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Background RZV (GSK) contains the varicella-zoster virus antigen glycoprotein E (gE) and the adjuvant system AS01B that enhances gE-specific immune responses through stimulating innate immunity. AS01B may contribute to the development of transient local or systemic post-vaccination reactions. A hypothesis that the magnitude of those reactions is predictive of immunogenicity and efficacy (i.e., “no pain, no gain”) remains untested. To evaluate potential correlations between RZV’s reactogenicity and immunogenicity in adults aged ≥ 50 years, a post-hoc analysis was conducted using data from 2 large phase 3 studies (NCT01165177, NCT01165229). Methods Reactogenicity was calculated as a single score per symptom (maximum grade recorded over 7 days post-vaccination). A global score obtained by adding each maximum severity for all reported symptoms (multivariate reactogenicity models) and a score for each reactogenicity symptom (univariate reactogenicity models) were estimated. Results The analysis included 904 and 147 RZV recipients with completed post-vaccination symptom diary cards and with anti-gE antibody results or cell-mediated immunity (CMI) results, respectively. The global score of reactogenicity post-dose 2 was significantly associated with anti-gE antibody response (p< 0.001, estimate 0.112) although the absolute antibody increase associated with reactogenicity was minimal (1.29-fold increase), while the association with CMI response was not statistically significant (p=0.073, estimate 0.230). There was a weak, but statistically significant association between gE-specific immune responses and the maximum pain post-dose 2 score (p=0.001, estimate 0.041), irrespective of post-vaccination time. Nevertheless, there are observations of immune responses in participants for whom pain was not reported. Conclusion A weak but statistically significant correlation was found between injection site pain intensity and immune responses in adult RZV recipients aged ≥ 50 years. However, participants reporting no pain were also able to mount a strong immune response, therefore pain cannot be a surrogate marker to inform on the level of immune response or on likelihood of being protected against herpes zoster. Funding GlaxoSmithKline Biologicals SA Disclosures Andrea Callegaro, PhD, GSK group of companies (Employee, Shareholder) David O. Willer, PhD, GSK group of companies (Employee, Other Financial or Material Support, Receive GSK shares as part of employment renumeration) Wivine Burny, PhD, GSK group of companies (Employee) Caroline Hervé, PhD, GSK group of companies (Employee) Joon Hyung Kim, MD, GSK group of companies (Employee, Shareholder) myron J. levin, MD, GSK group of companies (Employee, Research Grant or Support) Toufik Zahaf, PhD, GSK group of companies (Employee, Shareholder) Anthony L. Cunningham, F.A.H.M.S., MD, M.B.B.S., B. Med. Sci. (Hons), F.R.A.C.P., F.R.C.P.A., F.A.S.M., GSK group of companies (Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau) Arnaud Didierlaurent, PhD, GSK group of companies (Other Financial or Material Support, previous employee until 03/2020)Sanofi (Speaker’s Bureau)

The pressure waves of a high-speed train in a tunnel exhibit complicated variations in their characteristics because the waves propagate and reflect with superposition. Studies have been consistently carried out on the pressure waves of a single train since changes in the area of pressure is a key element that influences ride comfort. Recently, the frequency of the operation of coupled trains has increased in order to improve the efficiency of running a train. The cross-sectional area of a train entering a tunnel has a rate of change that greatly influences the pressure characteristics; therefore, a coupled train can have different pressure characteristics when compared to a single train. However, adequate research works have not been done to assess these characteristics. To this end, the pressure characteristics of a train according to the operating conditions are investigated in this study. A high-speed train operating in practice and a tunnel located in a service section were chosen for this study, and the pressure characteristics of a single train were assessed via numerical analysis and an experiment. The numerical analysis was carried out with high reliability by comparing and verifying each result. After the pressure wave characteristics caused by running a coupled train had been assessed by the established numerical analysis, an obvious pressure variation was confirmed to occur at the connecting point. In addition, the maximum pressure applied to a tunnel and a passenger car increased. Thus, the aerodynamic effect of a coupled train should be considered as an important parameter in the early design state of a new high-speed train.

Purpose To evaluate the safety of HPV-16/18 AS04-adjuvanted vaccine when administered as per the PI in Korea. Methods A total of 3084 women aged 10–25 years were enrolled in this post-marketing surveillance from 2008 to 2014. Subjects were invited to receive three doses of the vaccine (0, 1 and 6 months), and participants who received at least one dose were included in the analysis. Adverse events (AEs), adverse drug reactions (ADRs) and serious AEs (SAEs) were recorded after each dose. All AEs, ADRs and SAEs were presented with exact 95% confidence intervals (CI) (NCT01101542). Results Injection-site pain was the most frequent AE and ADR reported by 322 subjects (10.4% [95%CI: 9.4–11.6]); the local pain was transient and lasted 4–7 days in most cases. Dysmenorrhoea and vaginitis were the most common unexpected AEs reported by 30 (1.0% [95%CI: 0.7–1.4]) and 16 subjects (0.7% [95%CI: 0.3–0.8]), respectively. Pain (toe pain, leg pain and body pain [one case each]; foot pain [two cases]) was the most common unexpected ADR reported by five subjects (0.2% [95%CI: 0.1–0.4]). Four subjects reported a single SAE (one case each of exostosis, gastroenteritis, abortion and tonsillitis); none were fatal. All SAEs were assessed as unlikely to be related to vaccination; gastroenteritis, exostosis and tonsillitis resolved during the study period. Conclusions This is the first post-marketing surveillance study in Korea that provides 6-year safety data for HPV-16/18 AS04-adjuvanted vaccine. The vaccine showed an acceptable safety profile and favourable benefit/risk ratio when given to women aged 10–25 years in Korea. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.

The counter-rotating type pump-turbine is an advanced concept unit optimized for the renewable energy fields such as small hydraulic power for energy generation and power stabilization systems for energy storage purposes. Given the unique operational mechanism of the counter-rotating type pump-turbine, it has extremely complex internal flow patterns. More methodical and rational design techniques are therefore required to ensure the improved energy efficiency of this unit. In this study, the existing design was adapted to improve the system efficiency of the counter-rotating type pump-turbine by applying a design method, combining design of experiment (DOE) with numerical analysis. The design variables and the test sets were selected to perform the DOE design using a 2k factorial design. The influence of each design variable on the system performance was analysed based on the results of the performance evaluation on the test sets, as the regression analysis for the 2k factorial design was performed. Furthermore, the respective model, whose efficiency was improved according to the operating mode, was produced. Finally, the performance of each generated model was evaluated using numerical analysis, and it was confirmed that its system efficiency has indeed improved.

Background Herpes zoster can negatively impact older adults’ health and quality of life. An adjuvanted recombinant zoster vaccine (RZV) has excellent vaccine efficacy (VE), including in older adults. Given that frailty is strongly associated with vulnerability to illness and adverse health outcomes, we studied how frailty impacts RZV VE, immunogenicity, reactogenicity, and safety. Methods In the ZOE-50 and ZOE-70 pivotal Phase 3 efficacy studies of RZV, 29,305 participants aged 50–96 received 2 doses of RZV vs. placebo in 1:1 randomization. In this secondary analysis (NCT03563183), a baseline frailty index (FI) was created retrospectively following previously validated methods using pre-existing comorbidities and patient reported outcomes. Participants were categorized as non-frail (FI≤ 0.08), pre-frail (FI=0.08–0.25) or frail (FI≥ 0.25) for stratified analyses. Results FI was calculated for 99.8% of participants included in this secondary analysis (n=26,976), and was balanced between RZV and placebo groups. 45.6% were pre-frail and 11.3% were frail. Mean age was 68.8 years; 58.1% were women. RZV VE against HZ was consistently above 90% for all frailty categories [non-frail: 95.8% (95%CI: 91.6–98.2), pre-frail: 90.4% (84.4–94.4), frail: 90.2% (75.4–97.0)]. The RZV group demonstrated robust antibody responses post-dose 2 across frailty categories. In the RZV group, the percentage of participants reporting solicited adverse events decreased with increasing frailty. Unsolicited medically attended visits and serious adverse events increased with frailty and were balanced between placebo and RZV groups. Conclusion The ZOE studies included older adults who were frail and pre-frail, and VE was high across frailty categories. Reactogenicity decreased with increasing frailty, and no safety concerns were identified in any frailty group. Disclosures Melissa K. Andrew, MD, PhD, MSc(Ph), GSK (Grant/Research Support, Research Grant or Support) Joon Hyung Kim, MD, GSK (Employee, Shareholder) Sean Matthews, MSc, GSK (Consultant) Christophe Dessart, MSc, GSK (Employee) myron J. levin, MD, Curevo (Advisor or Review Panel member)GlaxoSmithKline (Grant/Research Support, Advisor or Review Panel member)GlaxoSmithKline (Grant/Research Support, Advisor or Review Panel member)Merck Research Laboratories (Advisor or Review Panel member, GlaxoSmithKline)Merck Research Laboratories (Advisor or Review Panel member)Merck ResearchLaboratories (Advisor or Review Panel member) Lidia Oostvogels, MD, GSK (Shareholder) Megan Riley, PhD, GSK (Employee) Shelly McNeil, FRCPC, MD, GSK (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support, Other Financial or Material Support, honoraria for talks) Anne Schuind, MD, GSK (Employee, Other Financial or Material Support, own GSK stock options or restricted shares as part of renumeration) Desmond Curran, PhD, GSK (Employee, Shareholder)

Background Older and immunocompromised adults are at increased risk for herpes zoster (HZ) and often experience persistent, severe HZ-related pain, impacting their quality of life and activities of daily living. High vaccine efficacy (VE) of the adjuvanted recombinant zoster vaccine (RZV) in preventing HZ and reducing severe and clinically significant HZ-related pain has been shown in adults ≥ 50 years of age (YOA; ZOE-50 study; NCT01165177), ≥ 70 YOA (ZOE-70; NCT01165229) and ≥ 18 YOA undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Methods In patients with confirmed HZ from the above phase III, randomized, placebo-controlled studies, we analyzed VE of RZV in reducing the duration of clinically significant HZ-related pain and in reducing the use and duration of HZ-related pain medication. Pain was assessed by the Zoster Brief Pain Inventory (ZBPI). Use of all HZ-related medication was recorded. Results VE in reducing the duration of clinically significant HZ-related pain (ZBPI pain score ≥3) during HZ episodes was 38.5% (p-value: 0.0099) in RZV-vaccinated patients from the ZOE-HSCT study compared to placebo. A similar trend (not statistically significant) was observed in the ZOE-50 (VE: 26.9%; p-value: 0.4318) and ZOE-70 (VE: 28.4%; p-value: 0.1877) studies. VE in reducing the use (Table 1) and duration (Table 2) of HZ-related pain medication was 39.6% (p-value: 0.0083) and 49.3%(p-value: 0.0404), respectively, in the ZOE-70 study; corresponding positive VE estimates were also seen in the ZOE-50 and ZOE-HSCT studies. Non-opioids were used by 61.2%, 44.3% and 22.1% of patients in the ZOE-50, ZOE-70 and ZOE-HSCT studies, respectively; weak opioids by 18.6%, 13.0% and 10.8% of patients, and strong opioids by 8.0%, 2.0% and 5.3% of patients (Table 3). Table 1. Reduction in the use of HZ-related pain medication in patients with confirmed HZ Table 2. Reduction in the duration of HZ-related pain medication use in patients with confirmed HZ Table 3. HZ-related medication types in patients with confirmed HZ Conclusion In addition to a high VE in preventing HZ in these studies, we also observed an attenuation of HZ-related pain, and thus lower use and duration of pain medication in breakthrough cases after RZV vaccination, thereby potentially improving patient quality of life. Funding: GlaxoSmithKline Biologicals SA Acknowledgment: Kristel Vercauteren/Sander Hulsmans (Modis c/o GSK) provided medical writing/editorial support Disclosures Joon Hyung Kim, MD, GSK (Employee, Shareholder) Robert Johnson, MD, FRCA, GSK (Other Financial or Material Support, I accept no fees but have had expense reimbursement in the past.) Martina Kovac, MD, GSK (Other Financial or Material Support, I was an employee of GSK at the time of the study) Anthony L. Cunningham, MBBS, MD, FRACP, FRCPA, GSK (Consultant) Srikanth Emmadi, MSc, GSK (Employee) Keith Sullivan, MD, FASTCT, GSK (Consultant) Alemnew F. Dagnew, MD, GSK group of companies (Employee, Shareholder) Desmond Curran, PhD, GSK (Employee, Shareholder) Anne Schuind, MD, GSK (Employee, Other Financial or Material Support, own GSK stock options or restricted shares as part of renumeration)

An enhancement in the efficiency of an inverse Class F (Class $\text{F}^{-1})$ Doherty power amplifier (DPA) using a proposed triple-level supply modulator (SM) is presented. A three-level SM provides a lower supply voltage at a low input voltage, while providing the maximum level beyond the power back off. By adjusting the supply voltage in terms of the magnitude of the input signal, the efficiency of the main amplifier of the DPA over a wide input range is extended. For verification, a 2.4-GHz GaN Class $\text{F}^{-1}$ DPA was designed and fabricated. Using a 10 MHz 8.6 dB peak-to-average power ratio signal, at an average output power of 34.1 dBm, the fabricated Class $\text{F}^{-1}$ DPA achieves an efficiency level of 49%, which is 7.1% higher than that of a conventional amplifier. Under this condition, the measured adjacent channel leakage ratio (ACLR) is below −30 dBc.

Background Herpes zoster (HZ) risk appears to vary by sex and geographic ancestry/ethnicity. Methods In 2 randomized clinical trials, participants received 2 doses of adjuvanted recombinant zoster vaccine (RZV) or placebo intramuscularly, 2 months apart. In this post-hoc analysis, we investigate efficacy of RZV against HZ and postherpetic neuralgia (PHN) by sex, geographic region, and geographic ancestry/ethnicity in ≥50-year-olds (ZOE-50: NCT01165177) and ≥70-year-olds (pooled data from ZOE-50 and ZOE-70: NCT01165229). Results Vaccine efficacy against HZ or PHN was similar in women and men. Across geographic regions, efficacy against HZ ranged between 95.7 and 97.2% in ≥50-year-olds, and between 87.3% and 95.1% in ≥70-year-olds; efficacy against PHN ranged between 86.8 and 100% in ≥70-year-olds. Across ancestral/ethnic groups, efficacy ranged between 88.1 and 100% against HZ and between 65.9 and 100% against PHN in ≥70-year-olds. Conclusions While the ZOE-50/70 studies were not powered or pre-designed for these post-hoc analyses, RZV appears efficacious against HZ and PHN irrespective of sex, region, or geographic ancestry/ethnicity.

Background Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. Methods This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. Results The analysis included 672 Korean subjects (mean age, 44 years; range, 11–81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was ‘live infant, no apparent congenital anomaly’ in 195 subjects (92.42%) or ‘lost to follow-up’ in 16 subjects. Conclusion Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. Trial Registration ClinicalTrials.gov Identifier: NCT01929291, Graphical Abstract

Heat energy storage equipment has the advantages of highly efficient energy storage performance and constant temperature owing to its adoption of Phase change material (PCM); however, its shortcoming is that it takes longer to complete thermal energy storage due to its low thermal conductivity. New technologies are being developed to overcome such shortcomings, including technology that would improve the heat transfer. This study is aimed at analyzing the impact on the energy storage time of the PCM via the Design of experiments (DOE) method and with changes to the following variables: The number of installed fins; the employed material (thermal conductivity); and the temperature of the supplied warm water, all by relying on Computational fluid dynamics (CFD). The PCM system is in the shape of a long vertical cylinder, with circular fins. The number of installed circular fins was one or five, the material used in the pipe and circular fins was changed from iron to copper, and the temperature of the warm water was 309.15 or 313.15 K. The thermal conductivity of each material employed for the CFD was 80.2 or 401.0 W/m-K. The DOE analysis was also performed to check for any curvature effect by adding a center point. The PCM used in this study is n-Octadecane 99% (CH3(CH2)16CH3) with its melting temperature being roughly 300.85 K. To sum up the conclusions of this study, the change in the number of installed circular fins and the temperature of supplied warm water have a substantial influence on the melting of the PCM. The change in the thermal conductivity of the pipe and circular fins has only a meager influence on the melting of the PCM. To reduce the melting time of the PCM most effectively, it is recommended to install as many circular fins as possible and to raise the temperature of the supplied warm water. This may be related to the fact that the melting of the PCM is influenced more by convection inside the PCM system rather than conduction.

The overhead multiple outlets ventilation duct system of 18 m long is used to maintain the specified indoor thermal comfort environment for each railway passenger car. Therefore, the flow uniformity of the overhead ventilation duct system is very important for heating, ventilation, and air conditioning performance of a train. In this study, design optimization was conducted to increase the flow uniformity of the overhead ventilation duct system for a train by combining computational fluid dynamics and design of experiment methods. To perform the study, the flow uniformity of the base model was evaluated using numerical analysis whose reliability was verified. Design parameters of the overhead ventilation duct system were selected, and an effectiveness evaluation was performed for each design parameter by using 2 k factorial design. Based on the results of the effectiveness evaluation for the design parameters, optimum models having improved flow uniformity were designed using the response surface method. The performances of the optimum models were also evaluated by the same numerical analysis that was applied to the base model. The flow uniformity of the optimum models was improved by controlling the opening ratios of the perforated plates and guide vane shape. In addition, nonuniform flow components locally existing in the base model were suppressed.

Fans are representative turbo-machinery widely used for ventilation throughout the industrial world. Recently, as the importance of energy saving has been magnified with the fans, the demand for the fans with high efficiency and performance has been increasing. The representative method for enhancing the performance includes design optimization; in practice, fan performance can be improved by changing the shape parameters such as those of meridional plane, impeller, and diffuser. Before optimizing the efficient design, a process of screening to select important design parameters is essential. The present study aimed to analyze the effects of mixed-flow fans’ shape parameters on fan performance (static pressure and fan static efficiency) and derive optimum models based on the results. In this study, the shape parameters considered in the impeller domain are as follows: tip clearance, number of blades, beta angle of Leading edge (LE) in the blade, and beta angle of Trailing edge (TE) in the blade. The shape parameters considered in the diffuser domain are as follows: meridional length of the Guide vane (GV), number of GV, beta angle of LE in the GV and beta angle of TE in the GV. The effects of individual shape parameters were analyzed using the CFD (Computational fluid dynamic) and DOE (Design of experiments) methods. The reliability of CFD was verified through the comparison between preliminary fan model’s experiment results and CFD results, and screening processes were implemented through 24-1 fractional factorial design. From the analysis of DOE results, it could be seen that the tip clearance and the number of blades in the impeller domain greatly affected the fan performance, and the beta angle of TE at the GV in the diffuser domain greatly affected the fan performance. Finally, the optimum models with improved fan performance were created using linear regression equations derived from 24-1 fractional factorial design.

Small fans with powerful performance are being developed recently, reflecting the trends of the times in which electrical home appliances are becoming smaller and smaller. In order to develop high-performance, high-efficiency fans, an analysis of the effects of design parameters and an optimum design process are essential. This study was conducted to analyze the effects of design parameters of the diffuser in a small, high-speed centrifugal fan, and to derive an optimum model based on the results. Six design parameters (independent variables) were considered for this study: the number of Guide vanes (GVs), the meridional plane length of the GV(rear), the crosssectional area of the Leading edge (LE) in the GV(rear), the beta angle of the Trailing edge (TE) in the GV(rear), the maximum thickness of the airfoil in the GV(rear), and the maximum thickness position of the airfoil in the GV(rear). In addition, the dependent variables were fan performance (vacuum and fan efficiency), and the results were converted to dimensionless values. For screening design, the 26-1 fractional factorial design method was used. To check the existence of the curvature effect, the center point was added. For optimum design, the central composite design method of the Response surface methodology (RSM) was used for two design variables. P-value and T-value were used to determine whether each compounded factor was appropriate for the analysis object of the design of experiments. The results of the screening design were expressed by Pareto chart and main effects plot, and the results of the optimum design by surface plot, overlaid contour plot, and Response optimization. The reliability of the Computational fluid dynamics (CFD) was verified through a comparison between the experiment results and CFD results of the optimum model. As a result of the screening design, the design parameter that had the greatest influence on fan performance was the beta angle of the TE in the GV(rear), followed by the number of the GV(rear) and the maximum thickness of airfoil in the GV(rear). It was judged that the vacuum increase was determined by the beta angle of the TE in the GV(rear), and that the main cause of the vacuum decrease was the increase of pressure loss due to the decreasing cross-sectional area between the GVs and the generation of a vortex at the hub of TE in the GV(rear).

A HVAC(Heating Ventilation and Air Conditioning) is adapted to increase the comfort of the cabin environment for train. The train HVAC duct system has very long duct and many outlets due to the shape of a train set. the duct cross section shape is limited by a roof structure and equipments. Therefore, the pressure distribution and flow uniformity is an important performance indicator for the duct system. In this study, the existing blow down type HVAC duct system for a train was supplemented to improve the flow uniformity by applying a design method combining design of experiment (DOE) with numerical analysis. The design variables and the test sets were selected and the performance for each test set was evaluated using CFD(Computational Fluid Dynamics). The influence of each design variable on the system performance was analysed based on the results of the performance evaluation on the test sets. Furthermore, the optimized model, whose the flow uniformity was improved was produced using the direct optimization(gradient-based method). Finally, the performance of the optimized model was evaluated using numerical analysis, and it was confirmed that its flow uniformity has indeed improved.

Influenza is a communicable disease with most of the mortality burden falling on high-risk populations and those with pre-existing comorbidities and chronic diseases. In South Korea, adults aged 50–64 years are recommended for influenza vaccination, but no government financial support is offered to encourage vaccination uptake, which has led to suboptimal vaccination rates and significant public health concerns. The purpose of this study was to identify the factors affecting influenza vaccine uptake in adults aged 50–64 years and to compare high-risk and non-high-risk groups. We conducted randomized telephone questionnaires in South Korea on influenza vaccination-related behavioural factors in adults aged 50–64 years based on their vaccination history during the 2015–2016 flu season. The vaccination rate was 29.9% in non-high-risk adults aged 50–64 years and 41.3% in high-risk adults aged 50–64 years, which is considerably lower than the 81.7% rate in adults aged ≥65 years. Individuals who reported awareness of the potential severity of influenza, the importance and safety of vaccination, and who had experienced influenza after immunization or received a healthcare recommendation reported higher influenza vaccination rates. Therefore, highlighting awareness of influenza disease and vaccination through public campaigns and by information from healthcare professionals could represent opportunities to improve vaccination uptake in this population.

The purpose of the present study was to investigate whether quantitative radiomic profiles extracted from multiparametric magnetic resonance (MR) profiles can predict the clinical outcomes for patients with newly diagnosed glioblastoma (GBM) before therapy.MR images from 93 treatment-naive patients with newly diagnosed GBM were analyzed. Through tumor segmentation, we selected 36 radiomic features. Using the unsupervised clustering method, we classified our patients into 2 groups and investigated their overall survival (OS) using Kaplan-Meier analyses.Among the 36 radiomic features, the apparent diffusion coefficient (ADC) histogram parameters demonstrated a significant association with OS (P0.05). To validate this finding, unsupervised clustering analysis revealed 3 clusters with similar radiomic expression patterns. Clusters 1 and 2 showed a significant correlation with the radiomic features representing the tumor volume, and cluster 2 also showed a significant correlation with relative cerebral blood volume values. In contrast, cluster 3 showed an inverse relationship with cluster 2, mainly representing the radiomic features indicating the ADC and mean transit time. Although no statistically significant difference was found in OS between cluster 1 plus 2 and cluster 3, cluster 3 showed a trend toward longer OS compared with cluster 1 plus 2 (P = 0.067). After stratification by methylation status and radiomic feature clustering, patients with methylated OADC histogram parameters are feasible prognostic biomarkers to predict the survival of patients with treatment-naive GBM. Quantitative MR profiles can predict the clinical outcomes of patients with GBM before therapy.

This paper presents a 120 GHz low-power wideband I/Q transmitter in a 40 nm CMOS technology for wireless chip to chip communication. The proposed transmitter consists of an up-conversion mixer, a Quadrature Injection-Locked Oscillator (QILO), gain amplifiers, and a power amplifier. The cross-coupled-capacitor topology was used to improve the conversion gain of the up-conversion mixer. By adopting a Iinearizer, the power amplifier achieved an output P1dB of 11 dBm. The transmitter exhibited a conversion gain of 13.5 dB, a 3 dB bandwidth of 14 GHz, and an output P1 dB of 4.5 dBm. The maximum gain mismatch between the I and Q channels in the signal bandwidth are within 2 dB. The transmitter consumed only 271 mW and its chip size is 1.51 mm2.

This paper presents a 120GHz low-power I/Q direct conversion receiver for chip to chip communication in a 65 nm complementary meteal-oxide-semiconductor (CMOS) process. The proposed receiver integrates a 120 GHz low noise amplifier (LNA) with an active balun, a down-conversion mixer with a baseband amplifier, and a quadrature injection locked oscillator (QILO), all integrated on a single chip. The receiver exhibits a gain of 27.5 dB, a 3 dB bandwidth of 14 GHz, and an output P1 dB of −4.5 dBm. The gain mismatch and phase mismatch between the I channel and Q channel in the signal bandwidth are within 2.1 dB and 3.7 degrees, respectively. The simulated noise figure of the receiver is 17.7 dB at 120 GHz. The receiver consumes only 174 mW and has a chip size of 3.06 mm2.

Background In the pivotal clinical trials, ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229), the adjuvanted recombinant zoster vaccine (RZV) showed high efficacy against herpes zoster and postherpetic neuralgia. The incidence of reported solicited events was higher in RZV compared with placebo recipients. Methods In these phase III, observer-blind, placebo-controlled trials conducted in 18 countries, adults ≥50 years of age (YOA, ZOE-50) and ≥70 YOA (ZOE-70), randomized 1:1, received 2 doses of RZV or placebo 2 months apart. Injection-site and general events were solicited for 7 days after each dose via diary cards in a participant subset. For this post-hoc analysis, ZOE-50 and ZOE-70 data from participants having completed the diary cards for both RZV doses were pooled. The intensity of each solicited event after dose 2 was stratified by the intensity of the same event after dose 1. Results Solicited injection-site and general events were recorded for both RZV doses by 4,676 and 4,668 vaccinees, respectively (Figure 1). Of 1,235 vaccinees with no injection-site event at dose 1, 881 (71.3%) reported no injection-site event and 20 (1.6%) reported a grade 3 event after dose 2. A total of 433 (9.3%) vaccinees reported a grade 3 injection-site event, either after dose 1 or dose 2. Of 244 vaccinees with grade 3 injection-site events at dose 1, 79 (32.4%) also reported a grade 3 event after dose 2. Of 2,312 vaccinees with no general event at dose 1, 1,617 (69.9%) reported no general event and 67 (2.9%) reported a grade 3 event after dose 2. A total of 499 (10.7%) vaccinees reported a grade 3 general event, either after dose 1 or dose 2. Of 222 vaccinees with grade 3 general events at dose 1, 81 (36.5%) also reported a grade 3 general event after dose 2. In general, vaccinees who did not experience a certain event after dose 1, did not experience this event after dose 2 either. Most vaccinees reporting a specific event at high intensity after dose 1, reported the same event at a lower intensity (or not at all) after dose 2 (Figures 2 and 3). Conclusion While not powered to predict event intensity of the second RZV dose, our data provides an overview of event intensity after RZV dose 2 according to the intensity of the same event experienced after dose 1. Funding: GlaxoSmithKline Biologicals SA. Disclosures All authors: No reported disclosures.

The venturi meter has an advantage in its use, because it can measure flow without being much affected by the type of the measured fluid or flow conditions. Hence, it has excellent versatility and is being widely applied in many industries. The flow of a liquid containing air is a representative example of a multiphase flow and exhibits complex flow characteristics. In particular, the greater the gas volume fraction (GVF), the more inhomogeneous the flow becomes. As a result, using a venturi meter to measure the rate of a flow that has a high GVF generates an error. In this study, the cause of the error occurred in measuring the flow rate for the multiphase flow when using the venturi meter for analysis by CFD. To ensure the reliability of this study, the accuracy of the multiphase flow models for numerical analysis was verified through comparison between the calculated results of numerical analysis and the experimental data. As a result, the Grace model, which is a multiphase flow model established by an experiment with water and air, was confirmed to have the highest reliability. Finally, the characteristics of the internal flow field about the multiphase flow analysis result generated by applying the Grace model were analyzed to find the cause of the uncertainty occurring when measuring the flow rate of the multiphase flow using the venturi meter. A phase separation phenomenon occurred due to a density difference of water and air inside the venturi, and flow inhomogeneity happened according to the flow velocity difference of each phase. It was confirmed that this flow inhomogeneity increased as the GVF increased due to the uncertainty of the flow measurement.

A centrifugal pump is the most common type of pump used in industrial areas. To design a higher-performance pump, design optimization using mechanical concepts is required. In this study, optimization of an impeller and a volute was carried out to improve the performance of a centrifugal pump. The base impeller was designed using fluid machinery design theory and internal design databases, and its performance was evaluated through numerical analysis. Design optimization was then performed to improve the performance of the base impeller. The design variables and variable ranges for the impeller were defined. Based on these design variables and ranges, experiment sets were produced, and their performance was evaluated through numerical analysis. An optimized impeller was then produced that satisfied the design specifications according to a response surface method (RSM) analysis. Finally, the performance of the optimized impeller was verified through numerical analysis. Stepanoff theory was also applied in the design of the volute, and an appropriate design was suggested by modifying the cross-section distribution of the volute and performance evaluation, with numerical analysis.

Tumors are capable of coopting hematopoietic cells to create a suitable microenvironment to support malignant growth. Here, we have demonstrated that upregulation of kinase insert domain receptor (KDR), also known as VEGFR2, in a myeloid cell sublineage is necessary for malignant progression of gliomas in transgenic murine models and is associated with high-grade tumors in patients. KDR expression increased in myeloid cells as myeloid-derived suppressor cells (MDSCs) accumulated, which was associated with the transformation and progression of low-grade fibrillary astrocytoma to high-grade anaplastic gliomas. KDR deficiency in murine BM-derived cells (BMDCs) suppressed the differentiation of myeloid lineages and reduced granulocytic/monocytic populations. The depletion of myeloid-derived KDR compromised its proangiogenic function, which inhibited the angiogenic switch necessary for malignant progression of low-grade to high-grade tumors. We also identified inhibitor of DNA binding protein 2 (ID2) as a key upstream regulator of KDR activation during myeloid differentiation. Deficiency of ID2 in BMDCs led to downregulation of KDR, suppression of proangiogenic myeloid cells, and prevention of low-grade to high-grade transition. Tumor-secreted TGF-β and granulocyte-macrophage CSF (GM-CSF) enhanced the KDR/ID2 signaling axis in BMDCs. Our results suggest that modulation of KDR/ID2 signaling may restrict tumor-associated myeloid cells and could potentially be a therapeutic strategy for preventing transformation of premalignant gliomas. This study was supported by the Department of Defense Con- gressionally Directed Medical Research Programs (DOD CDMRP, CA120318 to Y. Huang), Elizabeth’s Hope (J. Greenfield), the Starr Foundation, the Paduano Foundation, the Champalimaud Foun- dation, the Malcolm Hewitt Wiener Foundation, the POETIC Foundation, the Sohn Foundation, the Hartwell Foundation, and the Children’s Cancer and Blood Foundation (all to D. Lyden). Address correspondence to: David Lyden, Department of Pediatrics, Weill Medical Medicine, 413 E. 69th Street, Box 284, New York, New York 10021, USA. Phone: 646.962.6238; E-mail: dcl2001@med.cornell.edu. Or to: Jeffrey P. Greenfield, Department of Neurological Surgery, Weill Cornell Medicine, 525 E 68th Street, Box 99, New York, New York 10065, USA. Phone: 212.746.2363; E-mail: jpgreenf@med.cornell.edu. HP’s present address is: Microenvironment and Metastasis Group, Department of Molecular Oncology, Spanish National Cancer Research Center (CNIO), Madrid, Spain. Sí

Vacuum pump transfers waste that is pulverized by integrated macerator. For this reason, unlike ordinary pump systems, there is a rotating macerator ahead of impeller for pulverizing. It is hard to predict numerical solution because area of Inlet flow path changes according to the rotation angle of the integrated macerator. So, in this study, the verification of performance evaluation method of Marine vacuum pump were numerically studied by commercial ANSYS CFX 13.0 software. We select a model of performance evaluation for study, and we analyze change of inlet flow path of integrated macerator according to rotation angle. We generate 5 model sets according to rotation angle of the integrated macerator. And we evaluate their performance by numerical analysis. Then, we analyze internal flow field and performance according to rotation angle of the integrated macerator based on numerical analysis result. In addition, we compared with experimental data for validity of numerical result by using steady state analysis.

This paper describes the design optimization of a tunnel ventilation jet fan through multi-objective optimization techniques. Four design variables were selected for design optimization. To analyze the performance of the fan, numerical analyses were conducted, and three-dimensional Reynolds-averaged Navier–Stokes equations with a shear stress transport turbulence model were solved. Two objective functions, the total efficiency of the forward direction and the ratio of the reverse direction outlet velocity to the forward direction outlet velocity, were employed, and multi-objective optimization was carried out to improve the aerodynamic performance. A response surface approximation surrogate model was constructed for each objective function based on numerical solutions obtained at specified design points. The non-dominated sorting genetic algorithm with a local search procedure was used for multi-objective optimization. The tradeoff between the two objectives was determined and described with respect to the Pareto-optimal solutions. Based on the analysis of the optimization results, we propose an optimization model to satisfy the objective function. Finally, to verify the performance, experiments with the base model and the optimization model were carried out.

Background The risk of herpes zoster (HZ) has been reported to vary by sex and ethnicity. In 2 large-scale clinical trials, ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229), the adjuvanted recombinant zoster vaccine (RZV) demonstrated high vaccine efficacy (VE) against HZ and post-herpetic neuralgia (PHN). We present a post-hoc analysis of RZV efficacy against HZ and PHN in the ZOE-50/70 population stratified by sex, geographic region and geographic ancestry/ethnicity. Methods The ZOE-50 and ZOE-70 studies were phase III, observer-blind, placebo-controlled trials conducted across 5 geographic regions. Adults ≥ 50 years of age (YOA; ZOE-50) and ≥ 70 YOA (ZOE-70), randomized 1:1, received 2 doses of RZV or placebo 2 months apart. Here, VE against HZ by sub-population was estimated from the ZOE-50 population (≥ 50 YOA) and the pooled ZOE-50/70 population (pooled ≥ 70 YOA), and VE against PHN by sub-population was evaluated in the pooled ≥ 70 YOA. Results VE was evaluated in 7,340 RZV and 7,413 placebo recipients ≥ 50 YOA (mean age: 62.3 [RZV], 62.2 [placebo] YOA) and 8,250 RZV and 8,346 placebo recipients in pooled ≥ 70 YOA (mean age: 75.5 [RZV, placebo] YOA). VE against HZ and PHN was similar for women and men in the ≥ 50 YOA and pooled ≥ 70 YOA (Tables 1 and 2). Point estimates for VE against HZ by geographic region ranged from 95.7% to 97.2% in ≥ 50 YOA and from 87.3% to 95.1% in pooled ≥ 70 YOA (Table 1). Point estimates for VE against PHN by geographic region ranged from 86.8% to 100% in pooled ≥ 70 YOA. VE was similar across geographic ancestry groups in pooled ≥ 70 YOA: VE point estimates against HZ ranged from 89.6% to 100% and VE against PHN ranged from 87.5% to 100% (Tables 1 and 2). VE against HZ was 88.1% and against PHN was 65.9% in Hispanic participants in pooled ≥ 70 YOA (Tables 1 and 2). Conclusion Acknowledging the limitations including the post-hoc character of these analyses and the small number of participants and cases available, our data suggest that RZV is efficacious against HZ and PHN irrespective of sex, geographic region, geographic ancestry, and ethnicity. Funding: GlaxoSmithKline Biologicals SA. Disclosures All authors: No reported disclosures.

A new type of source matching for improving the efficiency of an inverse Class-F (Class-F $^{{-1}}$ ) amplifier is presented. The squared waveform voltage is generated by adjusting the phase of finite second harmonic voltage shift. To verify the superior performance of the proposed technique, two-stage HBT PAs with different types of source matching were fabricated using a commercial process. The proposed PA delivers approximately 4.8% improvement in efficiency over a conventional PA. The peak output power is enhanced by 2 dB.

In this paper, a new envelope amplifier (EA) scheme incorporating a linear regulator array is presented. The proposed EA achieves a higher efficiency over a wide envelope range utilizing multiple linear regulators. The linear regulators biased as multiple supply voltages are responsible for delivering a partial envelope current, ensuring high efficiency. A simulation revealed the superior performance efficiency of the proposed scheme in terms of the instantaneous envelope voltage compared with that of a conventional EA. Based on the simulation results, an envelope tracking (ET) amplifier consisting of the proposed EA was implemented using a commercially available 60-W gallium-nitride (GaN) device. The experimental results show that the implemented ET system has an overall efficiency of 47.8% and a gain of 14 dB at an average output power of 40.8 dBm. In this situation, the spectral performance is less than -49.5 dBc using the optimum digital predisotortion functionality.

Gross total resection of gliomas can be limited by the involvement of tumor in eloquent areas. Moreover, lesions can impart cortical reorganization and make the precise determination of hemispheric dominance and localization of language function even more difficult. Preoperative mapping with functional magnetic resonance imaging (fMRI), intraoperative imaging modalities, and intraoperative direct cortical stimulation enable surgeons to map the functional topography of the brain in relation to the tumor and perform a safe maximal resection. In this report, we present a patient with left frontal glioma of complex morphology, wherein the tumor was enveloped by Broca's area on fMRI. Intraoperative mapping and intraoperative magnetic resonance imaging (iMRI) allowed gross total resection of the tumor with preservation of language function and illustrate the utility of multiple contemporary modalities in the surgical management of low-grade gliomas located in eloquent cortices.

Brain metastasis is a common complication of systemic cancer and significant cause of suffering in oncology patients. Despite a plethora of available treatment modalities, the prognosis is poor with a median survival time of approximately one year. For patients with controlled systemic disease, good performance status, and a limited number of metastases, treatment typically entails surgical resection or radiosurgery, followed by whole brain radiotherapy (WBRT) to control microscopic disease. WBRT is known to control the progression of cancer in the brain, but it can also have toxic effects, particularly with regard to neurocognition. There is no consensus as to whether the benefit of WBRT outweighs the potential harm. We review the evidence related to the question of whether patients undergoing surgical resection of brain metastases should receive adjuvant WBRT.

Geographic variability exists in the use of IVC filters (IVCF). We hypothesized that variation in IVCF use is incompletely explained by variation in the prevalence of deep-vein thrombosis (DVT) and pulmonary embolism (PE) and may result from different practice patterns regarding prophylactic IVCF use. We characterize geographic variation in IVCF use at the state level and evaluate its association with clinical factors, patient demographics, and the medicolegal environment.Healthcare Cost and Utilization Project State Inpatient Database records were accessed to identify 230,445 IVCFs placed from 2006 to 2008 in 33 states. Similar queries were performed for DVT and PE. Additional state data were obtained from public sources. Analyses included descriptive statistics, Spearman Correlation (SC), Wilcoxon rank-sum test, and characterization of variability.Overall, IVCF use correlated with the prevalence of DVT (SC = 0.89, P.01). States on the East coast have significantly greater rates of IVCF use per 100K (mean ± SD = 41.2 ± 16.7 vs 27.8 ± 11.1, P.05) and greater rates of IVCF per DVT (20.2 ± 4.5% vs 15.2 ± 2.9%; P.005), despite similar rates of DVT per 100K (198.1 ± 51.2 vs 177.7 ± 46.7, P = NS) compared with all other states. Overall, states with the greatest rate of IVCF per DVT were (in descending order): Rhode Island, New Jersey, Florida, New York, and West Virginia. Rates of detected PE per 100K in these states were not significantly different from all other states (95.6 ± 16.6 vs 90.4 ± 16.1, P = NS). In these states, a greater percentage of IVCF recipients were older than 85 (15.3% vs 11.8%; P.01); fewer were pediatric (0.3% vs 0.7%; P.05) or aged 45 to 64 (26.1% vs 32.4%; P.001). There were no differences in patient sex, race, insurance type, hospital size, or teaching status. States with high rates of IVCF per DVT were noted to have significantly greater rates of paid malpractice claims per 100K (4.9 ± 2.51 vs 1.1 ± 0.8; P = .001), and annual general surgeon liability insurance premiums ($78,630 ± 34,822 vs $43,989 ± 17,794; P.05).Variation in IVCF use is incompletely explained by clinical factors. High rates of IVCF per DVT in some states may represent increased use of prophylactic IVCF in states with litigious medicolegal environments.

Purpose To evaluate the safety of HPV‐16/18 AS04‐adjuvanted vaccine when administered as per the PI in Korea. Methods A total of 3084 women aged 10–25 years were enrolled in this post‐marketing surveillance from 2008 to 2014. Subjects were invited to receive three doses of the vaccine (0, 1 and 6 months), and participants who received at least one dose were included in the analysis. Adverse events (AEs), adverse drug reactions (ADRs) and serious AEs (SAEs) were recorded after each dose. All AEs, ADRs and SAEs were presented with exact 95% confidence intervals (CI) (NCT01101542). Results Injection‐site pain was the most frequent AE and ADR reported by 322 subjects (10.4% [95%CI: 9.4–11.6]); the local pain was transient and lasted 4–7 days in most cases. Dysmenorrhoea and vaginitis were the most common unexpected AEs reported by 30 (1.0% [95%CI: 0.7–1.4]) and 16 subjects (0.7% [95%CI: 0.3–0.8]), respectively. Pain (toe pain, leg pain and body pain [one case each]; foot pain [two cases]) was the most common unexpected ADR reported by five subjects (0.2% [95%CI: 0.1–0.4]). Four subjects reported a single SAE (one case each of exostosis, gastroenteritis, abortion and tonsillitis); none were fatal. All SAEs were assessed as unlikely to be related to vaccination; gastroenteritis, exostosis and tonsillitis resolved during the study period. Conclusions This is the first post‐marketing surveillance study in Korea that provides 6‐year safety data for HPV‐16/18 AS04‐adjuvanted vaccine. The vaccine showed an acceptable safety profile and favourable benefit/risk ratio when given to women aged 10–25 years in Korea. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.

This article presents a multi-objective optimization to improve the hydrodynamic performance of a counter-rotating type pump-turbine operated in pump and turbine modes. The hub and tip blade angles of impellers/runners with four blades, which were extracted through a sensitivity test, were optimized using a hybrid multi-objective genetic algorithm with a surrogate model based on Latin hypercube sampling. Three-dimensional steady incompressible Reynolds-averaged Navier–Stokes equations with the shear stress transport turbulence model were discretized via finite volume approximations and solved on a hexahedral grid to analyze the flow in the pump-turbine domain. For the major hydrodynamic performance parameters, the pump and turbine efficiencies were selected as the objective functions. Global Pareto-optimal solutions were searched using the response surface approximation surrogate model with the non-dominated sorting genetic algorithm, which is a multi-objective genetic algorithm. The trade-off between the two objective functions was determined and described with regard to the Pareto-optimal solutions. As a result, the pump and turbine efficiencies for the arbitrarily selected optimum designs in the Pareto-optimal solutions were increased as compared with the reference design.

Wireless sensor network devices commonly use a single antenna for transmission and reception, as well as for relaying packets over multiple hops to a final destination, which is referred to as single-input-single-output (SISO) multihop transmission. Advancements in multiple antenna systems enable reliable broadband wireless communications using multiple-input-multiple-output (MIMO) transmission technology. In addition, through collaboration of several single-antenna-equipped devices, cooperative MIMO communication is possible in the form of virtual MIMO (V-MIMO), virtual multiple-input-single-output (V-MISO), and virtual single-input-multiple-output (V-SIMO), which are collectively called V-MIMO technology. In this paper, a multihop hybrid V-MIMO (HV-MIMO) networking scheme is proposed to configure a minimum energy consuming route (MECR) that provides high end-to-end connectivity while satisfying end-to-end data rate and bit error rate (BER) requirements by using the best cooperative MIMO configuration for each hop. In the proposed scheme, first, the source-to-destination path is divided into long wireless communication hops, and the minimum energy consuming V-MIMO configuration is applied to each hop. Next, the long communication hops are individually evaluated for replacement with two half-length V-MIMO hops, where changes are applied only when a gain in energy consumption is obtainable. If no gain is obtainable for a certain hop, then the hop configuration is not changed, and that hop is no longer compared for replacement. This procedure of testing for possible replacement with two half-length hops is repeated individually for all hops until no further changes are made in the source-to-destination path, which is when the HV-MIMO MECR is complete. For equivalent end-to-end data rate and BER requirements, the proposed HV-MIMO multihop scheme provides a significant energy saving (e.g., 52.32% energy saving at the node density of 0.003 nodes/m2) compared with the conventional SISO multihop path's MECR. In addition, the HV-MIMO scheme always results in an energy saving gain and a significantly higher end-to-end multihop MECR connection probability compared with using the same type of cooperative MIMO configuration for each hop (i.e., homogeneous V-MIMO configuration).

In this study, optimization of the impeller and design of volute were carried out in order to improve the performance of a centrifugal pump. Design parameters from vane plane development for impeller design were selected, and effect of the design parameters on the performance of the pump was analyzed by using Response Surface Methodology(RSM) to optimized impeller. In addition, total pump design method was suggested by designing volute which was suitable for the optimized impeller through volute design where Stepanoff theory was applied and numerical analysis.

This paper describes a numerical optimization procedure for performance improvement of a tunnel ventilation jet fan. We employ optimization techniques based on a PRESS (predicted error sum of squares)-based-averaging (PBA) model to improve the aerodynamic performance of a tunnel ventilation jet fan. For numerical analyses, three-dimensional Reynolds-averaged Navier-Stokes (RANS) equations with a shear stress transport turbulence model are discretized using finite volume approximations and solved on hexahedral grids to evaluate the total efficiency at operating conditions as the objective function. Numerical results are verified by using experimental data for the total efficiency and the effective outlet velocity at operating conditions. Further, four geometric variables are used defining the meridional length and the thickness profile at the hub and shroud in the jet fan rotor as the design variables for numerical optimization. The results of numerical optimization show a significant improvement in the total efficiency of the optimum model in comparison with the base model.

In this paper, the effect of the fundamental current provided by a peaking cell consisting of a Doherty amplifier is analyzed using a new closed-current model. The proposed current model can be used as a foundation to accurately explain and optimize previous compensation methods such as uneven, asymmetric, and gate envelope cases. Based on the proposed analysis, and in conjunction with the envelope tracking scheme, two-point envelope modulation simultaneously supplying the carrier and peaking cells is introduced to improve the overall efficiency. For further verification, the Doherty amplifier, targeting a third-generation long-term evolution base station at 2.6 GHz has been fabricated utilizing a commercially available 120-W gallium nitride device, which provides a drain efficiency of 53.1% at an average output power of 45.8 dBm with an 8.5-dB peak-to-average power ratio signal maintaining an adjacent channel leakage power ratio of - 48.6 dBc using digital pre-distortion functionality.

Study design Retrospective case-control study. Objective The purpose of this study was to assess whether preoperative use of fish oil supplements increases intraoperative blood loss and postoperative bleeding complications during lumbar decompression surgery. Summary of background data Omega-3 fatty acids (n-3FA) are widely used as over-the-counter supplements because of well-established cardioprotective and antiplatelet effects. Concern over bleeding associated with changes in platelet function have led to prohibiting these supplements before surgery although there are no clinical data available in the spinal surgery literature to guide such recommendations. Methods Ninety-five consecutive patients who underwent posterior-only lumbar decompression by a single surgeon were included. Patients who had taken n-3FA within 14 days of surgery were compared with a control group with respect to demographics, preoperative use of other anticoagulants, surgical time, estimated intraoperative blood loss, and postoperative complications including reoperation for epidural hematoma and wound infection. Power analysis suggested 11 patients taking n-3FA were necessary to reach statistical significance based on pilot data. Results Sixteen patients took n-3FA supplements, stopping an average of 2.3 days before surgery. These were no significant between-group differences in demographic parameters, use of other anticoagulants, and surgical time. Estimated blood loss was higher in the control group but the difference was not significant (154 vs. 138 mL, P=0.53). There were 2 complications related to bleeding in the control group and none in the n-3FA group. Conclusions We found no increase in intraoperative blood loss or postoperative bleeding complications associated with preoperative use of n-3FA supplements up to an average of 2.3 days before surgery. Although further studies are necessary before this finding can be generalized to other types of spinal surgery, our study corroborates findings from investigations in other surgical specialties that suggest preoperative n-3FA is not associated with increased risk of intraoperative and postoperative bleeding.

In this paper, we consider the canonical cusps in complex hyperbolic surfaces. We will classify canonical cusps in complex hyper-bolic surfaces and find correspondence between them and 3-dimensiona nilpotent groups. This paper is a sequel of our paper [6].

Objective Catheter-related infection remains a cause of morbidity in the use of external ventricular drains (EVDs). The aim of this retrospective single-center study was to assess the rate and factors related to ventriculostomy infections in the setting of the published literature. Methods Patients that underwent EVD placement in a single-center were retrospectively reviewed. Diagnosis, treatment, hospital course, and infection-related data were collected and analyzed in reference to ventriculitis rates. The protocols for EVD placement and maintenance were reviewed. Results Of 343 patients, 12 acquired an EVD infection. No significant differences existed between those with and without ventriculitis for age, sex, underlying diagnosis, or concomitant systemic infection. Although not significant, concomitant systemic infection existed in 4.7% of patients with ventriculitis versus 1.5% without. There was a significant difference in length of EVD placement in patients with ventriculitis (20.9 ± 15.3 days) versus those without (12.1 ± 18.2; P = 0.005). Coagulase-negative Staphylococcus and Staphylococcus aureus represented the most commonly associated pathogens. With an overall cumulative incidence of 3.5%, our rate compared favorably to the published literature (cumulative incidence 9.5%; range, 3.9%-23.2%). Conclusions Catheter-related infection remains an important complication of EVD placement. Of factors evaluated, length of time of catheter placement has the most notable relationship to infection incidence, suggesting that early drain removal should be a goal whenever medically appropriate.

This paper presents an optimization procedure for performance improvement of a tunnel ventilation jet fan. Optimization techniques based on response surface approximation (RSA) are employed to improve the aerodynamic performance of a tunnel ventilation jet fan. For numerical analysis, three-dimensional Renolds- averaged Navier-Stokes (RANS) equations with shear stress transport turbulence model are discretized by using finite volume approximations and solved on hexahedral grids to evaluate the total efficiency at the operating condition as the objective function. Four geometric variables defining the meridional length and the thickness profile at the hub and shroud in the jet fan rotor are selected as design variables for the numerical optimization. The results of the numerical optimization show that the total efficiency of the optimized model is significantly improved in comparison with the base model.

The kimchi refrigerator is the electronic home appliance which is used for the maturing and a custody of the kimchi. In this paper, performance improvement of fan and duct system for kimchi refrigerator has been studied by using a commercial CFD code. In order to achieve a improved fan performance, three-dimensional computational fluid dynamics and the Design of Experiments method have been applied. Additionally, to know the optimized duct inlet shape with the optimized fan, the overall performances were calculated with various duct inlet shapes. The final fan and duct system for kimchi refrigerator showed improved performance in efficiency and total head compared with the existing model.

In this paper, an analysis of a power amplifier manipulated using a second harmonic (PA-2HM) is described using a remarkable correlation between the fundamental and second harmonic impedances. The output loading condition, made up of an optimum fundamental impedance mapped to the conditional second harmonic reactance, allows us to achieve a high-efficiency power amplifier (PA) with a simple output matching circuit. For the analysis, the output voltage and current waveforms are modeled in terms of their output loading in order to extend the output power and efficiency. Specific PA-2HM cases, inverse Class-F and Class-J modes, are analyzed using different second harmonic reactance conditions. The allowable second harmonic reactance for maintaining maximum efficiency has been found to be spread throughout a wide range. To justify the analysis, a harmonic load-pull simulation and measurement are conducted and compared with analysis results. For verification, a commercially available 60-W gallium-nitride (GaN) device was used for different types of PA (inverse Class-F and Class-J) with appropriate second harmonic impedance. In terms of the output power and drain efficiency, the measured results are in good agreement with not only computer-aided design simulations, but also with our analysis and load-pull results.

In this paper, a high-efficiency envelope-tracking (ET) transmitter incorporating a novel efficiency-boosting function is proposed and implemented. An inverse Class-F power amplifier is utilized and optimized using the proposed output loading condition, which enhances its efficiency at the high probability region. This matching network can be conveniently implemented by controlling the nonlinear capacitance of the power transistor. For an accurate analysis, the output waveforms are modeled in terms of the nonlinear capacitance, and the efficiency and output power are subsequently analyzed and successfully optimized. For a high-efficiency envelope amplifier (EA), we propose a new EA utilizing a 2-bit switching stage in place of a 1-bit switching stage. This proposed architecture effectively reduces the ripple current, improving the efficiency of the EA. To verify our analysis, we have fully implemented a 3.54-GHz high-efficiency ET transmitter including a digital processing block. The experimental results show that the ET transmitter using a commercial 60-W peak-envelope-power GaN device operates at a drain efficiency of 44% and power-added efficiency of 39.6% with a gain of 10.1 dB at an average output power of 40 dBm for a 10-MHz third-generation long-term evolution signal with 8.5-dB peak-to-average power ratio. Using a digital pre-distortion function, the adjacent channel leakage ratio is less than -47.5 dBc.