This study developed a framework termed as \"mixNanohealthrisk\" hereafter, for the first time as per literature review, to provide exposure limit or reference dose for co-occurring nanoparticles (NPs) in water for different regions of the world. The effect of interaction of NPs on (i) NP occurrence in environment and (ii) toxic effects were incorporated for estimating NP exposure dose and associated risks (in terms of risk quotient (RQ) and hazard index (HI). Reference dose (RfD) values for SiO2, CeO2, TiO2, Al2O3, Fe2O3, CNT, C60, ZnO and CuO NPs were calculated for the first time in this study based on toxicity studies. RfD values for top three risk-posing nanoparticles when co-occurring together were found to be 0.1 mg/kg/d (CuO), 0.12 mg/kg/d (ZnO) and 0.19 mg/kg/d (TiO2). Calculated maximum allowable concentration values for these nanoparticles were found to be 70.8, 84.4 and 136 mg/L for CuO, ZnO and TiO2 NPs. Exposures to nanoparticles aggregate (ZnO NP + CuO NP) in mixture suspension was found to have allowable ZnO and CuO concentration values of 24.7 mg/L and 175.2 mg/L respectively when present as aggregate. Top three regions identified with highest risk quotient were found to be USA followed by Switzerland and whole of Europe. During use of NP-interaction data for estimating risks, Ag, TiO2 and CuO NPs were found to have lowest maximum allowable concentration values. The identified top three risk-posing NPs can be used for conducting toxicity studies for mixture of NPs and long-term monitoring so that it can be used for setting up guideline concentration values for NPs in mixture for water environment.

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin-to-skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research. Although the evidence for positive outcomes through skin-to-skin contact are robust, there is a dearth of research specifically focused on clinical practice. The methodology considers the four available data sets that used Widström\'s 9 stages, which consists of studies from Japan, Sweden, Italy and the United States, examining the parameters of each stage across settings from around the world. This research provides an expanded understanding of the timing of the newborn\'s progression through Widström\'s 9 observable stages. We found that newborns in all four data sets began with a birth cry and continued through the remaining stages of relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping during the first hours after birth and consolidated the data into a Sign of the Stages chart to assist in further research. The evidence supports making a safe space and time for this important newborn behaviour. Clinical practices should encourage and protect this sensitive period.