This study investigated international medical graduates (IMGs), registered between January 1, 2007 and April 14, 2011, at the Access Centre for Internationally Educated Health Professionals in Ontario. By way of logistic regression in a cross-sectional design, it was found that permanent residents who were recent immigrants had lesser chances of being employed full-time at registration (baseline). By way of survival analysis in a cohort design, it was found that younger IMGs who have been in Canada less than 5 years and who have taken the Medical Council of Canada Evaluating Exam (MCCEE) have the greatest chances of securing residency positions in Canada or the US, whereas IMGs from Eastern Europe, South Asia and Africa have lesser chances. It was revealed that registered IMGs are a vulnerable population, and certain groups may be disadvantaged due to underlying characteristics. These groups can be targeted for specific interventions.

Background: Prostate Cancer (PC) is a common and highly variable disease. Using current diagnostic methods, the prostate specific antigen (PSA) blood test and histological grading of prostate tissue needle biopsies, it is often difficult to evaluate whether the patient has a PC that requires active treatment or not. The absolute majority of all 10,000 cases of PCs diagnosed annually in Sweden have tumours graded as Gleason score (GS) 6-7 and a PSA value in blood below 10. Many of these are harmless and can be left without active treatment and hence spared problematic post-therapy side-effects, others are highly malignant and require early diagnosis and treatment. Better prognostic markers are needed and the aim of this study was to evaluate prognostic markers and to test if these markers could identify patients with indolent tumours. Methods: We have studied tumour material from 419 men consecutively diagnosed with PC at transurethral resection (1975-1990). The majority of these patients (295) had no metastasis at diagnosis and was not given any curative treatment and only hormonal treatment upon symptoms from metastatic progression. Standard histological sections and tissue microarrays (TMA) from these tumours and surrounding normal prostate tissue were stained and evaluated for cell proliferation (Ki67), blood vessels (endoglin and von Willebrand factor, vWf) and the extracellular matrix component hyaluronan (HA). An orthotopic rat PC model was used to explore hyaluronan staining, hyaluronic acid synthase (HAS)-1 mRNA levels and the effect of local HA treatment on tumour growth. Results: Tumour cell proliferation (Ki67) and the density of intra-tumoural endoglin stained blood vessels were independent prognostic markers (i.e. they added prognostic information to the conventional prognostic markers; clinical stage and GS). None of the GS 6 patients with low staining for both Ki67 and endoglin died of PC within 15 years of follow-up. High HA staining in the tumour epithelium and stroma was a negative prognostic marker of cancer specific survival but they were not independent of GS. High HA staining and high vascular density in the stroma of the surrounding morphologically normal prostate were prognostic for short cancer specific survival. Implantation of tumour cells in the normal rat prostate resulted in an increase in HA and HAS-1 mRNA levels in the prostate tissue surrounding prostate tumours. Concurrently intra-prostatic injection of HA also stimulated tumour growth. Conclusions: By evaluating both tumour cell proliferation (Ki67) and vascular density, it is possible to identify patients with very low risk of cancer specific death in the absence of active treatment. Prostate tumours influence the surrounding non-malignant prostate tissue, for example they cause an increased angiogenesis and synthesis of hyaluronan. Such responses can possibly be used to diagnose PC and to evaluate PC aggressiveness.

Thesis (Ph.D. in Clinical Science) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 86-91). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 100-107). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Submitted by Ronildo Prado (ronisp@ufscar.br) on 2017-08-17T14:39:42Z No. of bitstreams: 1 DissTRR.pdf: 2739559 bytes, checksum: 80c76b7b0d4fcf15e1c9962556cd8745 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-08-17T14:39:52Z (GMT) No. of bitstreams: 1 DissTRR.pdf: 2739559 bytes, checksum: 80c76b7b0d4fcf15e1c9962556cd8745 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-08-17T14:39:58Z (GMT) No. of bitstreams: 1 DissTRR.pdf: 2739559 bytes, checksum: 80c76b7b0d4fcf15e1c9962556cd8745 (MD5) / Made available in DSpace on 2017-08-17T14:40:04Z (GMT). No. of bitstreams: 1 DissTRR.pdf: 2739559 bytes, checksum: 80c76b7b0d4fcf15e1c9962556cd8745 (MD5) Previous issue date: 2017-03-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The frailty models are used to model the possible associations between survival times. Another alternative developed for modeling the dependence between multivariate data is the use of models based on copulas functions. In this paper we propose two derived survival models of copula of the Ali-Mikhail-Haq (AMH) and of the Frank to model the dependence of bivariate data in the presence of covariates and censored observations. For inferential purposes, we conducted a Bayesian approach using Monte Carlo methods in Markov Chain (MCMC). Some discussions on the model selection criteria were presented. In order to detect influential observations we use the Bayesian method of cases of deletion of influence analysis based on the difference ^. Finally, we show the applicability of the proposed models to sets of simulated and real data. We present, too, a new survival model with bivariate fraction of healing, which takes into account three settings for the latent activation mechanism: random activation, first activation and final activation. We apply this model to a set of Direct Credit loan data to the Consumer mode (DCC) and compare the settings, through Bayesian criteria for selection of models, which of the three models best fit. Finally, we show our future proposal for further research. / Os modelos de fragilidade são utilizados para modelar as possíveis associações entre os tempos de sobrevivência. Uma outra alternativa desenvolvida para modelar a dependência entre dados multivariados e o uso dos modelos baseados em funções cápulas. Neste trabalho propusemos dois modelos de sobrevivência derivados das copulas de Ali-Mikhail-Haq (AMH) e de Frank para modelar a dependência de dados bivariados na presença de covariáveis e observações censuradas. Para fins inferenciais, realizamos uma abordagem bayesiana usando métodos Monte Carlo em Cadeias de Markov (MCMC). Algumas discussões sobre os critérios de seleção de modelos são apresentadas. Com o objetivo de detectar observações influentes utilizamos o método bayesiano de analise de influencia de deleção de casos baseado na divergência. Por fim, mostramos a aplicabilidade dos modelos propostos a conjuntos de dados simulados e reais. Apresentamos, também, um novo modelo de sobrevivência bivariado com fração de cura, que leva em consideração três configurações para o mecanismo de ativação latente: ativação aleatória, primeira ativação e áltima ativação. Aplicamos este modelo a um conjunto de dados de empréstimo de Credito Direto ao modo do Consumidor (DCC) e comparamos os ajustes por meio dos critérios bayesianos de seleção de modelos para verificar qual dos três modelos melhor se ajustou. Por fim, mostramos nossa proposta futura para a continuaçaão da pesquisa.

Orientador: Rogério Antonio Oliveira / Resumo: A cirrose é uma doença hepática assintomática que, muitas vezes, é descoberta quando o quadro é irreversível. Por isso, o tratamento consiste em uma série de medidas para controlar o avanço da enfermidade, visto que a principal consequência da cirrose é o aumento da pressão na veia portal, que por sua vez, acarreta no surgimento de varizes e no seu respectivo rompimento, podendo ser fatal. Estudos relacionados à esta doença são muito importantes, pois a análise estatística é uma ferramenta que permite auxiliar na tomada de decisões nos procedimentos médicos e acompanhamento de pacientes. Um método estatístico bastante explorado nas ciências biomédicas é a análise de sobrevivência, que consiste em descrever o tempo de um evento inicial até a ocorrência de um outro de interesse. No entanto, existem situações em que uma proporção da amostra não vivencia o desfecho de interesse, mesmo que acompanhado por um período longo de tempo. Nestes casos, tais observações são dita imunes ao desfecho de interesse e as metodologias tradicionais de análise de sobrevivência não são indicadas. Logo, os modelos de fração de cura ou de longa duração, desenvolvido a partir do modelo de mistura, são os utilizados nestas situações. Neste trabalho diverso modelos foram considerados para analisar os tempos de vida de pacientes submetidos à Ligadura Elástica de Varizes Esofágicas, ao qual foram anotados os tempos até o óbito durante o acompanhamento de 129 pacientes do Hospital das Clínicas da Faculdade... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cirrhosis is an asymptomatic liver disease that is often discovered when the patient's condition is irreversible. Therefore, the treatment consists of a series of measures to control the progression of the disease, since the main consequence of the cirrhosis is the increase of the portal venous pressure, which causes the appearance of varices and their respective rupture may be fatal. Studies related to that disease are very important, so the statistical analysis is a tool that helps to make decisions in medical procedures and patient follow-up. The most applied statistical method in the biomedical sciences is survival analysis, which consists of describing the time of occurrence until the event of interest. However, there are situations in which a proportion of the sample does not experience the interest outcome, even if they are accompanied by a long period of time. In such cases, such observations are said to be immune to the outcome of interest and traditional survival analysis methodologies are not appropriated. Therefore, the care fraction or long duration models can be used in these situations because they incorporate mixtures of models to solve the complexity inherent in the actual study. In this work, some statistical models were considered to analyze the survival times of patients, after surgery of Endoscopic Band Ligation of the Esophageal Varices, such as Exponential, Gamma and Weibull models. The data is related to survival times of 129 patients, who were treated... (Complete abstract click electronic access below) / Mestre

The partial removal of carious dentine was studied by means of a literature review and a multicenter randomized controlled clinical trial. The clinical trial compared the effectiveness of an alternative treatment for deep caries lesions and the stepwise excavation in Public Health Services in Brazil. The treatment consists of partial removal of carious dentine followed by restoration in one session. A cost-effectiveness analysis the two treatments was performed. The clinical performance of amalgam and resin restorations placed in deep caries lesions with or without decayed tissue beneath them was also evaluated. Inclusion criteria: patients with ≥ nine years old, permanent molars with deep caries lesions and absence of periapical alterations, pulp sensitivity; absence of spontaneous pain; negative percussion test. The subjects were assigned to: test-group - partial removal of carious dentine (PDR) and restoration, and control-group - stepwise excavation (SW). SW consists of partial removal of carious tissue, indirect pulp capping with calcium hydroxide cement; temporary filling; cavity re-opening after 60 days, removal of the remaining soft carious tissue and filling. Clinical and radiological exams were performed annually. The outcomes were: (1) pulp sensitivity to cold test and absence of periapical alterations, assuming those parameters as indicators of pulp vitality; and (2) success of the restoration. To determine the cost-effectiveness of the treatments, the discounted cash flow method was adopted. The data were submitted to Kaplan-Meier, Log-rank test and logistic regression analysis, P<0.05. There were performed 299 treatments, 146 SW and 153 tests. There were no differences between the groups regarding baseline characteristics - age, gender and family income. The number of teeth evaluated after one and two years were 180 and 122. After one year of treatment performance, the therapy success rates were 97.9% and 74.1% of success in test and control groups respectively (P<0.000). After 2 years of follow-up, therapy survival rates of PDR and SW were 93.7% and 73.3% respectively (P=0.000). A total of 29 therapeutic failures were observed: PDR group - pulpitis (n=3), osteitis (n=1), hyperemia (n=2); SW group - pulpitis (n=15), necrosis (n=6), extraction (n=1) and restoration fracture (n=1). None of the variables studied showed a significant causal influence on the success rate, besides the type of treatment. After two year of follow-up, 181 restorations had been evaluated, 86 from the SW group and 95 from the PDR group; 65.8% were from the resin composite group and 34.2% were amalgam restorations. The survival analysis of the treatment associated with the filling material showed no difference in the rate of success (P=0.564). Regarding the treatment, both groups presented a similar rate of success: SW=95.3% and PDR=94.7% (P=0.928). Resin composite restorations presented 96.8% of success and amalgam restorations presented 94.1% of success (P=0.446). The reason for failure was fracture of filling material. The PDR provides an economy of R$ 143.37 (67.78%) per treatment compare to SW and 2.39% in the overall economy in the annual cost of the public health center. Partial caries removal could be performed as definitive treatment and the procedure of re-opening the cavity to remove the residual infected dentine is not necessary. The maintenance of carious dentine does not interfere in the maintenance of pulp vitality. The presence of decayed tissue in deep caries lesions does not seem to interfere with the survival of the restorations. Performing the partial removal of carious dentine in one session generates benefits for the public finances (direct economy), for the public health services (increase in number of treatments performed) and for the patients (comfort and time).

O acesso universal aos serviços de saúde e terapia antirretroviral foram importantes no aumento da sobrevida de pessoas vivendo com HIV/AIDS (PVHA). A incidência de comorbidades crônicas, porém, aumentou proporcionalmente. Considerando a epidemia de AIDS no RS, especialmente em Porto Alegre, é preciso investigar a sobrevida de PVHA no contexto local, especialmente entre coinfectados HIV/Tuberculose. Dados foram obtidos pelo relacionamento dos bancos SIM e SINAN 2007-2012. Foi utilizado o modelo de regressão de COX para obter o hazard ratio, o método de Kaplan-Meier para estimativas de sobrevida O banco compreendeu 1800 casos notificados em 2007. Correspondem a 60% homens, brancos em sua maioria (67%), com mediana de idade igual a 37 anos (AIQ=14), a maioria dos casos possui baixa escolaridade. Cerca de 70% adquiriu a doença via transmissão sexual. Comparados aos casos notificados por critério óbito, os óbitos totais tem maior proporção de indivíduos de raça/cor preta (46,1% e 32,5%, respectivamente) e maior freqüência de indivíduos do sexo masculino (40,0% e 27,8%, respectivamente). A proporção de dados incompletos também é maior para a escolaridade (72,1% e 68,7%, respect.), contagem de CD4+ (76% e 68%, respect.). Na análise bivariada a transmissão sanguínea, raça/cor negra e baixa escolaridade foram fatores associados a maior risco de óbito. Sexo feminino e idade acima de 30 anos foram fatores associados a menor risco de óbito por AIDS Raça/cor negra, transmissão do HIV pro via sanguínea, presença de infecção por TB e baixa escolaridade são fatores associados à mortalidade aumentada no modelo multivariado. A sobrevida média foi de 1.495 dias (IC 95% 1449 – 1550). O percentual de dados incompletos sugerem que o relacionamento dimensiona a subnotificação mas não qualifica o processo de vigilância. O Critério Óbito representa a perda de oportunidades de intervenção em eventos preveníveis e pode servir como indicador negativo da vigilância. / Universal Access to health services and antiretroviral therapy were crucial in improving the survival or people living with HIV/AIDS (PLHA). The incidence of cronic comorbidities, however, have proportionally rised. Considering the AIDS epidemics in the state of Rio Grande do Sul, specifically in the city of Porto Alegre, it is important to determine the survival of PLHA in a local context, specially between individuals coinfected with TB. Data were obtained by the linkage of SIM and SINAN databases from 2007-2012. A COX regression model was used for the hazard ratios, and the Kaplan-Meier method in order to determine survival estimates. The resulting database had 1800 cases notified in 2007. Sixty percent were male, mostly of white race (67%), median age of 37 years old (IQR=14), mosto f them had low schooling. Around 70% acquired the vírus through sexual transmission. Compared to the total of cases, those notified by the death criteria have proportionally more individuals of the black race (46,1% and 32,5%, respectively) and more males (40% and 27,8%, respectively). The proportion of incomplete data is also higher for scholarity (72,1% and 68,7% respectively) and CD4+ T lymphocite cell count (76% e 68%, respectively). Blood transmission, black race and low scholarity were associated with a higher risk of death in the bivariate analysis. Female gender and age over 30 years were factors associated with a low risk of AIDS-related death. In the multivariate model black race, blood transmission of the vírus e low scholarity were factors associated with higher mortality. Mean survival was of 1495 days (95% CI 1449 – 1550). The proportion of incomplete data suggests that the linkage scales the underreporting but doesn’t qualify the surveillance process. Death criterion represents missed opportunities of interventions in preventable events, and might serve as negative indicator of the surveillance.

Resumo: No Brasil, existem poucos estudos sobre longevidade de vacas de corte, principalmente utilizando ferramentas de análise de sobrevivência na estimação de parâmetros genéticos. Todavia, os critérios para avaliar esta característica são vários, tal que em alguns destes nem todos os registros das vacas nos rebanhos podem ser levados em consideração, devido à metodologia de análise utilizada. Uma variável que é de fácil mensuração e já faz parte da maioria dos controles zootécnicos das fazendas é a idade da vaca ao último parto (IVUP). Neste trabalho, objetivo foi avaliar a longevidade das vacas nos rebanhos utilizando a variável IVUP, por meio da metodologia de análise de sobrevivência. Esta variável foi utilizada mediante um critério para analisar a longevidade produtiva de vacas nos rebanhos. O critério adotado foi a diferença entre a data em relação ao último parto de cada vaca e a data do último parto de cada fazenda. Se esta diferença foi superior a 36 meses, a vaca falhou e foi considerada descartada. Caso contrário, esta vaca foi censurada, indicando que esta ainda poderia ter futuras parições. O critério de 36 meses foi proposto por ser período suficiente para a ocorrência de um novo parto. A metodologia de análise de sobrevivência foi utilizada por considerar dados censurados e não censurados. As variáveis: estação e ano de nascimento de cada vaca, a fazenda e a idade ao primeiro parto foram utilizadas para as análises da variável IVUP. Um estudo prévio por meio de curvas de Kaplan-Meier e o modelo de Cox, utilizando a distribuição gama para os touros, desconsiderando o parentesco entre eles, foram realizados. O software Survival Kit foi empregado para estimação dos parâmetros genéticos, levando em consideração o parentesco entre os animais. Verificou-se que a IVUP apresentou herdabilidade de 0,25, e que seu uso permite avaliar a ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In Brazil, there are few studies about stayability, especially using tools of survival analysis in the estimation of breeding values and heritability. The criteria for evaluating this characteristic are different, such that in some of these not all information in the herds of cows can be taken into consideration, because the method of analysis used. In addition, the definitions that consider the date of disposal of the animal affect the use of information obtained in practice, because until the cows come out of the flock may take years, thus the evaluation of their parents is impaired, since the goal is selection. A variable that is easy to measure and is already part of most controls husbandry farms are cow age at last birth (IVUP). This variable was used by one criterion to analyze the productive longevity of cows in herds. The criterion was the difference between the date from the last delivery date of each cow and the last part of each farm. If this difference was more than 36 months, the cow was considered failed and discarded. Otherwise, this cow was censored, indicating that this could still have further parities. The criterion of 36 months was proposed to be sufficient time for the occurrence of a new birth. The methodology of survival analysis was used. The variables season and year of birth of each cow, farm and age at first birth were used for analysis of variable IVUP. The objective of this study was to evaluate the performance of the variable IVUP through estimates of genetic and fixed effect, to study the longevity of cows in the herd. A previous study by Kaplan-Meier and Cox model using the gamma distribution for the bulls, disregarding the relationship between them, were performed. The Survival Kit software was used to estimate the genetic parameters, taking into account the relationship between the animals. It was found that the heritability of 0.25 for IVUP ... (Complete abstract click electronic access below) / Orientador: Danísio Prado Munari / Coorientador: Claudia Cristina Paro da Paz / Coorientador: Raysildo Barbosa Lobo / Banca: João Ademir de Oliveira / Banca: Henrique Nunes De Oliveira / Banca: Roberto Carvalheiro / Banca: Lenira El Faro Zadra / Doutor

Submitted by Cristiane Oliveira (cristiane.oliveira@fgv.br) on 2016-03-16T20:24:22Z No. of bitstreams: 1 Dissertacao_Versao Final_pos Banca_v3.pdf: 1185057 bytes, checksum: feed2dbb84423bff900a25bdb3589ead (MD5) / Approved for entry into archive by Renata de Souza Nascimento (renata.souza@fgv.br) on 2016-03-16T21:21:17Z (GMT) No. of bitstreams: 1 Dissertacao_Versao Final_pos Banca_v3.pdf: 1185057 bytes, checksum: feed2dbb84423bff900a25bdb3589ead (MD5) / Made available in DSpace on 2016-03-16T21:21:39Z (GMT). No. of bitstreams: 1 Dissertacao_Versao Final_pos Banca_v3.pdf: 1185057 bytes, checksum: feed2dbb84423bff900a25bdb3589ead (MD5) Previous issue date: 2016 / The intention of this work is to study how the level of capital as a percentage of riskweighted assets, i.e. the Basel Ratio, maintained by the financial intermediaries can serve as a predictor of the failure of these financial intermediaries. One of the challenges was the lack of availability of the Basel Ratio for each institution before 2009, while most of bank failures in Brazil occurred in the period between 1995 and 2005. Considering this, a Synthetic Basel Ratio (IBS) for the period from December 1995 to December 2014 was created, testing the assumption that a higher level of capital in relation to risk assets reduces the likelihood of such a failure. Both logit models with a discrete binary variable and a survival analysis are used, which allow an estimate to be made of how much of an increase in the level of capital brings in terms of life for the institution. The sample studied consist of 313 publicly and privately-owned financial intermediaries operating in Brazil, using semi-annually figures. In line with previous studies, empirical evidence was found pointing to an inverse relation between the level of capital and the likelihood of a failure, seen in the use of both the logit and survival models. / Este trabalho tem como proposta estudar se o nível de capital sobre os ativos ponderados pelo risco, o Índice de Basileia, mantido pelos intermediários financeiros, pode servir como preditor de falência dos intermediários financeiros. Um dos desafios apresentados foi o fato do Índice de Basileia reportado para cada instituição estar disponível ao público apenas a partir de 2009, ao passo que grande parte das falências bancárias no Brasil ocorreram no período entre 1995 e 2005. Dessa forma, construindo um Índice de Basileia Sintético (IBS) para o período de dezembro de 1995 a dezembro de 2014, testou-se a hipótese de que um nível mais alto de capital em relação aos ativos de risco diminui a probabilidade de falência da instituição. São utilizados modelos logit com variável binária discreta e análise survival, possibilitando estimar o quanto que um aumento no nível de capital proporciona em tempo de vida para a instituição. A amostra estudada é composta por 313 intermediários financeiros atuando no Brasil, tanto de controle público quanto privado, com dados semestrais. Em linha com estudos anteriores, foi encontrada evidência empírica apontando para uma relação inversa entre nível de capital e probabilidade de falência, tanto com o emprego de logit como de survival.