Examining the temporality of vitamin E acetate in illicit THC-containing e-cigarette, or vaping, products from a public health and law enforcement response to EVALI - Utah, 2018-2020

BACKGROUND

In the summer of 2019, e-cigarette, or vaping, product use-associated lung injury (EVALI) was detected in the United States. Multiple agencies reported illicit tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products containing vitamin E acetate (VEA) as a substance of concern.

METHODS

As an expansion of the Utah Department of Health's response to EVALI, the Utah Public Health Laboratory and the Utah Department of Public Safety screened 170 products from 96 seizures between October 2018 and January 2020. Using Pearson's correlation coefficient, we analyzed the temporal correlation of national, and Utah specific case counts, and the percentage of seizures indicating VEA by month.

RESULTS

The findings indicate strong and significant correlations between seizures indicating VEA and both the national (r = 0.70, p = 0.002) and Utah specific (r = 0.78, p < 0.001) case counts.

CONCLUSION

These findings underscore that VEA should not be added to e-cigarettes, or vaping, products and the importance of collaboration with law enforcement when responding to outbreaks associated with illicit substances.

The biomechanical modelling of non-ballistic skin wounding: blunt-force injury

Knowledge of the biomechanical dynamics of blunt force trauma is indispensable for forensic reconstruction of a wounding event. In this study, we describe and interpret wound features on a synthetic skin model under defined laboratory conditions. To simulate skin and the sub-dermal tissues we used open-celled polyurethane sponge (foam), covered by a silicone layer. A drop tube device with three tube lengths (300, 400, and 500 mm), each secured to a weighted steel scaffold and into which a round, 5-kg Federal dumbbell of length 180 mm and diameter 8 cm was placed delivered blows of known impact. To calculate energy and velocity at impact the experimental set-up was replicated using rigid-body dynamics and motion simulation software. We soaked each foam square in 500 mL water, until fully saturated, immediately before placing it beneath the drop tube. We then recorded and classified both external and internal lacerations. The association between external wounding rates and the explanatory variables sponge type, sponge thickness, and height were investigated using Poisson regression. Tears (lacerations) of the silicone skin layer resembled linear lacerations seen in the clinical literature and resulted from only 48.6% of impacts. Poisson regression showed there was no significant difference between the rate of external wounding for different sponge types (P = 0.294) or different drop heights (P = 0.276). Most impacts produced "internal wounds" or subsurface cavitation (96%). There were four internal "wound" types; Y-shape (53%), linear (25%), stellate (16%), and double crescent (6%). The two-way interaction height by sponge type was statistically significant in the analysis of variance model (P = 0.035). The other two-way interactions; height by thickness and sponge type by thickness, were also bordering on statistical significance (P = 0.061 and P = 0.071, respectively). The observation that external wounds were present for less than half of impacts only, but that nearly all impacts resulted in internal wounds, might explain the observed haematoma formation and contusions so often associated with blunt-force injuries. Our study also confirms the key role of hydrodynamic pressure changes in the actual tearing of subcutaneous tissue. At the moment and site of impact, transferred kinetic energy creates a region of high pressure on the fluid inside the tissue. As a result of the incompressibility of the fluid, this will be displaced away from the impact at a rate that depends on the velocity (or kinetic energy) of impact and the permeability and stiffness of the polymeric foam and skin layer.

Marine toxins

Seafood products are important both nutritionally and economically. Within Europe, some 12 billion Pounds of fishery products are consumed annually and an enormous variety of species are available. Although seafood is rarely implicated in food poisoning, compared to other food sources, it does provide some specific human health hazards unique to this particular resource. Generally, these are toxins from toxic microscopic algae which accumulate through the food-chain. The toxins can cause various neurological and gastrointestinal illnesses and, potentially, consumers are exposed from seafood produced within Europe, from imported products, or from seafood eaten while travelling abroad. The symptoms of illness which may be encountered, the source and mode of action of the toxins, and some emerging problems are described. European legislation aims to ensure the quality and safety of seafood products by prohibiting sale of some toxic species, setting toxin limits, requiring monitoring and controlling imports.

The Objective Structured Clinical Examination (OSCE) in the clinical clerkship: an overview

The Objective Structured Clinical Examination (OSCE) for student assessment is well established, with an extensive body of research documenting that this is a valid means to assess clinical skills that are fundamental to the practice of medicine. The OSCE consists of a circuit of stations which tests a range of skills and learning to assess undergraduate medical students. A well-constructed OSCE provides important information about candidate performance and the quality of training. It is used at the University of South Dakota School of Medicine (USDSM) in assessment of third year medical students during their Obstetrics Clerkship, and as a teaching tool in the Pediatric Clerkship. On August 10, 1996, the USDSM administered an OSCE for the first time to third year medical students. The purpose of this article is to present state of the art information about setting up OSCE based on our recent experience and to provide practical examples of OSCE questions which can be addressed in the clinical setting. The narrative, references and examples give guidelines for the preparation of OSCE testing. The OSCE provided a standardized way of assessing clinical competence. Both students and faculty were very satisfied with the examination, and felt that the material tested was relevant and appropriate. The OSCE process does serve to identify areas of weakness in the curriculum and/or teaching methods, and thus can serve as a mechanism to improve educational effectiveness.

Elevation of mercury in human blood from controlled chronic ingestion of methylmercury in fish

The relationship between the intake of methylmercury in fish and mercury in blood has been investigated in man. The intakes of methylmercury were carefully controlled and lay in the range 40-230 micrograms/day, the Provisional Tolerable Weekly Intake is equivalent to about 30 micrograms/day. The results indicate that a daily intake of 1 microgram methylmercury would, at equilibrium, produce a blood mercury concentration of 0.8 micrograms/kg. There is a good close-to-linear correlation between methylmercury intake and blood mercury concentrations within the wide range of intakes employed.