Impact of a rapid access chest pain clinic in Singapore to improve evaluation of new-onset chest pain.

BACKGROUND: Chest pain (CP) accounts for 5% of emergency department (ED) visits, unplanned hospitalisations and costly admissions. Conversely, outpatient evaluation requires multiple hospital visits and longer time to complete testing. Rapid access chest pain clinics (RACPCS) are established in the UK for timely, cost-effective CP assessment. This study aims to evaluate the feasibility, safety, clinical and economic benefits of a nurse-led RACPC in a multiethnic Asian country. METHODS: Consecutive CP patients referred from a polyclinic to the local general hospital were recruited. Referring physicians were left to their discretion to refer patients to the ED, RACPC (launched in April 2019) or outpatients. Patient demographics, diagnostic journey, clinical outcomes, costs, HEART (History, ECG, Age, Risk Factors, Troponin) scores and 1-year overall mortality were recorded. RESULTS: 577 CP patients (median HEAR score of 2.0) were referred; 237 before the launch of RACPC. Post RACPC, fewer patients were referred to the ED (46.5% vs 73.9%, p < 0.01), decreased adjusted bed days for CP, more non-invasive tests (46.8 vs 39.2 per 100 referrals, p = 0.07) and fewer invasive coronary angiograms (5.6 vs 12.2 per 100 referrals, p < 0.01) were performed. Time from referral to diagnosis was shortened by 90%, while requiring 66% less visits (p < 0.01). System cost to evaluate CP was reduced by 20.7% and all RACPC patients were alive at 12 months. CONCLUSIONS: An Asian nurse-led RACPC expedited specialist evaluation of CP with less visits, reduced ED attendances and invasive testing whilst saving costs. Wider implementation across Asia would significantly improve CP evaluation.

Spectrally separable photon-pair generation in dispersion engineered thin-film lithium niobate.

Existing nonlinear-optic implementations of pure, unfiltered heralded single-photon sources do not offer the scalability required for densely integrated quantum networks. Additionally, lithium niobate has hitherto been unsuitable for such use due to its material dispersion. We engineer the dispersion and the quasi-phasematching conditions of a waveguide in the rapidly emerging thin-film lithium niobate platform to generate spectrally separable photon pairs in the telecommunications band. Such photon pairs can be used as spectrally pure heralded single-photon sources in quantum networks. We estimate a heralded-state spectral purity of >94% based on joint spectral intensity measurements. Further, a joint spectral phase-sensitive measurement of the unheralded time-integrated second-order correlation function yields a heralded-state purity of (86±5)%.

Experimental Demonstration of Conjugate-Franson Interferometry.

Franson interferometry is a well-known quantum measurement technique for probing photon-pair frequency correlations that is often used to certify time-energy entanglement. We demonstrate, for the first time, the complementary technique in the time basis called conjugate-Franson interferometry. It measures photon-pair arrival-time correlations, thus providing a valuable addition to the quantum toolbox. We obtain a conjugate-Franson interference visibility of 96±1% without background subtraction for entangled photon pairs generated by spontaneous parametric down-conversion. Our measured result surpasses the quantum-classical threshold by 25 standard deviations and validates the conjugate-Franson interferometer (CFI) as an alternative method for certifying time-energy entanglement. Moreover, the CFI visibility is a function of the biphoton's joint temporal intensity, and is therefore sensitive to that state's spectral phase variation: something that is not the case for Franson interferometry or Hong-Ou-Mandel interferometry. We highlight the CFI's utility by measuring its visibilities for two different biphoton states: one without and the other with spectral phase variation, observing a 21% reduction in the CFI visibility for the latter. The CFI is potentially useful for applications in areas of photonic entanglement, quantum communications, and quantum networking.

Identifying COVID-19 cases in outpatient settings.

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.

Resolving Photon Numbers Using a Superconducting Nanowire with Impedance-Matching Taper.

Time- and number-resolved photon detection is crucial for quantum information processing. Existing photon-number-resolving (PNR) detectors usually suffer from limited timing and dark-count performance or require complex fabrication and operation. Here, we demonstrate a PNR detector at telecommunication wavelengths based on a single superconducting nanowire with an integrated impedance-matching taper. The taper provides a kΩ load impedance to the nanowire, making the detector's output amplitude sensitive to the number of photon-induced hotspots. The prototyping device was able to resolve up to four absorbed photons with 16.1 ps timing jitter and <2 c.p.s. device dark count rate. Its exceptional distinction between single- and two-photon responses is ideal for high-fidelity coincidence counting and allowed us to directly observe bunching of photon pairs from a single output port of a Hong-Ou-Mandel interferometer. This detector architecture may provide a practical solution to applications that require high timing resolution and few-photon discrimination.

Indistinguishable single-mode photons from spectrally engineered biphotons.

We use pulsed spontaneous parametric down-conversion in KTiOPO 4, with a Gaussian phase-matching function and a transform-limited Gaussian pump, to achieve near-unity spectral purity in heralded single photons at telecommunication wavelength. Theory shows that these phase-matching and pump conditions are sufficient to ensure that a biphoton state with a circularly symmetric joint spectral intensity profile is transform limited and factorable. We verify the heralded-state spectral purity in a four-fold coincidence measurement by performing Hong-Ou-Mandel interference between two independently generated heralded photons. With a mild spectral filter we obtain an interference visibility of 98.4±1.1% which corresponds to a heralded-state purity of 99.2%. Our heralded photon source is potentially an essential resource for measurement-based quantum information processing and quantum network applications.

Large-alphabet encoding for higher-rate quantum key distribution.

The manipulation of high-dimensional degrees of freedom provides new opportunities for more efficient quantum information processing. It has recently been shown that high-dimensional encoded states can provide significant advantages over binary quantum states in applications of quantum computation and quantum communication. In particular, high-dimensional quantum key distribution enables higher secret-key generation rates under practical limitations of detectors or light sources, as well as greater error tolerance. Here, we demonstrate high-dimensional quantum key distribution capabilities both in the laboratory and over a deployed fiber, using photons encoded in a high-dimensional alphabet to increase the secure information yield per detected photon. By adjusting the alphabet size, it is possible to mitigate the effects of receiver bottlenecks and optimize the secret-key rates for different channel losses. This work presents a strategy for achieving higher secret-key rates in receiver-limited scenarios and marks an important step toward high-dimensional quantum communication in deployed fiber networks.

Comparing monovalent and combination hepatitis B vaccine outcomes in children delivered by mothers with chronic hepatitis B.

AIM: We compared the vaccine effectiveness of monovalent and combination hepatitis B vaccine regimens in infants born to chronic hepatitis B carrier mothers. METHODS: An observational cohort of neonates was recruited over 78 months from two public hospital maternity units in Singapore. We enrolled term infants, born to chronic hepatitis B surface antigen-positive mothers regardless of their hepatitis Be antigen status, who completed the hepatitis B virus (HBV) vaccination programme in Singapore. Infants born to mothers on antiviral therapy, or with concurrent hepatitis C or human immunodeficiency virus infection were excluded. All infants received hepatitis B immunoglobulin at birth. One group received three doses of monovalent hepatitis B vaccine (0, 1, 6 months) (regimen A). The other group received two doses of monovalent vaccine, followed by one dose combination vaccine DTaP-IPV-Hib-HBV (0, 1, 6 months) (regimen B). Vaccine effectiveness was determined by immunoprophylaxis failure leading to HBV vertical transmission. Immunogenicity was assessed by hepatitis B surface antibody (anti-HBs) levels at 9 months of age. RESULTS: Total of 177 term neonates received regimen A and 115 received regimen B. Immunoprophylaxis failure rate was low, 2.3 and 2.6% (P = 1.00) in regimen A and B, respectively. Mean anti-HBs titres were similar at 643 ± 374 and 561 ± 396 IU/L (P = 0.08) for regimen A and B, respectively. CONCLUSION: Hepatitis B vaccine regimens using monovalent or combination vaccine for the third dose showed similarly high vaccine effectiveness and low immunoprophylaxis failure rate in term infants born to chronic hepatitis B carrier mothers.

Revealing hidden scenes by photon-efficient occlusion-based opportunistic active imaging.

The ability to see around corners, i.e., recover details of a hidden scene from its reflections in the surrounding environment, is of considerable interest in a wide range of applications. However, the diffuse nature of light reflected from typical surfaces leads to mixing of spatial information in the collected light, precluding useful scene reconstruction. Here, we employ a computational imaging technique that opportunistically exploits the presence of occluding objects, which obstruct probe-light propagation in the hidden scene, to undo the mixing and greatly improve scene recovery. Importantly, our technique obviates the need for the ultrafast time-of-flight measurements employed by most previous approaches to hidden-scene imaging. Moreover, it does so in a photon-efficient manner (i.e., it only requires a small number of photon detections) based on an accurate forward model and a computational algorithm that, together, respect the physics of three-bounce light propagation and single-photon detection. Using our methodology, we demonstrate reconstruction of hidden-surface reflectivity patterns in a meter-scale environment from non-time-resolved measurements. Ultimately, our technique represents an instance of a rich and promising new imaging modality with important potential implications for imaging science.

Efficient generation and characterization of spectrally factorable biphotons.

Spectrally unentangled biphotons with high single-spatiotemporal-mode purity are highly desirable for many quantum information processing tasks. We generate biphotons with an inferred heralded-state spectral purity of 99%, the highest to date without any spectral filtering, by pulsed spontaneous parametric downconversion in a custom-fabricated periodically-poled KTiOPO4 crystal under extended Gaussian phase-matching conditions. To efficiently characterize the joint spectral intensity of the generated biphotons at high spectral resolution, we employ a commercially available dispersion compensation module (DCM) with a dispersion equivalent to 100 km of standard optical fiber and with an insertion loss of only 2.8 dB. Compared with the typical method of using two temperature-stabilized equal-length fibers that incurs an insertion loss of 20 dB per fiber, the DCM approach achieves high spectral resolution in a much shorter measurement time. Because the dispersion amount and center wavelengths of DCMs can be easily customized, spectral characterization in a wide range of quantum photonic applications should benefit significantly from this technique.

Unity-Efficiency Parametric Down-Conversion via Amplitude Amplification.

We propose an optical scheme, employing optical parametric down-converters interlaced with nonlinear sign gates (NSGs), that completely converts an n-photon Fock-state pump to n signal-idler photon pairs when the down-converters' crystal lengths are chosen appropriately. The proof of this assertion relies on amplitude amplification, analogous to that employed in Grover search, applied to the full quantum dynamics of single-mode parametric down-conversion. When we require that all Grover iterations use the same crystal, and account for potential experimental limitations on crystal-length precision, our optimized conversion efficiencies reach unity for 1≤n≤5, after which they decrease monotonically for n values up to 50, which is the upper limit of our numerical dynamics evaluations. Nevertheless, our conversion efficiencies remain higher than those for a conventional (no NSGs) down-converter.

Computational multi-depth single-photon imaging.

We present an imaging framework that is able to accurately reconstruct multiple depths at individual pixels from single-photon observations. Our active imaging method models the single-photon detection statistics from multiple reflectors within a pixel, and it also exploits the fact that a multi-depth profile at each pixel can be expressed as a sparse signal. We interpret the multi-depth reconstruction problem as a sparse deconvolution problem using single-photon observations, create a convex problem through discretization and relaxation, and use a modified iterative shrinkage-thresholding algorithm to efficiently solve for the optimal multi-depth solution. We experimentally demonstrate that the proposed framework is able to accurately reconstruct the depth features of an object that is behind a partially-reflecting scatterer and 4 m away from the imager with root mean-square error of 11 cm, using only 19 signal photon detections per pixel in the presence of moderate background light. In terms of root mean-square error, this is a factor of 4.2 improvement over the conventional method of Gaussian-mixture fitting for multi-depth recovery.

Entanglement-enhanced sensing in a lossy and noisy environment.

Nonclassical states are essential for optics-based quantum information processing, but their fragility limits their utility for practical scenarios in which loss and noise inevitably degrade, if not destroy, nonclassicality. Exploiting nonclassical states in quantum metrology yields sensitivity advantages over all classical schemes delivering the same energy per measurement interval to the sample being probed. These enhancements, almost without exception, are severely diminished by quantum decoherence. Here, we experimentally demonstrate an entanglement-enhanced sensing system that is resilient to quantum decoherence. We employ entanglement to realize a 20% signal-to-noise ratio improvement over the optimum classical scheme in an entanglement-breaking environment plagued by 14 dB of loss and a noise background 75 dB stronger than the returned probe light. Our result suggests that advantageous quantum-sensing technology could be developed for practical situations.

Unconditional security of time-energy entanglement quantum key distribution using dual-basis interferometry.

High-dimensional quantum key distribution (HDQKD) offers the possibility of high secure-key rate with high photon-information efficiency. We consider HDQKD based on the time-energy entanglement produced by spontaneous parametric down-conversion and show that it is secure against collective attacks. Its security rests upon visibility data-obtained from Franson and conjugate-Franson interferometers-that probe photon-pair frequency correlations and arrival-time correlations. From these measurements, an upper bound can be established on the eavesdropper's Holevo information by translating the Gaussian-state security analysis for continuous-variable quantum key distribution so that it applies to our protocol. We show that visibility data from just the Franson interferometer provides a weaker, but nonetheless useful, secure-key rate lower bound. To handle multiple-pair emissions, we incorporate the decoy-state approach into our protocol. Our results show that over a 200-km transmission distance in optical fiber, time-energy entanglement HDQKD could permit a 700-bit/sec secure-key rate and a photon information efficiency of 2 secure-key bits per photon coincidence in the key-generation phase using receivers with a 15% system efficiency.

Spectral engineering by Gaussian phase-matching for quantum photonics.

We demonstrate Gaussian-shaped phase matching of a periodically-poled potassium titanyl phosphate (PPKTP) crystal by imposing a custom duty-cycle pattern on its grating structure while keeping the grating period fixed. The PPKTP's phase-matching characteristics are verified through optical difference-frequency generation measurements, showing good agreement with expected values based on our design parameters. Our theoretical analysis predicts that under extended phase-matching conditions the custom-poled PPKTP crystal is capable of generating heralded single photons with a spectral purity of 97%, and can reach as high as 99.5% with gentle spectral filtering, something that is highly desirable for photonic quantum information processing applications.

Near-infrared Hong-Ou-Mandel interference on a silicon quantum photonic chip.

Near-infrared Hong-Ou-Mandel quantum interference is observed in silicon nanophotonic directional couplers with raw visibilities on-chip at 90.5%. Spectrally-bright 1557-nm two-photon states are generated in a periodically-poled KTiOPO4 waveguide chip, serving as the entangled photon source and pumped with a self-injection locked laser, for the photon statistical measurements. Efficient four-port coupling in the communications C-band and in the high-index-contrast silicon photonics platform is demonstrated, with matching theoretical predictions of the quantum interference visibility. Constituents for the residual quantum visibility imperfection are examined, supported with theoretical analysis of the sequentially-triggered multipair biphoton, towards scalable high-bitrate quantum information processing and communications. The on-chip HOM interference is useful towards scalable high-bitrate quantum information processing and communications.

Entanglement's benefit survives an entanglement-breaking channel.

Entanglement is essential to many quantum information applications, but it is easily destroyed by quantum decoherence arising from interaction with the environment. We report the first experimental demonstration of an entanglement-based protocol that is resilient to loss and noise which destroy entanglement. Specifically, despite channel noise 8.3 dB beyond the threshold for entanglement breaking, eavesdropping-immune communication is achieved between Alice and Bob when an entangled source is used, but no such immunity is obtainable when their source is classical. The results prove that entanglement can be utilized beneficially in lossy and noisy situations, i.e., in practical scenarios.

Efficient single-spatial-mode periodically-poled KTiOPO4 waveguide source for high-dimensional entanglement-based quantum key distribution.

We demonstrate generation of high-purity photon pairs at 1560 nm in a single spatial mode from a periodically-poled KTiOPO4 (PPKTP) waveguide. With nearly lossless spectral filtering, the PPKTP waveguide source shows approximately 80 % single-mode fiber coupling efficiency and is well suited for high-dimensional time-energy entanglement-based quantum key distribution. Using high-count-rate self-differencing InGaAs single-photon avalanche photodiodes configured with either square or sinusoidal gating, we achieve > 1 Mbit/s raw key generation with 3 bits-per-photon encoding, and, to the best of our knowledge, the highest reported Franson quantum-interference visibility of 98.2 % without subtraction of accidental coincidences.

Surface Plasmon Enhanced Upconversion Fluorescence in Short-Wave Infrared for In Vivo Imaging of Ovarian Cancer.

Short-wave infrared (SWIR; 850-1700 nm) upconversion fluorescence enables "autofluorescence-free" imaging with minimal tissue scattering, yet it is rarely explored due to the lack of strongly emissive SWIR upconversion fluorophores. In this work, we apply SWIR upconversion fluorescence for in vivo imaging with exceptional image contrast. Gold nanorods (AuNRs) are used to enhance the SWIR upconversion emission of small organic dyes, forming a AuNR-dye nanocomposite (NC). A maximal enhancement factor of ∼1320, contributed by both excitation and radiative decay rate enhancement, is achieved by varying the dye-to-AuNR ratio. In addition, the upconversion emission intensity of both free dyes and AuNR-dye NCs depends linearly on the excitation power, indicating that the upconversion emission mechanism remains unchanged upon enhancement, and it involves one-photon absorption. Moreover, the SWIR upconversion emission shows a significantly higher signal contrast than downconversion emission in the same emission window in a nonscattering medium. Finally, we apply the surface plasmon enhanced SWIR upconversion fluorescence for in vivo imaging of ovarian cancer, demonstrating high image contrast and low required dosage due to the suppressed autofluorescence.

Spectral control of nonclassical light pulses using an integrated thin-film lithium niobate modulator.

Manipulating the frequency and bandwidth of nonclassical light is essential for implementing frequency-encoded/multiplexed quantum computation, communication, and networking protocols, and for bridging spectral mismatch among various quantum systems. However, quantum spectral control requires a strong nonlinearity mediated by light, microwave, or acoustics, which is challenging to realize with high efficiency, low noise, and on an integrated chip. Here, we demonstrate both frequency shifting and bandwidth compression of heralded single-photon pulses using an integrated thin-film lithium niobate (TFLN) phase modulator. We achieve record-high electro-optic frequency shearing of telecom single photons over terahertz range (±641 GHz or ±5.2 nm), enabling high visibility quantum interference between frequency-nondegenerate photon pairs. We further operate the modulator as a time lens and demonstrate over eighteen-fold (6.55 nm to 0.35 nm) bandwidth compression of single photons. Our results showcase the viability and promise of on-chip quantum spectral control for scalable photonic quantum information processing.