Low order channel estimation for CDMA systems

New approaches and algorithms are developed for the identification and estimation of low order models that represent multipath channel effects in Code Division Multiple Access (CDMA) communication systems. Based on these parsimonious channel models, low complexity receivers such as RAKE receivers are considered to exploit these propagation effects and enhance the system performance. We consider the scenario where multipath is frequency selective slowly fading and where the channel components including delays and attenuation coefficients are assumed to be constant over one or few signalling intervals. We model the channel as a long FIR-like filter (or a tapped delay line filter) with the number of taps related to the ratio between the channel delay-spread and the chip duration. Due to the high data rate of new CDMA systems, the channel length in terms of the chip duration will be very large. With classical channel estimation techniques this will result in poor estimates of many of the channel parameters where most of them are zero leading to a reduction in the system performance. Unlike classical techniques which estimate directly the channel response given the number of taps or given an estimate of the channel length, the proposed techniques in this work will firstly identify the significant multipath parameters using model selection techniques, then estimate these identified parameters. Statistical tests are proposed to determine whether or not each individual parameter is significant. A low complexity RAKE receiver is then considered based on estimates of these identified parameters only. The level of significance with which we will make this assertion will be controlled based on statistical tests such as multiple hypothesis tests. Frequency and time domain based approaches and model selection techniques are proposed to achieve the above proposed objectives.The frequency domain approach for parsimonious channel estimation results in an efficient implementation of RAKE receivers in DS-CDMA systems. In this approach, we consider a training based strategy and estimate the channel delays and attenuation using the averaged periodogram and modified time delay estimation techniques. We then use model selection techniques such as the sphericity test and multiple hypotheses tests based on F-Statistics to identify the model order and select the significant channel paths. Simulations show that for a pre-defined level of significance, the proposed technique correctly identifies the significant channel parameters and the parsimonious RAKE receiver shows improved statistical as well as computational performance over classical methods. The time domain approach is based on the Bootstrap which is appropriate for the case when the distribution of the test statistics required by the multiple hypothesis tests is unknown. In this approach we also use short training data and model the channel response as an FIR filter with unknown length. Model parameters are then estimated using low complexity algorithms in the time domain. Based on these estimates, bootstrap based multiple hypotheses tests are applied to identify the non-zero coefficients of the FIR filter. Simulation results demonstrate the power of this technique for RAKE receivers in unknown noise environments. Finally we propose adaptive blind channel estimation algorithms for CDMA systems. Using only the spreading code of the user of interest and the received data sequence, four different adaptive blind estimation algorithms are proposed to estimate the impulse response of frequency selective and frequency non-selective fading channels. Also the idea is based on minimum variance receiver techniques. Tracking of a frequency selective varying fading channel is also considered.A blind based hierarchical MDL model selection method is also proposed to select non-zero parameters of the channel response. Simulation results show that the proposed algorithms perform better than previously proposed algorithms. They have lower complexity and have a faster convergence rate. The proposed algorithms can also be applied to the design of adaptive blind channel estimation based RAKE receivers

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