The relationship between cause and timing of death in 294 adults who had been hospitalized with community-acquired bacterial meningitis was investigated. For 74 patients with community-acquired bacterial meningitis who died during hospitalization, the underlying and immediate causes of death were identified according to the criteria of the World Health Organization and National Center for Health Statistics. Patients were classified into 3 groups: category I, in which meningitis was the underlying and immediate cause of death (59% of patients; median duration of survival, 5 days); category II, in which meningitis was the underlying but not immediate cause of death (18%; median duration of survival, 10 days); and category III, in which meningitis was neither the underlying nor immediate cause of death (23%; median duration of survival, 32 days). In a substantial proportion of adults hospitalized with community-acquired bacterial meningitis, meningitis was neither the immediate nor the underlying cause of death. A 14-day survival end point discriminated between deaths attributable to meningitis and those with another cause.

Exposure to botanicals in dietary supplements is increasing across many geographies; with increased expectations from consumers, regulators, and industry stewards centered on quality and safety of these products. We present a tiered approach to assess the safety of botanicals, and an in silico decision tree to address toxicity data gaps. Tier 1 describes a Threshold of Toxicologic Concern (TTC) approach that can be used to assess the safety of conceptual levels of botanicals. Tier 2 is an approach to document a history of safe human use for botanical exposures higher than the TTC. An assessment of botanical‐drug interaction (BDI) may also be necessary at this stage. Tier 3 involves botanical chemical constituent identification and safety assessment and the in silico approach as needed. Our novel approaches to identify potential hazards and establish safe human use levels for botanicals is cost and time efficient and minimizes reliance on animal testing.

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The origin of the natural/organic products industry, with its roots in healthy foods and beverages, can be traced back to the beginning of the last century. The difference between natural and organic is that there are no definitions or regulations of natural products; organic products are largely defined and regulated within the United States. There are nongovernmental agencies working on standards and are able to supply eco‐seals to products (ECOCERT and BDIH, for example). Advertising self‐regulation has grown due to the public distrust of advertising claims in general. This article contains information on natural cosmetic formulations using natural fragrances, natural lipids, quercetin, curcumin, ayurvedic ingredients, and traditional Chinese herbs. Natural and organic cosmetic sales are part of the fastest growing sector in the cosmetic industry. Safety of the use of natural products is discussed. Natural does not always mean safe so extensive research is being performed in re toxicology, allergy problems, and whether the use of natural preservatives or preservative free can be considered safe. Biodegradability is a central aspect of the sustainability profile and environmental preferability of formulated products.