Spatial modulation: theory to practice

Spatial modulation (SM) is a transmission technique proposed for multiple–input multiple– output (MIMO) systems, where only one transmit antenna is active at a time, offering an increase in the spectral efficiency equal to the base–two logarithm of the number of transmit antennas. The activation of only one antenna at each time instance enhances the average bit error ratio (ABER) as inter–channel interference (ICI) is avoided, and reduces hardware complexity, algorithmic complexity and power consumption. Thus, SM is an ideal candidate for large scale MIMO (tens and hundreds of antennas). The analytical ABER performance of SM is studied and different frameworks are proposed in other works. However, these frameworks have various limitations. Therefore, a closed–form analytical bound for the ABER performance of SM over correlated and uncorrelated, Rayleigh, Rician and Nakagami–m channels is proposed in this work. Furthermore, in spite of the low–complexity implementation of SM, there is still potential for further reductions, by limiting the number of possible combinations by exploiting the sphere decoder (SD) principle. However, existing SD algorithms do not consider the basic and fundamental principle of SM, that at any given time, only one antenna is active. Therefore, two modified SD algorithms tailored to SM are proposed. It is shown that the proposed sphere decoder algorithms offer an optimal performance, with a significant reduction of the computational complexity. Finally, the logarithmic increase in spectral efficiency offered by SM and the requirement that the number of antennas must be a power of two would require a large number of antennas. To overcome this limitation, two new MIMO modulation systems generalised spatial modulation (GNSM) and variable generalised spatial modulation (VGSM) are proposed, where the same symbol is transmitted simultaneously from more than one transmit antenna at a time. Transmitting the same data symbol from more than one antenna reduces the number of transmit antennas needed and retains the key advantages of SM. In initial development simple channel models can be used, however, as the system develops it should be tested on more realistic channels, which include the interactions between the environment and antennas. Therefore, a full analysis of the ABER performance of SM over urban channel measurements is carried out. The results using the urban measured channels confirm the theoretical work done in the field of SM. Finally, for the first time, the performance of SM is tested in a practical testbed, whereby the SM principle is validated

Performance of Spatial Modulation using Measured Real-World Channels

In this paper, for the first time real-world channel measurements are used to analyse the performance of spatial modulation (SM), where a full analysis of the average bit error rate performance (ABER) of SM using measured urban correlated and uncorrelated Rayleigh fading channels is provided. The channel measurements are taken from an outdoor urban multiple input multiple output (MIMO) measurement campaign. Moreover, ABER performance results using simulated Rayleigh fading channels are provided and compared with a derived analytical bound for the ABER of SM, and the ABER results for SM using the measured urban channels. The ABER results using the measured urban channels validate the derived analytical bound and the ABER results using the simulated channels. Finally, the ABER of SM is compared with the performance of spatial multiplexing (SMX) using the measured urban channels for small and large scale MIMO. It is shown that SM offers nearly the same or a slightly better performance than SMX for small scale MIMO. However, SM offers large reduction in ABER for large scale MIMO.Comment: IEEE Vehicular Technology Conference Fall 2013 (VTC-Fall 2013), Accepte

2-User Multiple Access Spatial Modulation

International audienceSpatial modulation (SM) is a recently proposed approach to multiple-input-multiple-output (MIMO) systems which entirely avoids inter-channel interference (ICI) and requires no synchronisation between the transmit antennas, while achieving a spatial multiplexing gain. SM allows the system designer to freely trade off the number of transmit antennas with the signal constellation. Additionally, the number of transmit antennas is independent from the number of receive antennas which is an advantage over other multiplexing MIMO schemes. Most contributions thus far, however, have only addressed SM aspects for a point-to-point communication systems, i.e. the single-user scenario. In this work we seek to characterise the behaviour of SM in the interference limited scenario. The proposed maximumlikelihood (ML) detector can successfully decode incoming data from multiple sources in an interference limited scenario and does not suffer from the near-far problem

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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

Sphere Decoding for Spatial Modulation

International audienceIn this paper, Sphere Decoding (SD) algorithms for Spatial Modulation (SM) are developed to reduce the computational complexity of Maximum-Likelihood (ML-) optimum detectors, which foresee an exhaustive search of the whole search space and have a complexity that linearly increases with the product of number of transmit-antenna, receive-antenna, and size of the modulation scheme. Three SDs specifically designed for SM are proposed and analyzed in terms of Bit Error Probability (BEP) and computational complexity. By judiciously choosing some key parameters, e.g., the radius of the sphere centered around the received signal, it is shown that the proposed algorithms offer the same BEP as ML-optimum detection, with a significant reduction of the computational complexity. Also, it is shown that none of the proposed SDs is always superior to the others, but the best SD to use depends on the system setup, i.e., the number of transmit-antenna, receive-antenna, and the size of the modulation scheme. The computational complexity trade-off offered by the proposed solutions is studied via analysis and simulation, and numerical results are shown to validate our findings

Generalized Sphere Decoding for Spatial Modulation

International audienceIn this paper, Sphere Decoding (SD) algorithms for Spatial Modulation (SM) are developed to reduce the computational complexity of Maximum-Likelihood (ML) detectors. Two SDs specifically designed for SM are proposed and analysed in terms of Bit Error Ratio (BER) and computational complexity. Using Monte Carlo simulations and mathematical analysis, it is shown that by carefully choosing the initial radius the proposed sphere decoder algorithms offer the same BER as ML detection, with a significant reduction in the computational complexity. A tight closed form expression for the BER performance of SM-SD is derived in the paper, along with an algorithm for choosing the initial radius which provides near to optimum performance. Also, it is shown that none of the proposed SDs are always superior to the others, but the best SD to use depends on the target spectral efficiency. The computational complexity trade-off offered by the proposed solutions is studied via analysis and simulation, and is shown to validate our findings. Finally, the performance of SM-SDs are compared to Spatial Multiplexing (SMX) applying ML decoder and applying SD. It is shown that for the same spectral efficiency, SM-SD offers up to 84% reduction in complexity compared to SMX-SD, with up to 1 dB better BER performance than SMX-ML decoder