Amiodarone-Induced Pulmonary Toxicity - A Frequently Missed Complication.

IntroductionAmiodarone is often used in the suppression of tachyarrhythmias. One of the more serious adverse effects includes amiodarone pulmonary toxicity (APT). Several pulmonary diseases can manifest including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary nodules or masses, and pleural effusion. Incidence of APT varies from 5-15% and is correlated to dosage, age of the patient, and preexisting lung disease.DescriptionA 56-year-old male with a past medical history of coronary artery disease and chronic obstructive pulmonary disease was admitted for a coronary artery bypass graft. Post-operatively, the patient was admitted to the ICU for ventilator management and continued to receive his home dose of amiodarone 400 mg orally twice daily, which he had been taking for the past 3 months. The patient was found to be hypoxemic with a PaO2 52 mmHg and bilateral infiltrates on chest x-ray. Patient also complained of new onset dyspnea. Physical exam found bilateral rhonchi with bibasilar crackles and subcutaneous emphysema along the left anterior chest wall. Daily chest x-rays showed worsening of bilateral interstitial infiltrates and pleural effusions. A chest high-resolution computed tomography on post-operative day 3 showed extensive and severe bilateral ground glass opacities. APT was suspected and amiodarone was discontinued. A course of oral prednisone without antibiotics was initiated, and after one week of treatment the chest film cleared, the PaO2 value normalized and dyspnea resolved.DiscussionAPT occurs via cytotoxic T cells and indirectly by immunological reaction. Typically the lungs manifest a diffuse interstitial pneumonitis with varying degrees of fibrosis. Infiltrates with a 'ground-glass' appearance appreciated on HRCT are more definitive than chest x-ray. Pulmonary nodules can be seen, frequently in the upper lobes. These are postulated to be accumulations of amiodarone in areas of previous inflammation. Those undergoing major cardiothoracic surgery are known to be predisposed to APT. Some elements require consideration: a baseline pulmonary function test (PFT) did not exist prior. APT would manifest a restrictive pattern of PFTs. In APT diffusing capacity (DLCO) is generally >20 percent from baseline. A DLCO was not done in this patient. Therefore, not every type of interstitial lung disease could be ruled out. Key features support a clinical diagnosis: (1) new dyspnea, (2) exclusion of lung infection, (3) exclusion of heart failure, (4) new radiographic features, (5) improvement with withdrawal of amiodarone. Our case illustrates consideration of APT in patients who have extensive use of amiodarone and new onset dyspnea

CIDPro: Custom Instructions for Dynamic Program Diversification

Timing side-channel attacks pose a major threat to embedded systems due to their ease of accessibility. We propose CIDPro, a framework that relies on dynamic program diversification to mitigate timing side-channel leakage. The proposed framework integrates the widely used LLVM compiler infrastructure and the increasingly popular RISC-V FPGA soft-processor. The compiler automatically generates custom instructions in the security critical segments of the program, and the instructions execute on the RISC-V custom co-processor to produce diversified timing characteristics on each execution instance. CIDPro has been implemented on the Zynq7000 XC7Z020 FPGA device to study the performance overhead and security tradeoffs. Experimental results show that our solution can achieve 80% and 86% timing side-channel capacity reduction for two benchmarks with an acceptable performance overhead compared to existing solutions. In addition, the proposed method incurs only a negligible hardware area overhead of 1% slices of the entire RISC-V system

Gradient Echo Quantum Memory for Light using Two-level Atoms

We propose a quantum memory for light that is analogous to the NMR gradient echo. Our proposal is ideally perfectly efficient and provides simplifications to current 3-level quantum memory schemes based on controlled inhomogeneous broadening. Our scheme does not require auxiliary light fields. Instead the input optical pulse interacts only with two-level atoms that have linearly increasing Stark shifts. By simply reversing the sign of the atomic Stark shifts, the pulse is retrieved in the forward direction. We present analytical, numerical and experimental results of this scheme. We report experimental efficiencies of up to 15% and suggest simple realizable improvements to significantly increase the efficiency.Comment: 4 pages, 4 figure

Nash Welfare and Facility Location

We consider the problem of locating a facility to serve a set of agents located along a line. The Nash welfare objective function, defined as the product of the agents' utilities, is known to provide a compromise between fairness and efficiency in resource allocation problems. We apply this welfare notion to the facility location problem, converting individual costs to utilities and analyzing the facility placement that maximizes the Nash welfare. We give a polynomial-time approximation algorithm to compute this facility location, and prove results suggesting that it achieves a good balance of fairness and efficiency. Finally, we take a mechanism design perspective and propose a strategy-proof mechanism with a bounded approximation ratio for Nash welfare

Precision spectral manipulation of optical pulses using a coherent photon echo memory

Photon echo schemes are excellent candidates for high efficiency coherent optical memory. They are capable of high-bandwidth multi-pulse storage, pulse resequencing and have been shown theoretically to be compatible with quantum information applications. One particular photon echo scheme is the gradient echo memory (GEM). In this system, an atomic frequency gradient is induced in the direction of light propagation leading to a Fourier decomposition of the optical spectrum along the length of the storage medium. This Fourier encoding allows precision spectral manipulation of the stored light. In this letter, we show frequency shifting, spectral compression, spectral splitting, and fine dispersion control of optical pulses using GEM

Isotope Paleoecology of the Miocene Planktic Foraminifera Globoquadrina Dehiscens as Inferred from International Ocean Discovery Program Site U1510, Southwest Pacific

Globoquadrina dehiscens is a species of planktic foraminifera which lived during the Miocene Epoch. While this species has an easily recognizable test, the paleoecology of G. dehiscens from prior studies indicate it has a variable position in the water column. One study placed G. dehiscens in the intermediate section of the water column, but this was based on limited sample size. Additionally, little work has been done on determining if and how G. dehiscences changes location in the water column throughout its life cycle. The purpose of this study is to establish the dwelling depth of Globoquadrina dehiscens and if that dwelling depth changed through its life cycle. This was accomplished through stable isotopic analyses (δ13C, δ18O) of fossil specimens in six different size fractions from samples that span the Miocene Climate Optimum at IODP Site U1510. By comparing the stable isotopic values of this species to those of known species who live in the mixed-layer and thermocline, it will be possible to determine where and how G. dehiscens lived and moved throughout the water column during its life cycle. Through this work it will be possible to determine if G. dehiscens can be reliably used to reconstruct Miocene ocean conditions. Understanding the location of an additional species that is common in the warm Miocene could help illustrate past ocean conditions that are used as analogues for future warming.https://orb.binghamton.edu/research_days_posters_2022/1005/thumbnail.jp