On a Hybrid Preamble/Soft-Output Demapper Approach for Time Synchronization for IEEE 802.15.6 Narrowband WBAN

In this paper, we present a maximum likelihood (ML) based time synchronization algorithm for Wireless Body Area Networks (WBAN). The proposed technique takes advantage of soft information retrieved from the soft demapper for the time delay estimation. This algorithm has a low complexity and is adapted to the frame structure specified by the IEEE 802.15.6 standard for the narrowband systems. Simulation results have shown good performance which approach the theoretical mean square error limit bound represented by the Cramer Rao Bound (CRB)

Performance Study of a Near Maximum Likelihood Code-Aided Timing Recovery Technique

International audienceIn this paper, we propose a new code-aided (CA) timing recovery algorithm for various linear constant modulus constellations based on the Maximum Likelihood (ML) estimator. The first contribution is the derivation of a soft estimator expression of the transmitted symbol instead of its true or hard estimated value which is fed into the timing error detector (TED) equation. The proposed expression includes the Log-Likelihood Ratios (LLRs) obtained from a turbo decoder. Our results show that the proposed CA approach achieves almost as good results as the data-aided (DA) approach over a large interval of SNR values while achieving a higher spectral efficiency. We also derive the corresponding CA Cramer Rao Bounds (CRB) for various modulation orders. Contrarily to former work, we develop here the CRB analytical expression for different M-PSK modulation orders and validate them through comparison to empirical CRB obtained by Monte Carlo iterations. The proposed CA estimator realizes an important gain over the non data-aided approach (NDA) and achieves a smaller gap when compared to its relative CA CRB, especially at moderate SNR values where modern systems are constrained to work

CRB derivation and new Code-Aided timing recovery technique for QAM modulated signals

International audience— * In this paper, we propose a maximum likelihood based Code-Aided (CA) timing recovery algorithm for square-QAM modulated signals. We also theoretically derive the analytical expression of the CA Cramer-Rao Bound for time delay estimation. Our simulations show that the proposed CA approach realizes a performance equivalent to the Data-Aided (DA) approach over a large interval of signal to noise ratio (SNR) values

A soft maximum likelihood technique for time delay recovery

International audienceTime delay synchronization is crucial for the reception quality in digital transmission systems. In this contribution, we consider a maximum likelihood approach and incorporate a soft-demapper to improve the synchronization performance. In particular, the proposed scheme allows to update the time delay at each symbol with an adaptive loop using the Log-Likelihood Ratio (LLR) of each bit provided by the demapper. Simulation results show that the proposed approach provides improvements compared to non data aided approach while avoiding data aided approach overhead

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research