Jamming and unusual charge density fluctuations of strange metals.

The strange metallic regime across a number of high-temperature superconducting materials presents numerous challenges to the classic theory of Fermi liquid metals. Recent measurements of the dynamical charge response of strange metals, including optimally doped cuprates, have revealed a broad, featureless continuum of excitations, extending over much of the Brillouin zone. The collective density oscillations of this strange metal decay into the continuum in a manner that is at odds with the expectations of Fermi liquid theory. Inspired by these observations, we investigate the phenomenology of bosonic collective modes and the particle-hole excitations in a class of strange metals by making an analogy to the phonons of classical lattices falling apart across an unconventional jamming-like transition associated with the onset of rigidity. By making comparisons to the experimentally measured dynamical response functions, we reproduce many of the qualitative features using the above framework. We conjecture that the dynamics of electronic charge density over an intermediate range of energy scales in a class of strongly correlated metals can be at the brink of a jamming-like transition.

2021 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System.

Introduction: This is the 2021 Annual Report of the Kansas Poison Control Center (KSPCC) at The University of Kansas Health System. The KSPCC serves the state of Kansas 24-hours a day, 365 days a year with certified specialists in poison information and clinical and medical toxicologists. Methods: Encounters reported to the KSPCC from January 1, 2021 through December 31, 2021 were analyzed. Data recorded includes caller demographics, exposure substance, nature and route of exposure, interventions, medical outcome, disposition, and location of care. Results: The KSPCC logged 18,253 total encounters in 2021, including calls from every county in Kansas. A majority of human exposure cases (53.6%) were female. Approximately 59.8% were pediatric exposures (defined as 19 years of age or less). Most encounters occurred at a residence (91.7%) and most were managed there (70.5%). Unintentional exposures were the most common reason for exposures (70.5%). The most common reported substance in pediatric encounters was household cleaning products (n = 815) and cosmetics/personal care products (n = 735). For adult encounters, analgesics (n = 1,241) and sedative/ hypnotics/antipsychotics (n = 1,013) were the most frequently reported. Medical outcomes were 26.0% no effect, 22.4% minor effect, 10.7% moderate effect, and 2.7% major effects. There were 22 deaths. Conclusions: The 2021 KSPCC annual report demonstrated that cases were received from the entire state of Kansas. Pediatric exposures remained most common but cases with serious outcomes continued to increase. This report supported the continued value of the KSPCC to both public and health care providers in the state of Kansas.

Epidemiology and Characteristics of North American Crotalid Bites Reported to the National Poison Data System 2006-2020.

OBJECTIVES: North American pit viper, or crotalid bites, remain a low-incidence and potentially high-consequence medical event. Although the venom of these snakes is known to cause tissue, hematologic, and neurologic toxicity, the published literature on North American crotalid bites remains limited. The National Poison Data System, the data repository for the 55 poison control centers in the United States, offers a unique opportunity to examine nationwide trends involving venomous snake bites. METHODS: National Poison Data System cases involving North American crotalids from 2006 to 2020 were analyzed. Data collected included age and type of snake, date, geographic location, pertinent clinical characteristics, treatments administered, and medical outcomes including incidence of "dry" bites and death. RESULTS: A total of 55,914 cases were identified during the 15-year study period. Cases, especially those involving copperheads, increased during the study period. Most of the cases were reported in July. Cases were reported in all 50 states and Washington, DC, with Texas having the most cases (n = 9115). North Carolina had the largest increase in bites during the study period. Moderate or major medical outcomes were documented in 58% (n = 32,584) of cases, with 25% (n = 14,195) being admitted to a critical care unit. Puncture wound, edema, and pain were the most commonly documented symptoms. Antivenom was documented as being administered in 25% (n = 14,151) of cases. Dry bites were reported in <1.5% of cases. Thirty-two deaths were reported, 23 involving rattlesnakes. CONCLUSIONS: This study demonstrates that reported North American crotalid bites appear to be increasing over time and are associated with potentially significant morbidity. Mortality, however, remains low.

Universal scaling for disordered viscoelastic matter near the onset of rigidity.

The onset of rigidity in interacting liquids, as they undergo a transition to a disordered solid, is associated with a rearrangement of the low-frequency vibrational spectrum. In this Letter, we derive scaling forms for the singular dynamical response of disordered viscoelastic networks near both jamming and rigidity percolation. Using effective-medium theory, we extract critical exponents, invariant scaling combinations, and analytical formulas for universal scaling functions near these transitions. Our scaling forms describe the behavior in space and time near the various onsets of rigidity, for rigid and floppy phases and the crossover region, including diverging length scales and timescales at the transitions.

Time to Burn? Characteristics of Hydroxocobalamin Administration in an Academic Medical Center.

Background/Objective: Hydroxocobalamin is indicated for cyanide poisoning and its package insert states it should be given "without delay". We sought to evaluate time to administration and clinical characteristics when hydroxocobalamin was administered in a quaternary care academic medical center. Methods: All hydroxocobalamin administrations from January 1, 2007 to December 31, 2018 were analyzed. Data points recorded were: carboxyhemoglobin, cyanide and methemoglobin levels, hospital time and course, time and dose of hydroxocobalamin administration, lactate and bicarbonate levels, initial and nadir pH, initial heart rate, and initial and lowest systolic blood pressure. Results: Fifty-six cases were identified. One case was excluded as hydroxocobalamin was administered for nitroprusside toxicity. Among 55 cases analyzed, 93% (n = 51) were adults. Median hospital length of stay was 4.3 days (IQR 2.5 to 12). Burn, inhalation injury, and smoke inhalation were 80% of admitting diagnoses. Median time to hydroxocobalamin administration was 208 minutes (IQR 62.5 to 330). Eleven of 55 cases died. Hydroxocobalamin was given within 60 minutes of arrival in 12 cases, of which 3 died. All adults received 5 g of hydroxocobalamin. Time to hydroxocobalamin administration was longer in death cases [median: 221 minutes (IQR 119 to 594)] vs survivors [median: 184.5 minutes (IQR 62.8 to 315)]. Seventeen cases had cyanide levels drawn, with 9 being measurable, but none were toxic. Conclusions: Significant delay in hydroxocobalamin administration was seen in this study. Cases that resulted in death had significantly longer times to hydroxocobalamin administration. Further studies are warranted to identify reasons for delays in hydroxocobalamin administration.

2020 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System.

Introduction: This is the 2020 Annual Report of the Kansas Poison Control Center (KSPCC) at The University of Kansas Health System. The KSPCC receives calls from the public, law enforcement, healthcare professionals, and public health agencies. Methods: Encounters reported to the KSPCC from January 1, 2020 through December 31, 2020 were analyzed for caller location, demographics, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, and location of care. Encounters were classified as human or animal exposure, confirmed non-exposure, or information call (no exposure). Results: There were 19,780 total encounters, including 18,492 human exposure cases. These cases were primarily female (53.6%, n = 9,911) and pediatric (19 years of age or less; 59.5%, n = 10,995). Acute cases (82.7%, n = 15,294), unintentional exposures (73.8%, n = 13,643), and ingestions (85.9%, n = 15,901) were most common. The most common reported substance was household cleaning products (n = 937) in pediatric (children ≤ 5) and analgesics (n = 1,335) in adults. An increase in exposures to disinfectants and household cleaning products was seen. Moderate (n = 1,812) or major (n = 482) clinical outcomes were seen in 12.4% of cases. There were 18 deaths in 2020 reported to the KSPCC. Conclusions: Over 18,400 exposures were managed by the KSPCC in 2020. Pediatric exposures remained the most common encounter. An increase in exposures to disinfectants and other household cleaning products was seen. This report supported the continued value of the KSPCC to both public and acute healthcare in the state of Kansas.

A different challenge with Benadryl: adolescent diphenhydramine ingestions reported to National Poison Database System, 2007-2020.

BACKGROUND: The US Food and Drug Administration released a warning related to potential adverse effects related to intentional misuse or abuse ingestions of diphenhydramine in September 2020. We sought to evaluate adolescent-aged (13-19 y) diphenhydramine ingestions reported to US poison control centers to characterize these exposures, adverse effects, outcomes, and trends in outcomes and reasons for ingestion. METHODS: The US National Poison Database System was queried for all exposures to diphenhydramine between January 1, 2007 and December 31, 2020. RESULTS: 47,644 ingestions were included for analysis. An increase in the number of ingestions, percentage of cases due to an intentional reason for ingestion and suspected suicide was observed. More serious outcomes, cardiac complications, seizures, and deaths were more common following intentional ingestions and specifically suspected suicide over misuse or abuse. CONCLUSIONS: Adolescent ingestions of diphenhydramine increased between 2007 and 2020. More serious outcomes, intentional reasons, and suspected suicide also increased over the study interval. Suspected suicide was associated with cardiac complications, seizures, coma, and death at higher rates than misuse or abuse. While misuse and abuse remain a concern, public health interventions focusing on the risk that diphenhydramine pose as an agent of suicide attempt may be of higher impact.

Viscerocutaneous Loxoscelism Manifesting with Myocarditis: A Case Report.

BACKGROUND Envenomation from the brown recluse spider (Loxosceles reclusa) is described to cause both local and systemic symptoms. We report a case of an adolescent boy who developed severe systemic loxoscelism, and his clinical course was complicated by myocarditis, which has not been previously reported in association with loxoscelism. CASE REPORT A 16-year-old boy presented with non-specific symptoms and forearm pain following a suspected spider bite, which subsequently evolved into a necrotic skin lesion. During his clinical course, he developed a characteristic syndrome of systemic loxoscelism with hemolysis, disseminated intravascular coagulopathy, and severe systemic inflammatory response syndrome, necessitating transfer to the Intensive Care Unit. The diagnosis was confirmed with an enzyme-linked immunosorbent assay that detected Loxosceles venom in the wound. Additionally, he developed pulmonary edema and cardiogenic shock secondary to myocarditis, which was confirmed with cardiac magnetic resonance imaging. Steroids and plasmapheresis were initiated to manage the severe inflammatory syndrome, and the myocarditis was treated with intravenous immunoglobulins, resulting in resolution of symptoms and improvement of cardiac function. CONCLUSIONS This is the first reported case of myocarditis associated with loxoscelism, providing evidence for Loxosceles toxin-associated cardiac injury, which has been previously described in animal models only. Furthermore, this case provides further support for the use of confirmatory testing in the clinical diagnosis of loxoscelism.

2019 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System.

INTRODUCTION: This is the 2019 Annual Report of the Kansas Poison Control Center (KSPCC) at The University of Kansas Health System. The KSPCC is one of 55 certified poison control centers in the United States and serves the state of Kansas 24-hours a day, 365 days a year with certified specialists in poison information and clinical and medical toxicologists. The KSPCC receives calls from the public, law enforcement, health care professionals, and public health agencies. All calls to the KSPCC are recorded electronically in the Toxicall® data management system and uploaded in near real-time to the National Poison Data System (NPDS) which is the data repository for all poison control centers in the United States. METHODS: All encounters reported to the KSPCC from January 1, 2019 through December 31, 2019 were analyzed. Data recorded for each exposure includes caller location, age, weight, gender, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, disposition, and location of care. Encounters were classified as human exposure, animal exposure, confirmed non-exposure, or information call (no exposure reported). RESULTS: The KSPCC logged 20,589 total encounters in 2019, including 19,406 human exposure cases. The KSPCC received calls from every county in Kansas. A slim majority of human exposure cases (50.5%, n = 9,790) were female. Approximately 61% (n = 11,876) of human exposures involved a child (defined as 19 years of age or less). Most encounters occurred at a residence (91.6%, n = 17,780) and most cases (64.9%, n = 12,599) originated from a residence. The majority of human exposures (85.5%, n = 16,589) were acute cases (exposures occurring over 8 hours or less). Ingestion was the most common route of exposure documented (85.3%, n = 16,548). The most commonly reported substance in pediatric (children ≤ 5) encounters was cosmetics/personal care products (n = 959) followed closely by household cleaning products (n = 943). For adult encounters, analgesics (n = 1,296) and sedative/hypnotics/antipsychotics (n = 1,084) were the most frequently involved substances. Unintentional exposures were the most common reason for exposures (75.4%, n = 14,634). Most encounters (65.9%, n = 12,780) were managed in a non-healthcare facility (i.e., a residence). Among human exposures, 14,591 involved exposures to pharmaceutical agents while 9,439 involved exposure to non-pharmaceuticals. Medical outcomes were 26.4% (n = 5,116) no effect, 18.8% (n = 3,652) minor effect, 9.3% (n = 1,813) moderate effect, and 3.1% (n = 603) major effects. There were 14 deaths in 2019 reported to the KSPCC. Cases from healthcare facilities and cases with moderate or major medical outcomes increased in 2019 compared to 2018. The number of deaths reported to the KSPCC increased in 2019 to 14 from 7 in 2018. CONCLUSIONS: The results of the 2019 Kansas Poison Control Center's annual report demonstrated that cases were received from the entire state of Kansas totaling over 19,400 human exposures per year. While pediatric exposures remained the most common encounter, there continued a trend of increasing number of cases from healthcare facilities and for cases with serious outcomes. The experience of the KSPCC is comparable to national data. This report supported the continued value of the KSPCC to both public and acute health care in the state of Kansas.

Utilization of a poison control center by critical access hospitals-one state's experience.

PURPOSE: Critical access hospitals (CAH) are an important source of exposures for poison control centers (PCC), yet there is a paucity of literature on how these calls differ from larger, more urban hospitals (UH). This study aimed to compare call characteristics from CAH and UH received by a regional PCC. METHODS: This retrospective chart review used the Toxicall® database of the Kansas PCC. All cases involving calls from a health care facility from 1 January 2012 to 31 December 2017 were identified. Cases were then identified as either from a CAH or from one of the four largest UH in Kansas for comparison. CAH were defined using the criteria from the Centers for Medicare & Medicaid Services. All information was de-identified in REDCAPS and analyzed in Microsoft Excel. FINDINGS: A total of 12,469 unique patient cases were identified, including 6392 CAH and 6077 UH cases. Patients at UH were more likely to have longer duration of medical effects and experience more severe medical effects. Significant differences in the unique exposures, rates of intentional overdose, routes, and number of exposures were found. Patients at CAH were more likely to receive activated charcoal, flumazenil, and be transferred to another healthcare facility, but were less likely to have been referred by the PCC, need an ICU admission, or require consultation with a toxicologist. CONCLUSIONS: PCC calls from CAHs were common and resulted in significant differences when compared to UH calls. Future research is warranted to optimize PCC services for rural hospitals.

A Retrospective Review of Morbidity and Mortality Associated with Acute Benzodiazepine Withdrawal at a Midwestern Academic Medical Center.

INTRODUCTION: There is concern that acute benzodiazepine (BZD) withdrawal may result in morbidity and mortality. However, there is a paucity of medical literature regarding clinical characteristics and outcomes of acute BZD withdrawal. We sought to characterize acute BZD withdrawal and its associated clinical outcomes and treatment at a midwestern academic medical center. METHODS: This was a retrospective study. The medical records of the University of Kansas Hospital, a tertiary academic medical center, were queried for patients with a diagnosis of BZD withdrawal, drug withdrawal, sedative-hypnotic withdrawal, or withdrawal-NOS from January 1, 2009 to January 1, 2016. Data collected included age, sex, month/year of encounter, initial vital signs, type of drug withdrawal (alcohol, opioid, BZD, or other), type of BZD withdrawing from, disposition, duration of hospitalization, seizures, endotracheal intubation, mortality, and pharmacological treatment. RESULTS: Eighty-two cases were identified. Cases per year increased over the study period. Thirty-one (38%) cases involved concurrent drug withdrawal with opioids most common (n = 25). Alprazolam (n = 32) was the most common BZD implicated in BZD withdrawal. Thirty-nine cases (47%) were admitted including seven to the ICU. Seizures were reported in 8 (10%) cases. Endotracheal intubation occurred in three (3.6%). Sixty-seven patients (81%) were treated with a BZD, with lorazepam (n = 42) most used. There were no deaths. Upon discharge, 40 (49%) patients received a prescription for a benzodiazepine. CONCLUSIONS: Cases of acute BZD withdrawal increased over the study period but were associated with only occasional morbidity and no mortality. Further multi-center studies are warranted to characterize the incidence and characteristics of acute BZD withdrawal better.

Sustained stimulation? Characteristics of modified release and immediate release stimulant exposures reported to the national poison data system.

OBJECTIVE: We sought to examine ADHD modified release (MR) and immediate release (IR) stimulant ingestion exposures reported to the National Poison Data System (NPDS) to characterize the nature of the exposures and the outcomes associated with them. METHODS: The NPDS was queried for all single-substance exposures to MR and IR ADHD preparations between January 1, 2007 and December 31, 2017. MR and IR preparations were identified by a generic code of "amphetamine and related compounds" or "methylphenidate" and specific product name containing XR, CD, ER, LA, and SR. RESULTS: A total of 15,796 MR ingestions and 23,418 IR ingestions were identified and followed to known outcome. The majority of ingestions occurred in male patients and in own residence. More serious outcomes (moderate, major, or death) were more common in adult IR and MR ingestions as compared to pediatric; rates of serious outcome increased with age amongst pediatric ingestions. Unintentional ingestions were more common in both MR and IR pediatric cases while intentional ingestions occurred more frequently in adult cases. Symptoms consistent with a hyperadrenergic state were experienced in adult and pediatric patients for both MR and IR ingestions. Supportive care including benzodiazepine administration was more common in IR than MR ingestions. Decontamination with whole bowel irrigation was infrequent. CONCLUSION: Rates of more serious outcome were similar between IR and MR ADHD stimulant ingestions. More serious outcomes were associated with advancing age and intentional ingestions. Similar rates of agitation, tachycardia, and hypertension were experienced by pediatric IR and MR ingestions while more common in adult IR as compared to MR ingestions. Rates of decontamination with whole bowel irrigation were overall low.

Massive Iatrogenic Pediatric Ketamine Overdose With Serial Levels and Minimal Morbidity.

ABSTRACT: Ketamine is a dissociative anesthetic commonly used for procedural sedation owing to its perceived favorable safety profile. Despite its frequent use, overdoses of ketamine are rarely reported, and no cases with serum levels of ketamine or its metabolite have previously been reported. We report a case of an iatrogenic pediatric ketamine 20 mg/kg intramuscular overdose with serial ketamine and norketamine levels that resulted in minimal toxicity.

Respiratory depression following medications for opioid use disorder (MOUD)-approved buprenorphine product oral exposures; National Poison Database System 2003-2019.

BACKGROUND: Medications for opioid use disorder (MOUD) including buprenorphine is recommended for patients with opioid use disorders. We sought to evaluate the frequencies of respiratory depression, intubation, and naloxone administration, and clinical outcomes among patients reported to the National Poison Database System (NPDS) following single-substance and multiple-substance buprenorphine oral exposures. METHODS: NPDS was queried for all MOUD-approved buprenorphine product exposures between 1 January 2003 and 31 December 2019. Data abstracted included year, route, gender, age, site of exposure, management site, medical outcome, recorded "related" respiratory depression ("respiratory rate <10 breaths/min and/or a SpO2 (pulse oximetry)≤90%), reported administration of naloxone and intubation in oral exposure cases followed to known outcome. Concomitant products were also recorded in multiple-substance buprenorphine cases. RESULTS: 27,275 (11,010 multiple and 16,265 single) buprenorphine oral exposures were identified and followed to known outcome. A 65-fold increase in reported cases was reported over the study interval. A steady increase in the frequency of more serious outcomes by year was also observed. Respiratory depression occurred at a frequency of 11.8% (pediatric single-substance), 11.2% (pediatric multiple-substance), 11.3% (adult single-substance), and 11.9% (adult multiple-substance). Among oral exposures of buprenorphine and only one other product, benzodiazepines, opioids, ethanol, and amphetamines were most common. CONCLUSIONS: Oral exposures have increased substantially between 2003 and 2019. More serious outcomes including deaths following oral exposures to buprenorphine have also increased over the same interval for both adult and pediatric patients. Clinically significant rates of respiratory depression in both adult and pediatric patients when taken alone and with additional substances were observed.

2018 Annual Report of the University of Kansas Health System Poison Control Center.

INTRODUCTION: This is the 2018 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System (KSPCC). The KSPCC serves the state of Kansas 24-hours per day, 365 days a year with certified specialists in poison information and clinical and medical toxicologists. METHODS: All encounters reported to the KSPCC from January 1, 2018 through December 31, 2018 were analyzed. Data recorded for each exposure included caller location, age, weight, gender, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, disposition, and location of care. RESULTS: There were 21,072 total encounters, including 20,031 human exposure cases. Calls were received from every county and hospital in Kansas. Most of the exposures involved females (51.5%, n = 10,320) and a child less than 19 year of age (64%, n = 12,865). Medical outcomes were 24.5% (n = 4,912) no effect, 17.7% (n = 3,542) minor effect, 9.1% (n = 1,830) moderate effect, and 2.4% (n = 476) major effect. Seven deaths were reported in 2018. The number of exposure calls from healthcare facilities and severity of medical outcomes increased in 2018 compared to 2017. CONCLUSION: The 2018 KSPCC annual report demonstrated that the center receives calls from the entire state of Kansas totaling over 20,000 human exposures. While pediatric exposures remain the most common encounter, a trend continued of an increasing number of calls from healthcare facilities and for cases with serious outcomes. This report supported the continued value of the KSPCC to both public and acute health care in the state of Kansas.

Photometric Sensing of Active Chlorine, Total Chlorine, and pH on a Microfluidic Chip for Online Swimming Pool Monitoring.

A microfluidic sensor was studied for the photometric detection of active chlorine, total chlorine, and pH in swimming pool samples. The sensor consisted of a four-layer borosilicate glass chip, containing a microchannel network and a 2.2 mm path length, 1.7 mL optical cell. The chip was optimised to measure the bleaching of methyl orange and spectral changes in phenol red for quantitative chlorine (active and total) and pH measurements that were suited to swimming pool monitoring. Reagent consumption (60 mL per measurement) was minimised to allow for maintenance-free operation over a nominal summer season (3 months) with minimal waste. The chip was tested using samples from 12 domestic, public, and commercial swimming pools (indoor and outdoor), with results that compare favourably with commercial products (test strips and the N,N'-diethyl-p-phenylenediamine (DPD) method), precision pH electrodes, and iodometric titration.

Patch Problems? Characteristics of Transdermal Drug Delivery System Exposures Reported to the National Poison Data System.

BACKGROUND: Transdermal drug delivery systems (TDDS) pose special risks considering a large amount of drug they contain and their modified release properties. We sought to characterize TDDS exposures reported to the National Poison Data System (NPDS). METHODS: NPDS was searched for all human exposures to a TDDS from 1/1/2006 to 12/31/2015. Only single-substance TDDS exposures followed to a known medical outcome were included for final analysis. Specific data analyzed was date, sex, age, TDDS product, exposure reason, route of exposure, medical outcome, management site, level of health care facility care, clinical effects, and interventions. RESULTS: Over that 10-year period, 6746  adults and 1917 pediatric exposures were identified. Exposures declined over the study period. The most common exposure reason in adults was intentional abuse (n = 1622) compared to unintentional-general (n =1 070) in pediatric cases. TDDS ingestion was reported in 4519 adults and 2825 pediatric cases. Fentanyl was the most common substance encountered in adult (n = 4656) and pediatric cases (n = 474). No or minor effect were the most common medical outcomes in both groups. In fentanyl cases, moderate or major outcomes were seen in 54 % (n = 1062) of adult and 26 % (n = 54) of pediatric cases. Naloxone was given in 1080 cases. Ninety-seven deaths (91 adults, 6 pediatrics) were reported, all involving ingestion of the TDDS. Fentanyl was associated with 80 adult and 5 pediatric deaths. CONCLUSION: Overall, single-substance TDDS exposures decreased over the duration of this study and typically resulted in no or mild effects. However, exposures involving fentanyl resulted in higher rates of major or moderate medical outcomes and were associated with multiple deaths.