Factor Vape

The potential public well being impression of e-cigarettes is a topic of scorching debate. Despite inconclusiveness about their quick- and long-time period well being results, e-cigarettes stay largely unregulated and their popularity among youth and younger adults continues to rapidly escalate. At the same time, serious illness and podsmall.com deaths have been linked to their use and up to date research couldn't conclusively decide that they posed fewer health dangers than combustible cigarettes. A 2018 report from the NASEM concluded that there is «substantial proof that e-cigarette use will increase threat of ever utilizing combustible tobacco cigarettes among youth and younger adults,» suggesting that e-cigarette use itself is a danger factor, not only a correlation with smoking.

Our Pachamama e-liquid vape juice is made within the USA by Charlie's Chalk Dust. Our disposable e-cigarette is a draw-activated vape pen that provides up-to 800 puffs per e-cig Puff Bar and is pre-charged, pre-crammed & leak resistant. The FLIQ disposable e-cig vape gadget has a glossy and elegant design with a clean finish. FLIQ® Disposable Vape is a handy & affordable all-in-one electronic cigarette. The findings problem conventional wisdom about vaping nicotine, says Carol Boyd, professor emerita on the University of Michigan School of Nursing.

Among present e-cigarette customers, an estimated 34.2% (95% CI, 31.2%-37.three%) of highschool students and 18.0% (ninety five% CI, 15.2%-21.2%) of center school college students reported using e-cigarettes on 20 or extra days in the past 30 days. An estimated 21.4% (95% CI, 19.zero%-24.zero%) of current e-cigarette customers in highschool and eight.eight% (95% CI, 6.9%-11.2%) of users in middle college reported every day e-cigarette use (information on 2018 frequency of e-cigarette use may be found in eTable 2 in the Supplement). An estimated sixty three.6% (ninety five% CI, 59.three%-sixty seven.8%) of highschool students and sixty five.4% (95% CI, 60.6%-sixty nine.9%) of center college college students reported unique use of e-cigarettes.

While ECIG use might acutely increase blood pressure, people who smoke with hypertension who decreased or stop smoking by ECIG use had a major EightVape reduction in blood stress in two small studies. This section discusses information from research with health results as the main consequence; different sections of the assertion additionally focus on well being results of ECIGs. Only a number of studies have addressed the consequences of ECIGs on customers, also known as vapers.

Nicotine

The presence of poisonous compounds with known cardiovascular detriments and the absence of clear smoking cessation profit throughout the current literature should lead us as clinicians to err on the aspect of caution, avoiding e-cigarettes altogether. The use of ECIGs as a smoking cessation tool is insufficiently supported by managed medical trials. In the treatment context, just a few related research of early ECIG sorts have been published so far.

Effective in 2018, Oregon raised the purchase age from 18 to 21 for e-cigarettes and tobacco products. However, center and high school college students proceed to make use of e-cigarettes and vapes at concerning rates. New information launched by Oregon Health Authority present one in four Oregon eleventh graders report vaping a nicotine product within the final 30 days. ReadOregon Health Authority's 2019 Data Brief on the Youth Vaping Crisis. FIN is an digital cigarette that looks and seems like a traditional cigarette. Many of our customers use our electronic cigarettes as an alternative to smoking tobacco cigarettes.

Many condo-dwellers are actually discovering that their lease terms deny them the best to smoke tobacco inside their own items. Since this development will doubtless continue into the future, e-cigs would be the subsequent smartest thing. Kids’ developing brains are extra susceptible to addictionand e-cigarettes basically provide a smoke-free method to inhale nicotine, which is extra addictive than heroin, cocaine or alcohol.

The ruling stemmed from a lawsuit filed by numerous well being groups, together with the American Academy of Pediatrics. As of Sept. 6, 2019, greater than 450 lung sicknesses potentially linked to the usage of e-cigarettes were reported in 33 states and one U.S. territory. State health departments have launched investigations into local vaping-linked ailments and Michigan became the primary state to ban flavored e-cigarettes.

Users' signatures are the massive, billowy clouds of vapor they blow. The palm-held units have a mouthpiece containing the heating coil and a small receptacle, or «tank,» for e-liquid hooked up to a squarish body housing the rechargeable batteries. Second- and third-generation units are known as «open methods» as a result of the person refills the tank. Vapers can combine their very own e-liquids using a wide range of flavors and strengths of nicotine. Enthusiasts personalized batteries and coils in their own garages and workshops, and ultimately opened Vape Shop shops and lounges.

What We Find Out About Electronic Cigarettes

The e-cigarette story is a dire chapter in the sociology of public-well being science. In the longer term, nevertheless, it might prove to be an instructive one as well. If there are any grounds for optimism within the lengthy-run, they come from overseas. Public-well being authorities in England, Canada, and New Zealand endorse and promote vaping as a harm-reduction technique for smokers. As these nations save smokers' lives — and as illicit vaping markets take root here — American policymakers and the general public will be forced to notice.

This consists of the biennial WHO Report on the Global Tobacco Epidemic, which tracks the status of the tobacco epidemic and interventions to combat it and other related sources. WHO often displays and reviews the evidence on ENDS and well being and offers steerage to governments. The aerosols generated by ENDS usually include toxic substances. ENDS contain nicotine, which is highly addictive, and ENDS use involves the inhalation of a nicotine-infused aerosol. At least 5 other countries have initiated investigations to determine cases of lung injuries associated to the EVALI circumstances reported in the US.

Tiffany Capers, at lectern, petitioned the Town Board to create laws limiting where smoke retailers can function. She was joined by city officers at a news convention on March 8 to announce the legislation. Dr. Zorba Paster is a family physician and host of the public radio program «Zorba Paster on Your Health.» He may be reached at

In addition, metals within the aerosol may be released as nanoparticles. Heating of the liquids generates oxidising chemical substances, together with reactive oxygen species. Levels of oxidants are reported to be orders of magnitude decrease than those in cigarette smoke, but greater than that of air pollution. However, oxidant generation has been reported for just a few merchandise and use situations.

In August 2016, podsmall.com the US FDA prolonged its regulatory energy to incorporate e-cigarettes, cigars, and «all different tobacco merchandise». Nicotine, a key ingredient in most e-liquids, is properly-acknowledged as one of the addictive substances, as addictive as heroin and cocaine. Addiction is believed to be a disorder of expertise-dependent brain plasticity.

People assume that water filters tobacco smoke, making it much less dangerous. Investors seem like optimistic about the future of e-cigarettes. Altria's major investment in Juul came after the FDA's taste laws have been introduced, suggesting that tobacco corporations don't see the agency's regulatory energy as a significant menace. Bloomberg Industries has projected that e-cigarette sales might overtake these of the old tobacco-and-paper selection by 2024. The U.S. market for e-cigarettes is projected to reach $sixteen.5 billion by 2024, whereas the worldwide market is predicted to hit $fifty three billion. The most properly-identified e-cigarette brand is Juul, which held three-quarters of the U.S. e-cigarette market on the end of 2018.

Public

Exposure to the same toxins as cigarettes however in higher portions.Waterpipe smoke incorporates excessive levels of many poisonous compounds present in cigarettes. These include carbon monoxide, heavy metals, and vapinger.com chemicals linked to most cancers. In the United States, waterpipes are especially popular among school college students and young folks.

But the device was never a promising expertise for nicotine delivery; Jacobson attributes its failure to it being inherently faulty. While the system proved to be a useless-finish, the inventors did contribute the verb «vape» to the language. Suggest that your child look into native applications and wikipilipinas.vibalgroup.com web sites that assist individuals quit vaping. Your health care supplier might help you and your youngster find the best assist. Vaping hasn't been around lengthy enough for us to know the way it affects the physique over time.

Connect with other dad and mom who are working to guard kids from vaping and nicotine dependence. Health care suppliers ought to report attainable instances of lung harm associated with e-cigarette use to the NYC Poison Control Center by calling 212-POISONS ( ). E-cigarettes are available in many sizes and shapes and podsmall.com may also be known as e-cigs, e-hookahs, vapes or vape pens. E-cigarettes are units that heat a liquid, called e-liquid, into an aerosol that the person can inhale.

The vapor is inhaled by the user as a substitute for inhaling cigarette smoke. But instead of smoking, the liquid nicotine is vaporized without burning or combustion. As a result of the explosion of JUUL Pods products leading to an unprecedented improve in youth e-cigarette use, state and local governments are contemplating quite a lot of coverage choices to manage this rapidly expanding market. Taxation has confirmed to be some of the effective strategies to reduce youth cigarette use.

However, some methodological considerations in regards to the studies and analysis have been raised. Several research indicated that the intention to quit smoking is one of the main reasons reported by adults for initiating ECIG use [42, 236–239]. In addition, studies show that ECIG use is related to quit intentions and that ECIG users are more likely to have tried unsuccessfully to give up smoking up to now. Indeed, those that use ECIGs to give up smoking are more likely to reduce or stop tobacco use, and longer period of ECIG use has been shown to conicide with decreases in daily consumption of cigarettes. Daily use is associated with increased probability of quitting, whereas intermittent use has been associated with a decreased chance of quitting. Product traits may be important; for instance, one study found the variety of flavours was independently associated with smoking cessation.

The nicotine in e-cigarettes is harmful for growing babies, and can result in dependancy and harm brain development in children and young adults into their early 20s. Although there is nonetheless a lot to find out about e-cigarettes, the proof is clear that the harmful well being results of using e-cigarettes means teenagers and young adults shouldn't use them. Be conscious that some e-cigarettes that claim to be nicotine-free have been discovered to contain nicotine. BLOW began selling e-hookahs, an electronic model of the hookah, in 2014. The handle of every hose for the e-hookah accommodates a heating factor and a liquid, which produces vapor. Gopal Bhatnagar primarily based in Toronto, Canada invented a 3D printed adapter to turn a traditional hookah into an e-hookah.

Lung

Common sales-monitoring and retail measurement corporations like Nielsen do not look at vape shop knowledge, which can constitute as a lot as 20% of the market. Because JUUL relied closely on social media promoting for its launch, unlike other e-cigarette manufacturers who targeted their advertising through conventional retailers (e.g., TV), teen and young adults made up a big majority of JUUL’s social media viewers. JUUL spent more than $1 million to market its merchandise on the web and has paid for campaigns on Twitter, Instagram and YouTube. By 2016, nearly four out of 5 middle and highschool students, or more than 20 million youth, saw no less than one e-cigarette advertisement. More lately, mobile ads have become a popular place to advertise e-cigarettes. Mobile adverts, or paid advertisements on smartphone applications and web sites optimized for cell, have the potential to succeed in tens of millions of younger people.

Weighted prevalence estimates and ninety five% CIs for present use of any tobacco product, cigarettes, and e-cigarettes have been assessed among high school and middle college students individually. Estimates are thought of statistically unreliable and are suppressed if the unweighted denominator is less than 50 or the relative commonplace error is greater than 30%. Using PuffPacket could assist vapers monitor their very own nicotine consumption – tougher to trace than for conventional cigarette smokers, who can easily inform how much they’ve smoked by watching a cigarette burn or seeing how many remain in a pack.

Six Senators send letter to Federal Trade Commission urging an investigation of e-cigarette advertising practices. R.J. Reynolds proclaims new vapor vapinger product, VUSE, might be launched in July in Colorado as the first state in an eventual nationwide rollout. American E-Liquid Manufacturing Standards Association, a trade association specifically dedicated to creating/maintaining self-regulating requirements for podsmall.com the manufacturing of its members’ e-liquids used in e-cigarettes,proclaims its launch.

It is essential to notice, nevertheless, that epidemiological information from a survey such as this does have its limitations, including the potential for recall bias and a scarcity of ability to ascertain temporal causation. Other incessantly expressed reasons for making an attempt and utilizing ECIGs included the attraction of the flavour options and apaari.org the approval of household and associates who saw them as an enchancment on conventional cigarettes. Some customers additionally saw them as a recreational product, with young individuals in one study specifically viewing them as a part of the ever-rising technological tradition of their day by day lives.

Should Cigarette Smoking On Florida Seashores Be Banned?

E-cigarettes produced fewer free-radicals than flamable cigarettes, however, even low levels of repeated publicity to free-radicals could cause oxidative stress, which will increase the chance for cardiovascular and respiratory ailments. Heavy metals corresponding to cadmium, lead, nickel, tin and copper have all been detected in aerosols produced by e-cigarettes. At least 60 chemical compounds have been found in e-liquids, and nonetheless extra are current in the aerosol produced by e-cigarettes.

E-cigarettes could cut back cigarette craving and withdrawal symptoms. It is not clear whether or not e-cigarette use will lower or increase total nicotine dependancy, podsmall.com but the nicotine content in e-cigarettes is sufficient to sustain nicotine dependence. Chronic nicotine use causes a broad range of neuroplastic diversifications, making quitting hard to accomplish. A 2015 examine found that customers vaping non-nicotine e-liquid exhibited indicators of dependence. Experienced customers are inclined to take longer puffs which can result in larger nicotine intake.

Included is a chargeable E-Cigarette Battery and a USB Charger to recharge your eCig battery. Since the inaugural US Summit in 2017 which welcomed over 300 attendees, the tobacco management and policy panorama has continued to alter. Currently there may be some controversy surrounding the usage of this substance in vapor products, although no concrete proof has emerged to explicitly label it as harmful. There has been discussion of acetyl propionyl inflicting damage to the respiratory tract, and it has been recognized to hurt the lungs in studies done on animals.

Prolonged use of smokeless tobacco merchandise contributes to critical well being points. Since no single product or substance has but been linked to the illness, the CDC and the FDA are recommending that individuals cease utilizing these products. If you continue to use e-cigarettes, the CDC recommends that you don't modify cartridges or purchase them off the street and that you simply monitor your well being.

The Utah Department of Health additionally issued a short lived emergency rule to limit the sale of flavored e-liquids to licensed specialty tobacco shops. In March 2018, shedevr31.ru a bunch of public health organizations, together with Truth Initiative, sued the FDA for unlawfully delaying the implementation of the deeming rule. The FDA seems to have accepted this timetable, podsmall.com though business teams are still challenging the federal decide’s decision.

While much stays to be decided about these lasting well being consequences of those merchandise, we're very troubled by what we see thus far. The inhalation of harmful chemical compounds could cause irreversible lung damage and lung illnesses. The American Lung Association could be very involved that we're susceptible to dropping another era to tobacco-caused ailments as the result of e-cigarettes. The Lung Association remains extremely troubled in regards to the speedy improve of youth utilizing these merchandise and has repeatedly referred to as upon the Food and Drug Administration to increase their oversight and scrutiny of these products to guard kids.

Products

United Tobacco Vapor Group Inc., a department of TVECA, wins a lawsuit challenging the Dutch Ministry of Health's ban on e-cigarette sales. Herbert A. Gilbert is usually credited with the creation of the first gadget that closely resembled the trendy e-cigarette. He reports receiving a patent in and created prototypes, but failed to commercialize it. He attributes this failure the businesses who might have commercialized it preferring to wait for the patent to run out rather than license it, though it is not clear whether it had commercial potential at the time.

Even if an e-cigarette incorporates no nicotine, the user mimics the actions of smoking. There is a possible risk of re-normalizing of tobacco use in areas where smoking is banned. Government intervention is beneficial to keep children secure from the re-normalizing of tobacco, according to a 2017 evaluate. In the context of medicine, the gateway hypothesis is that utilizing less harmful medicine can result in a future danger of utilizing more harmful drugs or crime. However, it is also plausible that any favorable relation between vaping and beginning smoking is a result of frequent threat factors.

However, vapinger pattern analyses of taste varieties used during 2016 to 2019 have been conducted; this analysis makes use of more knowledge points and is thus much less depending on strategies modifications throughout a single year. This is, Smok Novo 2 to our information, the first national study to point out the rising popularity of menthol- and mint-flavored e-cigarettes amongst youth. In this research, the 2016 knowledge showed that menthol or mint flavors had been selected a lot much less incessantly than fruit- or sweet-flavored e-cigarettes by high school college students. Students absent on the day of survey administration could participate utilizing an internet-based mostly version of the questionnaire, which was programmed to imitate the pill-based software.

allows for the licensing of e-cigarettes as medicinal quitting aids, however no producer has yet taken this path to product approval. A 2015 study in the International Journal of Environmental Research and Public Health found that causes for quitting e-cigarettes various by smoker standing. Never smokers cited e-cigarettes being bad for their well being and tasting unhealthy as their reasons for Smok Novo 2 quitting.

Public

Exposure to the same toxins as cigarettes but in greater portions.Waterpipe smoke incorporates high ranges of many toxic compounds found in cigarettes. These include carbon monoxide, heavy metals, and chemicals linked to cancer. In the United States, waterpipes are particularly in style amongst school students and young people.

But the device was never a promising know-how for nicotine supply; Jacobson attributes its failure to it being inherently defective. While the device proved to be a dead-end, the inventors did contribute the verb «vape» to the language. Suggest that your youngster look into native packages and web sites that assist folks quit vaping. Your health care supplier might help you and your youngster discover the right help. Vaping hasn't been around long enough for EightVape us to know how it impacts the body over time.

Connect with other dad and mom who're working to guard kids from vaping and nicotine dependence. Health care suppliers ought to report potential cases of lung harm associated with e-cigarette use to the NYC Poison Control Center by calling 212-POISONS ( ). E-cigarettes come in many styles and sizes and can be referred to as e-cigs, e-hookahs, vapes or vape pens. E-cigarettes are units that heat a liquid, known as e-liquid, podsmall.com into an aerosol that the consumer can inhale.

The vapor is inhaled by the user as an alternative choice to inhaling cigarette smoke. But as an alternative of smoking, the liquid nicotine is vaporized without burning or combustion. As a result of the explosion of JUUL products resulting in an unprecedented increase in youth e-cigarette use, state and native governments are contemplating a variety of policy options to manage this rapidly increasing market. Taxation has confirmed to be one of the most effective methods to reduce youth cigarette use.

However, some methodological considerations in regards to the research and analysis have been raised. Several studies indicated that the intention to stop smoking is among the main reasons reported by adults for initiating ECIG use [forty two, 236–239]. In addition, research show that ECIG use is associated with quit intentions and that ECIG customers usually tend to have tried unsuccessfully to quit smoking in the past. Indeed, those who use ECIGs to give up smoking are more likely to reduce or stop tobacco use, and longer duration of ECIG use has been shown to conicide with decreases in daily consumption of cigarettes. Daily use is associated with increased chance of quitting, whereas intermittent use has been related to a reduced probability of quitting. Product characteristics may be necessary; for instance, one examine found the variety of flavours was independently associated with smoking cessation.

The nicotine in e-cigarettes is dangerous for developing infants, and might lead to habit and hurt mind growth in kids and young adults into their early 20s. Although there is nonetheless a lot to find out about e-cigarettes, the evidence is evident that the harmful well being effects of utilizing e-cigarettes means teens and Vape Pens young adults should not use them. Be aware that some e-cigarettes that declare to be nicotine-free have been found to comprise nicotine. BLOW started selling e-hookahs, an digital model of the hookah, in 2014. The handle of every hose for the e-hookah contains a heating factor and a liquid, which produces vapor. Gopal Bhatnagar based mostly in Toronto, Canada invented a 3D printed adapter to turn a standard hookah into an e-hookah.

Youth

They urged companies to obscure the identified dangers by generating «Controversy! Contradiction!» and introducing «Other Factors! Unknowns!» in the words of one high public-relations specialist. For over a decade, our commitment to high quality has been acknowledged and awarded in over a hundred nations, because the #1 American-made e-liquids for Tobacco and Menthol. We think about it our obligation to deliver premium value to every shopper by sustaining the very best standards in all features of our merchandise.Our goal is to offer clients looking for high-tier vape products with superior, American-made e-liquids, hardware, and equipment.

But it'll grow if lawmakers proceed their irrational push to make e-cigarettes as costly and exhausting-to-get as possible. And the bigger it grows, the simpler will probably be for youth to buy these products on-line. That is as a result of, along with ignoring shipping laws and skirting taxes, dealers on Snapchat and Facebook aren’t likely to verify the age of their customers. Since this product was first developed in 2004 in China as a tobacco cessation device, vapinger.com it has grown quickly so that in 2013 the estimated market is about 1.5 billion as in comparison with 100 billion for tobacco sales. The CDC means that as more folks utilize e-cigarettes, the dramatic improve in nicotine poisoning in kids will continue if nothing is finished to prevent young children having access to nicotine-containing liquids. According to the FDA, over two million middle and highschool college students had been e-cigarette customers in 2016.

In 2019, an outbreak is going on in the United States of a very critical lung illness associated with using vaping gadgets. The particular reason for this outbreak has yet to be determined; it is unclear whether the outbreak is caused by e-fluids that contain nicotine or THC and whether or not the dangerous merchandise were bought «off the road» or in retail outlets. Until extra is thought, all individuals of any age are strongly advised to refrain from using any vaping gadgets. Even within the vaping culture, there’s nonetheless a stigma in relation to Chinese-made products. This can cause a number of inconveniences for some, since a big proportion of electronic cigarettes and vaporizers come from China.

Electronic_Cigarette, a subreddit for discussing everything e-cigs and vaping together with mods, tanks, juice, advocacy, methodology, safety, current news and well being issues. If you have questions or considerations for Juul related to underage vaping, you'll be able to e-mail them at Halpern-Felsher is one of several scientists who've been known as into high schools to provide shows to college students warning of the Juul's high nicotine content. Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University who research nicotine and just lately printed a evaluate of Juul units, stated she found the product's excessive nicotine content «scary.» Not only does the Juul have a better nicotine focus than different comparable gadgets (a Juul pod is 5% nicotine by volume; a Blu e-cig cartridge is 2.four%), it additionally uses a barely completely different nicotine formula than most Element Vape Discount Code pens use. Unlike conventional cigarettes, which have a natural cease mechanism — they burn to the top — e-cigs could be re-filled and reused.

Sen. Ron Johnson (R-WI), chairman of the Senate Homeland Security and Governmental Affairs Committee, sent a second letter to FDA elevating concerns about new e-cigarette laws, a follow-up to his earlier letter to FDA Commissioner Robert M. Califf on May 17, 2016. President Obama indicators S 142, the Child Nicotine Poisoning Prevention Act of 2015, which requires the packaging of «liquid nicotine containers» to be subject to current youngster poisoning prevention packaging standards, effective date of July 26, 2016. SEVIA USA, an affiliation of Chinese e-cigarette manufacturers, varieties to be able to commit sources to fight towards «unfair and burdensome FDA regulations.» SEVIA USA's founding members include Aspire, Kangertech, Innokin, and SMOK.

They have only been readily available in the United States since 2006. As a end result, there is limited research on their long-time period health risks. Food and Drug Administration took initial steps towards regulating these merchandise in 2016, Electric Tobacconist although there is nonetheless restricted regulation of the contents of the e-liquids and the devices. But draft rules overlaying vaping have been first revealed in 2014, and the FDA did not outlaw promoting e-cigarettes to minors until 2016. Groups like the Campaign for Tobacco-Free Kids and the American Cancer Society hailed the measures, and the FDA called them «a milestone in shopper safety.» However, e-cigarette use has continued to increase in years since. E-cigarettes, also referred to as vapes, have gained in popularity since they have been introduced to the U.S. market.

Madvapes

Many of the suspect products tested by the states or federal health officers have been identified as vaping merchandise containing THC, vapinger.com the primary psychotropic ingredient in marijuana. Some of the patients reported a mixture of THC and nicotine; and some reported vaping nicotine alone. While the CDC and FDA proceed to research possible other contributing substances, CDC has recognized a thickening agent—Vitamin E acetate—as a chemical of concern amongst people with e-cigarette or vaping associated lung accidents.

But Juul’s four flavors are only a fraction of all the e-juice flavors available for purchase. E-juice comes in over 7,000 totally different flavors, which are largely unregulated and undocumented. A public policy group over at UNC has a database of some of these flavors and their chemical constituents, however Juul pods haven’t been included. The chemical is greatest generally known as a stimulant that raises the heart fee and blood pressure. It’s also a temper booster because of the way in which it stimulates dopamine transmission in the brain, and blocks different receptors from dampening dopamine’s sign.

Most e-cigarettes comprise nicotine and their repeated use can lead to nicotine dependancy or enhance the user's threat of dependancy. Some e-cigarette brands comprise nicotine salts to masks the harshness of nicotine and make it extra palatable. As of 2018, all tobacco products must bear the required nicotine addictiveness warning statement on product packages and commercials so as to warn shoppers concerning the presence of and addictive nature of nicotine.

The last five years have seen enormous spikes in youth e-cigarette use rates. The way an e-cigarette is used or modified also impacts the supply of nicotine to a person person. A third generation e-cigarette refers to gadgets that do not resemble a combustible cigarette and sometimes have very giant and typically customizable batteries. Some parts may be replaceable, which is why they are typically referred to as «mods.» These units are refillable.