Ultrafast quantum key distribution using fully parallelized quantum channels.

The field of quantum information processing offers secure communication protected by the laws of quantum mechanics and is on the verge of finding wider application for the information transfer of sensitive data. To improve cost-efficiency, extensive research is being carried out on the various components required for high data throughput using quantum key distribution (QKD). Aiming for an application-oriented solution, we report the realization of a multichannel QKD system for plug-and-play high-bandwidth secure communication at telecom wavelengths. We designed a rack-sized multichannel superconducting nanowire single photon detector (SNSPD) system, as well as a highly parallelized time-correlated single photon counting (TCSPC) unit. Our system is linked to an FPGA-controlled QKD evaluation setup for continuous operation, allowing us to achieve high secret key rates using a coherent-one-way protocol.

Influence of wettability and surface design on the adhesion of terrestrial cyanobacteria to additive manufactured biocarriers.

Productive biofilms are gaining growing interest in research due to their potential of producing valuable compounds and bioactive substances such as antibiotics. This is supported by recent developments in biofilm photobioreactors that established the controlled phototrophic cultivation of algae and cyanobacteria. Cultivation of biofilms can be challenging due to the need of surfaces for biofilm adhesion. The total production of biomass, and thus production of e.g. bioactive substances, within the bioreactor volume highly depends on the available cultivation surface. To achieve an enlargement of surface area for biofilm photobioreactors, biocarriers can be implemented in the cultivation. Thereby, material properties and design of the biocarriers are important for initial biofilm formation and growth of cyanobacteria. In this study, special biocarriers were designed and additively manufactured to investigate different polymeric materials and surface designs regarding biofilm adhesion of the terrestrial cyanobacterium Nostoc flagelliforme (CCAP 1453/33). Properties of 3D-printed materials were characterized by determination of wettability, surface roughness, and density. To evaluate the influence of wettability on biofilm formation, material properties were specifically modified by gas-phase fluorination and biofilm formation was analyzed on biocarriers with basic and optimized geometry in shaking flask cultivation. We found that different polymeric materials revealed no significant differences in wettability and with identical surface design no significant effect on biomass adhesion was observed. However, materials treated with fluorination as well as optimized biocarrier design showed improved wettability and an increase in biomass adhesion per biocarrier surface.

The Public Health Response to a Large Poisoning Outbreak Involving an Illicit Substance: Synthetic Cannabinoids Contaminated With a Long-Acting Anticoagulant Rodenticide, Illinois, March-July, 2018.

During March-July 2018, the Illinois Department of Public Health responded to an acute outbreak of severe coagulopathy among patients with recent synthetic cannabinoid use. Toxicological testing indicated that cases were exposed to brodifacoum, a long-acting anticoagulant rodenticide. A total of 174 confirmed and probable cases, including 5 deaths, were linked to this outbreak. On the basis of the experience of responding to this complex outbreak, we recommend several steps for consideration to improve health department preparation for acute outbreaks involving illicit substances including strengthening communication between public health and law enforcement agencies, reviewing legal authority to investigate noninfectious acute disease outbreaks, continuing strong partnerships with state poison control centers, partnering with substance abuse and mental health agencies to provide services to patients, and determining health department ability to rapidly enter into public-private partnership agreements.

Impact of Vial Washing and Depyrogenation on Surface Properties and Delamination Risk of Glass Vials.

PURPOSE: The proper understanding of glass delamination is important to glass manufacturers, pharmaceutical companies, and health authorities to mitigate the occurrence of glass flakes from the vial when in contact with specific drug product solutions. The surface of glass vials is altered during glass cane- and vial forming processes and is exposed to different stress conditions during drug product processing before coming in contact with the drug product solution. In this study, the impact of vial washing and depyrogenation including an evaluation of various residual water volumes on surface properties of glass vials was investigated for a defined set of vials. METHODS: 3D laser scanning microscopy was established as a new method for topographic analysis of curved surfaces of glass vials operating in high-throughput mode. A subset of vials was subsequently exposed to delamination stress testing and both the stressed solution and inner vial surface were analyzed by a panel of conventional and advanced analytical techniques including 3D laser scanning microscopy. RESULTS: The data showed that vial washing and depyrogenation strongly influenced surface properties, in particular those of uncoated vials. Surface characteristics such as pits increased depending on the process conditions, which especially applies to Expansion 33 vials. Even low residual water volumes of 50 µL after vial washing were sufficient to change the surface properties of the glass and weaken the surface in those positions prone to glass delamination. An increase in pits was related to a greater risk for glass delamination. CONCLUSIONS: Vial processing conditions need to be assessed when aiming at minimizing the glass delamination risk during parenteral product storage.

Probing the phosphatidylinositol 3-kinase/mammalian target of rapamycin pathway in gliomas: A phase 2 study of everolimus for recurrent adult low-grade gliomas.

BACKGROUND: Activation of the phosphatidylinositol 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) pathway is common in patients with low-grade gliomas (LGGs), but agents that inhibit this pathway, including mTOR inhibitors, have not been studied in this population. METHODS: Fifty-eight patients with pathologic evidence of recurrence after they had initially been diagnosed with World Health Organization (WHO) grade II gliomas were enrolled into a prospective phase 2 clinical trial and received daily everolimus (RAD001) for 1 year or until progression. Tissue at the time of enrollment was analyzed for markers of PI3K/mTOR pathway activation. Thirty-eight patients underwent serial multiparametric magnetic resonance imaging, with the tumor volume and the perfusion metrics (the fractional blood volume [fBV] for capillary density and the transfer coefficient [Kps ] for vascular permeability) measured during treatment. The primary endpoint was progression-free survival at 6 months (PFS-6) in patients with WHO II disease at enrollment. RESULTS: For patients with WHO II gliomas at enrollment, the PFS-6 rate was 84%, and this met the primary endpoint (P < .001 for an improvement from the historical rate of 17%). Evidence of PI3K/mTOR activation by immunohistochemistry for phosphorylated ribosomal S6Ser240/244 (p-S6Ser240/244 ) was associated with worse progression-free survival (PFS; hazard ratio [HR], 3.03; P = .004) and overall survival (HR, 12.7; P = .01). Tumor perfusion decreased after 6 months (median decrease in fBV, 15%; P = .03; median decrease in Kps , 12%; P = .09), with greater decreases associated with improved PFS (HR for each 10% fBV decrease, 0.71; P = .01; HR for each 10% Kps decrease, 0.82; P = .04). CONCLUSIONS: Patients with recurrent LGGs demonstrated a high degree of disease stability during treatment with everolimus. PI3K/mTOR activation, as measured by immunohistochemistry for p-S6, was associated with a worse prognosis. Tumor vascular changes were observed that were consistent with the antiangiogenic effects of mTOR inhibitors. These results support further study of everolimus for LGGs. Cancer 2017;123:4631-4639. © 2017 American Cancer Society.

Intraoperative floppy iris syndrome and its association with various concurrent medications, bulbus length, patient age and gender.

PURPOSE: To evaluate the association between intraoperative floppy iris syndrome (IFIS) and concurrent medications containing selective alpha1A receptor antagonists as well as nonselective alpha1-adrenergic receptor antagonists, bulbus length, patient age and gender. METHODS: We performed a prospective data acquisition of IFIS occurrence and grading, and retrospective evaluation of concurrent medications, bulbus length, patient age and gender of all patients undergoing cataract surgery over a 6-month period. RESULTS: IFIS was observed in 119 of 947 cases (12.6 %). 31 of those 119 patients (26.1 %) had a concurrent medication with a drug that is associated with a higher risk of causing IFIS. Tamsulosin was the drug most commonly associated with IFIS (n = 11), followed by a combination of drugs (n = 7), doxazosin (n = 4), quetiapine (n = 4), finasterid (n = 2), prothipendyl (n = 2), and mianserin (n = 1). Bulbus length and age did not show any significant association with occurrence or grade of IFIS. Gender distribution among IFIS cases was 57.1 % males (n = 68) and 42.9 % (n = 51) females. CONCLUSIONS: The occurrence of IFIS has to be expected with a variety of concurrent medications. The number of IFIS cases and the percentage of females in this series are higher compared to previous reports. The observations might be due to a rising awareness of surgeons or to an increasing number of causative medications on the market.

More frequent requests for day-case cataract surgery : An impressive mind switch in the Austrian population within 7 years.

BACKGROUND: Cataract surgery is the most commonly performed elective surgical procedure worldwide. While the operation has been mainly conducted as day-case (outpatient) surgery throughout the world since the beginning of this millennium, this development has been much slower in Austria. The number of patients requesting day-case surgery has markedly increased in the last few years. METHODS: Prior to the introduction of a day clinic at our department in 2007, we evaluated the patients' acceptance of day-case surgery using a questionnaire. At the time, less than half of the patients wished to undergo day-case surgery. Another survey was performed 7 years later to determine if there were any changes. RESULTS: The desire for day-case surgery increased significantly from 38.8 to 87.1%. The mean age of the patients and their visual impairment had decreased. Home care improved, but not to the same extent. The number of patients who had to travel more than an hour to reach the hospital had significantly increased. CONCLUSIONS: Improvements in perioperative limitations and most of all patients becoming accustomed to the idea have led to an impressive mind switch, culminating in a clear desire for day-case cataract surgery.

Postextraction bleeding in a patient taking antithrombotics: report of a case.

Antithrombotic medications, including antiplatelets and anticoagulants, are used by millions of patients to prevent stroke or heart attack. When these patients present for dental surgery, a decision must be made whether to continue the antithrombotic medication and risk a bleeding problem or to interrupt the medication and risk an embolic complication such as a stroke or heart attack. In patients taking antithrombotic medications, a small risk of postoperative bleeding after dental extractions must be weighed against a small risk of stroke or heart attack when these medications are interrupted. This case report discusses an episode of minor postextraction bleeding in a patient taking combination anticoagulant and antiplatelet therapy. Antithrombotic therapy generally should not be interrupted for dental procedures, as the prognosis of potential postextraction bleeding that could result from antithrombotic continuation is almost always better than the prognosis of a potential stroke or heart attack that could follow antithrombotic interruption.

Optimizing Luminous Transmittance of a Three-Dimensional-Printed Fixed Bed Photobioreactor.

The development of innovative production processes and the optimization of photobioreactors play an important role in generating industrial competitive production technologies for phototrophic biofilms. With emerse photobioreactors a technology was introduced that allowed efficient surface attached cultivation of terrestrial cyanobacteria. However, the productivity of emerse photobioreactors depends on the available cultivation surface. By the implementation of biocarriers to the bioreactor volume, the cultivation surface can be increased which potentially improves productivity and thus the production of valuable compounds. To investigate the surface attached cultivation on biocarriers new photobioreactors need to be developed. Additive manufacturing (AM) offers new opportunities for the design of photobioreactors but producing the needed transparent parts can be challenging using AM techniques. In this study an emerse fixed bed photobioreactor was designed for the use of biocarriers and manufactured using different AM processes. To validate the suitability of the photobioreactor for phototrophic cultivation, the optical properties of three-dimensional (3D)-printed transparent parts and postprocessing techniques to improve luminous transmittance of the components were investigated. We found that stereolithography 3D printing can produce parts with a high luminous transmittance of over 85% and that optimal postprocessing by sanding and clear coating improved the clarity and transmittance to more than 90%. Using the design freedom of AM resulted in a bioreactor with reduced part count and improved handling. In summary, we found that modern 3D-printing technologies and materials are suitable for the manufacturing of functional photobioreactor prototypes.

A 9-state analysis of designer stimulant, "bath salt," hospital visits reported to poison control centers.

STUDY OBJECTIVE: A new generation of designer stimulants marketed as "bath salts" emerged in late 2010. The goal is to describe the epidemiologic emergence of designer stimulants in 9 states in the Midwest. METHODS: A retrospective review of the National Poison Data System was performed between November 1, 2010, and November 30, 2011. Inclusion criteria were health care-evaluated bath salts or other synthetic stimulants exposures. Cases were excluded if the exposure was unrelated to a designer stimulant. Demographic and clinical characteristics of cases were calculated and differences in outcome and exposure by generation were examined. RESULTS: One thousand six hundred thirty-three patients met the inclusion criteria. Age ranged from 1 day to 61 years (mean=29.2 years), with 67.9% male patients. The most common clinical features were agitation (62.2%), tachycardia (55.2%), and hallucinations (32.7%). In addition to 15.5% of patients having a major medical effect, 0.6% died. Reason for use was primarily intentional abuse (88.5%). However, 0.7% of patients reported withdrawal. Treatment involved primarily benzodiazepines (58.5%), with 8.7% of patients being intubated. Baby Boomers were more likely to have a major medical outcome (24.2%) and to report injection as the method of administration (8.6%-12.9%). CONCLUSION: Synthetic stimulants rapidly swept across the Midwest, resulting in more than 1,600 patients seeking medical care. Serious medical effects or death was observed in 16.1% of cases. Older generations were more likely to inject and to have a major medical outcome.

Direct comparison of 20-hour IV, 36-hour oral, and 72-hour oral acetylcysteine for treatment of acute acetaminophen poisoning.

There is no general consensus among clinicians on the superior route or duration of treatment with N-acetylcysteine (NAC) for acute acetaminophen (APAP) poisoning, and head-to-head studies comparing intravenous (IV) and oral NAC have not been done. Recent 20-hour IV NAC protocol failures in the United States prompted some to question its safety. Our objective was to determine if treatment with the 20-hour IV NAC protocol results in clinical outcomes different from the longer 36-hour oral or 72-hour oral NAC protocols in cases of acute APAP poisoning. We performed a retrospective analysis of all consecutive cases of acute APAP overdose where NAC treatment was initiated within 8 hours of ingestion between January 1, 2002, and December 31, 2007. Outcomes were survival, transplant, and death; secondary outcomes were based on King's College Criteria; interrater reliability was calculated with a kappa score. Out of 4642 cases of APAP overdose, 795 met study inclusion criteria: 213 were treated with 20-hour IV protocol, 213 with the 36-hour oral protocol, and 369 with the 72-hour oral protocol. The mean age in these groups was 25 years [95% confidence interval (CI): 22-26], 26 years (95%CI: 23-29), and 27 years (95%CI: 25-28), respectively. The mean 4-hour APAP concentration was 199 µg/mL (95%CI: 188-211), 174 µg/mL (95%CI: 164-184), and 205 µg/mL (95%CI: 195-216), respectively. No cases of transplant or death occurred, and secondary outcomes were rare. When administered within 8 hours of acute APAP poisoning, the 20-hour IV treatment protocol was as effective as the longer 36-hour oral and 72-hour oral treatment protocols. Further study is needed to determine outcome differences between IV and oral NAC when treatment is initiated >8 hours after overdose or in cases of coingestion with other drugs.

Critical appraisal: dental amalgam update­part I: clinical efficacy.

Dental amalgam use has been controversial ever since the Crawcour brothers of France introduced amalgam to the United States in 1833. It has been criticized for its alleged clinical shortcomings and biologic effects. As a result, we thought that it would be useful to provide an update on dental amalgam in two parts. Part I, presented here, focuses on the clinical aspects of dental amalgam, whereas Part II will focus on dental amalgam's biologic effects.

Critical appraisal: dental amalgam update--part II: biological effects.

Dental amalgam restorations have been controversial for over 150 years. In Part I of this Critical Appraisal, the clinical efficacy of dental amalgam was updated. Here in Part II, the biological effects of dental amalgam are addressed.

Cannabis Toxicity in Children and Adolescents.

The legalization of recreational and medical cannabis has increased the availability and potency of cannabis products in homes and communities. Although state laws regarding legalization and commercial sale often encompass adult use only, pediatric toxicity from unintentional exposures to cannabis edibles and adolescent harm from chronic use are increasing in states and countries that have relaxed laws on use. Unintentional edible ingestions are shown to increase in regions that legalize and commercialize cannabis products at the retail level. Long-term effects on teenagers regarding psychiatric changes as well as acute gastrointestinal effects from hyperemesis syndrome are well documented in the medical literature. This article provides clinical information on the presentation, evaluation, and management of adverse effects from pediatric and adolescent teen exposures to cannabis seen in acute care and emergent settings. [Pediatr Ann. 2023;52(5):e181-e186.].

Pediatric Edible Cannabis Exposures and Acute Toxicity: 2017-2021.

OBJECTIVES: This study evaluates trends in pediatric cannabis edible ingestions in children younger than age 6 years with regard to toxicity, medical outcome, and health care utilization for the years 2017-2021. METHODS: We performed retrospective analysis of the National Poison Data System data for pediatric exposures to edible cannabis products in children <6 years from 2017 to 2021. Data were analyzed quantitatively with a focus on incidence, common clinical effects, medical outcomes, health care utilization, and changes in acute toxicity between the pre-COVID years (2017-2019) to the COVID years (2020-2021). RESULTS: There were 7043 exposures reported during 2017-2021. In 2017, there were 207 reported cases, and in 2021 there were 3054 cases, an increase of 1375.0%. Most exposures (97.7%) occurred in a residential setting. Seventy percent of cases followed to a known outcome were reported to have central nervous system depression. Of all reported cases, 22.7% of patients were admitted to the hospital. There was a significant increase in both ICU and non-ICU admissions, whereas the number of patients treated and released decreased when comparing the pre-COVID years (2017-2019) to the COVID years (2020-2021) (P < .05). Major and moderate effects also significantly increased during the prepandemic years compared with the 2 years during the pandemic (P < .05). CONCLUSIONS: There has been a consistent increase in pediatric edible cannabis exposures over the past 5 years, with the potential for significant toxicity. It is important for providers to be aware of this in their practice and it presents an important opportunity for education and prevention.

Patient With Missed Right Ventricular Rupture From Blunt Trauma Remains Hemodynamically Stable for 3 Days.

Cardiac chamber rupture from blunt trauma is rare but can be fatal. Surprisingly, in some subsets of patients, it can be subtle and rather easily missed. Rapid recognition and management are essential. Percutaneous closure can be successful in iatrogenic chamber perforation (during pericardiocentesis) but possibly not in traumatic chamber rupture. (Level of Difficulty: Intermediate.).

Scaling waveguide-integrated superconducting nanowire single-photon detector solutions to large numbers of independent optical channels.

Superconducting nanowire single-photon detectors are an enabling technology for modern quantum information science and are gaining attractiveness for the most demanding photon counting tasks in other fields. Embedding such detectors in photonic integrated circuits enables additional counting capabilities through nanophotonic functionalization. Here, we show how a scalable number of waveguide-integrated superconducting nanowire single-photon detectors can be interfaced with independent fiber optic channels on the same chip. Our plug-and-play detector package is hosted inside a compact and portable closed-cycle cryostat providing cryogenic signal amplification for up to 64 channels. We demonstrate state-of-the-art multi-channel photon counting performance with average system detection efficiency of (40.5 ± 9.4)% and dark count rate of (123 ± 34) Hz for 32 individually addressable detectors at minimal noise-equivalent power of (5.1 ± 1.2) · 10-18 W/Hz. Our detectors achieve timing jitter as low as 26 ps, which increases to (114 ± 17) ps for high-speed multi-channel operation using dedicated time-correlated single photon counting electronics. Our multi-channel single photon receiver offers exciting measurement capabilities for future quantum communication, remote sensing, and imaging applications.