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This paper concerns the development of a novel monolithic active pixel radiation sensor based on SOI technology. In this device, the sensitive volume corresponds to a high resistivity SOI 'handle' wafer and the front-end CMOS electronics is integrated in the SOI device layer. Pixel test matrices have been manufactured and are under extensive characterization. The conceptual design, together with architecture and technology issues is addressed; the latest experimental results are reported. Index Terms--Position sensitive particle detectors, silicon on insulator technology, silicon radiation detectors.

Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium's (ToxIC) North American Snakebite Registry (NASBR) Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management. Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7–12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours. Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations. Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours. [ABSTRACT FROM AUTHOR]

Background:Novel substances often referred to as “designer drugs” have emerged as drugs of abuse, and recognition of these is difficult as routine blood and urine screening tests do not detect these agents. U-47700 is a synthetic selective μ-opioid agonist that can be bought online for as little as $40 per gram. We report two patients presenting after insufflation of U-47700, with subsequent confirmation of this substance in urine samples. Case details:A 26-year-old man and 24-year-old woman insufflated a substance they believed to be “synthetic cocaine.” The man was found down with cyanosis and agonal respirations. He was intubated and taken to hospital where he recovered well with supportive care. The woman presented with anxiety, tremors and drowsiness and was admitted for observation. Urine samples from both patients were analyzed using GC/MS/MS and LC/QToF, and U-47700 was isolated in both cases. No other opioids were detected. Discussion:These cases are concerning because U-47700 is a relatively new agent that is easy to obtain over the internet and has the potential to cause significant morbidity and mortality. [ABSTRACT FROM PUBLISHER]

On 24 June 2022, the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organisation held that:'The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives.'Since the ruling, thirteen states have enacted 'trigger laws' that restrict access to abortion except in specified circumstances, such as to save the life of the pregnant patient in a medical emergency. These laws not only inappropriately insert the State into the physician-patient relationship, but create an uncertain practice landscape for physicians by placing them at risk of criminal penalties. We illustrate the complexity of medical decision making for pregnant patients using examples from the case report literature, and discuss how leaving the definition of 'medical emergency' up to courts to decide will create a patchwork of restrictive and permissive standards that criminalises physicians and creates a 'political standard of care' that replaces evidence based medical care.

Novel psychoactive substances have emerged as drugs of abuse. 2-Fluorodeschloroketamine (2-FDCK) is a ketamine derivative that can be purchased online for as little as $12 per gram. We report the case of a patient with a history of polysubstance use presenting after insufflation of 2-FDCK, with subsequent confirmation of metabolites in the patient's urine. A 28-year-old man presented to the Emergency Department in a dissociated state. He recovered well with supportive care, and described during interview his experience of substance use including the novel psychoactive substance 2-FDCK. A urine sample was sent for analysis and 2-FDCK metabolites were isolated. This case is concerning because 2-FDCK is a relatively new agent that has not yet been reported in the United States. It is easy to obtain over the internet and has significant abuse potential.

In adults, membranous nephropathy is the second most common cause of nephrotic syndrome. In contrast, minimal change disease and focal segmental glomerulosclerosis constitute the most common forms of nephrotic syndrome in children, while membranous nephropathy accounts for <5% of cases. In adults, causes of membranous nephropathy include autoantibodies directed against phospholipase A 2 receptor and thrombospondin type 1 containing 7A, various infections, environmental toxicities, autoimmune disorders, malignancies, and other secondary forms. The most common causes of secondary membranous nephropathy in children are infections, autoimmune diseases, and neoplasia. We discuss an unusual presentation of new-onset membranous nephropathy due to mercury toxicity in a 14-year-old male with reflux nephropathy. This case underscores the importance of a high index of suspicion for uncommon causes of nephrotic syndrome in pediatric patients with membranous nephropathy., (Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Case Details: A 51-year-old man presented with rapid onset encephalopathy and respiratory failure after a suspected intravascular envenomation from a North American pit viper. The patient received antivenom and was transferred to a tertiary care facility where he had cardiovascular collapse and persistent coagulopathy requiring 28 vials of Crotalidae polyvalent immune Fab antivenom for initial control and six vials for maintenance. The patient's coagulopathy was monitored using "traditional" measures (platelets, fibrinogen, and prothrombin time/international normalized ratio) and rotational thromboelastometry (ROTEM ® ). The patient also subsequently developed intestinal necrosis requiring exploratory laparotomy with ileum and colonic resections, and anuric renal failure requiring continuous renal replacement therapy. After coordinated multidisciplinary management, he was discharged to an acute inpatient rehabilitation on hospital day 25 and has since made a full recovery., Discussion: In the setting of a severe intravascular pit viper envenomation, thromboelastometry correlated well with "traditional" measures. During recovery, ROTEM ® demonstrated measurable improvements in the extrinsic coagulation pathway while the INR remained between 1.5 and 1.6. Patient's intestinal necrosis may have resulted from microvascular thrombosis due to Crotalinae venom. The patient's ultimate recovery necessitated a coordinated multidisciplinary effort. ROTEM ® abnormalities after North American pit viper envenomation may be more sensitive than "traditional" measures and may have prognostic value to determine the severity of envenomation, but further research to define its utility is required., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Metal-halide perovskites have emerged as promising materials for optoelectronics applications, such as photovoltaics, light-emitting diodes, and photodetectors due to their excellent photoconversion efficiencies. However, their instability in aqueous solutions and most organic solvents has complicated their micropatterning procedures, which are needed for dense device integration, for example, in displays or cameras. In this work, a lift-off process based on poly(methyl methacrylate) and deep ultraviolet lithography on flexible plastic foils is presented. This technique comprises simultaneous patterning of the metal-halide perovskite with a top electrode, which results in microscale vertical device architectures with high spatial resolution and alignment properties. Hence, thin-film transistors (TFTs) with methyl-ammonium lead iodide (MAPbI 3 ) gate dielectrics are demonstrated for the first time. The giant dielectric constant of MAPbI 3 (>1000) leads to excellent low-voltage TFT switching capabilities with subthreshold swings ≈80 mV decade -1 over ≈5 orders of drain current magnitude. Furthermore, vertically stacked low-power Au-MAPbI 3 -Au photodetectors with close-to-ideal linear response (R 2 = 0.9997) are created. The mechanical stability down to a tensile radius of 6 mm is demonstrated for the TFTs and photodetectors, simultaneously realized on the same flexible plastic substrate. These results open the way for flexible low-power integrated (opto-)electronic systems based on metal-halide perovskites., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

A series of [60]fullerenes covalently functionalized with the polymer poly(ethylene glycol) is presented. These new [60]fullerene-based materials have been incorporated as additives in CH 3 NH 3 PbI 3 (MAPbI 3 ), the most common organic-inorganic perovskite used in perovskite solar cells. The extensive photovoltaic study performed by using these materials shows several beneficial effects on the performance of these cells, including a reduction in hysteresis and an increased stability against moisture, whereby the solar cells retain up to 97 % of their initial power conversion efficiency in an ambient atmosphere., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objectives: Published reports have suggested that the concurrent use of alcohol or drugs occurs among some snakebite victims, but no national assessment of such data exists., Methods: We used data from US poison control centers collected during telephone calls in calendar years 2000-2013 to compare snake envenomations with concomitant use of drugs, alcohol, or both to snakebites lacking such use., Results: A total of 608 snakebites with 659 instances of concomitant alcohol/drug use were reported, which represent approximately 1% of 92,751 snakebites reported to US poison control centers. An annual mean of 48 snakebites with concomitant use of alcohol/drugs was reported, compared with a mean of 6625 snakebites per year with no concomitant use of alcohol/drugs. Most cases involved men, peaked during the summer months, and involved copperheads or rattlesnakes, which mirrored overall trends. Snakebite victims who also used alcohol/drugs were more likely than victims with only a snakebite reported to be bitten by rattlesnakes, to be admitted to the hospital, and die. Alcohol was the most common reported concomitant substance, but other substances were reported., Conclusions: Snakebites with concomitant use of alcohol/drugs are uncommon, accounting for approximately 1% of the snakebite envenomations reported annually to US poison control centers; however, snakebite victims also reporting alcohol/drug use are more likely to be bitten by rattlesnakes, be admitted to a healthcare facility, and die.

Mixed ion perovskite solar cells (PSC) are manufactured with a metal-free hole contact based on press-transferred single-walled carbon nanotube (SWCNT) film infiltrated with 2,2,7,-7-tetrakis(N,N-di-p-methoxyphenylamine)-9,90-spirobifluorene (Spiro-OMeTAD). By means of maximum power point tracking, their stabilities are compared with those of standard PSCs employing spin-coated Spiro-OMeTAD and a thermally evaporated Au back contact, under full 1 sun illumination, at 60 °C, and in a N 2 atmosphere. During the 140 h experiment, the solar cells with the Au electrode experience a dramatic, irreversible efficiency loss, rendering them effectively nonoperational, whereas the SWCNT-contacted devices show only a small linear efficiency loss with an extrapolated lifetime of 580 h., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The illicit drug market has rapidly evolved from synthetic cannabinoids to cathinone derivatives and now a new emerging threat of synthetic opioids. These compounds were mostly developed by pharmaceutical companies during drug discovery. The new psychoactive substances are not routinely covered in drug screening and may go undetected. Recently fentanyl analogous, AH-7921, MT-45 and now U-47700 have been encountered in clinical and forensic casework. U-47700 is gaining popularity on drug user forms as a legal alternative to heroin. It is a µ-receptor agonist that is part of the trans-1-2-diamine opioid analgesic drug class developed by The Upjohn Company in an attempt to develop a non-addicting analgesic. A LC-MS-MS method was developed and validated to detect and quantify U-47700. Additional analysis was conducted with an LC-QToF to identify the presence of the parent drug and metabolites. A total of four cases have been evaluated by the LC-MS-MS methodology which has an analytical range of 1-1,250 ng/mL and limit of detection of 1 ng/mL. The concentration of U-47700 in urine specimens ranged from below the limit of quantification to 224 ng/mL. The ToF analysis detected the presence of suspected phase I demethylated metabolites that may assist future analysis of this compound. The prevalence of designer opioids in casework highlights the importance of analysis for new psychoactive substances. Traditional opiates/opioids were not detected in the presented cases, but the available case histories revealed an opioid toxidrome. These findings suggest that U-47700 drug may cause significant morbidity and mortality within the United States as an emerging drug threat., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)