Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: A case report.

Emergency department management of hypoxemia in the setting of COVID-19 is riddled with uncertainty. The lack of high-quality research has translated to an absence of clarity at the bedside. With disease spread outpacing treatment consensus, provider discretion has taken on a heightened role. Here, we report a case of dexmedetomidine use in the setting of worsening hypoxemia, whereby oxygenation improved and intubation was avoided. Well known pharmacologic properties of the drug, namely the lack of respiratory depression and its anti-delirium effects, as well as other possible physiologic effects, suggest potential benefit for patients being managed with a delayed intubation approach. If dexmedetomidine can improve compliance with non-invasive oxygen support (the current recommended first-line therapy) while promoting better oxygenation, it may also decrease the need for mechanical ventilation and thus improve mortality.

High-power pulsed-current-mode operation of an overdriven tapered amplifier.

We experimentally investigate the performance of a commercial tapered amplifier diode operating in a pulsed-current mode with a peak current that is significantly higher than the specified maximum continuous current. For a tapered amplifier rated at 500 mW of continuous power, we demonstrate 2.6 W of peak optical output power with 15 mW of injection light for 200 micros, 7 A current pulses. Different failure mechanisms for the tapered amplifier, including thermal and optical damage, are identified under these conditions.

Modeling CTLA4-linked autoimmunity with RNA interference in mice.

The CTLA4 gene is important for T lymphocyte-mediated immunoregulation and has been associated with several autoimmune diseases, in particular, type 1 diabetes. To model the impact of natural genetic variants of CTLA4, we constructed RNA interference (RNAi) "knockdown" mice through lentiviral transgenesis. Variegation of expression was observed in founders but proved surmountable because it reflected parental imprinting, with derepression by transmission from male lentigenics. Unlike the indiscriminate multiorgan autoimmune phenotype of the corresponding knockout mice, Ctla4 knockdown animals had a disease primarily focused on the pancreas, with rapid progression to diabetes. As with the human disease, the knockdown phenotype was tempered by genetic-modifier loci. RNAi should be more pertinent than gene ablation in modeling disease pathogenesis linked to a gene-dosage variation.

Suppression of spin projection noise in broadband atomic magnetometry.

We demonstrate that quantum nondemolition measurement, combined with a suitable parameter estimation procedure, can improve the sensitivity of a broadband atomic magnetometer by reducing uncertainty due to spin projection noise. Furthermore, we provide evidence that real-time quantum feedback control offers robustness to classical uncertainties, including shot-to-shot atom number fluctuations, that would otherwise prevent quantum-limited performance.

Real-time quantum feedback control of atomic spin-squeezing.

Real-time feedback performed during a quantum nondemolition measurement of atomic spin-angular momentum allowed us to influence the quantum statistics of the measurement outcome. We showed that it is possible to harness measurement backaction as a form of actuation in quantum control, and thus we describe a valuable tool for quantum information science. Our feedback-mediated procedure generates spin-squeezing, for which the reduction in quantum uncertainty and resulting atomic entanglement are not conditioned on the measurement outcome.

Quantum Kalman filtering and the Heisenberg limit in atomic magnetometry.

The shot-noise detection limit in current high-precision magnetometry [Nature (London) 422, 596 (2003)] is a manifestation of quantum fluctuations that scale as 1/sqrt[N] in an ensemble of N atoms. Here, we develop a procedure that combines continuous measurement and quantum Kalman filtering [Rep. Math. Phys. 43, 405 (1999)]] to surpass this conventional limit by exploiting conditional spin squeezing to achieve 1/N field sensitivity. Our analysis demonstrates the importance of optimal estimation for high bandwidth precision magnetometry at the Heisenberg limit and also identifies an approximate estimator based on linear regression.

Adaptive homodyne measurement of optical phase.

We present an experimental demonstration of the power of feedback in quantum metrology, confirming the predicted [H. M. Wiseman, Phys. Rev. Lett. 75, 4587 (1995)]] superior performance of an adaptive homodyne technique for single-shot measurement of optical phase. For measurements performed on weak coherent states with no prior knowledge of the signal phase, adaptive homodyne estimation approaches closer to the intrinsic quantum uncertainty than any previous technique. Our results underscore the importance of real-time feedback for reaching quantum limits in measurement and control.