Tânia Pereira

Abstract
Nuclear-derived morphological features and biomarkers provide relevant insights regarding the tumour microenvironment, while also allowing diagnosis and prognosis in specific cancer types. However, manually annotating nuclei from the gigapixel Haematoxylin and Eosin (H&E)-stained Whole Slide Images (WSIs) is a laborious and costly task, meaning automated algorithms for cell nuclei instance segmentation and classification could alleviate the workload of pathologists and clinical researchers and at the same time facilitate the automatic extraction of clinically interpretable features for artificial intelligence (AI) tools. But due to high intra- and inter-class variability of nuclei morphological and chromatic features, as well as H&Estains susceptibility to artefacts, state-of-the-art algorithms cannot correctly detect and classify instances with the necessary performance. In this work, we hypothesize context and attention inductive biases in artificial neural networks (ANNs) could increase the performance and generalization of algorithms for cell nuclei instance segmentation and classification. To understand the advantages, use-cases, and limitations of context and attention-based mechanisms in instance segmentation and classification, we start by reviewing works in computer vision and medical imaging. We then conduct a thorough survey on context and attention methods for cell nuclei instance segmentation and classification from H&E-stained microscopy imaging, while providing a comprehensive discussion of the challenges being tackled with context and attention. Besides, we illustrate some limitations of current approaches and present ideas for future research. As a case study, we extend both a general (Mask-RCNN) and a customized (HoVer-Net) instance segmentation and classification methods with context- and attention-based mechanisms and perform a comparative analysis on a multicentre dataset for colon nuclei identification and counting. Although pathologists rely on context at multiple levels while paying attention to specific Regions of Interest (RoIs) when analysing and annotating WSIs, our findings suggest translating that domain knowledge into algorithm design is no trivial task, but to fully exploit these mechanisms in ANNs, the scientific understanding of these methods should first be addressed.

Abstract
The large gap between the generalization level of state-of-the-art machine learning and human learning systems calls for the development of artificial intelligence (AI) models that are truly inspired by human cognition. In tasks related to image analysis, searching for pixel-level regularities has reached a power of information extraction still far from what humans capture with image-based observations. This leads to poor generalization when even small shifts occur at the level of the observations. We explore a perspective on this problem that is directed to learning the generative process with causality-related foundations, using models capable of combining symbolic manipulation, probabilistic reasoning, and pattern recognition abilities. We briefly review and explore connections of research from machine learning, cognitive science, and related fields of human behavior to support our perspective for the direction to more robust and human-like artificial learning systems.

Abstract
Traumatic Brain Injury (TBI) is a form of brain injury caused by external forces, resulting in temporary or permanent impairment of brain function. Despite advancements in healthcare, TBI mortality rates can reach 30%–40% in severe cases. This study aims to assist clinical decision-making and enhance patient care for TBI-related complications by employing Artificial Intelligence (AI) methods and data-driven approaches to predict decompensation. This study uses learning models based on sequential data from Electronic Health Records (EHR). Decompensation prediction was performed based on 24-h in-mortality prediction at each hour of the patient's stay in the Intensive Care Unit (ICU). A cohort of 2261 TBI patients was selected from the MIMIC-III dataset based on age and ICD-9 disease codes. Logistic Regressor (LR), Long-short term memory (LSTM), and Transformers architectures were used. Two sets of features were also explored combined with missing data strategies by imputing the normal value, data imbalance techniques with class weights, and oversampling. The best performance results were obtained using LSTMs with the original features with no unbalancing techniques and with the added features and class weight technique, with AUROC scores of 0.918 and 0.929, respectively. For this study, using EHR time series data with LSTM proved viable in predicting patient decompensation, providing a helpful indicator of the need for clinical interventions. © 2025 Elsevier Ltd

Abstract
Lung cancer stands as the most prevalent and deadliest type of cancer, with adenocarcinoma being the most common subtype. Computed Tomography (CT) is widely used for detecting tumours and their phenotype characteristics, for an early and accurate diagnosis that impacts patient outcomes. Machine learning algorithms have already shown the potential to recognize patterns in CT scans to classify the cancer subtype. In this work, two distinct pipelines were employed to perform binary classification between adenocarcinoma and non-adenocarcinoma. Firstly, radiomic features were classified by Random Forest and eXtreme Gradient Boosting classifiers. Next, a deep learning approach, based on a Residual Neural Network and a Transformer-based architecture, was utilised. Both 2D and 3D CT data were initially explored, with the Lung-PET-CT-Dx dataset being employed for training and the NSCLC-Radiomics and NSCLC-Radiogenomics datasets used for external evaluation. Overall, the 3D models outperformed the 2D ones, with the best result being achieved by the Hybrid Vision Transformer, with an AUC of 0.869 and a balanced accuracy of 0.816 on the internal test set. However, a lack of generalization capability was observed across all models, with the performances decreasing on the external test sets, a limitation that should be studied and addressed in future work.

Abstract
Deep learning techniques have demonstrated significant potential in computer-assisted diagnosis based on medical imaging. However, their integration into clinical workflows remains limited, largely due to concerns about interpretability. To address this challenge, we propose Efficient-Proto-Caps, a lightweight and inherently interpretable model that combines capsule networks with prototype learning for lung nodule characterization. Additionally, an innovative Davies-Bouldin Index with multiple centroids per cluster is employed as a loss function to promote clustering of lung nodule visual attribute representations. When evaluated on the LIDC-IDRI dataset, the most widely recognized benchmark for lung cancer prediction, our model achieved an overall accuracy of 89.7 % in predicting lung nodule malignancy and associated visual attributes. This performance is statistically comparable to that of the baseline model, while utilizing a backbone with only approximately 2 % of the parameters of the baseline model’s backbone. State-of-the-art models achieved better performance in lung nodule malignancy prediction; however, our approach relies on multiclass malignancy predictions and provides a decision rationale aligned with globally accepted clinical guidelines. These results underscore the potential of our approach, as the integration of lightweight and less complex designs into accurate and inherently interpretable models represents a significant advancement toward more transparent and clinically viable computer-assisted diagnostic systems. Furthermore, these findings highlight the model’s potential for broader applicability, extending beyond medicine to other domains where final classifications are grounded in concept-based or example-based attributes. © 2013 IEEE.