Estudo comparativo da viabilidade miocárdica em áreas dissinérgicas ao ecocardiograma basal : cintilografia tomográfica com Tecnécio 99m-mibi sob baixa dose de Dobutamina versus Tálio em repouso-redistribuição

A cintilografia com radioisótopos em repouso tem despertado muito interesse nos últimos anos para pesquisa da viabilidade miocárdica na disfunção isquêmica avançada do VE, porque esta pode ser reversível e porque há melhora prognóstica neste contexto. O objetivo desse trabalho é buscar identificar a acurácia da cintilografia tomográfica Tc-99m-Sestamibi, sob a infusão de dobutamina em baixa dose. Foram protocolados trinta pacientes que sofreram um infarto do miocárdio com padrão “Q”, com dissinergia ao ecocardiograma, e submetidos a estudos perfusionais em dias diferentes, com Tc-99m-Sestamibi − dobutamina e Tl-201 em repouso-redistribuição 4 horas, usado como padrão ouro. Não ocorreram complicações com nenhum paciente submetido ao protocolo do estudo. Os resultados revelaram: sensibilidade = 85%, especificidade = 87%, valor preditivo positivo = 96%, valor preditivo negativo = 65 % e acurácia de = 85,2%. A razão de probabilidade positiva foi de 6,68 e a razão de probabilidade negativa de 0,17. Confrontando-se nossos dados com uma metanálise de resultados para o Tc-99m-Sestamibi em repouso, a sensibilidade no presente estudo foi 85% vs. 81% e a especificidade de 87% vs. 60%. Em relação aos dados da literatura para Tl-201: 85% vs. 90% e 87% vs. 54%, sensibilidade e especificidade, respectivamente. Em conclusão, o Tc-99m-Sestamibi sob a infusão de dobutamina parece ser um método promissor para detectar viabilidade superior a esta modalidade de cintilografia em repouso, com valores preditivos comparáveis à literatura disponível para esse mesmo método: 85,2% vs. 87%, 96% vs. 90% e 65% vs. 83%, para acurácia, valor preditivo positivo e valor preditivo negativo, respectivamente.

Estudo de caso-controle para desenvolvimento e validação de um questionário de avaliação de abuso sexual em crianças

Objetivos: Desenvolver e validar instrumento que auxilie o pediatra a determinar a probabilidade de ocorrência do abuso sexual em crianças. Métodos: Estudo de caso-controle com 201 crianças que consultaram em ambulatórios de pediatria e locais de referência para vítimas de abuso sexual, entre março e novembro de 2004: grupo caso (com suspeita ou revelação de abuso sexual) e grupo controle (sem suspeita de abuso sexual). Aplicou-se, junto aos responsáveis, um questionário com 18 itens e cinco opções de respostas segundo a escala Likert, abordando comportamento, sintomas físicos e emocionais apresentados pelas crianças. Excluíram-se nove crianças sem controle esfincteriano e um item respondido por poucas pessoas. A validade e consistência interna dos itens foram avaliadas com obtenção de coeficientes de correlação (Pearson, Spearman e Goodman-Kruskal), coeficiente α de Cronbach e cálculo da área da curva ROC. Calculou-se, após, a razão de verossimilhança (RV) e os valores preditivo positivos (VPP) para os cinco itens do questionário que apresentaram os melhores desempenhos. Resultados: Obteve-se um questionário composto pelos cinco itens que melhor discriminaram crianças com e sem abuso sexual em dois contextos. Cada criança recebeu um escore resultante da soma das respostas com pesos de 0 a 4 (amplitude de 0 a 20), o qual, através do teorema de Bayes (RV), indicou sua probabilidade pós-teste (VPP) de abuso sexual. Conclusões: O instrumento proposto é útil por ser de fácil aplicação, auxiliando o pediatra na identificação de crianças vítimas de abuso sexual. Ele fornecerá, conforme o escore obtido, a probabilidade (VPP) de abuso sexual, orientando na conduta de cuidado à criança.

Wald tests for IV regression with weak instruments

This dissertation deals with the problem of making inference when there is weak identification in models of instrumental variables regression. More specifically we are interested in one-sided hypothesis testing for the coefficient of the endogenous variable when the instruments are weak. The focus is on the conditional tests based on likelihood ratio, score and Wald statistics. Theoretical and numerical work shows that the conditional t-test based on the two-stage least square (2SLS) estimator performs well even when instruments are weakly correlated with the endogenous variable. The conditional approach correct uniformly its size and when the population F-statistic is as small as two, its power is near the power envelopes for similar and non-similar tests. This finding is surprising considering the bad performance of the two-sided conditional t-tests found in Andrews, Moreira and Stock (2007). Given this counter intuitive result, we propose novel two-sided t-tests which are approximately unbiased and can perform as well as the conditional likelihood ratio (CLR) test of Moreira (2003).

Optimal two-sided tests for instrumental variables regression with heteroskedastic and autocorrelated errors

This paper considers two-sided tests for the parameter of an endogenous variable in an instrumental variable (IV) model with heteroskedastic and autocorrelated errors. We develop the nite-sample theory of weighted-average power (WAP) tests with normal errors and a known long-run variance. We introduce two weights which are invariant to orthogonal transformations of the instruments; e.g., changing the order in which the instruments appear. While tests using the MM1 weight can be severely biased, optimal tests based on the MM2 weight are naturally two-sided when errors are homoskedastic. We propose two boundary conditions that yield two-sided tests whether errors are homoskedastic or not. The locally unbiased (LU) condition is related to the power around the null hypothesis and is a weaker requirement than unbiasedness. The strongly unbiased (SU) condition is more restrictive than LU, but the associated WAP tests are easier to implement. Several tests are SU in nite samples or asymptotically, including tests robust to weak IV (such as the Anderson-Rubin, score, conditional quasi-likelihood ratio, and I. Andrews' (2015) PI-CLC tests) and two-sided tests which are optimal when the sample size is large and instruments are strong. We refer to the WAP-SU tests based on our weights as MM1-SU and MM2-SU tests. Dropping the restrictive assumptions of normality and known variance, the theory is shown to remain valid at the cost of asymptotic approximations. The MM2-SU test is optimal under the strong IV asymptotics, and outperforms other existing tests under the weak IV asymptotics.

Comparação, em mulheres inférteis, de teste de avaliação psicológica com a análise psicanalítica clássica

This study aims to compare a psychological evaluation test to classical psychoanalysis in infertile women. Two hundred women were submitted to the Psychological Evaluation Test (PET). The sum of the scores for the responses ranged from 15 to 60 points, with scores ≥ 30 points being defined as psycho-emotional maladjustment (cut-off point: median + 25%). For comparison, a psychologist submitted the patients to a psychological examination simultaneously, who was unaware of the PET results. From the 200 patients, 66 (33%) presented a test with ≥ 30 points (psycho-emotional maladjustment) and 134 (67%) a test with < 30 points (normal). Upon psychological examination, 105 (52.5%) presented an abnormal evaluation and 95 (47.5%) a normal evaluation. For the PET, statistical analysis showed 82% efficiency, 62% sensitivity, 98% positive predictive value, 99% specificity, 70% negative predictive value, likelihood ratio for a positive test result 62, and likelihood ratio for negative test result 0.38. The PET proved to be a useful clinical instrument, being of help for the selection of patients with psychological needs induced by infertility.

Prospective study of postoperative sensory disturbances after surgical treatment of mandibular fractures

Introduction: This present study's purpose is to evaluate the degree of paresthesia and recovery of inferior alveolar nerve in patients with mandible fractures who underwent surgical treatment. Material and methods: Nineteen patients were evaluated (27 hemimandibles) at six different times: preoperative (T1), postoperative 1 week (T2), postoperative 1 month (T3), postoperative 3 months (T4), postoperative 6 months (T5), and postoperative 1 year (T6). Subjective and objective methods were used for this evaluation. Results: The results were analyzed using likelihood ratio chi-square test for the hypothesis of no association between indicators of sensitivity and responses to the questionnaire, and the Cochran-Mantel-Haenszel test for equality hypothesis. All objective tests showed a statistically significant worsening in sensitivity at T2 (p < 0. 0001) and a significant improvement after T4 (α < 0. 05). The subjective tests showed an association with the objectives tests, and improvement in sensitivity after T4 (p < 0. 0001) was noted. Discussion: The first postoperative week is the period in which there are major changes with respect to sensitivity, and after 3 months postoperatively, the recovery reaches its apex with little difference observed after this period. In this research 100 % of the patients analyzed recovered all sensibility until T6. © 2012 Springer-Verlag.

Sequential Sampling Plan for Tenuipalpus heveae Baker (Acari: Tenuipalpidae) on Rubber Tree

The objective of the present study was to develop a sequential sampling plan for the decision-making process to control Tenuipalpus heveae Baker (Acari: Tenuipalpidae), an important pest of the rubber tree crop. The experimental area was represented by 1,000 plants of the RRIM 600 clone divided in 100 plots with 10 plants each. Leaves were collected and the number of mites determined under laboratory conditions. The sequential sampling plan was developed in accordance with the Sequential Test Likelihood Ratio. The value 0.10 was pre-established for α and β representing type I and type II errors, respectively. The level of control adopted was six mites per 12 cm2. The operating characteristic curve and the curve of maximum expected sample were determined. Two lines were generated: the upper one, when the condition for chemical control is recommended (S1 = 23.3080 + 2.1972); and the lower, when chemical control is not recommended (S0 = -23.3080 + 2.1972). Sample size for the decision-making process to control T. heveae requires 6 to 18 plants. © 2013 Sociedade Entomológica do Brasil.

Distribuição espacial e plano de amostragem seqüencial de ácaros fitófagos na cultura da seringueira [Hevea brasiliensis (Wild. Ex Adr. de Juss.) Müell.Arg.]

Pós-graduação em Agronomia - FEIS

Descrição do potencial de retenção de nitrogênio em frangas de postura por diferentes metodologias: máxima deposição e estimativas da ingestão de metionina+cistina

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Lesões bucomaxilofaciais: estudo dos casos periciados de 2007 a 2013 no Instituto Médico Legal Nina Rodrigues - Salvador / BA

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diagnostic accuracy of the EMG parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome

Objective To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). Design Sensitivity and specificity analysis. Setting Physical rehabilitation center and laboratory of biomechanics and motor control. Participants Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. Interventions Not applicable. Main Outcome Measure The diagnostic accuracy was calculated for sEMG parameters’ reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. Results The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80–.90), precise (SEM=2.71–3.87 normalized unit), and able to differentiate participants with and without PFPS (P<.05). The association of B2 with anterior knee pain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). Conclusions The results provide evidence to support the use of EMG signals (B2 – frequency band of 45–96Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS.

Validation of the Short-Version of Rose Angina Questionnaire in Brazil

Background: Stable angina pectoris is a serious condition with few epidemiological studies in Brazil. Objective: To validate the short-version of the Rose angina questionnaire in Brazilian Portuguese for its implementation in surveys and longitudinal studies. Methods: A total of 116 consecutive patients from an outpatient clinic without prior myocardial infarction and/or coronary revascularization were enrolled for application of three questions of the Rose angina questionnaire addressing chest pain after exertion. We used the treadmill test as the gold standard with the Ellestad protocol. Results: The short-version of the Rose angina questionnaire of the 116 subjects submitted to the exercise treadmill test disclosed 89.7% of accuracy, 25% of sensitivity, 92.0% of specificity, 10.0% of positive predictive value, 97.2% of negative predictive value, and 3.1 of positive likelihood ratio and 0.82 of negative likelihood ratio. Conclusion: The Portuguese version with three items of the Rose angina questionnaire is suitable for epidemiological purposes. (Arq Bras Cardiol 2012; 99(5): 1056-1059)

Bartlett corrections in Birnbaum-Saunders nonlinear regression models

Lemonte and Cordeiro [Birnbaum-Saunders nonlinear regression models, Comput. Stat. Data Anal. 53 (2009), pp. 4441-4452] introduced a class of Birnbaum-Saunders (BS) nonlinear regression models potentially useful in lifetime data analysis. We give a general matrix Bartlett correction formula to improve the likelihood ratio (LR) tests in these models. The formula is simple enough to be used analytically to obtain several closed-form expressions in special cases. Our results generalize those in Lemonte et al. [Improved likelihood inference in Birnbaum-Saunders regressions, Comput. Stat. DataAnal. 54 (2010), pp. 1307-1316], which hold only for the BS linear regression models. We consider Monte Carlo simulations to show that the corrected tests work better than the usual LR tests.

Essays in Macroecometrics: methodological aspects and empirical applications

In the first chapter, I develop a panel no-cointegration test which extends Pesaran, Shin and Smith (2001)'s bounds test to the panel framework by considering the individual regressions in a Seemingly Unrelated Regression (SUR) system. This allows to take into account unobserved common factors that contemporaneously affect all the units of the panel and provides, at the same time, unit-specific test statistics. Moreover, the approach is particularly suited when the number of individuals of the panel is small relatively to the number of time series observations. I develop the algorithm to implement the test and I use Monte Carlo simulation to analyze the properties of the test. The small sample properties of the test are remarkable, compared to its single equation counterpart. I illustrate the use of the test through a test of Purchasing Power Parity in a panel of EU15 countries. In the second chapter of my PhD thesis, I verify the Expectation Hypothesis of the Term Structure in the repurchasing agreements (repo) market with a new testing approach. I consider an "inexact" formulation of the EHTS, which models a time-varying component in the risk premia and I treat the interest rates as a non-stationary cointegrated system. The effect of the heteroskedasticity is controlled by means of testing procedures (bootstrap and heteroskedasticity correction) which are robust to variance and covariance shifts over time. I fi#nd that the long-run implications of EHTS are verified. A rolling window analysis clarifies that the EHTS is only rejected in periods of turbulence of #financial markets. The third chapter introduces the Stata command "bootrank" which implements the bootstrap likelihood ratio rank test algorithm developed by Cavaliere et al. (2012). The command is illustrated through an empirical application on the term structure of interest rates in the US.

Study of the sensitivity of the XENON1T experiment with the profile likelihood method

Oggi sappiamo che la materia ordinaria rappresenta solo una piccola parte dell'intero contenuto in massa dell'Universo. L'ipotesi dell'esistenza della Materia Oscura, un nuovo tipo di materia che interagisce solo gravitazionalmente e, forse, tramite la forza debole, è stata avvalorata da numerose evidenze su scala sia galattica che cosmologica. Gli sforzi rivolti alla ricerca delle cosiddette WIMPs (Weakly Interacting Massive Particles), il generico nome dato alle particelle di Materia Oscura, si sono moltiplicati nel corso degli ultimi anni. L'esperimento XENON1T, attualmente in costruzione presso i Laboratori Nazionali del Gran Sasso (LNGS) e che sarà in presa dati entro la fine del 2015, segnerà un significativo passo in avanti nella ricerca diretta di Materia Oscura, che si basa sulla rivelazione di collisioni elastiche su nuclei bersaglio. XENON1T rappresenta la fase attuale del progetto XENON, che ha già realizzato gli esperimenti XENON10 (2005) e XENON100 (2008 e tuttora in funzione) e che prevede anche un ulteriore sviluppo, chiamato XENONnT. Il rivelatore XENON1T sfrutta circa 3 tonnellate di xeno liquido (LXe) e si basa su una Time Projection Chamber (TPC) a doppia fase. Dettagliate simulazioni Monte Carlo della geometria del rivelatore, assieme a specifiche misure della radioattività dei materiali e stime della purezza dello xeno utilizzato, hanno permesso di predire con accuratezza il fondo atteso. In questo lavoro di tesi, presentiamo lo studio della sensibilità attesa per XENON1T effettuato tramite il metodo statistico chiamato Profile Likelihood (PL) Ratio, il quale nell'ambito di un approccio frequentista permette un'appropriata trattazione delle incertezze sistematiche. In un primo momento è stata stimata la sensibilità usando il metodo semplificato Likelihood Ratio che non tiene conto di alcuna sistematica. In questo modo si è potuto valutare l'impatto della principale incertezza sistematica per XENON1T, ovvero quella sulla emissione di luce di scintillazione dello xeno per rinculi nucleari di bassa energia. I risultati conclusivi ottenuti con il metodo PL indicano che XENON1T sarà in grado di migliorare significativamente gli attuali limiti di esclusione di WIMPs; la massima sensibilità raggiunge una sezione d'urto σ=1.2∙10-47 cm2 per una massa di WIMP di 50 GeV/c2 e per una esposizione nominale di 2 tonnellate∙anno. I risultati ottenuti sono in linea con l'ambizioso obiettivo di XENON1T di abbassare gli attuali limiti sulla sezione d'urto, σ, delle WIMPs di due ordini di grandezza. Con tali prestazioni, e considerando 1 tonnellata di LXe come massa fiduciale, XENON1T sarà in grado di superare gli attuali limiti (esperimento LUX, 2013) dopo soli 5 giorni di acquisizione dati.