Participants returned for follow-up measures and cotinine testing 6 and 12 months after baseline. Study incentives were $30 for the baseline, $35 for the 6-month, and $40 for the 12-month follow-up visits.Cessation information and local treatment options were provided. The research design and study procedures were approved by the University of California, San Francisco Institutional Review Board.In this longitudinal study of adolescent e-cigarette use with self-reported and biomarker data, 80.3% of the sample continued to use e-cigarettes at 12 months, with significantly greater ecigarette use frequency, dependence, and nicotine exposure. The percentage of daily e-cigarette users doubled from 14.5% at baseline to 29.8% at 12-month follow-up. The patterns of ecigarette use observed over time indicate substantial persistence and the use of greater amounts of nicotine over time . These findings lend support to concerns regarding the addictiveness of e-cigarettes for adolescents. In the United States, prevalence of past-month e-cigarette use increased dramatically among adolescents in 2018, whereas cigarette use declined and cannabis use remained constant. Results of this study suggest that increased prevalence of recent e-cigarette use may lead to frequent use, dependence, and greater nicotine exposure. Dependence scores at baseline were low on average, with most participants meeting a classification of “not dependent,” and 13.3% meeting a classification of moderate to heavy dependence. By 12 months, the percentage classified with moderate to heavy dependence increased to 23.3%. These findings would suggest that factors other than dependence are driving early use of e-cigarettes, and that over the course of just 1 year, more teens become daily users and more heavily dependent. Along with the self-reported increase in frequency of e-cigarette use and dependence, cotinine levels increased over time, reflecting increased exposure to nicotine. The increase in cotinine levels may be both the result of increased dependence and a catalyst for the development of dependence. Adolescents who become increasingly dependent on e-cigarettes may increase their nicotine use, thereby worsening dependence. Notably,pot drying devices with higher nicotine yield became increasingly popular over the course of the 12-month trial, consistent with the reports of greater nicotine dependence and higher cotinine levels.
Transitions from single to dual and dual to single nicotine product use were observed in approximately one in three users over the study period. None of the baseline dual users abstained from both products at either follow-up, which may be partially due to their higher dependence on e-cigarettes at baseline, as well as the normalization of smoking behavior and associations between smoking cues that can perpetuate use of both products. Consistent with prior research, adolescent participants offered a wide range of reasons for e-cigarette use. The top three reasons for initiating and continuing use were socializing, enjoyment, and flavors. The top three reasons for quitting were a desire for self-improvement, difficulty maintaining an e-cigarette device, and getting in trouble for vaping at home or school. The top flavors were fruit, menthol/mint, and candy. Taken together with experimental research demonstrating the influence of flavors on adolescents’ product choices, these findings suggest that efforts to reduce adolescent e-cigarette use ought to include regulatory action that addresses kid-friendly flavors. Little research has examined adolescents’ reasons for quitting e-cigarette use, and our findings preliminarily suggest that adolescents perceive parental controls and appropriate disciplinary consequences to be impactful.All participants were recruited from the San Francisco Bay Area, and a majority were male and White, which may limit generalizability. The sample size was relatively small, although adequate to detect significant differences over time in this repeated-measures study design. The combination of self-report and biomarker data was a study strength. Over the course of a year, the vast majority of adolescents continued to use e-cigarettes, daily use increased from 14.5% to 29.8%, and product type evolved to higher nicotine delivery devices, with Juul being the most preferred brand at 12 months. Flavor preferences stayed fairly constant , and dependence and cotinine levels increased. Transitions from single to dual and dual to single nicotine product use were observed in approximately one in three users over the study period in about equal proportions. None of the baseline dual users abstained from both products at either follow-up. The findings indicate persistence in adolescents’ e-cigarette use, with significant increases in frequency of use and nicotine exposure over time and with associated increases in dependence.
Electrical injury is responsible for approximately 1000 deaths and 3–5% of all burn admissions per year in the US. EI victims are not only hospitalized for burns, but also for skeletal muscle tetany, respiratory muscle paralysis, or ventricular fibrillation. However, these statistics do not include the victims that mainly suffer from the neuropsychological, neurological, and psychiatric sequelae associated with EI. While the past literature shows that EI sequelae is typically associated with burns due to the current’s thermal load and the body’s tissue resistance, the literature also shows that remote psychiatric effects are indicative of and distinct to EI.White matter abnormalities after EI have also been found on magnetic resonance imaging scans, particularly hyperintensities in the cerebral corticospinal tract.One morning in the spring of 2009, the 37-year-old patient was walking his dog in a densely populated city, when his dog stepped in a puddle of melted snow and suddenly jumped upwards, yelped, and started convulsing and defecating himself. The patient bent down on his right knee and grabbed the dog with his left arm as he held himself up with his right hand, which was in the puddle. He reported a ‘‘buzzing feeling” traveling up his right arm. After bringing his dog to safety, the patient returned to the site, got down on both knees, put both hands in the puddle, felt a ‘‘humming” sensation travel up both arms and felt ‘‘stuck” in that position for 2–3 s . Immediately after the shock, the patient sustained burn marks and experienced short-term memory loss and fatigue. Three days later, the patient saw an internist and reported upper right quadrant pain, headaches, numbness, weakness, fatigue, insomnia, and minimal, first degree burn marks on his right underarm and on the dorsal aspect of both forearms. The surface area was 1.1% for each forearm, and an additional 1.1% for the right underarm,cannabis drying for a total affected area of 3.3%. One week later, the patient received MRIs of the lumbosacral spine, cervical spine and brain which all reported no abnormalities. One month later, the patient visited a psychologist regarding anxiety, insomnia, and depression, and was diagnosed with post-traumatic stress disorder and retrograde amnesia. Three months after the electrical injury, the patient saw an ophthalmologist regarding pain behind his right orbital and ‘‘drooping” of the right side of his face; he was diagnosed with Bell’s palsy. Two years after the incident, the patient had an orthopedic evaluation for right side body pain, loss of right hand motor control, right hand tremors, pain behind the right orbital and headaches with no orthopedic abnormalities found. The following day, the patient visited a neurologist and a different ophthalmologist regarding the same symptoms, with no abnormalities found. Three years after the electrical injury, the patient visited a neurologist regarding hypesthesia in the right side of the face and to pinpricks to the right hand, severe pain in the right arm and hand, moderate pain in the left arm and hand, and was diagnosed with electrocution neuropathy.
Five months later, the same neurologist noted improvement of the pain in the right arm and hand area. During the same year, the patient visited a therapist and was diagnosed with PTSD, severe anxiety, and situational depression and was prescribed psychotherapy as treatment. Six years after the injury, additional documentation of the damage sustained from the electrical injury was needed to provide objective evidence as part of a lawsuit against the electric company responsible for the exposed wires. The patient visited our laboratory for an MRI DTI and quantitative volumetric analysis, and a clinical neuropsychologist for an exam. At the time of the neuropsychological exam, the patient was taking Bupropion XL, Clobex, Hydrocodone/Acetaminophen, melatonin, Klonopin , Namenda , Neurontin , and medical marijuana. On the Diller-Weinberg Test, the patient missed 39/47 stimuli, and his visual encoding/processing speed on specific Wechsler Adult Intelligence Scale subtests was between the 1st and 5th percentile. On the dominant finger tapping test, the patient scored in the 5th percentile. His performance on a timed task of fine motor dexterity was impaired between 2 – 3 standard deviations below the mean, and his motor and processing speed index was in the 2nd percentile, which is typical residual of electrical injury. The patient scored 20 less points on his Performance intelligent quotient than his Verbal IQ , which is statistically significant and notably unusual. He scored as severely depressed on his Beck, and has had severe chronic pain and PTSD symptoms in the clinical range. The patient’s past medical history was significant for meningitis at age 10, and arthritis and hypertension as an early adolescent. The patient underwent several unrelated orthopedic surgeries from sports related injuries, with the last surgery being sixteen years before the electrical injury. According to his ex-fiancé, the patient was very social and outgoing before the electrical shock, while he became withdrawn and isolated afterwards. The patient enjoyed activities such as surfing, swimming, hiking, basketball, and skateboarding, all of which he was unable to do, or did differently, after the injury. At the time of the incident, he was in good health and working as a physical trainer.Most electrical injuries happen in the workplace, while some occur in household settings. In dense cities that experience heavy snow during the winter, like Boston or New York City, residents are at a higher risk of electrocution through stray voltage when the snow starts to melt. Stray voltage is the unintended occurrence of an electrical potential between two objects due to a fault in an electrical system and is defined to be less than 10 volts by the U.S. Department of Agriculture. These circumstances, coupled with the increased conductance caused by high-salinity snow melt, can charge normally non-threatening metal objects, or puddles with ample amounts of stray voltage. Electrical injury occurs when a person has at least two points of contact with two sources of different voltage, one of which may be the earth ground The extent of electrical injury is dependent on the voltage, amperage, path of and type of the current /direct current, duration of contact, and premorbid state of the patient.Skin is the body’s primary defense against external electric currents. A dry hand may have a resistance of approximately 100,000 X, while the internal body may have a resistance of approximately 300 X due to wet and salty tissues under the skin. Skin resistance can be greatly reduced to approximately 1000 X if there is significant physical damage such as a cut, burn or abrasion, or if the skin has been wet. At roughly 16 mA for a 60 Hz AC, the average man would experience a muscle spasm known better as the ‘‘no-let-go” phenomenon, in which he would not be able to let go of the current source .In the presence of an external electric field, cell membrane permeabilization occurs as the lipids in the lipid bilayer undergo reorganization in a process known as electroporation . In turn, cell contents such as ions are able to move freely in and out of cells. Through the phenomenon of electroporation, current is able to travel through and leave the body through the second contact point to a grounding source. Clearly these aspects of EI are quite mechanistic, however, one of its enigmas include the remote neuropsychological deterioration of the patient regardless of the trajectory of the current .Duff compiled a review of twenty eight studies of EI and lightning injury patients, logging 2738 victims reporting a total of 4441 signs or symptoms. These signs/ symptoms were ‘‘categorized into nine different domains of sequelae, which included disturbance of consciousness, attention/concentration deficits, speech/language deficits, sensory deficits, memory deficits, other cognitive deficits, psychiatric complaints, somatic complaints, and neurological complaints”. Another study of the long-term sequelae of low-voltage electrical injury done by Singerman reported numbness, weakness, and memory problems as the most frequent neurological problems and anxiety, nightmares, insomnia, and flash backs of the event as the most frequent psychological problems.