Orientador: Prof. Dr. Filipe Ieda Fazanaro / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Engenharia da Informação, 2018. / A detecção de atividade de voz é um problema importante em muitas aplicações de fala/áudio, incluindo codificação e reconhecimento automático de fala; vários algoritmos foram propostos na literatura explorando diferentes métricas de sinais (como a energia do sinal). Neste trabalho, é apresentada uma metodologia alternativa para detecção de atividade vocal (VAD) de um discurso ou sinal de áudio com base nas informações fornecidas pelos gráficos de recorrência do sinal. O método proposto foi capaz de classificar corretamente sinais limpos e com baixos níveis de ruído, apresentando desempenho próximo ao algoritmo incluído no codec G.729, que é comumente usado em aplicativos de Voz sobre IP (VoIP). / Voice activity detection is an important problem in many speech/audio applications, including coding and automatic speech recognition; several algorithms have been proposed in the literature to explore different signal metrics (such as signal energy). In this work, an alternative methodology for the Voice Activity Detection (VAD) of a discourse or audio signal is presented based on the information provided by the signals¿ recurrence plots. The proposed method was able to correctly classify clean signals and with low levels of noise, obtained performance similar to the algorithm included in the G.729 codec, which is commonly used in VoIP applications.

INTRODUÇÃO: Aproximadamente 50% dos pacientes com tumor colorretal apresentam metástase hepática e a hepatectomia é o procedimento terapêutico de escolha. Discutem-se diversos fatores prognósticos, entre eles a margem cirúrgica é um fator sempre recorrente, pois não existe consenso da distância mínima necessária entre o nódulo metastático e a linha de secção hepática. Alguns autores identificaram que a margem cirúrgica maior que 1cm é um fator de melhor prognóstico com maior sobrevida e menor recidiva. Contudo, outros estudos demonstram resultados semelhantes entre pacientes com margens cirúrgicas maiores que 1cm, exíguas e até mesmo microscopicamente acometidas. Essas controvérsias conduzem à idéia de que outros fatores biológicos possam estar envolvidos na fisiopatologia de recorrência. Assim sendo, é de grande importância a avaliação da relação das margens cirúrgicas de ressecções hepáticas de metástases de câncer colorretal com a sobrevida e recidiva da doença. OBJETIVOS: Avaliar as margens cirúrgicas e o tipo de borda tumoral nas ressecções de metástases hepáticas de câncer colorretal e sua correlação com recidiva local e sobrevida. MÉTODOS: Estudo retrospectivo, baseado na revisão dos prontuários de 91 pacientes submetidos à ressecção de metástases hepáticas de neoplasia colorretal, durante o período compreendido entre janeiro de 2000 e dezembro de 2009. Revisão histopatológica prospectiva de todos os casos com aferição da menor margem cirúrgica e classificação das bordas tumorais como expansiva ou infiltrativa. RESULTADOS: Não houve diferença estatística nas taxas de recidiva e no tempo de sobrevivência global entre as margens livres e acometidas, assim como não houve diferença entre as margens subcentimétricas e maiores de 1cm. A sobrevida livre de doença dos pacientes com margens microscopicamente acometidas foi significativamente menor do que os pacientes com margens livres (p=0,002). A análise multivariada identificou o tipo de borda infiltrativa como fator de risco para recidiva (0,05). A sobrevida livre de doença foi significativamente menor nos pacientes com borda infiltrativa em comparação com os tumores com bordas expansivas (p=0,05). CONCLUSÕES: As ressecções de metástase hepática com margens livres de doença, independentemente da distância da margem, não influencia na recidiva tumoral (hepática ou extra-hepática) ou sobrevida do paciente. A borda tumoral do tipo infiltrativa foi fator de risco para recidiva / INTRODUCTION: Approximately 50% of patients with colorectal cancer have liver metastases and hepatectomy is the therapeutic procedure of choice. Surgical margin is an ever-recurring discussed prognostic factor, because there is no consensus of the minimum required distance between the metastatic nodule and the liver section line. Some authors reported surgical margin larger than 1 cm as a better prognosis factor ensuring longer survival rates and lower recurrence. However, other studies showed similar outcomes among patients with surgical margins larger than 1 cm, narrow margins and even microscopically affected ones. These controversies led the idea that other biological factors may be involved in the pathophysiology of recurrence. Therefore, it is valuable to assess the relationship between surgical margins of liver resection for colorectal cancer metastases with survival and recurrence. OBJECTIVES: To evaluate the surgical margins size and tumors growth pattern of colorectal liver metastases and its correlation with local recurrence and survival. METHODS: A retrospective study based on review of medical records of 91 patients undergoing resection of colorectal liver metastases during the period between January 2000 and December 2009. In addition, we undertook a detailed pathologic analysis of each pathological specimen with record of the closest surgical margins and tumors growth pattern classification as pushing or infiltrative. RESULTS: There was no statistical difference in recurrence rates and overall survival time between positive or negative margins, as well as no difference between the margins of 1cm width or more with subcentimeter margins. The disease-free survival of patients with microscopically positive margins was significantly lower than patients with negative margins (p = 0.002). Multivariate analysis identified infiltrative tumor growth pattern as a risk factor for recurrence (p=0.05). Disease-free survival was significantly lower in patients with infiltrative growth pattern compared to tumors with expansive margins (p = 0.05). CONCLUSIONS: Colorectal liver metastases resection with negative margins, regardless of width, has no influence on recurrence (hepatic or extrahepatic), neither on patient survival. The infiltrative tumor growth pattern type was a risk factor for recurrence

Jednou z nejsložitěji verifikovaných vlastností programů v oblasti formální analýzy je živost. K jedné z metod ověřujících tuto vlastnost patří i dokazování neukončitelnosti programů. Naše práce popisuje návrh a implementaci dvou algoritmů ověřujících neukončitelnost. Inspirujeme se již existujícími přístupy, jako jsou rekurentní množiny a nadaproximace cyklů s využitím invariantů ve tvaru rekurentních relací. Hlavní výzvu pro nás představovalo přizpůsobení těchto algoritmů SSA (single static assignment) reprezentaci použité v 2LS a jejich celková integrace v našem frameworku. Vzpomínané přístupy se nám podařilo spojit do analýzy neukončitelnosti, která dosahuje nejlepší výsledky v porovnání s existujícími nástroji, které byly srovnané na soutěži SV-COMP 2017.

Approximately one in four men will have surgery for ingunial hernia in their lifetime. In Sweden, 16 000 procedures are performed each year. To investigate the possible link between handling of nerves and sensory disturbance, 97 groins in 92 patients were examined one year after inguinal hernia surgery. Sensory disturbances were found to be common after open surgery (29 %), but were not seen after the laparoscopic procedures. No significant relationship between sensory disturbance and handling of nerves or pain was seen. The risk for recurrence has been significantly reduced due to the use of prosthetic meshes, but continued surveillance of this important outcome will always be necessary. In that context, the time frame in which recurrence develops in relation to possible risk factors can help our understanding of the underlying mechanisms. To explore such temporal relationships, 142,578 patients were included in a register study. A relative over-risk for early recurrence was seen after suture repair, laparoscopic repair, after postoperative complications, and after surgery for previous recurrence. Corticosteroids are known to decrease pain and nausea after several surgical procedures. In a randomised trial on open hernia surgery, 398 patients were randomised to treatment with 12 mg of betamethasone or placebo. Decreased levels of pain were seen on the day of surgery, the next day and after one month. No difference was seen on days 2-7 and after one year. Nausea was not common and did not differ between the groups. Reoperation is sometimes performed to correct a presumed structural defect thought to cause the long-term pain. In order to evaluate the result of such treatment, 111 cases were analysed based on register data, questionnaires and medical records. Sixty-two per-cent of the patients reported an improvement compared to before the reoperation, but a high level of pain remaining (42 %), and impaired quality of life was seen. There was no clear advantage for any surgical intervention over the other.

Understanding the complex growth process of dendritic arbors is essential for the medical field and disciplines like Biology and Neurosciences. The establishment of the dendritic patterns has received increasing attention from experimental researchers that seek to determine the cellular mechanisms that play a role in the growth of neural trees. Our goal in this thesis was to prove the recurrence formula for the probability distribution of all possible neural trees, as well as the formulas of the expected number of active branches and their variances. We also derived formulas for the spatial locations of the optimal targeting region for a tree with branching probability. These formulas were necessary for the simplified stochastic computational model that Osan et al have developed in order to examine how changes in branching probability influence the success of targeting neurons located at different distances away from a starting point.

BACKGROUND:The aim of this study was to evaluate clinico-pathologic specific predictors of recurrence for stage II/III disease. Improving recurrence prediction for resected stage II/III colon cancer patients could alter surveillance strategies, providing opportunities for more informed use of chemotherapy for high risk individuals.METHODS:871 stage II and 265 stage III patients with colon cancers were included. Features studied included surgery date, age, gender, chemotherapy, tumor location, number of positive lymph nodes, tumor differentiation, and lymphovascular and perineural invasion. Time to recurrence was evaluated, using Cox's proportional hazards models. The predictive ability of the multivariable models was evaluated using the concordance (c) index.RESULTS:For stage II cancer patients, estimated recurrence-free survival rates at one, three, five, and seven years following surgery were 98%, 92%, 90%, and 89%. Only T stage was significantly associated with recurrence. Estimated recurrence-free survival rates for stage III patients at one, three, five, and seven years following surgery were 94%, 78%, 70%, and 66%. Higher recurrence rates were seen in patients who didn't receive chemotherapy (p=0.023), with a higher number of positive nodes (p<0.001). The c-index for the stage II model was 0.55 and 0.68 for stage III.CONCLUSIONS:Current clinic-pathologic information is inadequate for prediction of colon cancer recurrence after resection for stage II and IIII patients. Identification and clinical use of molecular markers to identify the earlier stage II and III colon cancer patients at elevated risk of recurrence are needed to improve prognostication of early stage colon cancers.

Bakgrund: Bröstcancer är den vanligast förekommande tumörsjukdomen hos kvinnor och årligen drabbas 8000 personer i Sverige. Risken för återfall är störst de fem första åren, denna risk för återfall kan väcka en rädsla. Syfte: Att beskriva bröstcancerdrabbade kvinnors upplevelse av rädsla för återfall. Metod: En allmän litteraturstudie. Den systematiska litteratursökningen resulterade i tio kvalitativa artiklar. Resultat: Rädsla för återfall var den mest förekommande känslan och den utlöstes främst vid förändringar i kontakten med sjukvården, uppkomsten av oförklarliga fysiska symtom och läkarbesök. Dock förekom det avsaknad av rädsla för återfall hos vissa. Det framkom även att användande av socialt stöd, distraktion och ett positivt synsätt var återkommande bemästringsstrategier för att hantera rädslan för återfall. Diskussion: Det är av stor vikt att sjuksköterskan informerar och motiverar kvinnan till utvecklande av egna bemästringsstrategier. Slutsats: Kunskapen kan och bör tillämpas av sjuksköterskestudenter och sjuksköterskor, för att minska frekvensen av rädsla för återfall hos personer med cancer. Området bör uppmärksammas för vidare forskning. / Background: Breast cancer is the most common cancer disease among women and 8000 people is annually affected in Sweden. The risk of recurrence is the highest within the first five years. The risk can trigger a sense of fear. Aim: To describe how women with breast cancer experience fear of recurrence. Method: A literature review. The systematic literature search resulted in ten qualitative articles. Results: Fear of recurrence was the most frequent emotion and was primarily triggered by changes in contact with health care, the emergence of unexplainable physical symptoms and doctor appointments. Though, absence of fear of recurrence occurred among some women. Usage of social support, distraction and positive approach emerged to be the most common coping strategies to deal with fear of recurrence. Discussion: It’s significant that the nurse informs and motivates women to the development of their own coping strategies. Conclusion: The knowledge can and ought to be practiced by nursing students and nurses, to reduce the frequency of fear of recurrence among people with cancer. This field ought to be noticed for further research.

Prognostic models have clinical appeal to aid therapeutic decision making. In the UK, the Nottingham Prognostic Index (NPI) has been used, for over two decades, to inform patient management. However, it has been commented that NPI is not capable of identifying a subgroup of patients with a prognosis so good that adjuvant therapy with potential harmful side effects can be withheld safely. Tissue Microarray Analysis (TMA) now makes possible measurement of biological tissue microarray features of frozen biopsies from breast cancer tumours. These give an insight to the biology of tumour and hence could have the potential to enhance prognostic modelling. I therefore wished to investigate whether biomarkers can add value to clinical predictors to provide improved prognostic stratification in terms of Recurrence Free Survival (RFS). However, there are very many biomarkers that could be measured, they usually exhibit skewed distribution and missing values are common. The statistical issues raised are thus number of variables being tested, form of the association, imputation of missing data, and assessment of the stability and internal validity of the model. Therefore the specific aim of this study was to develop and to demonstrate performance of statistical modelling techniques that will be useful in circumstances where there is a surfeit of explanatory variables and missing data; in particular to achieve useful and parsimonious models while guarding against instability and overfitting. I also sought to identify a subgroup of patients with a prognosis so good that a decision can be made to avoid adjuvant therapy. I aimed to provide statistically robust answers to a set of clinical question and develop strategies to be used in such data sets that would be useful and acceptable to clinicians. A unique data set of 401 Estrogen Receptor positive (ER+) tamoxifen treated breast cancer patients with measurement for a large panel of biomarkers (72 in total) was available. Taking a statistical approach, I applied a multi-faceted screening process to select a limited set of potentially informative variables and to detect the appropriate form of the association, followed by multiple imputations of missing data and bootstrapping. In comparison with the NPI, the final joint model derived assigned patients into more appropriate risk groups (14% of recurred and 4% of non-recurred cases). The actuarial 7-year RFS rate for patients in the lowest risk quartile was 95% (95% C.I.: 89%, 100%). To evaluate an alternative approach, biological knowledge was incorporated into the process of model development. Model building began with the use of biological expertise to divide the variables into substantive biomarker sets on the basis of presumed role in the pathway to cancer progression. For each biomarker family, an informative and parsimonious index was generated by combining family variables, to be offered to the final model as intermediate predictor. In comparison with NPI, patients into more appropriate risk groups (21% of recurred and 11% of non-recurred patients). This model identified a low-risk group with 7-year RFS rate at 98% (95% C.I.: 96%, 100%).

Venous leg ulceration has a high recurrence rate. Patients with healed or frequently recurring venous ulceration are required to perform self-care behaviours to prevent recurrence or promote healing, but many find these difficult to perform. Bandura’s self-efficacy theory is a widely used and robust behaviour change model and underpins many interventions designed to promote self-care in a variety of chronic conditions. By identifying areas where patients may experience difficulty in performing self-care, interventions can be developed to strengthen their self-efficacy beliefs in performing these activities successfully. There are currently a variety of self-efficacy scales available to measure self-efficacy in a variety of conditions; but not a disease-specific scale for use with venous ulcer patients. The aim of this study, therefore, was to develop a disease-specific, patient-focused self-efficacy scale for patients with healed venous leg ulceration. Phase 1 consisted of a qualitative design and used focus group methodology to generate an item pool for potential inclusion into the scale from the patients’ perspective. In phase 2, factor analysis using equamax orthogonal rotation methods was used to reduce the items from 60 to 30, resulting in 5 major domains: general self-care; daily self-care tasks; normal living; developing expertise and avoiding trauma. Preliminary reliability studies indicated that the developed scale, VeLUSET© has good internal consistency, with an overall Cronbach alpha of .929 and a strong test-re-test reliability. Furthermore, correlation with the General Self-Efficacy Scale demonstrated a strong positive relationship between the two scales. These results indicate that the VeLUSET©, although still in the early validation stages, is a reliable instrument to measure venous leg ulcer patients’ self-efficacy in performing self-care tasks within clinical practice. The development of this disease-specific tool has now filled a gap in the research on managing patients with healed venous leg ulceration.

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