Dual input neural networks for positional sound source localization

In many signal processing applications, metadata may be advantageously used in conjunction with a high dimensional signal to produce a desired output. In the case of classical Sound Source Localization (SSL) algorithms, information from a high dimensional, multichannel audio signals received by many distributed microphones is combined with information describing acoustic properties of the scene, such as the microphones' coordinates in space, to estimate the position of a sound source. We introduce Dual Input Neural Networks (DI-NNs) as a simple and effective way to model these two data types in a neural network. We train and evaluate our proposed DI-NN on scenarios of varying difficulty and realism and compare it against an alternative architecture, a classical Least-Squares (LS) method as well as a classical Convolutional Recurrent Neural Network (CRNN). Our results show that the DI-NN significantly outperforms the baselines, achieving a five times lower localization error than the LS method and two times lower than the CRNN in a test dataset of real recordings

Signal compaction using polynomial EVD for spherical array processing with applications

Multi-channel signals captured by spatially separated sensors often contain a high level of data redundancy. A compact signal representation enables more efficient storage and processing, which has been exploited for data compression, noise reduction, and speech and image coding. This paper focuses on the compact representation of speech signals acquired by spherical microphone arrays. A polynomial matrix eigenvalue decomposition (PEVD) can spatially decorrelate signals over a range of time lags and is known to achieve optimum multi-channel data compaction. However, the complexity of PEVD algorithms scales at best cubically with the number of channel signals, e.g., the number of microphones comprised in a spherical array used for processing. In contrast, the spherical harmonic transform (SHT) provides a compact spatial representation of the 3-dimensional sound field measured by spherical microphone arrays, referred to as eigenbeam signals, at a cost that rises only quadratically with the number of microphones. Yet, the SHT’s spatially orthogonal basis functions cannot completely decorrelate sound field components over a range of time lags. In this work, we propose to exploit the compact representation offered by the SHT to reduce the number of channels used for subsequent PEVD processing. In the proposed framework for signal representation, we show that the diagonality factor improves by up to 7 dB over the microphone signal representation with a significantly lower computation cost. Moreover, when applying this framework to speech enhancement and source separation, the proposed method improves metrics known as short-time objective intelligibility (STOI) and source-to-distortion ratio (SDR) by up to 0.2 and 20 dB, respectively

Polynomial eigenvalue decomposition for multichannel broadband signal processing

This article is devoted to the polynomial eigenvalue decomposition (PEVD) and its applications in broadband multichannel signal processing, motivated by the optimum solutions provided by the eigenvalue decomposition (EVD) for the narrow-band case [1], [2]. In general, the successful techniques from narrowband problems can also be applied to broadband ones, leading to improved solutions. Multichannel broadband signals arise at the core of many essential commercial applications such as telecommunications, speech processing, healthcare monitoring, astronomy and seismic surveillance, and military technologies like radar, sonar and communications [3]. The success of these applications often depends on the performance of signal processing tasks, including data compression [4], source localization [5], channel coding [6], signal enhancement [7], beamforming [8], and source separation [9]. In most cases and for narrowband signals, performing an EVD is the key to the signal processing algorithm. Therefore, this paper aims to introduce PEVD as a novel mathematical technique suitable for many broadband signal processing applications

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

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

Polynomial matrix eigenvalue decomposition-based source separation using informed spherical microphone arrays

Audio source separation is essential for many applications such as hearing aids, telecommunications, and robot audition. Subspace decomposition approaches using polynomial matrix eigenvalue decomposition (PEVD) algorithms applied to the microphone signals, or lower-dimension eigenbeams for spherical microphone arrays, are effective for speech enhancement. In this work, we extend the work from speech enhancement and propose a PEVD subspace algorithm that uses eigenbeams for source separation. The proposed PEVD-based source separation approach performs comparably with state-of-the-art algorithms, such as those based on independent component analysis (ICA) and multi-channel non-negative matrix factorization (MNMF). Informal listening examples also indicate that our method does not introduce any audible artifacts.<br/

Polynomial matrix eigenvalue decomposition of spherical harmonics for speech enhancement

Speech enhancement algorithms using polynomialmatrixeigenvalue decomposition (PEVD) have been shown to be effective for noisy and reverberant speech. However, these algorithms do not scale well in complexity with the number of channels used in the processing. For a spherical microphone array sampling an order-limited sound field, the spherical harmonics provide a compact representation of the microphone signals in the form of eigenbeams. We propose a PEVD algorithm that uses only the lower dimension eigenbeams for speech enhancement at a significantly lower computation cost. The proposed algorithm is shown to significantly reduce complexity while maintaining full performance. Informal listening examples have also indicated that the processing does not introduce any noticeable artefacts