Case Presentation: A four-year-old female patient presented to the emergency department with an epinephrine auto-injector that had unintentionally discharged into her mandible. There was difficulty removing the auto-injector at bedside. Images we acquired noted needle curvature not present in an off-the-shelf model. She was sedated, and the auto-injector was removed by retracing the angle of discharge, with care taken not to inject epinephrine into the patient.

Discussion: Epinephrine auto-injector accidental discharges are an unusual injury pattern, but the incidence of such events is increasing in the United States. The emergency clinician should be cognizant of complicating factors with discharges, such as bent needles. Here we discuss a case of discharge into the maxillofacial region (lower jaw), with approaches to treatment.

The efficient conversion of low-energy, near-infrared (NIR) photons to higher energies promises advancements across a range of disparate fields, from more efficient solar energy capture to advanced biologic studies and therapies. At the forefront of this effort, upconverting nanoparticles (UCNPs) contain an array of lanthanide ions alloyed into a ceramic matrix, most commonly NaYF4. These lanthanide ions possess a 4f orbital manifold with a series of ladder-like, long-lived electronic states, allowing the sequential absorption of NIR photons at relatively low photon flux. The electrons climb the 4f Stark levels, absorbing multiple photons from the excitation source before relaxing back to the ground state upon emission of a photon with an energy higher than those from the source. While UCNPs are among the most efficient systems for converting NIR light to visible, they still hold key limitations, namely, they only weakly absorb incoming photons, hindering their external quantum efficiencies and overall performance.

This thesis presents studies designed to enhance the efficiency and brightness of UCNPs. One method to circumvent the inherently weak absorption in UCNPs involves attaching organic dye antennae to the surface of the nanoparticles to absorb incoming light and funnel the absorbed energy into the UCNP. However, a detailed understanding of the energy transfer mechanism between dye and UCNP is required to fully realize the potential of this system. We propose, using a series of spectroscopic and kinetic measurements, that this energy transfer is mediated via the absorbing dye triplet state, and further that the intersystem crossing rate within the dye is enhanced by interactions with the heavy nuclei of the lanthanides within the UCNP. We then design a highly efficient dye:UCNP hybrid system utilizing this new understanding. Lastly we present a study highlighting the power and potential of using UCNPs for biological applications. Together these studies will advance the utilization of photon upconversion towards realizing its promise in applications.