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Chunlei Tan,1 Jinling Xu,2 Shiyuan Zhang,1 Shuqiang Liu,1 Xiaotian Yang,1 Danping Wu,1 Boqian Yu,1 Yuanxi Huang1 1Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, People’s Republic of China; 2Endoscope Department, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, People’s Republic of ChinaCorrespondence: Yuanxi Huang, Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, People’s Republic of China, Tel/Fax +86-0451-86298053, Email rxwk@163.comPurpose: The current investigation is to assess FOXP3 expression in breast cancer patients and evaluate the predictive significance of FOXP3.Patients and Methods: A cohort of 313 cases between January 2015 and November 2015 were enrolled this research. Immunohistochemistry (IHC) assay was utilized to detect the expression levels of FOXP3 in primary breast carcinoma specimens. These patients were separated into two groups by semiquantitative scoring approach. Chi-square test and Fisher’s exact test were conducted to investigate the correlations between FOXP3 expression in tumors and clinicopathological variables. Kaplan–Meier method and Log rank test were utilized to generate survival curves for disease-free survival (DFS) and overall survival (OS). The independent factors were examined using Cox regression analysis. Nomogram models were created for assessing DFS and OS rates.Results: Depending on the levels of FOXP3 expression in tumors, these patients were categorized into two groups: low FOXP3 expression (174 cases) and high FOXP3 expression (139 cases). The patients exhibiting low levels of FOXP3 expression in tumors demonstrated a longer survival duration contrasted with those with high expression (DFS: 88.75 vs 65.87 months, χ2=36.1100, P< 0.0001; OS: 89.70 vs 78.37 months, χ2=32.4900, P< 0.0001). Multivariate analysis revealed that FOXP3 was a significant prognostic factor [DFS: h

The short fiction “The Paradise of Bachelors and the Tartarus of Maids” is written in first-person narration as a diptych in which Melville ponders the human spiritual crisis in the industrialized world. This article explores the contradiction of the narrator’s spiritual liberation and others’ exclusion employing the narrator’s shifting experiencing and retrospective viewpoints, with the engagement of Romantic Irony. Through the dual viewpoints, the subjectivity and uncertainty of the first-person Romantic ironist manifest the uncertainty of the human spiritual crisis in industrialization. Melville questions human spirits and technology to elevate his ambiguous narration and philosophical concerns.

The short fiction “The Paradise of Bachelors and the Tartarus of Maids” is written in first-person narration as a diptych in which Melville ponders the human spiritual crisis in the industrialized world. This article explores the contradiction of the narrator’s spiritual liberation and others’ exclusion employing the narrator’s shifting experiencing and retrospective viewpoints, with the engagement of Romantic Irony. Through the dual viewpoints, the subjectivity and uncertainty of the first-person Romantic ironist manifest the uncertainty of the human spiritual crisis in industrialization. Melville questions human spirits and technology to elevate his ambiguous narration and philosophical concerns.

Kun Qiao,1,&ast; Cheng Luo,2,&ast; Rong Huang,3,4 Jingfeng Xiang,5 You Pan,3,4 Shiyuan Zhang,1 Cong Jiang,1 Shuaijie Ding,6 Huawei Yang,3,4 Yuanxi Huang,1 Shipeng Ning3,4 1Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, People’s Republic of China; 2Department of Anesthesiology, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530000, People’s Republic of China; 3Guangxi Medical University Cancer Hospital, Nanning, 530000, People’s Republic of China; 4Key Laboratory of Breast Cancer Diagnosis and Treatment Research of Guangxi Department of Education, Nanning, 530000, People’s Republic of China; 5Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China; 6Department of Gastrointestinal Surgery & Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shipeng Ning; Yuanxi Huang, Email nspdoctor@163.com; rxwk@163.comIntroduction: Sonodynamic therapy (SDT) as an emerging tumor treatment gained wide attention. However, tumor vascular destruction and oxygen depletion in SDT process may lead to further hypoxia. This may lead to enhanced glycolysis, lactate accumulation, and immunosuppression.Methods: A glycolysis inhibitor (3PO) loaded and PEG modified black phosphorus nanosheets (BO) is constructed for potent starvation therapy and efficient immune activation.Results: Under ultrasound irradiation, the BO can produce ROS to destroy tumors and tumor blood vessels and lead to further hypoxia and nutrients block. Then

BACKGROUND: Black-White disparities in heart disease treatment may be attributable to differences in physician referral networks. We mapped physician networks for Medicare patients and examined within-physician Black-White differences in patient sharing between primary care physicians and cardiologists. METHODS AND RESULTS: Using Medicare fee-for-service files for 2016 to 2017, we identified a cohort of Black and White patients with heart disease and the primary care physicians and cardiologists treating them. To ensure the robustness of within-physician comparisons, we restricted the sample to regional health care markets (ie, hospital referral regions) with at least 10 physicians sharing ≥3 Black and White patients. We used claims to construct 2 race-specific physician network measures: degree (number of cardiologists with whom a primary care physician shares patients) and transitivity (network tightness). Measures were adjusted for Black-White differences in physician panel size and calculated for all settings (hospital and office) and for office settings only. Of 306 US hospital referral regions, 226 and 145 met study criteria for all settings and office setting analyses, respectively. Black patients had more cardiology encounters overall (6.9 versus 6.6; P<0.001) and with unique cardiologists (3.0 versus 2.6; P<0.001), but fewer office encounters (31.7% versus 41.1%; P<0.001). Primary care physicians shared Black patients with more cardiologists than White patients (mean differential degree 23.4 for all settings and 3.6 for office analyses; P<0.001 for both). Black patient-sharing networks were less tightly connected in all but office settings (mean differential transitivity -0.2 for all settings [P<0.001] and near 0 for office analyses [P=0.74]). CONCLUSIONS: Within-physician Black-White differences in patient sharing exist and may contribute to disparities in cardiac care.

Shiyuan Zhang,1 Denise King,2 Virginia M Rosen,3 Afisi S Ismaila1,4 1Value Evidence and Outcomes, GlaxoSmithKline plc, Collegeville, PA, USA; 2Value Evidence and Outcomes, GlaxoSmithKline plc, Brentford, UK; 3Optum Inc, Eden Prairie, MN, USA; 4Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Afisi S IsmailaValue Evidence and Outcomes, GlaxoSmithKline plc., 1250 S. Collegeville Road, Collegeville, PA 19426-0989, USATel +1 919 315 8229Email afisi.s.ismaila@gsk.comAbstract: With increasing choice of medications and devices for asthma and chronic obstructive pulmonary disease (COPD) treatment, comparative evidence may inform treatment decisions. This systematic literature review assessed clinical and economic evidence for using a single combination inhaler versus multiple inhalers to deliver the same medication for patients with asthma or COPD. In 2016, Embase, PubMed and the Cochrane library were searched for publications reporting studies in asthma or COPD comparing a single-inhaler combination medicine with multiple inhalers delivering the same medication. Publications included English-language articles published since 1996 and congress abstracts since 2013. Clinical, economic and adherence endpoints were assessed. Of 2031 abstracts screened, 18 randomized controlled trials (RCTs) in asthma and four in COPD, nine retrospective and three prospective observational studies in asthma, and four observational studies in COPD were identified. Of these, five retrospective and one prospective study in asthma, and two retrospective studies in COPD reported greater adherence with a single inhaler than multiple inhalers. Nine observational studies reported significantly (n=7) or numerically (n=2) higher rates of adherence with single- versus multiple-inhaler therapy. Economic analyses from retrospective and prospective studies showed that use of single-inhaler therapies was associated with reduced healthcare res

Ike Iheanacho,1 Shiyuan Zhang,2 Denise King,3 Maria Rizzo,1 Afisi S Ismaila2,4 1Meta Research, Evidera, London, UK; 2Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA; 3Value Evidence and Outcomes, GlaxoSmithKline plc., Brentford, UK; 4Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Afisi S IsmailaValue Evidence and Outcomes, GlaxoSmithKline plc., 1250 South Collegeville Road, Collegeville, PA 19426-0989, USATel +1 919 315 8229Email afisi.s.ismaila@gsk.comBackground and Objectives: Chronic obstructive pulmonary disease (COPD) affects over 250 million people globally, carrying a notable economic burden. This systematic literature review aimed to highlight the economic burden associated with moderate-to-very severe COPD and to investigate key drivers of healthcare resource utilization (HRU), direct costs and indirect costs for this patient population.Materials and Methods: Relevant publications published between January 1, 2006 and November 14, 2016 were captured from the Embase, MEDLINE and MEDLINE In-Process databases. Supplemental searches from relevant 2015– 2016 conferences were also performed. Titles and abstracts were reviewed by two independent researchers against pre-defined inclusion and exclusion criteria. Studies were grouped by the type of economic outcome presented (HRU or costs). Where possible, data were also grouped according to COPD severity and/or patient exacerbation history.Results: In total, 73 primary publications were included in this review: 66 reported HRU, 22 reported direct costs and one reported indirect costs. Most of the studies (94%) reported on data from either Europe or North America. Trends were noted across multiple studies for higher direct costs (including mean costs per patient per year and mean costs per exacerbation) being associated with increasingly severe COPD and/or a history of more frequent or severe exacerbations. Simila

Recent years have witnessed the rapid development in the research topic of WiFi sensing that automatically senses human with commercial WiFi devices. This work falls into two major categories, i.e., the activity recognition and the indoor localization. The former work utilizes WiFi devices to recognize human daily activities such as smoking, walking, and dancing. The latter one, indoor localization, can be used for indoor navigation, location-based services, and through-wall surveillance. The key rationale behind this type of work is that people behaviors can influence the WiFi signal propagation and introduce specific patterns into WiFi signals, called WiFi fingerprints, which can be further explored to identify human activities and locations. In this paper, we propose a novel deep learning framework for joint activity recognition and indoor localization task using WiFi Channel State Information~(CSI) fingerprints. More precisely, we develop a system running standard IEEE 802.11n WiFi protocol, and collect more than 1400 CSI fingerprints on 6 activities at 16 indoor locations. Then we propose a dual-task convolutional neural network with 1-dimensional convolutional layers for the joint task of activity recognition and indoor localization. Experimental results and ablation study show that our approach achieves good performances in this joint WiFi sensing task. Data and code have been made publicly available at https://github.com/geekfeiw/apl., Comment: accepted by IEEE Access; 10 pages, 15 figures, 4 tables

We build CSI-Net, a unified Deep Neural Network~(DNN), to learn the representation of WiFi signals. Using CSI-Net, we jointly solved two body characterization problems: biometrics estimation (including body fat, muscle, water, and bone rates) and person recognition. We also demonstrated the application of CSI-Net on two distinctive pose recognition tasks: the hand sign recognition (fine-scaled action of the hand) and falling detection (coarse-scaled motion of the body)., Comment: 14 pages, 6 figures and 10 tables

Shiyuan Zhang,1 James Paul,2 Manyat Nantha-Aree,2 Norman Buckley,2 Uswa Shahzad,2 Ji Cheng,2 Justin DeBeer,5 Mitchell Winemaker,5 David Wismer,5 Dinshaw Punthakee,5 Victoria Avram,5 Lehana Thabane1–4 1Department of Clinical Epidemiology and Biostatistics, McMaster University, 2Department of Anesthesia, McMaster University, 3Biostatistics Unit/Centre for Evaluation of Medicines, St Joseph’s Healthcare-Hamilton, 4Population Health Research Institute, Hamilton Health Science/McMaster University, 5Department of Surgery, Division of Orthopaedics, McMaster University, Hamilton, ON, Canada Background: Postoperative pain management in total joint replacement surgery remains ineffective in up to 50% of patients and has an overwhelming impact in terms of patient well-being and health care burden. We present here an empirical analysis of two randomized controlled trials assessing whether addition of gabapentin to a multimodal perioperative analgesia regimen can reduce morphine consumption or improve analgesia for patients following total joint arthroplasty (the MOBILE trials). Methods: Morphine consumption, measured for four time periods in patients undergoing total hip or total knee arthroplasty, was analyzed using a linear mixed-effects model to provide a longitudinal estimate of the treatment effect. Repeated-measures analysis of variance and generalized estimating equations were used in a sensitivity analysis to compare the robustness of the methods. Results: There was no statistically significant difference in morphine consumption between the treatment group and a control group (mean effect size estimate 1.0, 95% confidence interval −4.7, 6.7, P=0.73). The results remained robust across different longitudinal methods. Conclusion: The results of the current reanalysis of morphine consumption align with those of the MOBILE trials. Gabapentin did not significantly reduce morphine consumption in patients undergoing major replacement surgeries. Th

Shiyuan Zhang,1 James Paul,2 Manyat Nantha-Aree,2 Norman Buckley,2 Uswa Shahzad,2 Ji Cheng,2 Justin DeBeer,5 Mitchell Winemaker,5 David Wismer,5 Dinshaw Punthakee,5 Victoria Avram,5 Lehana Thabane1–41Department of Clinical Epidemiology and Biostatistics, 2Department of Anesthesia, McMaster University, Hamilton, ON, Canada; 3Biostatistics Unit/Centre for Evaluation of Medicines, St Joseph's Healthcare - Hamilton, Hamilton, ON, Canada; 4Population Health Research Institute, Hamilton Health Science/McMaster University, 5Department of Surgery, Division of Orthopaedics, McMaster University, Hamilton, ON, CanadaBackground: Although seemingly straightforward, the statistical comparison of a continuous variable in a randomized controlled trial that has both a pre- and posttreatment score presents an interesting challenge for trialists. We present here empirical application of four statistical methods (posttreatment scores with analysis of variance, analysis of covariance, change in scores, and percent change in scores), using data from a randomized controlled trial of postoperative pain in patients following total joint arthroplasty (the Morphine COnsumption in Joint Replacement Patients, With and Without GaBapentin Treatment, a RandomIzed ControlLEd Study [MOBILE] trials).Methods: Analysis of covariance (ANCOVA) was used to adjust for baseline measures and to provide an unbiased estimate of the mean group difference of the 1-year postoperative knee flexion scores in knee arthroplasty patients. Robustness tests were done by comparing ANCOVA with three comparative methods: the posttreatment scores, change in scores, and percentage change from baseline.Results: All four methods showed similar direction of effect; however, ANCOVA (-3.9; 95% confidence interval [CI]: -9.5, 1.6; P=0.15) and the posttreatment score (-4.3; 95% CI: -9.8, 1.2; P=0.12) method provided the highest precision of estimate compared with the change score (-3.0; 95% CI: -9.9, 3.8; P=0.38)

Background: Post-operative pain management in total joint replacement surgery remains to be ineffective in up to 50% of patients and remains to have overwhelming impacts in terms of patient well-being and healthcare burden. The MOBILE trial was designed to assess whether the addition of gabapentin to a multimodal perioperative analgesia regimen can reduce morphine consumption or improve analgesia of patients following total joint arthroplasty. We present here empirical application of these various statistical methods to the MOBILE trial. Methods: Part 1: Analysis of covariance (ANCOVA) was used to adjust for baseline measures and to provide an unbiased estimate of the mean group difference of the one year post-operative knee flexion scores in knee arthroplasty patients. Robustness test were done by comparing ANCOVA to three comparative methods: i) the post-treatment scores, ii) change in scores, iii) percentage change from baseline. Part 2: Morphine consumption, taken at 4 time periods, of both the total hip and total knee arthroplasty patients was analyzed using linear mixed-effects model (LMEM) to provide a longitudinal estimate of the group difference. Repeated measures ANOVA and generalized estimating equations were used in a sensitivity analysis to compare robustness of the methods. Additionally, robustness of different covariance matrix structures in the LMEM were tested, namely first order auto-regressive compared to compound symmetry and unstructured. Results: Part 1: All four methods showed similar direction of effect, however ANCOVA (-3.9, 95% CI -9.5, 1.6, p=0.15) and post-treatment score (-4.3, 95% CI -9.8, 1.2, p=0.12) method provided the highest precision of estimate compared to change score (-3.0, 95% CI -9.9, 3.8, p=0.38) and percent change (-0.019, 95% CI -0.087, 0.050, p=0.58). Part 2: There was no statistically significant difference between the morphine consumption in the treatment group and the control group (1.0, Master of Science (MSc)

Zainab Samaan,1–3 Lawrence Mbuagbaw,2 Daisy Kosa,2,4 Victoria Borg Debono,2,5 Rejane Dillenburg,6 Shiyuan Zhang2, Vincent Fruci,7 Brittany Dennis,2 Monica Bawor,8 Lehana Thabane2,5,91Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, 3Population Genomics Program, McMaster University, Hamilton, 4Department of Nephrology, Toronto General Hospital, Toronto, 5Department of Anesthesia, McMaster University, Hamilton, 6Department of Pediatrics, McMaster University, Hamilton, 7Michael G DeGroote School of Medicine, McMaster University, Hamilton, 8McMaster Integrative Neuroscience Discovery and Study (MiNDS) Program, McMaster University, Hamilton, 9Centre for Evaluation of Medicines, Hamilton, ON, CanadaBackground: Reporting guidelines have been available for the past 17 years since the inception of the Consolidated Standards of Reporting Trials statement in 1996. These guidelines were developed to improve the quality of reporting of studies in medical literature. Despite the widespread availability of these guidelines, the quality of reporting of medical literature remained suboptimal. In this study, we assess the current adherence practice to reporting guidelines; determine key factors associated with better adherence to these guidelines; and provide recommendations to enhance adherence to reporting guidelines for future studies.Methods: We undertook a systematic scoping review of systematic reviews of adherence to reporting guidelines across different clinical areas and study designs. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, and Medline) from January 1996 to September 2012. Studies were included if they addressed adherence to one of the following guidelines: Consolidated Standards of Reporting Trials (CONSORT), Preferred Reporting Items for Systematic Reviews and

Lawrence Mbuagbaw,1–3 Frederick Morfaw,4 John-Eudes L Kunda,5 Jackson K Mukonzo,6 Jasmine Kastner,7 Shiyuan Zhang,2,3 Madzouka Kokolo,8 Lehana Thabane1,3,9–11 1Centre for Development of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon; 2Department of Clinical Epidemiology and Biostatistics, McMaster University, 3Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada; 4Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; 5Community Information and Epidemiological Technologies, Lusaka, Zambia; 6School of Biomedical Sciences, College of Health Sciences, University of Makerere, Kampala, Uganda; 7Faculty of Health Sciences, Simon Fraser University, BC, Canada; 8Ottawa Hospital Research Institute, 9Departments of Pediatrics and Anaesthesia, McMaster University, 10Centre for Evaluation of Medicine, St Joseph's Healthcare, 11Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada Abstract: Young health researchers all over the world often encounter difficulties in the early stages of their careers. Formal acquisition of research skills in academic settings does not always offer sufficient guidance to overcome these challenges. Based on the collective experiences of some young researchers and research mentors, we describe some tips for a successful health career and offer some useful resources. These tips include: institutional affiliation, early manuscript writing, early manuscript reviewing, finding a mentor, collaboration and networking, identifying sources of funding, establishing research interests, investing in research methods training, developing interpersonal and personal skills, providing mentorship, and balancing work with everyday life. The rationale behind these tips and how to achieve them is provided. Keywords: health research career, young