Ternary and quadriphase sequence diffusers

A room acoustic diffuser breaks up reflected wavefronts, and this can be achieved by presenting a spatially varying surface impedance. In hybrid surfaces, varying impedance is achieved by patches of absorption and reflection, giving reflection coefficients nominally of 0 and 1. These surfaces are hybrids, absorbing some of the incident sound while diffusing any reflected energy. A problem with planar hybrid surfaces is that specular energy is only removed by absorption. By exploiting interference, by reflecting waves out-of-phase with the specular energy, it is possible to diminish the specular energy further. This can be achieved by using a diffuser based on a ternary sequence that nominally has reflection coefficients of 0, -1, and +1. Ternary sequences are therefore a way of forming hybrid absorber-diffusers that achieve better scattering performance without additional absorption. This paper discusses methods for making ternary sequence diffusers, including giving sequence generation methods. It presents prediction results based on Fourier and boundary element method models to examine the performance. While ternary diffusers have better performance than unipolar binary diffusers at most frequencies, there are frequencies at which the performances are the same. This can be overcome by forming diffusers from four-level, quadriphase sequences

Lüke and power residue sequence diffusers

Conventional Schroeder diffusers have been successfully used for many years. However, their frequency range is limited by the flat plate effect that occurs when all the wells radiate in phase. This occurs at harmonics of p times the design frequency f(0), where p is the small prime that is used to generate the structure. A typical diffuser, using p=7 and f(0)=500 Hz, has an upper frequency limit of only 3.5 kHz. Achieving a first flat plate frequency above 20 kHz requires a prime equal to at least 41 and results in diffusers that are too big to be practical in most applications. This paper suggests an alternative approach using number theoretic sequences that, although short in length, are based on large integers. Two new sequences, Type-II Luke and power residue, have this desired characteristic. They are investigated using both simple models and the more exact boundary element method. The results show the flat plate effect is moved to much higher frequencies as expected. For Luke sequences at certain frequencies, redirection rather than dispersion is achieved. Modulation techniques can be used to mitigate these problems. Power residue sequences perform the best, providing good diffusion and a flat plate frequency outside the audible range

Diffusive benefits of cylinders in front of a Schroeder diffuser

A numerical investigation is performed into the diffusive effects of cylinders positioned in front of a Schroeder diffuser. A regular line of cylinders is shown to offer notable improvements to diffusion from a periodic Schroeder device, provided lateral cylinder spacing is incommensurable with the Schroeder period width. Further investigation considers angular dependence and low frequency results in greater detail, as well as the effects on narrowband and modulated Schroeder devices. An optimization procedure is subsequently performed to investigate the effects of an irregular cylinder arrangement, which provides further diffusive benefits. (C) 2010 Acoustical Society of America

Volumetric diffusers : pseudorandom cylinder arrays on a periodic lattice

Most conventional diffusers take the form of a surface based treatment, and as a result can only operate in hemispherical space. Placing a diffuser in the volume of a room might provide greater efficiency by allowing scattering into the whole space. A periodic cylinder array (or sonic crystal) produces periodicity lobes and uneven scattering. Introducing defects into an array, by removing or varying the size of some of the cylinders, can enhance their diffusing abilities. This paper applies number theoretic concepts to create cylinder arrays that have more even scattering. Predictions using a Boundary Element Method are compared to measurements to verify the model, and suitable metrics are adopted to evaluate performance. Arrangements with good aperiodic autocorrelation properties tend to produce the best results. At low frequency power is controlled by object size and at high frequency diffusion is dominated by lattice spacing and structural similarity. Consequently the operational bandwidth is rather small. By using sparse arrays and varying cylinder sizes, a wider bandwidth can be achieved

Bilateral femoral neck fractures due to transient osteoporosis of pregnancy: a case report

We describe a case of bilateral femoral neck fractures secondary to transient osteoporosis of pregnancy, which were diagnosed after delivery due to the desire to avoid ionising radiation. These fractures were presumed to be secondary to transient osteoporosis of pregnancy and were treated successfully with internal fixation despite delayed presentation. We discuss the role of MRI in the evaluation of hip pain in pregnancy

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A Comparison of the Performance of 'Pruned Tree' versus 'Stack" Algorithms for Look-Ahead Sigma delta Modulators

Look-ahead Sigma-Delta modulators look forward k samples before deciding to output a “one” or a “zero”. The Viterbi algorithm is then used to search the trellis of the exponential number of possibilities that such a procedure generates. This paper describes alternative tree based algorithms. Tree based algorithms are simpler to implement because they do not require backtracking to determine the correct output value. They can also be made more efficient using “Stack” algorithms. Both the tree algorithm and the more computationally efficient “Stack” algorithms are described. Implementations of both algorithms are described in some detail. In particular, the appropriate data structures for both the trial filters and score memories. Comparative results of their performance are also presented

The Effects of Specular Versus Diffuse Reflections on the Frequency Response at the Listener

It is shown how the frequency response of the sound from a monitoring loudspeaker in a control room is affected by the presence of specular or diffuse early reflections. The effect of specular and diffuse early reflections on the frequency response described by means of a simple theoretical model. Simulated results are presented and the results discussed