety management should be continuously strengthened according to the thorough system so that the violation of the standard among cosmetic raw materials and manufacturing process techniques is not detected.

Opportunities and obstacles in translating evidence to policy in occupational asthma

PurposeOccupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. MethodsIn three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. Results and conclusionsSeveral preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices.

Raw milk consumption and health

Contrary to the safe practices of milk pasteurization or sterilization, which effectively reduce foodborne outbreaks incidence associated with raw milk and dairy products use, outbreaks caused by such products continue to occur. Despite this fact, a worldwide movement advocating for the rights of raw milk and cheese selling and consumption, due to their specific nutritive characteristics, has strengthened significantly in recent years. Traditional agricultural manufacturers from Serbia still sell products related to thermally unprocessed milk, such as cottage cheese and raw cream. In AP Vojvodina during the period of 1981-2010 a total of 179 foodborne outbreaks were reported, where the incriminated cause of the outbreak were milk or diary. In 126 (70.39%) outbreaks, totaling 2276 sick individuals and one casualty, it was confirmed that the incriminated food was from the group of dairy products. In 48 instances (26.82%), bacteriological tests confirmed that milk and dairy products were excluded as the outbreak causes, while in another 5 (2.79%) outbreaks, microbiological analysis of food failed to confirm any relation to the actual epidemiological instances. In some cases, bacteriological testing of incriminated foods was not possible. In the cases of outbreaks associated with the consumption of milk and dairy products, traditional raw milk products were cited as being used. Consumption of unpasteurized milk and cheese represents public health threat. National and international rules ensuring use of safe products for human consumption have to set rules of trade of thermally processed milk and products on the market.

Regulated dose adjustment of commercial orchard spraying products

A generalised model of regulated dose adjustment is formulated to examine the potential for reducing the usage of commercial orchard spraying products. The model considers the harmonised regulations for pesticide registration and spray interception by different orchard structures with different distributions of target pest/disease across the tree-row. Different orchard structure standards (i.e. the values of orchard structure parameters that define the limits for safe and efficacious dose adjustment) are used to model the real-world operational constraint of different product types as they are established by the pesticide registration process (i.e. maximum Ground Area (GA) dose rate for safe product use and the manufacturer's Leaf-Wall-Area (LWA) dose rate for efficacious product use). To eliminate the need for a recommended LWA dose rate on the product label a standard ratio of tree height to row spacing is used to express the intersection between the limits for safe and efficacious product use. Light Detection and Range (LiDAR) recordings of commercial pome-fruit orchards are used to determine model inputs. The LiDAR recordings, selected for use in this study, represent a typical sample distribution of commercial orchards of different: tree size, density, cultivation-method, growth-stage, age and variety. The model outputs obtained from LiDAR recordings are grouped to represent the typical uses of different product types, defined by orchard growth-stage and target pest/disease distribution across the tree-row-width. The generalised model of regulated dose adjustment predicts pesticide usage levels in the range 43%–60% of maximum GA dose rate, depending on product type, with very low liability risk to pesticide manufacturers for reduced product efficacy (c. 1 in 200). This compares with predicted usage levels of (72%–88% of maximum GA dose rate) for the equivalent LWA model. The generalised model of regulated dose adjustment will therefore be needed to provide support for new spraying technologies and regulations in order to achieve the full potential for reducing the use of orchard spraying products as pressure for more sustainable fruit production increase in the future.

Cognitive interviewing in risk minimization survey development: patient and healthcare professional surveys

Risk minimization programs are often required for selected drugs and other products to ensure that the benefits of these prescription products outweigh their risks. Regulators in the USA and Europe have recently called for more rigorous standards in developing measures for risk minimization program assessment. Cognitive pretesting interviews are a critical step in the development of survey instruments used to evaluate patients’ and healthcare professionals’ knowledge and behaviors associated with the safe use of products requiring a risk minimization program. This article is intended as a guide for the researcher who is charged with the development of survey instruments used in these programs and focuses on the role of cognitive pretesting interviews in successful survey instrument design, data analysis and interpretation.

P3.137 Rectal Lubricant Use & Incident STI Infections at 9 US STD Clinics

BackgroundLubricants (lube) used during receptive anal intercourse (RAI) may affect the acquisition of rectally sexually transmitted infections (rSTIs). We assessed the association between lube use during RAI and rSTI among...

Product stewardship and science: Safe manufacture and use of fiber glass

This paper describes a proactive product stewardship program for glass fibers. That effort included epidemiological studies of workers, establishment of stringent workplace exposure limits, liaison with customers on safe use of products and, most importantly, a research program to evaluate the safety of existing glass fiber products and guide development of new even safer products. Chronic inhalation exposure bioassays were conducted with rodents and hamsters. Amosite and crocidolite asbestos produced respiratory tract cancers as did exposure to “biopersistent” synthetic vitreous fibers. “less biopersistent” glass fibers did not cause respiratory tract cancers. Corollary studies demonstrated the role of slow fiber dissolution rates and biopersistence in cancer induction. These results guided development of safer glass fiber products and have been used in Europe to regulate fibers and by IARC and NTP in classifying fibers. IARC concluded special purpose fibers and refractory ceramic fibers are “possibly carcinogenic to humans” and insulation glass wool, continuous glass filament, rock wool and slag wool are “not classifiable as to their carcinogenicity to human.” The NTP’s 12th report on carcinogens lists “Certain Glass Wool Fibers (Inhalable)” as “reasonably anticipated to be a human carcinogen.” “Certain” in the descriptor refers to “biopersistent” glass fibers and excludes “less biopersistent” glass fibers.

Results of a Community-University Partnership to Reduce Deadly Hazards in Hardwood Floor Finishing

A community-university partnership used community-based participatory research (CBPR) to design, implement, and evaluate a multi-cultural public health campaign to eliminate flammable products and reduce use of products high in volatile organic compounds (VOCs) in hardwood floor finishing in Massachusetts. Leading participants were Vietnamese-American organizations and businesses. Following the public health campaign, a multi-lingual survey of self-reported experiences with fires, product use, exposure to outreach activities, and changes made, was conducted with floor finishers. One hundred nine floor finishers responded. Over 40% reported fires at their companies' jobs, mostly caused by lacquer sealers. Over one third had heard radio or TV shows about health and safety in floor finishing, and over half reported making changes as a result of outreach. Exposure to various outreach activities was associated with reducing use of flammable products, increasing use of low-VOC products, and greater knowledge about product flammability. However, most respondents still reported using flammable products. Outreach led by community partners reached large proportions of floor finishers, was associated with use of safer products, and adds to recent work on CBPR with immigrant workers. Continued use of flammable products supports the belief that an enforceable ban was ultimately necessary to eradicate them.

Hazard v. Risk in EU Chemicals Regulation

Hazard is the potential of something to cause harm; risk is the likelihood of harm occurring. Chemicals regulation is largely focused on minimising risks associated with chemicals — and rightly so. However, in the EU the hazard classification of individual chemicals can impact significantly the regulation of products containing those chemicals, regardless of the actual risks that the products may pose to human health or the environment. This can lead to undesirable consequences, such as restrictions on the use of safe products, substitution towards less safe products, and disincentives to innovate. Such hazard-based regulation tends to be at odds with World Trade Organization rules and has raised significant concern with EU trading partners. This journal is an ideal forum for discussing how the EU can move towards a better and more coordinated legal framework for the regulation of chemicals.

Manufacturers’ Information Is a Useful Resource for Practice

I am very impressed with the work of the Evidence-Based Practice Resource Work Group (EBPRWG)1 in its change regarding how AACN evaluates evidence for practice. Nursing knowledge is generated in many fashions and the evidence used to make decisions that impact patient care needs to value nonresearch evidence and qualitative studies.The new evidence-leveling system with letters takes away the bias that only quantitative research is scientific. I will use this new table in my lessons to nursing staff about how to evaluate information for evidence-based nursing practices along with their clinical expertise, patient values, and their preferences to give the best quality of care.The item “M” is important in most practice settings like mine. We rely on manufacturers to give us information on safe use of products until there is adequate published research for identifying best practices.Thanks for providing a very useful tool in evaluating evidence for practice.