Alternative analytical methods for the identification of cancer-related symptom clusters

Advances in symptom management strategies through a better understanding of cancer symptom clusters depend on the identification of symptom clusters that are valid and reliable. The purpose of this exploratory research was to investigate alternative analytical approaches to identify symptom clusters for patients with cancer, using readily accessible statistical methods, and to justify which methods of identification may be appropriate for this context. Three studies were undertaken: (1) a systematic review of the literature, to identify analytical methods commonly used for symptom cluster identification for cancer patients; (2) a secondary data analysis to identify symptom clusters and compare alternative methods, as a guide to best practice approaches in cross-sectional studies; and (3) a secondary data analysis to investigate the stability of symptom clusters over time. The systematic literature review identified, in 10 years prior to March 2007, 13 cross-sectional studies implementing multivariate methods to identify cancer related symptom clusters. The methods commonly used to group symptoms were exploratory factor analysis, hierarchical cluster analysis and principal components analysis. Common factor analysis methods were recommended as the best practice cross-sectional methods for cancer symptom cluster identification. A comparison of alternative common factor analysis methods was conducted, in a secondary analysis of a sample of 219 ambulatory cancer patients with mixed diagnoses, assessed within one month of commencing chemotherapy treatment. Principal axis factoring, unweighted least squares and image factor analysis identified five consistent symptom clusters, based on patient self-reported distress ratings of 42 physical symptoms. Extraction of an additional cluster was necessary when using alpha factor analysis to determine clinically relevant symptom clusters. The recommended approaches for symptom cluster identification using nonmultivariate normal data were: principal axis factoring or unweighted least squares for factor extraction, followed by oblique rotation; and use of the scree plot and Minimum Average Partial procedure to determine the number of factors. In contrast to other studies which typically interpret pattern coefficients alone, in these studies symptom clusters were determined on the basis of structure coefficients. This approach was adopted for the stability of the results as structure coefficients are correlations between factors and symptoms unaffected by the correlations between factors. Symptoms could be associated with multiple clusters as a foundation for investigating potential interventions. The stability of these five symptom clusters was investigated in separate common factor analyses, 6 and 12 months after chemotherapy commenced. Five qualitatively consistent symptom clusters were identified over time (Musculoskeletal-discomforts/lethargy, Oral-discomforts, Gastrointestinaldiscomforts, Vasomotor-symptoms, Gastrointestinal-toxicities), but at 12 months two additional clusters were determined (Lethargy and Gastrointestinal/digestive symptoms). Future studies should include physical, psychological, and cognitive symptoms. Further investigation of the identified symptom clusters is required for validation, to examine causality, and potentially to suggest interventions for symptom management. Future studies should use longitudinal analyses to investigate change in symptom clusters, the influence of patient related factors, and the impact on outcomes (e.g., daily functioning) over time.

Spectral coding methods for speech compression and speaker identification

This thesis investigates aspects of encoding the speech spectrum at low bit rates, with extensions to the effect of such coding on automatic speaker identification. Vector quantization (VQ) is a technique for jointly quantizing a block of samples at once, in order to reduce the bit rate of a coding system. The major drawback in using VQ is the complexity of the encoder. Recent research has indicated the potential applicability of the VQ method to speech when product code vector quantization (PCVQ) techniques are utilized. The focus of this research is the efficient representation, calculation and utilization of the speech model as stored in the PCVQ codebook. In this thesis, several VQ approaches are evaluated, and the efficacy of two training algorithms is compared experimentally. It is then shown that these productcode vector quantization algorithms may be augmented with lossless compression algorithms, thus yielding an improved overall compression rate. An approach using a statistical model for the vector codebook indices for subsequent lossless compression is introduced. This coupling of lossy compression and lossless compression enables further compression gain. It is demonstrated that this approach is able to reduce the bit rate requirement from the current 24 bits per 20 millisecond frame to below 20, using a standard spectral distortion metric for comparison. Several fast-search VQ methods for use in speech spectrum coding have been evaluated. The usefulness of fast-search algorithms is highly dependent upon the source characteristics and, although previous research has been undertaken for coding of images using VQ codebooks trained with the source samples directly, the product-code structured codebooks for speech spectrum quantization place new constraints on the search methodology. The second major focus of the research is an investigation of the effect of lowrate spectral compression methods on the task of automatic speaker identification. The motivation for this aspect of the research arose from a need to simultaneously preserve the speech quality and intelligibility and to provide for machine-based automatic speaker recognition using the compressed speech. This is important because there are several emerging applications of speaker identification where compressed speech is involved. Examples include mobile communications where the speech has been highly compressed, or where a database of speech material has been assembled and stored in compressed form. Although these two application areas have the same objective - that of maximizing the identification rate - the starting points are quite different. On the one hand, the speech material used for training the identification algorithm may or may not be available in compressed form. On the other hand, the new test material on which identification is to be based may only be available in compressed form. Using the spectral parameters which have been stored in compressed form, two main classes of speaker identification algorithm are examined. Some studies have been conducted in the past on bandwidth-limited speaker identification, but the use of short-term spectral compression deserves separate investigation. Combining the major aspects of the research, some important design guidelines for the construction of an identification model when based on the use of compressed speech are put forward.