Photon-efficient quantum key distribution using time–energy entanglement with high-dimensional encoding

Conventional quantum key distribution (QKD) typically uses binary encoding based on photon polarization or time-bin degrees of freedom and achieves a key capacity of at most one bit per photon. Under photon-starved conditions the rate of detection events is much lower than the photon generation rate, because of losses in long distance propagation and the relatively long recovery times of available single-photon detectors. Multi-bit encoding in the photon arrival times can be beneficial in such photon-starved situations. Recent security proofs indicate high-dimensional encoding in the photon arrival times is robust and can be implemented to yield high secure throughput. In this work we demonstrate entanglement-based QKD with high-dimensional encoding whose security against collective Gaussian attacks is provided by a high-visibility Franson interferometer. We achieve unprecedented key capacity and throughput for an entanglement-based QKD system because of four principal factors: Franson interferometry that does not degrade with loss; error correction coding that can tolerate high error rates; optimized time–energy entanglement generation; and highly efficient WSi superconducting nanowire single-photon detectors. The secure key capacity yields as much as 8.7 bits per coincidence. When optimized for throughput we observe a secure key rate of 2.7 Mbit s[superscript −1] after 20 km fiber transmission with a key capacity of 6.9 bits per photon coincidence. Our results demonstrate a viable approach to high-rate QKD using practical photonic entanglement and single-photon detection technologies.United States. Army Research Office (Defense Advanced Research Projects Agency. Information in a Photon (InPho) Program Grant W911NF-10-1-0416

Entanglement-based quantum communication secured by nonlocal dispersion cancellation

Quantum key distribution (QKD) enables participants to exchange secret information over long distances with unconditional security. However, the performance of today's QKD systems is subject to hardware limitations, such as those of available nonclassical-light sources and single-photon detectors. By encoding photons in high-dimensional states, the rate of generating secure information under these technical constraints can be maximized. Here, we demonstrate a complete time-energy entanglement-based QKD system with proven security against the broad class of arbitrary collective attacks. The security of the system is based on nonlocal dispersion cancellation between two time-energy entangled photons. This resource-efficient QKD system is implemented at telecommunications wavelength, is suitable for optical fiber and free-space links, and is compatible with wavelength-division multiplexing.United States. Army Research Office (Defense Advanced Research Projects Agency. Information in a Photon (InPho) Program (Grant W911NF-10-1-0416))National Science Foundation (U.S.). Integrative Graduate Education and Research Traineeship (Grant DGE-1069420

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Automatic Measurement of Quality Metrics for

Colonoscopy is the accepted screening method for detection of colorectal cancer or its precursor lesions, colorectal polyps. Indeed, colonoscopy has contributed to a decline in the number of colorectal cancer related deaths. However, not all cancers or large polyps are detected at the time of colonoscopy, and methods to investigate why this occurs are needed. We present a new computer-based method that allows automated measurement of a number of metrics that likely reflect the quality of the colonoscopic procedure. The method is based on analysis of a digitized video file created during colonoscopy, and produces information regarding insertion time, withdrawal time, images at the time of maximal intubation, the time and ratio of clear versus blurred or non-informative images, and a first estimate of effort performed by the endoscopist. As these metrics can be obtained automatically, our method allows future quality control in the day-to-day medical practice setting on a large scale. In addition, our method can be adapted to other healthcare procedures. Last but not least, our method may be useful to assess progress during colonoscopy training, or as part of endoscopic skills assessment evaluations