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The authors discuss a study by L. Cuba and colleagues which reported on a hybrid type III effectiveness-implementation trial to sustainably expand the reach of the AMBORA care program model. The AMBORA trial reported on the impact of an intensified oral antitumor theperapeutics pharmacological care program on improving patient safety outcomes. The importance of both implementation science and quality improvement to help drive improvement and change in cancer care delivery is emphasized.

Quantum random number generators (QRNGs) are able to generate numbers that are certifiably random, even to an agent who holds some side information. Such systems typically require that the elements being used are precisely calibrated and validly certified for a credible security analysis. However, this can be experimentally challenging and result in potential side-channels which could compromise the security of the QRNG. In this work, we propose, design and experimentally demonstrate a QRNG protocol that completely removes the calibration requirement for the measurement device. Moreover, our protocol is secure against quantum side information. We also take into account the finite-size effects and remove the independent and identically distributed requirement for the measurement side. More importantly, our QRNG scheme features a simple implementation which uses only standard optical components and are readily implementable on integrated-photonic platforms. To validate the feasibility and practicability of the protocol, we set up a fibre-optical experimental system with a home-made homodyne detector with an effective efficiency of 91.7% at 1550 nm. The system works at a rate of 2.5 MHz, and obtains a net randomness expansion rate of 4.98 kbits/s at 1010 rounds. Our results pave the way for an integrated QRNG with self-testing feature and provable security. Quantum random number generators should ideally rely on few assumptions, have high enough generation rates, and be cost-effective and easy to operate. Here, the authors show an untrusted-homodyne-based MDI scheme that does not rely on i.i.d. assumption and is secure against quantum side information. [ABSTRACT FROM AUTHOR]

347 Background: Dihydropyrimidine dehydrogenase gene (DPYD) testing is crucial in preventing toxicities from fluoropyrimidine chemotherapy. Despite benefits and established guidelines, its adoption within healthcare organizations remains inconsistent and suboptimal. We implemented a quality improvement project to improve DPYD testing prior to fluoropyrimidine chemotherapy at a community-based hospital. We aimed to increase DPYD testing for patients receiving fluoropyrimidine-based chemotherapy from 65% to 95% between July 2023 to July 2024. Balancing measures included DPYD testing turnaround time. Methods: For baseline diagnostics, manual chart review was performed on 126 patients to identify frequency of DPYD testing, and turnaround time (TAT) between May 1, 2023 to August 4, 2023. Patients were excluded if they received fluoropyrimidine-based chemotherapy prior to May 1, 2023. A multidisciplinary team including medical oncology residents and staff, pharmacists, nurses, and clinical informatics specialists worked jointly to identify and address barriers to implementation. Barriers identified included lack of established workflows and awareness of the importance of testing. Diagnostic tools utilized included Ishikawa diagrams and process mapping. The team used Plan-Do-Study-Act (PDSA) cycles to address barriers. A p-chart was used to analyze the results. Results: The baseline DPYD testing rate was 65%. Barriers identified via multidisciplinary sessions included lack of established workflow, awareness and importance of testing. PDSA cycles included education sessions to breast medical oncologists and medical oncology nurses, and development of a best-practice advisory in the electronic medical record. The percentage of eligible patients receiving DPYD testing increased from 65% to 95.8% in the total population. For breast cancer patients, the rate increased from 16.7% to 100%. For gastrointestinal cancer patients, the rate increased from 56.1% to 94.2%. Sustainability was demonstrated two months post-intervention with TAT stable between 7-8 days. Conclusions: Through PDSA cycles, we improved the frequency of DPYD testing for patients receiving fluoropyrimidine chemotherapy from 65% to 95.8%. Future work will assess changes in chemotherapy prescribing behavior in the setting of variant DPYD results, and outcomes of patients with variant DPYD testing. [ABSTRACT FROM AUTHOR]

The observed increase in osteoarthritis (OA) of the knee as a result of an aging population and the obesity epidemic has led to a concomitant increase in the rates of total knee replacement (TKR), placing an additional financial and social burden on the ability of health care systems to control medical costs. Our study shows how a home-based, noninvasive biomechanical intervention reduced the rate of progression to surgery for a cohort of 237 patients with knee OA deemed eligible for TKR based on pre-established clinical selection criteria. Over the 24-month study period, 204 patients (86%) avoided surgery, with only 33 patients (14%, 95% confidence interval 82%–91%) progressing to a TKR with an average length of time to TKR of 324 days (ranging from 31 to 671 days). The application of this intervention provides health plans and provider networks managing patient care under financial risk arrangements an opportunity to realize significant cost savings without compromising quality of care or clinical outcomes. [ABSTRACT FROM AUTHOR]

Device-independent quantum key distribution (DIQKD) enables the generation of secret keys over an untrusted channel using uncharacterized and potentially untrusted devices1–9. The proper and secure functioning of the devices can be certified by a statistical test using a Bell inequality10–12. This test originates from the foundations of quantum physics and also ensures robustness against implementation loopholes13, thereby leaving only the integrity of the users’ locations to be guaranteed by other means. The realization of DIQKD, however, is extremely challenging—mainly because it is difficult to establish high-quality entangled states between two remote locations with high detection efficiency. Here we present an experimental system that enables for DIQKD between two distant users. The experiment is based on the generation and analysis of event-ready entanglement between two independently trapped single rubidium atoms located in buildings 400 metre apart14. By achieving an entanglement fidelity of ℱ ≥ 0.892 (23) and implementing a DIQKD protocol with random key basis15, we observe a significant violation of a Bell inequality of S = 2.578(75)—above the classical limit of 2—and a quantum bit error rate of only 0.078(9). For the protocol, this results in a secret key rate of 0.07 bits per entanglement generation event in the asymptotic limit, and thus demonstrates the system’s capability to generate secret keys. Our results of secure key exchange with potentially untrusted devices pave the way to the ultimate form of quantum secure communications in future quantum networks.A system based on trapped rubidium atoms for generating quantum secure keys between distant users is presented, which could operate in a device-independent fashion. [ABSTRACT FROM AUTHOR]

One of the most pressing issues in quantum key distribution (QKD) is the problem of detector side-channel attacks. To overcome this problem, researchers proposed an elegant "time-reversal" QKD protocol called measurement-device-independent QKD (MDI-QKD), which is based on time-reversed entanglement swapping. However, MDI-QKD is more challenging to implement than standard point-to-point QKD. Recently, an intermediary QKD protocol called detector-device-independent QKD (DDI-QKD) has been proposed to overcome the drawbacks of MDI-QKD, with the hope that it would eventually lead to a more efficient detector side-channel-free QKD system. Here, we analyze the security of DDI-QKD and elucidate its security assumptions. We find that DDI-QKD is not equivalent to MDI-QKD, but its security can be demonstrated with reasonable assumptions. On the more practical side, we consider the feasibility of DDI-QKD and present a fast experimental demonstration (clocked at 625MHz), capable of secret key exchange up to more than 90 km. [ABSTRACT FROM AUTHOR]

Device-independent quantum key distribution (DIQKD) provides the strongest form of secure key exchange, using only the input–output statistics of the devices to achieve information-theoretic security. Although the basic security principles of DIQKD are now well understood, it remains a technical challenge to derive reliable and robust security bounds for advanced DIQKD protocols that go beyond the previous results based on violations of the CHSH inequality. In this work, we present a framework based on semidefinite programming that gives reliable lower bounds on the asymptotic secret key rate of any QKD protocol using untrusted devices. In particular, our method can in principle be utilized to find achievable secret key rates for any DIQKD protocol, based on the full input–output probability distribution or any choice of Bell inequality. Our method also extends to other DI cryptographic tasks. [ABSTRACT FROM AUTHOR]

Device-independent quantum key distribution (DIQKD) is the art of using untrusted devices to distribute secret keys in an insecure network. It thus represents the ultimate form of cryptography, offering not only information-theoretic security against channel attacks, but also against attacks exploiting implementation loopholes. In recent years, much progress has been made towards realising the first DIQKD experiments, but current proposals are just out of reach of today's loophole-free Bell experiments. Here, we significantly narrow the gap between the theory and practice of DIQKD with a simple variant of the original protocol based on the celebrated Clauser-Horne-Shimony-Holt (CHSH) Bell inequality. By using two randomly chosen key generating bases instead of one, we show that our protocol significantly improves over the original DIQKD protocol, enabling positive keys in the high noise regime for the first time. We also compute the finite-key security of the protocol for general attacks, showing that approximately 108–1010 measurement rounds are needed to achieve positive rates using state-of-the-art experimental parameters. Our proposed DIQKD protocol thus represents a highly promising path towards the first realisation of DIQKD in practice. Device-independent quantum key distribution aims at the ultimate quantum-based unconditional security, but current protocols' rates are quite far from anything practical. The authors' protocol narrows this gap by using two randomly chosen key generating bases instead of one. [ABSTRACT FROM AUTHOR]

Background: Trimodality therapy (TMT) with neoadjuvant chemoradiotherapy (nCRT) using concurrent carboplatin plus paclitaxel (CP) followed by surgery is the standard of care for locoregional esophageal or gastroesophageal junction (GEJ) cancers. Alternatively, nCRT with cisplatin plus fluorouracil (CF) can be used. Definitive chemoradiotherapy (dCRT) with CP or CF can be used if surgery is not planned. In the absence of comparative trials, we aimed to evaluate outcomes of CP and CF in the settings of TMT and dCRT. Methods: A single-site, retrospective cohort study was conducted at the Princess Margaret Cancer Centre to identify all patients who received CRT for locoregional esophageal or GEJ cancer. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method and multivariable Cox regression model. The inverse probability treatment weighting (IPTW) method was used for sensitivity analysis. Results: Between 2011 and 2015, 93 patients with esophageal (49%) and GEJ (51%) cancers underwent nCRT (n = 67; 72%) or dCRT (n = 26; 28%). Median age was 62.3 years and 74% were male. Median follow-up was 23.9 months. Comparing CP to CF in the setting of TMT, the OS and DFS rates were similar. In the setting of dCRT, CP was associated with significantly inferior 3-year OS (36 vs. 63%; p = 0.001; HR 3.1; 95% CI: 1.2–7.7) and DFS (0 vs. 41%; p = 0.004; HR 3.6; 95% CI: 1.4–8.9) on multivariable and IPTW sensitivity analyses. Conclusions: TMT with CF and CP produced comparable outcomes. However, for dCRT, CF may be a superior regimen. [ABSTRACT FROM AUTHOR]

It is well-known that no local model—in theory—can simulate the outcome statistics of a Bell-type experiment as long as the detection efficiency is higher than a threshold value. For the Clauser–Horne–Shimony–Holt (CHSH) Bell inequality this theoretical threshold value is η T = 2 (2 - 1) ≈ 0.8284 . On the other hand, Phys. Rev. Lett. 107, 170404 (2011) outlined an explicit practical model that can fake the CHSH inequality for a detection efficiency of up to 0.5. In this work, we close this gap. More specifically, we propose a method to emulate a Bell inequality at the threshold detection efficiency using existing optical detector control techniques. For a Clauser–Horne–Shimony–Holt inequality, it emulates the CHSH violation predicted by quantum mechanics up to η T . For the Garg–Mermin inequality—re-calibrated by incorporating non-detection events—our method emulates its exact local bound at any efficiency above the threshold. This confirms that attacks on secure quantum communication protocols based on Bell violation is a real threat if the detection efficiency loophole is not closed. [ABSTRACT FROM AUTHOR]

Background: The goal of surveillance testing is to enable curative salvage therapy through early disease detection, however supporting evidence in gastroesophageal adenocarcinoma is limited. We evaluated frequency of successful salvage therapy and outcomes in patients who underwent surveillance. Methods: A single‐site, retrospective cohort study was conducted to identify all patients who received curative resection for gastroesophageal adenocarcinoma. Surveillance testing were those investigations not triggered by abnormal symptoms, physical examination, or blood tests. Successful salvage therapy was any potentially curative therapy for disease recurrence which resulted in postrecurrence disease‐free survival ≥2 years. Time‐to‐event data were analyzed using the Kaplan‐Meier method and log rank tests. Results: Between 2011 and 2016, 210 consecutive patients were reviewed. Esophageal (14%), gastroesophageal junction (40%), and gastric adenocarcinomas (45%) were treated with surgery alone (29%) or multimodality therapy (71%). Adjuvant therapy was administered in 35%. At median follow‐up of 38.3 months, 5‐year overall survival (OS) rate was 56%. Among 97 recurrences, 53% were surveillance‐detected, and 46% were symptomatic. None was detected by surveillance endoscopy. Median time‐to‐recurrence (TTR) was 14.8 months. Recurrences included locoregional only (4%), distant (86%), and both (10%). Salvage therapy was attempted in 15 patients, 4 were successful. Compared to symptomatic recurrences, patients with surveillance‐detected recurrences had longer median OS (36.2 vs 23.7 months, P =.004) and postrecurrence survival (PRS, 16.5 vs 4.6 months, P <.001), but similar TTR (16.2 vs 13.3 months, P =.40) and duration of palliative chemotherapy (3.9 vs 3.3 months, P =.64). Conclusions: Among patients surveyed, 96% of recurrences were distant, and salvage therapy was successful in only 1.9% of patients. Longer OS in patients with surveillance‐detected compared to symptomatic recurrences was not associated with significant earlier disease detection, and may be contributed by differences in disease biology. Further prospective data are warranted to establish the benefit of surveillance testing in gastroesophageal adenocarcinoma. [ABSTRACT FROM AUTHOR]

A 'twin-field' repeater-less protocol has enabled an experimental demonstration of secure quantum key distribution over a 511-km long-haul optical fibre link. [ABSTRACT FROM AUTHOR]

Lung cancer remains the leading cause of cancer-related death and economic burden worldwide. Despite the heavy toll of lung cancer, multiple new advances have improved patient outcomes, largely through precision medicine and targeted therapy. The associated rising economic burden however may impact the uptake of novel therapeutic agents in lung cancer, thereby limiting patient access. This article identifies and reviews economic evaluations of targeted agents in lung cancer in the era of precision medicine. Articles evaluating biomarker-directed test-and-treat strategies are also reviewed to evaluate the cost impact of novel therapeutic agents at a population level. The Quality of Health Economic Studies instrument is applied to assess the quality of included studies. Forty-six studies are reviewed and encompass studies of epidermal growth factor receptor inhibitors and monoclonal antibodies, anaplastic lymphoma kinase inhibitors, vascular endothelial growth factor and vascular endothelial growth factor receptor inhibitors and immunotherapy (programmed death-1 inhibitors). Key factors influencing results of economic analyses include comparators chosen, perspective used, magnitude of clinical benefit, utility weighting of outcomes and drug acquisition costs. Biomarker-driven decision making should be integrated into cost evaluations given the important role of molecular testing for individualising treatment for non-small-cell lung cancer. We conclude that despite major clinical advances in lung cancer therapeutics, cost remains an important consideration in the adoption of novel therapies. [ABSTRACT FROM AUTHOR]

Proposed in 1984, quantum key distribution (QKD) allows two users to exchange provably secure keys via a potentially insecure quantum channel. Since then, QKD has attracted much attention and significant progress has been made both in theory and practice. On the application front, however, the operating distance of practical fibre-based QKD systems is limited to about 150 km (ref. 4), mainly due to the high background noise of practical single-photon detectors and inefficient finite-key security analysis. Here, we present, for the first time, a compact and autonomous QKD system that is capable of distributing provably secure cryptographic keys over 307 km of optical fibre. This is achieved by using semiconductor single-photon detectors with record low background noise and a novel finite-key security analysis, which is efficient even for short key lengths. This demonstrates the feasibility of practical long-distance QKD based on standard fibre-optic telecom components. [ABSTRACT FROM AUTHOR]

Recently, a quantum key distribution (QKD) scheme based on entanglement swapping, called measurement-device-independent QKD (mdiQKD), was proposed to bypass all measurement side-channel attacks. While mdiQKD is conceptually elegant and offers a supreme level of security, the experimental complexity is challenging for practical systems. For instance, it requires interference between two widely separated independent single-photon sources, and the secret key rates are dependent on detecting two photons--one from each source. Here, we demonstrate a proof-ofprinciple experiment of a QKD scheme that removes the need for a two-photon system and instead uses the idea of a two-qubit single-photon to significantly simplify the implementation and improve the efficiency of mdiQKD in several aspects. [ABSTRACT FROM AUTHOR]

This paper aims to identify the current challenges facing the sustainable development of island tourism and to develop a new conceptual approach to sustainable development based upon optimisation. The optimisation process for island tourism will be discussed through the development of a new life cycle model — the multifunctional interactive process cycle that is calibrated using a set of 15 island tourism status indicators. The paper also seeks to explain how a complex and dynamic tourism system can be developed that takes a destination towards an optimal sustainable state to satisfy both visitors and the local community. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Private information retrieval (PIR) is a database query protocol that provides user privacy in that the user can learn a particular entry of the database of his interest but his query would be hidden from the data centre. Symmetric private information retrieval (SPIR) takes PIR further by additionally offering database privacy, where the user cannot learn any additional entries of the database. Unconditionally secure SPIR solutions with multiple databases are known classically, but are unrealistic because they require long shared secret keys between the parties for secure communication and shared randomness in the protocol. Here, we propose using quantum key distribution (QKD) instead for a practical implementation, which can realise both the secure communication and shared randomness requirements. We prove that QKD maintains the security of the SPIR protocol and that it is also secure against any external eavesdropper. We also show how such a classical-quantum system could be implemented practically, using the example of a two-database SPIR protocol with keys generated by measurement device-independent QKD. Through key rate calculations, we show that such an implementation is feasible at the metropolitan level with current QKD technology. [ABSTRACT FROM AUTHOR]

Prepare-and-measure (P&M) quantum networks are the basic building blocks of quantum communication and cryptography. These networks crucially rely on non-orthogonal quantum encodings to distribute quantum correlations, thus enabling superior communication rates and information-theoretic security. Here, we present a computational toolbox that can efficiently characterise the set of input–output probability distributions for any discrete-variable P&M quantum network, assuming only the inner-product information of the quantum encodings. Our toolbox is thus highly versatile and can be used to analyse a wide range of quantum network protocols, including those that employ infinite-dimensional quantum code states. To demonstrate the feasibility and efficacy of our toolbox, we use it to solve open problems in multipartite quantum distributed computing and quantum cryptography. Taken together, these findings suggest that our method may have implications for quantum network information theory and the development of new quantum technologies. [ABSTRACT FROM AUTHOR]

We propose a method for implementing mutually unbiased generation and measurement of time-bin qudits using a cascade of electro-optic phase modulator–coded fiber Bragg grating pairs. Our approach requires only a single spatial mode and can switch rapidly between basis choices. We obtain explicit solutions for dimensions d = 2, 3, and 4 that realize all d + 1 possible mutually unbiased bases and analyze the performance of our approach in quantum key distribution. Given its practicality and compatibility with current technology, our approach provides a promising springboard for scalable processing of high-dimensional time-bin states. [ABSTRACT FROM AUTHOR]